The condition tuberous sclerosis, due to mutation in one of two tumor suppressor genes, TSC1 or TSC2, causes the growth of non-malignant tumors throughout the body and skin. These tumors can be unsightly and cause serious damage to organs. Growth of tumors in the brain may cause seizures and in the kidney, liver or heart, tumors can disrupt normal function, to the extent of causing the organ to fail. New research published in BioMed Central's open access journal Cell and Bioscience shows that the growth of glucose-dependent TSC-related tumors can be restricted by 2-deoxyglucose, which blocks glucose metabolism, but not by restricting dietary carbohydrates. TSC1 and TSC2 normally inhibit the mTOR signaling pathway but if the TSC genes are mutated, so that they no longer function, unregulated mTORC1 drives glycolysis and cell growth. Rapamycin works by blocking mTORC1 and is currently used to treat tuberous sclerosis. However, rapamycin is an immunosuppressant and can have significant side effects, especially when used long term. A group of researchers from the University of Washington, led by Prof Raymond S. Yeung, looked in detail at the potential of blocking cell proliferation by directly reducing glycolysis.
Surprisingly TSC2-negative tumors in mice kept on an unrestricted carbohydrate-free diet grew bigger than those on a western-style diet. However the glucose analogue, 2-deoxyglucose (2DG), which disrupts glucose metabolism, reduced the tumor size in mice on either diet. Prof Yeung explained: "Treatment with 2DG significantly reduced the rate at which the tumor cells divided, especially when paired with a diet which contained carbohydrates. This combination of 2DG and a western-style diet imposed the greatest energy stress on the tumors and correlated with the lowest levels of serum glucose. On the other hand, while the carbohydrate-free (and high-fat) diet provided enough free fatty acids to sustain tumor growth, some of the saturated fatty acids appeared toxic to the tumor cells. This in turn led to an accumulation of liquefied, necrotic materials that contributed to greater tumor size."
Compounds such as 2DG are able to inhibit TSC2-negative tumor growth by restricting glycolysis in a manner not seen by reducing dietary glucose. 2DG is currently undergoing trials for use in prostate cancer. This and other metabolic interventions hold promise for future cancer treatment.
**Source: BioMed Central
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24 October 2011
Biggest ever study shows no link between mobile phone use and tumors
There is no link between long-term use of mobile phones and tumours of the brain or central nervous system, finds new research published online in the British Medical Journal. In what is described as the largest study on the subject to date, Danish researchers found no evidence that the risk of brain tumours was raised among 358,403 mobile phone subscribers over an 18-year period.
The number of people using mobile phones is constantly rising with more than five billion subscriptions worldwide in 2010. This has led to concerns about potential adverse health effects, particularly tumours of the central nervous system.
Previous studies on a possible link between phone use and tumours have been inconclusive particularly on long-term use of mobile phones. Some of this earlier work took the form of case control studies involving small numbers of long-term users and were shown to be prone to error and bias. The International Agency for Research on Cancer (IARC) recently classified radio frequency electromagnetic fields, as emitted by mobile phones, as possibly carcinogenic to humans.
The only cohort study investigating mobile phone use and cancer to date is a Danish nationwide study comparing cancer risk of all 420,095 Danish mobile phone subscribers from 1982 until 1995, with the corresponding risk in the rest of the adult population with follow-up to 1996 and then 2002. This study found no evidence of any increased risk of brain or nervous system tumours or any cancer among mobile phone subscribers.
So researchers, led by the Institute of Cancer Epidemiology in Copenhagen, continued this study up to 2007.
They studied data on the whole Danish population aged 30 and over and born in Denmark after 1925, subdivided into subscribers and non-subscribers of mobile phones before 1995. Information was gathered from the Danish phone network operators and from the Danish Cancer Register.
Overall, 10,729 central nervous system tumours occurred in the study period 1990-2007.
When the figures were restricted to people with the longest mobile phone use -- 13 years or more -- cancer rates were almost the same in both long-term users and non-subscribers of mobile phones.
The researchers say they observed no overall increased risk for tumours of the central nervous system or for all cancers combined in mobile phone users.
They conclude: "The extended follow-up allowed us to investigate effects in people who had used mobile phones for 10 years or more, and this long-term use was not associated with higher risks of cancer.
"However, as a small to moderate increase in risk for subgroups of heavy users or after even longer induction periods than 10-15 years cannot be ruled out, further studies with large study populations, where the potential for misclassification of exposure and selection bias is minimised, are warranted."
In an accompanying editorial, Professors Anders Ahlbom and Maria Feychting at the Karolinska Institutet in Sweden say this new evidence is reassuring, but continued monitoring of health registers and prospective cohorts is still warranted.
**Source: BMJ-British Medical Journal
The number of people using mobile phones is constantly rising with more than five billion subscriptions worldwide in 2010. This has led to concerns about potential adverse health effects, particularly tumours of the central nervous system.
Previous studies on a possible link between phone use and tumours have been inconclusive particularly on long-term use of mobile phones. Some of this earlier work took the form of case control studies involving small numbers of long-term users and were shown to be prone to error and bias. The International Agency for Research on Cancer (IARC) recently classified radio frequency electromagnetic fields, as emitted by mobile phones, as possibly carcinogenic to humans.
The only cohort study investigating mobile phone use and cancer to date is a Danish nationwide study comparing cancer risk of all 420,095 Danish mobile phone subscribers from 1982 until 1995, with the corresponding risk in the rest of the adult population with follow-up to 1996 and then 2002. This study found no evidence of any increased risk of brain or nervous system tumours or any cancer among mobile phone subscribers.
So researchers, led by the Institute of Cancer Epidemiology in Copenhagen, continued this study up to 2007.
