La interacción online de los pacientes crónicos con profesionales de la salud permite reducir reingresos y visitas a urgencias, además de ahorrar costes, ya que están más informados sobre su enfermedad y se adhieren mejor al tratamiento, según diversos estudios que se presentan hoy jueves en la jornada 'Salud 2.0: Nuevas herramientas aplicadas a la salud', organizada por el Departamento de Salud de Navarra y Área Científica Menarini. El director-gerente del Servicio Navarro de Salud-Osasunbidea inaugura esta cita, seguida en Twitter con la etiqueta #salu20.
El Hospital materno-infantil Sant Joan de Déu, de Barcelona, es pionero en la interactividad con los pacientes y ha puesto en marcha un modelo llamado hospital líquido, que “rompe las paredes físicas para trasladarse allí donde están los enfermos”, explica su director de E-Health y Salud 2.0, Jorge Juan Fernández. Del total de pacientes que interaccionan online con el centro (los e-pacientes y e-cuidadores), más de la mitad reconocieron, en una encuesta, haber adoptado un hábito de vida saludable gracias a los proyectos en la Red del hospital, “lo que confirma la eficacia de este nuevo entorno frente a la consulta tradicional”, concluye Fernández.
Además de recoger sugerencias de los enfermos a través de los medios sociales, el centro ha puesto en marcha diferentes proyectos de educación y atención sanitaria online, como uno dirigido a diabéticos operativo desde hace 3 años, que incluye un servicio de asistencia telefónica y por email, que sólo en su fase inicial ha conseguido reducir significativamente sus visitas a urgencias. “La clave está en hacer corresponsable al enfermo", añade. El cambio del modelo ha dado origen a otras iniciativas como el portal Guía Metabólica (www.guiametabolica.org), sobre enfermedades raras del metabolismo, que recoge información útil y que permite hacer consultas online y contactar con otros enfermos. “La mayor parte de estas patologías cuentan con muy pocos afectados, en ocasiones sólo 2 ó 3 en todo el mundo de habla hispana, y ya tenemos ejemplos de intercambios de experiencias muy conmovedores”, indica este experto.
La salud 2.0 tiene beneficios en pacientes y médicos. Un estudio publicado en el último número del 'Journal of Rehabilitation Research' confirma sus buenos resultados en enfermos de cáncer. Un proyecto piloto de formación online sobre su patología e interacción con el personal sanitario logró “la mejora en el proceso de toma de decisiones sobre su tratamiento y un menor impacto emocional ante decisiones médicas de riesgo”. En Corea del Sur, un programa interactivo de control de la glucosa por teléfono e Internet consiguió una reducción media de 8.1 mmHg, según una investigación publicada en el Journal of Korean Academy of Nursing.
Los expertos presentes en la jornada de Pamplona coinciden en relacionar los avances tecnológicos y la mejora de la calidad asistencial. El último informe del organismo Red.es sobre la sanidad detalla que ya el 95% de los centros sanitarios públicos ofrecen la posibilidad de realizar prescripciones por vía telemática, a las que tienen acceso cerca de 40 millones de ciudadanos, y que el 65% cuentan con cita previa por Internet. Los médicos españoles se encuentran entre los más entusiastas sobre las posibilidades de las nuevas tecnologías en la mejora de la salud de los pacientes, según una reciente encuesta de Accenture.
Humanizar la MedicinaPara Iñaki González, de la Fundación Hospital Calahorra, que participa en la jornada, “los hospitales e instituciones que entren en el mundo 2.0 tienen que asumir la premisa de que la relación médico-paciente ya no es vertical descendente, sino horizontal, de igual a igual”. A diferencia de lo que pueda parecer, “las tecnologías 2.0 han introducido la posibilidad de humanizar la Medicina, al mejorar la comunicación y hacerla bidireccional”. Además de su blog sobre recursos humanos en salud Sobrevivirrhhé, Iñaki González ha participado en la puesta en marcha de la campaña 'Mírame: Diferénciate', respaldada por cientos de profesionales e instituciones, y dirigida a fomentar entre los profesionales sanitarios el trato humano a los pacientes y a escuchar sus necesidades. Diversos estudios han demostrado que lo que más aprecian los enfermos de su médico es que les escuchen y eso es lo que, según este experto, facilitan los medios sociales.
En ese mismo sentido, el estudiante de 6º de Medicina de la Universidad de Navarra Aitor Guitarte impulsa el blog de intercambio profesional Somosmedicina. A su juicio, el entorno 2.0 está logrando “la reducción de la burocracia y de las largas colas de espera en los hospitales, y