They studied data on the whole Danish population aged 30 and over and born in Denmark after 1925, subdivided into subscribers and non-subscribers of mobile phones before 1995. Information was gathered from the Danish phone network operators and from the Danish Cancer Register.
Overall, 10,729 central nervous system tumours occurred in the study period 1990-2007.
When the figures were restricted to people with the longest mobile phone use -- 13 years or more -- cancer rates were almost the same in both long-term users and non-subscribers of mobile phones.
The researchers say they observed no overall increased risk for tumours of the central nervous system or for all cancers combined in mobile phone users.
They conclude: "The extended follow-up allowed us to investigate effects in people who had used mobile phones for 10 years or more, and this long-term use was not associated with higher risks of cancer.
"However, as a small to moderate increase in risk for subgroups of heavy users or after even longer induction periods than 10-15 years cannot be ruled out, further studies with large study populations, where the potential for misclassification of exposure and selection bias is minimised, are warranted."
In an accompanying editorial, Professors Anders Ahlbom and Maria Feychting at the Karolinska Institutet in Sweden say this new evidence is reassuring, but continued monitoring of health registers and prospective cohorts is still warranted.
**Source: BMJ-British Medical Journal
Burden of osteoporotic fractures increases dramatically in the Middle East and Africa
A new audit report issued October 22 by the International Osteoporosis Foundation (IOF) shows that osteoporosis is a serious and growing problem throughout the Middle East and parts of Africa. Gathering data from 17 countries in the Middle East and Africa as well as Turkey, 'The Middle East & Africa Regional Audit' is a landmark report examining epidemiology, costs and burden in individual countries as well as collectively across the region. The report was introduced at the close of the 1st Middle East and Africa Osteoporosis Meeting in the presence of His Highness Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai.
A major increase in fractures is predicted for the region as a whole. In the Middle East, a predicted demographic explosion in the number of people over the age of 50 will take place in the coming decades. By 2020 it is expected that 25% of the population will be over the age of 50 and by 2050 this will rise to 40%. In Lebanon, Jordan, and Syria, this means that the number of hip fractures is projected to quadruple by 2050.
An alarming finding from the report shows that solid epidemiological research on osteoporosis and fracture incidence, and related relevant outcomes, is scarce at best. The Lead Author of the report, Professor Ghada El-Hajj Fuleihan, Director of the Calcium Metabolism and Osteoporosis Program, and WHO Collaborating Center for Metabolic Bone Disorders, at the American University of Beirut, commented, "This report reveals that a great research gap needs to be filled. Published data on incidence rates for hip fractures are only available for Iran, Kuwait, Saudi Arabia, Lebanon, Morocco and Turkey. Furthermore, access to densitometry and care was limited in many countries, and reimbursement for diagnostics and therapeutics varied widely." One of the primary recommendations of this report is the need for more research to gather the necessary evidence that would aid health authorities to develop comprehensive healthcare policies at all levels.
Due to economic development, non-communicable diseases have become the leading cause of mortality and morbidity in the region yet osteoporosis has been identified as a national health priority in only three countries in this report and national osteoporosis treatment guidelines are available in only five countries. As well DXA technology, considered the gold standard for measurement of bone mineral density, is not widely available or available only in urban centres in many cases. Furthermore, the level of awareness of osteoporosis among primary healthcare professionals is estimated as poor to medium in many countries. Education and lifestyle prevention programmes for the general public, measures which could help stem the rising tide of fractures in the coming decades, are also seriously lacking.
Widespread vitamin D deficiency and low calcium intake may be in part responsible for the alarming increase in osteoporosis. The prevalence of hypovitaminosis D is one of the highest in the world, and has been estimated to range between 50-90% in many countries and across all age groups, despite ample sunshine in the region. Dr. med Gemma Adib, first author of the report and General Secretary of the Pan Arab Osteoporosis Society, stated "Vitamin D is an essential component of bone health and a relatively inexpensive way to decrease fracture risk. It is essential that the region develops vitamin D supplementation strategies based on local data for at-risk groups."
For the individual, fragility fractures result in great suffering, disability as well as loss of productivity and quality of life. Fractures also represent an enormous burden for healthcare systems. Older people who suffer hip fractures are often faced with long-term disability that results in loss of independence and higher risk of death. Mortality rates after hip fracture may be higher in the Middle East and Africa than those reported from Western populations. While such rates vary between 25-35% in Western populations, preliminary studies have shown that these rates may be as high as to 2-2.5 fold higher in certain populations within this region.
IOF President Professor John A. Kanis spoke at the launch of the Audit and commented, "Despite the severity of the problem, osteoporosis is being dangerously ignored as it competes with other diseases for scarce healthcare resources and recognition. Notwithstanding the burden of fragility fractures, osteoporosis remains greatly under diagnosed and under treated, and both health professional training and public awareness is sub optimal in most countries in the region. The result is premature death for many hip fracture sufferers, immense personal suffering, lost productivity and long-term dependence on family members."
The International Osteoporosis Foundation joins local osteoporosis societies throughout the region to urge immediate government action to help prevent the rising tide of fractures and their profound socio-economic impact on millions of people and communities throughout the Middle-East and Africa.
**Source: International Osteoporosis Foundation
A major increase in fractures is predicted for the region as a whole. In the Middle East, a predicted demographic explosion in the number of people over the age of 50 will take place in the coming decades. By 2020 it is expected that 25% of the population will be over the age of 50 and by 2050 this will rise to 40%. In Lebanon, Jordan, and Syria, this means that the number of hip fractures is projected to quadruple by 2050.
An alarming finding from the report shows that solid epidemiological research on osteoporosis and fracture incidence, and related relevant outcomes, is scarce at best. The Lead Author of the report, Professor Ghada El-Hajj Fuleihan, Director of the Calcium Metabolism and Osteoporosis Program, and WHO Collaborating Center for Metabolic Bone Disorders, at the American University of Beirut, commented, "This report reveals that a great research gap needs to be filled. Published data on incidence rates for hip fractures are only available for Iran, Kuwait, Saudi Arabia, Lebanon, Morocco and Turkey. Furthermore, access to densitometry and care was limited in many countries, and reimbursement for diagnostics and therapeutics varied widely." One of the primary recommendations of this report is the need for more research to gather the necessary evidence that would aid health authorities to develop comprehensive healthcare policies at all levels.
Due to economic development, non-communicable diseases have become the leading cause of mortality and morbidity in the region yet osteoporosis has been identified as a national health priority in only three countries in this report and national osteoporosis treatment guidelines are available in only five countries. As well DXA technology, considered the gold standard for measurement of bone mineral density, is not widely available or available only in urban centres in many cases. Furthermore, the level of awareness of osteoporosis among primary healthcare professionals is estimated as poor to medium in many countries. Education and lifestyle prevention programmes for the general public, measures which could help stem the rising tide of fractures in the coming decades, are also seriously lacking.
Widespread vitamin D deficiency and low calcium intake may be in part responsible for the alarming increase in osteoporosis. The prevalence of hypovitaminosis D is one of the highest in the world, and has been estimated to range between 50-90% in many countries and across all age groups, despite ample sunshine in the region. Dr. med Gemma Adib, first author of the report and General Secretary of the Pan Arab Osteoporosis Society, stated "Vitamin D is an essential component of bone health and a relatively inexpensive way to decrease fracture risk. It is essential that the region develops vitamin D supplementation strategies based on local data for at-risk groups."
For the individual, fragility fractures result in great suffering, disability as well as loss of productivity and quality of life. Fractures also represent an enormous burden for healthcare systems. Older people who suffer hip fractures are often faced with long-term disability that results in loss of independence and higher risk of death. Mortality rates after hip fracture may be higher in the Middle East and Africa than those reported from Western populations. While such rates vary between 25-35% in Western populations, preliminary studies have shown that these rates may be as high as to 2-2.5 fold higher in certain populations within this region.
IOF President Professor John A. Kanis spoke at the launch of the Audit and commented, "Despite the severity of the problem, osteoporosis is being dangerously ignored as it competes with other diseases for scarce healthcare resources and recognition. Notwithstanding the burden of fragility fractures, osteoporosis remains greatly under diagnosed and under treated, and both health professional training and public awareness is sub optimal in most countries in the region. The result is premature death for many hip fracture sufferers, immense personal suffering, lost productivity and long-term dependence on family members."
The International Osteoporosis Foundation joins local osteoporosis societies throughout the region to urge immediate government action to help prevent the rising tide of fractures and their profound socio-economic impact on millions of people and communities throughout the Middle-East and Africa.
**Source: International Osteoporosis Foundation
La fuga disociativa va acompañada de una dificultad para recordar el pasado
Ocurrió hace unos meses en una localidad madrileña. Un buen día, un hombre de mediana edad salió de su trabajo pero no volvió a casa. Desapareció durante seis jornadas, hasta que fue encontrado por la Policía en un estado de confusión y llevado al Hospital de Getafe. Allí comprobaron que sufría amnesia retrógrada autobiográfica: recordaba lo que había hecho en la última semana -fundamentalmente, pasear junto al río-, pero había olvidado completamente su vida anterior.
Tras ser valorado en el Servicio de Psiquiatría del citado centro, el afectado fue derivado al Centro de Salud Mental de la misma población, donde un equipo de médicos analizó cuidadosamente sus circunstancias, diagnosticó el trastorno que padecía e inició el tratamiento. Por lo curioso y excepcional de la patología, dichos profesionales decidieron dar a conocer este caso en la 'Revista de la Asociación Española de Neuropsiquiatría'.
Aparentemente, nuestro protagonista no tenía ningún motivo para escapar de su hogar. Ese es, precisamente, uno de los rasgos característicos de lo que se conoce como fuga disociativa. Quienes la experimentan no tienen por qué presentar razones poderosas para esfumarse de la noche a la mañana. Lo que sí ocurre la mayoría de las veces es que los afectados han tenido alguna vivencia traumática o estresante. Y así fue también en esta ocasión, puesto que, al tirar del hilo y entrevistar a sus familiares, quienes atendieron a aquel hombre descubrieron que era consumidor de cocaína (supuestamente en abstinencia en los últimos tiempos), padecía depresión desde hacía 17 años y tenía problemas económicos y de pareja.
El afectado tenía intacta lo que se conoce como memoria procedimental, que es la que se necesita para vestirse, caminar, leer y escribir. Sin embargo, ya no sabía conducir ni cocinar, a pesar de que era cocinero de profesión desde hacía 30 años. Sí que presentaba recuerdos generales (una canción, un personaje público o un lugar), pero no de su propia vida. Poco a poco, fue recuperando su memoria biográfica, pero no la relativa a su relación de pareja, el consumo de tóxicos o su entorno laboral.
La fuga disociativa es uno de los trastornos disociativos, que en su conjunto afectan a menos del 2% de la población y constituyen un problema de salud de creciente interés. Suponen una alteración de las funciones integradoras de la conciencia, la memoria, la identidad y la percepción del entorno. Junto con el que nos ocupa, otro de los más llamativos y cinematográficos es el denominado trastorno de identidad disociativo (antes denominado personalidad múltiple), que consiste en la coexistencia en un individuo de dos o más personalidades múltiples.
Tanto la huida con incapacidad para recordar como la personalidad múltiple son objeto de picaresca por parte de quienes desean zafarse de un conflicto con la Justicia. Los psiquiatras forenses son los encargados de desenmascarar a los simuladores que fingen una patología de este tipo para no ser declarados culpables de un robo o un asesinato. "Hay gente que desaparece y se lleva todo el dinero de su empresa. Las fugas que reportan algún tipo de beneficio plantean dudas sobre su origen psiquiátrico", reflexiona Jesús Cobo, del Servicio de Salud mental de la Corporación Sanitaria Parc Taulí de Sabadell (Barcelona).
-Traumas infantiles
Este psiquiatra y otros especialistas llevaron a cabo un análisis de 36 casos de trastorno disociativo tratados en su hospital y hace dos años publicaron sus resultados en la revista 'Actas Españolas de Psiquiatría'. La principal conclusión del estudio fue que, tal y como se había observado previamente en otras poblaciones occidentales, la aparición de estos trastornos mentales está relacionada con los traumas infantiles en general y, en especial, con los abusos sexuales.
El diagnóstico se basa exclusivamente en la clínica, es decir, en los síntomas. Para ello son especialmente útiles los cuestionarios destinados a esclarecer las experiencias de los afectados y la frecuencia con la que aparecen. Por ejemplo, se les pregunta si han tenido la vivencia de encontrarse en un lugar sin tener idea de cómo llegaron allí, si se les ha aproximado gente que les llama por otro nombre, si han tenido dificultades para reconocer a miembros de su propia familia o amigos, si han olvidado momentos importantes de su vida, si experimentan que el entorno que les rodea no es real o si no se reconocen cuando se miran al espejo.
En teoría, no existe ninguna alteración orgánica relacionada con este tipo de patologías que, a diferencia de otros trastornos psiquiátricos, no están relacionadas con ningún daño estructural en el cerebro. Sin embargo, en los últimos tiempos se han llevado a cabo estudios de neuroimagen que demuestran que las personas afectadas sí presentan diferencias funcionales, como una menor actividad metabólica en ciertas regiones cerebrales relacionadas con la recuperación de los recuerdos autobiográficos.
En cuanto al tratamiento, el doctor Cobo explica que se basa en dos enfoques: el biológico y el psicológico. "Es difícil que el trastorno disociativo se presente aislado", comenta. "Generalmente va asociado a depresión u otros problemas". Por eso, se administran antidepresivos, ansiolíticos, antipsicóticos... Igual de importante es la psicoterapia. Pero no todas las personas se recuperan igual de bien. "No siempre se obtienen resultados inmediatos", manifiesta el especialista.
**Publicado en "EL MUNDO"
Tras ser valorado en el Servicio de Psiquiatría del citado centro, el afectado fue derivado al Centro de Salud Mental de la misma población, donde un equipo de médicos analizó cuidadosamente sus circunstancias, diagnosticó el trastorno que padecía e inició el tratamiento. Por lo curioso y excepcional de la patología, dichos profesionales decidieron dar a conocer este caso en la 'Revista de la Asociación Española de Neuropsiquiatría'.
Aparentemente, nuestro protagonista no tenía ningún motivo para escapar de su hogar. Ese es, precisamente, uno de los rasgos característicos de lo que se conoce como fuga disociativa. Quienes la experimentan no tienen por qué presentar razones poderosas para esfumarse de la noche a la mañana. Lo que sí ocurre la mayoría de las veces es que los afectados han tenido alguna vivencia traumática o estresante. Y así fue también en esta ocasión, puesto que, al tirar del hilo y entrevistar a sus familiares, quienes atendieron a aquel hombre descubrieron que era consumidor de cocaína (supuestamente en abstinencia en los últimos tiempos), padecía depresión desde hacía 17 años y tenía problemas económicos y de pareja.
El afectado tenía intacta lo que se conoce como memoria procedimental, que es la que se necesita para vestirse, caminar, leer y escribir. Sin embargo, ya no sabía conducir ni cocinar, a pesar de que era cocinero de profesión desde hacía 30 años. Sí que presentaba recuerdos generales (una canción, un personaje público o un lugar), pero no de su propia vida. Poco a poco, fue recuperando su memoria biográfica, pero no la relativa a su relación de pareja, el consumo de tóxicos o su entorno laboral.
La fuga disociativa es uno de los trastornos disociativos, que en su conjunto afectan a menos del 2% de la población y constituyen un problema de salud de creciente interés. Suponen una alteración de las funciones integradoras de la conciencia, la memoria, la identidad y la percepción del entorno. Junto con el que nos ocupa, otro de los más llamativos y cinematográficos es el denominado trastorno de identidad disociativo (antes denominado personalidad múltiple), que consiste en la coexistencia en un individuo de dos o más personalidades múltiples.
Tanto la huida con incapacidad para recordar como la personalidad múltiple son objeto de picaresca por parte de quienes desean zafarse de un conflicto con la Justicia. Los psiquiatras forenses son los encargados de desenmascarar a los simuladores que fingen una patología de este tipo para no ser declarados culpables de un robo o un asesinato. "Hay gente que desaparece y se lleva todo el dinero de su empresa. Las fugas que reportan algún tipo de beneficio plantean dudas sobre su origen psiquiátrico", reflexiona Jesús Cobo, del Servicio de Salud mental de la Corporación Sanitaria Parc Taulí de Sabadell (Barcelona).
-Traumas infantiles
Este psiquiatra y otros especialistas llevaron a cabo un análisis de 36 casos de trastorno disociativo tratados en su hospital y hace dos años publicaron sus resultados en la revista 'Actas Españolas de Psiquiatría'. La principal conclusión del estudio fue que, tal y como se había observado previamente en otras poblaciones occidentales, la aparición de estos trastornos mentales está relacionada con los traumas infantiles en general y, en especial, con los abusos sexuales.
El diagnóstico se basa exclusivamente en la clínica, es decir, en los síntomas. Para ello son especialmente útiles los cuestionarios destinados a esclarecer las experiencias de los afectados y la frecuencia con la que aparecen. Por ejemplo, se les pregunta si han tenido la vivencia de encontrarse en un lugar sin tener idea de cómo llegaron allí, si se les ha aproximado gente que les llama por otro nombre, si han tenido dificultades para reconocer a miembros de su propia familia o amigos, si han olvidado momentos importantes de su vida, si experimentan que el entorno que les rodea no es real o si no se reconocen cuando se miran al espejo.
En teoría, no existe ninguna alteración orgánica relacionada con este tipo de patologías que, a diferencia de otros trastornos psiquiátricos, no están relacionadas con ningún daño estructural en el cerebro. Sin embargo, en los últimos tiempos se han llevado a cabo estudios de neuroimagen que demuestran que las personas afectadas sí presentan diferencias funcionales, como una menor actividad metabólica en ciertas regiones cerebrales relacionadas con la recuperación de los recuerdos autobiográficos.
En cuanto al tratamiento, el doctor Cobo explica que se basa en dos enfoques: el biológico y el psicológico. "Es difícil que el trastorno disociativo se presente aislado", comenta. "Generalmente va asociado a depresión u otros problemas". Por eso, se administran antidepresivos, ansiolíticos, antipsicóticos... Igual de importante es la psicoterapia. Pero no todas las personas se recuperan igual de bien. "No siempre se obtienen resultados inmediatos", manifiesta el especialista.
**Publicado en "EL MUNDO"
Female shift workers may be at higher risk of heart disease
Women hospital staff working night shifts may be compromising their own health as they try to improve the health of patients, Dr. Joan Tranmer told the Canadian Cardiovascular Congress 2011, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society. Dr. Tranmer's study investigated the connection between shift work and risk factors for heart disease in female hospital employees who worked both shift and non-shift rotations.
As a former nurse familiar with shift work and because of her concern about the health of the female hospital work force, Dr. Tranmer questioned whether late nights were taking their toll on the health of her fellow hospital employees. "As I walked through the hospital and talked with my colleagues, I was concerned about what I was seeing in a lot of the workers," she said. "We did not know if this is related to shift work or other aspects of hospital work."
Her study reinforced what she observed about the health of female hospital employees. Dr. Tranmer studied 227 women ranging in age between 22 and 66 (with a mean age of 46) from two hospitals in southeastern Ontario. The study included not only nurses but a variety of staff, including administrative employees as well as lab and equipment technicians, who worked a variety of rotations.
She examined each of the women's possible risk factors associated with metabolic syndrome. The syndrome's five indicators are abdominal obesity (elevated waist circumference), high blood pressure, elevated blood glucose, elevated triglycerides, and low levels of high-density lipoprotein (HDL) cholesterol, also known as 'good cholesterol.' The women also completed a detailed survey about their work history and lifestyle.
The findings of this study suggest that approximately one in five middle-aged women who do shift work have at least three risk indicators for heart disease.
From the group, 17 per cent had metabolic syndrome, with at least three of the identified indicators. Thirty-eight per cent had high blood pressure. Of particular concern was the finding that 60 per cent of the participants had a waist circumference greater than 80 cm (31.5 inches).
Abdominal obesity and elevated waist circumference are good predictors for risk of developing heart disease, stroke, high blood pressure, cholesterol and type 2 diabetes. The greater your waist circumference, the higher your risk of developing these conditions.
The study found that age and current shift work status were significantly associated with increased risk. Women over 45 years, those who had reached menopause, had a shift work history of more than six years, and those currently working either 12 hour shifts or rotational shifts were more likely to have metabolic syndrome.
Metabolic syndromewas present in eight per cent of those working shifts for less than six years, in 18 per cent in those working shifts for six to 15 years, and in 74 percent of those working shifts for more than 15 years. While the increase in prevalence of risk factors is also associated with age, the influence of the combination of older age and shift work on risk raises concern.
"Just how shift work contributes to the development of such risk factors isn't clear," says Dr. Tranmer. "It is possible that the disruption of biological rhythms, sleeping, eating, and exercise patterns may be factors." The research team is exploring these potential pathways in a current study.
A Statistics Canada survey on the work-life balance of shift workers found that long work hours were associated with role overload. Shift workers were more likely to cut back on sleep, to spend less time with their spouse, and to worry about not spending enough time with family, compared with regular day workers.
"All women should manage their weight and other risk factors, and this study shows women working shift work especially need to be aware," said Heart and Stroke Foundation spokesperson Dr. Beth Abramson. "We spend so many of our hours and days at work, it is important for employers and employees to create as healthy a work environment as possible -- especially for shift workers."
She says that, given the prevalence of these cardiovascular risk factors, and in particular with abdominal obesity rates and the increasing age of the female hospital workforce, this study raises the need to examine workplace policy encouraging healthy behaviours for all employees.
She recommends that women find out how they can protect their heart health through the Foundation's The Heart Truth™ campaign (thehearttruth.ca), which educates women about identifying their risks and warning signs of heart disease and stroke, and shows them how to make lifestyle changes and take action to reduce their risk by as much as 80 per cent.
"These women work so hard caring for others, but they need to take the time to properly care of their own health," says Dr. Tranmer.
According to Statistics Canada,over 4 million workers aged 19 to 64 worked something other than a regular day shift in 2005. Of these shift workers, about 3.3 million worked full time (30 or more hours a week). Rotating shifts and irregular schedules were the most common types of shift work, accounting for 2.3 million full-time workers. Women made up 37 per cent of all full-time shift workers. The majority of women working shifts (69 per cent) worked part time.
When asked if similar conclusions could be drawn for male shift workers, Dr. Tranmer said that much of our understanding about the associations between shift work and health come from studies that have predominantly included men so she wanted to focus on the link in women.
The study was funded by the Canadian Institutes of Health Research.
**Source: Heart and Stroke Foundation of Canada
As a former nurse familiar with shift work and because of her concern about the health of the female hospital work force, Dr. Tranmer questioned whether late nights were taking their toll on the health of her fellow hospital employees. "As I walked through the hospital and talked with my colleagues, I was concerned about what I was seeing in a lot of the workers," she said. "We did not know if this is related to shift work or other aspects of hospital work."
Her study reinforced what she observed about the health of female hospital employees. Dr. Tranmer studied 227 women ranging in age between 22 and 66 (with a mean age of 46) from two hospitals in southeastern Ontario. The study included not only nurses but a variety of staff, including administrative employees as well as lab and equipment technicians, who worked a variety of rotations.
She examined each of the women's possible risk factors associated with metabolic syndrome. The syndrome's five indicators are abdominal obesity (elevated waist circumference), high blood pressure, elevated blood glucose, elevated triglycerides, and low levels of high-density lipoprotein (HDL) cholesterol, also known as 'good cholesterol.' The women also completed a detailed survey about their work history and lifestyle.
The findings of this study suggest that approximately one in five middle-aged women who do shift work have at least three risk indicators for heart disease.
From the group, 17 per cent had metabolic syndrome, with at least three of the identified indicators. Thirty-eight per cent had high blood pressure. Of particular concern was the finding that 60 per cent of the participants had a waist circumference greater than 80 cm (31.5 inches).
Abdominal obesity and elevated waist circumference are good predictors for risk of developing heart disease, stroke, high blood pressure, cholesterol and type 2 diabetes. The greater your waist circumference, the higher your risk of developing these conditions.
The study found that age and current shift work status were significantly associated with increased risk. Women over 45 years, those who had reached menopause, had a shift work history of more than six years, and those currently working either 12 hour shifts or rotational shifts were more likely to have metabolic syndrome.
Metabolic syndromewas present in eight per cent of those working shifts for less than six years, in 18 per cent in those working shifts for six to 15 years, and in 74 percent of those working shifts for more than 15 years. While the increase in prevalence of risk factors is also associated with age, the influence of the combination of older age and shift work on risk raises concern.
"Just how shift work contributes to the development of such risk factors isn't clear," says Dr. Tranmer. "It is possible that the disruption of biological rhythms, sleeping, eating, and exercise patterns may be factors." The research team is exploring these potential pathways in a current study.
A Statistics Canada survey on the work-life balance of shift workers found that long work hours were associated with role overload. Shift workers were more likely to cut back on sleep, to spend less time with their spouse, and to worry about not spending enough time with family, compared with regular day workers.
"All women should manage their weight and other risk factors, and this study shows women working shift work especially need to be aware," said Heart and Stroke Foundation spokesperson Dr. Beth Abramson. "We spend so many of our hours and days at work, it is important for employers and employees to create as healthy a work environment as possible -- especially for shift workers."
She says that, given the prevalence of these cardiovascular risk factors, and in particular with abdominal obesity rates and the increasing age of the female hospital workforce, this study raises the need to examine workplace policy encouraging healthy behaviours for all employees.
She recommends that women find out how they can protect their heart health through the Foundation's The Heart Truth™ campaign (thehearttruth.ca), which educates women about identifying their risks and warning signs of heart disease and stroke, and shows them how to make lifestyle changes and take action to reduce their risk by as much as 80 per cent.
"These women work so hard caring for others, but they need to take the time to properly care of their own health," says Dr. Tranmer.
According to Statistics Canada,over 4 million workers aged 19 to 64 worked something other than a regular day shift in 2005. Of these shift workers, about 3.3 million worked full time (30 or more hours a week). Rotating shifts and irregular schedules were the most common types of shift work, accounting for 2.3 million full-time workers. Women made up 37 per cent of all full-time shift workers. The majority of women working shifts (69 per cent) worked part time.
When asked if similar conclusions could be drawn for male shift workers, Dr. Tranmer said that much of our understanding about the associations between shift work and health come from studies that have predominantly included men so she wanted to focus on the link in women.
The study was funded by the Canadian Institutes of Health Research.
**Source: Heart and Stroke Foundation of Canada
Dabigatran, la alternativa al Sintrom, en las farmacias españolas desde el 7 nov
Tras 50 años de absoluta hegemonía, llega el relevo del «sintrom», el famoso anticoagulante que toman 650.000 pacientes cardiovasculares en España. Lo sustituirá el «Dabigatrán» un nuevo fármaco más eficaz, seguro y cómodo para los pacientes que reduce el riesgo de hemorragia y no se altera con cambios en la dieta o el estrés. Y, sobre todo, evita los controles periódicos y análisis de sangre mensuales que exige el «sintrom» para garantizar la seguridad del tratamiento.
El Ministerio de Sanidad dio luz verde la semana pasada a su financiación pública. El viernes, durante el congreso de la Sociedad Española de Cardiología, se anunció su llegada a las farmacias el próximo 7 de noviembre.
Los anticoagulantes licúan la sangre, la vuelven más líquida para que circule con mayor fluidez. Su uso reduce a una décima parte el riesgo de sufrir una complicación cardiovascular, al impedir la formación de trombos, que taponan las arterias. Con ellos se previene el ictus en casos de que el corazón sufra una arritmia y se evitan nuevos infartos.
Para los pacientes supondrá un cambio radical en su tratamiento, aunque en una primera fase no se ofrecerá a todos los enfermos que ya toman «sintrom». De momento, se reservará para los pacientes que no están bien controlados con la medicación actual, aproximadamente un 20% del total.
-Más caro
El filtro de Sanidad se hace por el elevado precio del medicamento. El nuevo anticoagulante cuesta 63 euros mensuales frente a los 3 del antiguo. A medio y largo plazo se conseguirán ahorros al eliminar los análisis de sangre exigidos y descongestionar las consultas de los centros de salud.
Sanidad autorizó la financiación pública de este nuevo fármaco junto a otros cinco otros, también de elevado coste para tratar la esclerosis múltiple, el lupus o la hepatitis C. Solo dos de los fármacos autorizados tendrán un impacto añadido en las arcas autonómicas de más de 40 millones de euros anuales porque el Ministerio autoriza y son las Comunidades quienes lo sufragan.
**Publicado en "VOCENTO"
23 October 2011
BG-12 ORAL (DIMETILFUMARATO) REDUCE CONSIDERABLEMENTE LAS RECAÍDAS Y LA PROGRESIÓN DE LA DISCAPACIDAD EN PACIENTES CON ESCLEROSIS MÚLTIPLE
Biogen Idec ha presentado los datos positivos del ensayo en fase III DEFINE, en el que se está analizando la eficacia de BG-12 oral (dimetilfumarato) en el tratamiento de la Esclerosis Múltiple Recurrente/Remitente (EMRR). Los resultados demuestran que la administración de 240 mg de BG-12, administrados dos (BID) o tres veces al día (TID), reducen considerablemente el porcentaje de pacientes con recaídas en un 49% y 50%, respectivamente, a los dos años, comparado con placebo. Fue durante el V Congreso de los Comités Europeo y Americano para el Tratamiento y la Investigación de la Esclerosis Múltiple (ECTRIMS y ACTRIMS), celebrado en Ámsterdam.
"La significativa respuesta clínica y radiológica demostrada en DEFINE es otra prueba más de que BG-12 podría convertirse en una nueva opción de tratamiento para los pacientes de EM", asegura Doug Williams, vicepresidente ejecutivo de investigación y desarrollo de Biogen Idec. "Los resultados de nuestro segundo ensayo en fase III, CONFIRM, ofrecerán información adicional sobre el perfil de BG-12 y un conjunto exhaustivo de datos para las posteriores negociaciones con los organismos reguladores. Prevemos la publicación de datos de primera línea de CONFIRM a finales de año".
DEFINE ha sido el primero de dos ensayos clínicos de fase III diseñados para determinar la eficacia y seguridad de BG-12 en pacientes con EMRR. BG-12 BID y TID cumplieron todos los objetivos primarios y secundarios del estudio. Además de demostrar una reducción considerable en el porcentaje de pacientes con recaídas, BG-12 redujo notablemente la tasa anualizada de brotes y el riesgo de progresión de la discapacidad según la escala de estado ampliado de discapacidad (EDSS, por sus siglas en inglés) en dos años frente a los pacientes que tratados con placebo.
BG-12 redujo el riesgo de recaídas en un 49% en el grupo BID y en el 50% en el grupo TID.
BG-12 BID redujo la tasa anualizada de brotes en un 53%, mientras que BG-12 TID la redujo en un 48%.
BG-12 BID redujo el riesgo de progresión de la discapacidad en un 38%, mientras que BG-12 TID redujo el riesgo en un 34%.
"BG-12 podría ser una opción terapéutica valiosa para los pacientes de EM porque combina una eficacia sólida, un perfil favorable de seguridad y su administración es oral", explica el doctor Ralf Gold, catedrático de Neurología de la Universidad St. Josef-Hospital/Ruhr de Bochum, Alemania. "La investigación preclínica ha demostrado que BG-12 presenta efectos anti-inflamatorios y neuroprotectores. Si las respuestas clínicas observadas en el estudio DEFINE se replican en el segundo ensayo en fase III, BG-12 tiene el potencial de ofrecer un nuevo enfoque en el tratamiento de la Esclerosis Múltiple y representar un importante paso hacia adelante para los pacientes".
Al inicio del estudio, al cabo de 24 semanas, de uno y de dos años, se realizaron escáneres a través de resonancia magnética, para determinar el número de lesiones hiperintensas (T2), lesiones realzantes de gadolinio (Gd+) y lesiones hipointensas (T1). A los dos años, los resultados demuestran que los pacientes de EMRR tratados con BG-12 experimentaron reducciones significativas en el número de lesiones cerebrales frente a los pacientes de placebo.
BG-12 BID y TID redujeron el número medio de lesiones hiperintensas T2 nuevas o nuevamente ampliadas en un 85% y 74%, respectivamente.
BG-12 BID y TID redujeron el número medio de lesiones Gd+ en un 90% y 73%, respectivamente.
BG-12 BID y TID redujeron el número medio de lesiones nuevas hipointensas T1 en un 72% y 63%, respectivamente.
"El programa de BG-12 demuestra, además, el compromiso de Biogen Idec hacia las terapias innovadoras que responden a las necesidades insatisfechas de la comunidad de EM", añadió el doctor Williams. "El mecanismo diferenciado de acción de BG-12 combinado con unos datos sólidos de eficacia y seguridad, lo sitúan como una opción valiosa para los pacientes de EM y un motor de crecimiento futuro para Biogen Idec".
En DEFINE, el perfil de seguridad de dos grupos de tratamiento con BG-12 fue similar. La incidencia global de efectos secundarios (AE, por sus siglas en inglés), efectos secundarios graves (SAE, por sus siglas en inglés) y efectos secundarios conducentes a la descontinuación del estudio fue similar en los grupos de BG-12 y placebo. Se informó de efectos secundarios en el 95-96% de los pacientes, independientemente del grupo de estudio. Los efectos secundarios más frecuentes en los tres grupos del estudio fueron sofocos, recaídas, nasofaringitis, dolor de cabeza, diarrea y fatiga. Los sofocos (35% BG-12; 5% placebo), AE gastrointestinales como la diarrea (17% BG-12; 13% placebo), náuseas (13% BG-12; 9% placebo), dolor abdominal superior (11% BG-12; 7% placebo) y dolor abdominal (10% BG-12; 5% placebo) fueron superiores en el grupo combinado de BG-12 respecto al de placebo, y se presentaron, principalmente, durante el primer mes de tratamiento, con un descenso posterior.
Se informó de SAE en el 21% de los pacientes tratados con placebo y en el 17% de los pacientes tratados con BG-12. Los SAE más frecuentes en todos los grupos de tratamiento fueron las recaídas (15% placebo; 9% BG-12). No se produjo ninguna muerte relacionada con el tratamiento del estudio. No hubo aumento de infecciones, infecciones graves, infecciones oportunistas ni neoplasias.
"La significativa respuesta clínica y radiológica demostrada en DEFINE es otra prueba más de que BG-12 podría convertirse en una nueva opción de tratamiento para los pacientes de EM", asegura Doug Williams, vicepresidente ejecutivo de investigación y desarrollo de Biogen Idec. "Los resultados de nuestro segundo ensayo en fase III, CONFIRM, ofrecerán información adicional sobre el perfil de BG-12 y un conjunto exhaustivo de datos para las posteriores negociaciones con los organismos reguladores. Prevemos la publicación de datos de primera línea de CONFIRM a finales de año".
DEFINE ha sido el primero de dos ensayos clínicos de fase III diseñados para determinar la eficacia y seguridad de BG-12 en pacientes con EMRR. BG-12 BID y TID cumplieron todos los objetivos primarios y secundarios del estudio. Además de demostrar una reducción considerable en el porcentaje de pacientes con recaídas, BG-12 redujo notablemente la tasa anualizada de brotes y el riesgo de progresión de la discapacidad según la escala de estado ampliado de discapacidad (EDSS, por sus siglas en inglés) en dos años frente a los pacientes que tratados con placebo.
BG-12 redujo el riesgo de recaídas en un 49% en el grupo BID y en el 50% en el grupo TID.
BG-12 BID redujo la tasa anualizada de brotes en un 53%, mientras que BG-12 TID la redujo en un 48%.
BG-12 BID redujo el riesgo de progresión de la discapacidad en un 38%, mientras que BG-12 TID redujo el riesgo en un 34%.
"BG-12 podría ser una opción terapéutica valiosa para los pacientes de EM porque combina una eficacia sólida, un perfil favorable de seguridad y su administración es oral", explica el doctor Ralf Gold, catedrático de Neurología de la Universidad St. Josef-Hospital/Ruhr de Bochum, Alemania. "La investigación preclínica ha demostrado que BG-12 presenta efectos anti-inflamatorios y neuroprotectores. Si las respuestas clínicas observadas en el estudio DEFINE se replican en el segundo ensayo en fase III, BG-12 tiene el potencial de ofrecer un nuevo enfoque en el tratamiento de la Esclerosis Múltiple y representar un importante paso hacia adelante para los pacientes".
Al inicio del estudio, al cabo de 24 semanas, de uno y de dos años, se realizaron escáneres a través de resonancia magnética, para determinar el número de lesiones hiperintensas (T2), lesiones realzantes de gadolinio (Gd+) y lesiones hipointensas (T1). A los dos años, los resultados demuestran que los pacientes de EMRR tratados con BG-12 experimentaron reducciones significativas en el número de lesiones cerebrales frente a los pacientes de placebo.
BG-12 BID y TID redujeron el número medio de lesiones hiperintensas T2 nuevas o nuevamente ampliadas en un 85% y 74%, respectivamente.
BG-12 BID y TID redujeron el número medio de lesiones Gd+ en un 90% y 73%, respectivamente.
BG-12 BID y TID redujeron el número medio de lesiones nuevas hipointensas T1 en un 72% y 63%, respectivamente.
"El programa de BG-12 demuestra, además, el compromiso de Biogen Idec hacia las terapias innovadoras que responden a las necesidades insatisfechas de la comunidad de EM", añadió el doctor Williams. "El mecanismo diferenciado de acción de BG-12 combinado con unos datos sólidos de eficacia y seguridad, lo sitúan como una opción valiosa para los pacientes de EM y un motor de crecimiento futuro para Biogen Idec".
En DEFINE, el perfil de seguridad de dos grupos de tratamiento con BG-12 fue similar. La incidencia global de efectos secundarios (AE, por sus siglas en inglés), efectos secundarios graves (SAE, por sus siglas en inglés) y efectos secundarios conducentes a la descontinuación del estudio fue similar en los grupos de BG-12 y placebo. Se informó de efectos secundarios en el 95-96% de los pacientes, independientemente del grupo de estudio. Los efectos secundarios más frecuentes en los tres grupos del estudio fueron sofocos, recaídas, nasofaringitis, dolor de cabeza, diarrea y fatiga. Los sofocos (35% BG-12; 5% placebo), AE gastrointestinales como la diarrea (17% BG-12; 13% placebo), náuseas (13% BG-12; 9% placebo), dolor abdominal superior (11% BG-12; 7% placebo) y dolor abdominal (10% BG-12; 5% placebo) fueron superiores en el grupo combinado de BG-12 respecto al de placebo, y se presentaron, principalmente, durante el primer mes de tratamiento, con un descenso posterior.
Se informó de SAE en el 21% de los pacientes tratados con placebo y en el 17% de los pacientes tratados con BG-12. Los SAE más frecuentes en todos los grupos de tratamiento fueron las recaídas (15% placebo; 9% BG-12). No se produjo ninguna muerte relacionada con el tratamiento del estudio. No hubo aumento de infecciones, infecciones graves, infecciones oportunistas ni neoplasias.
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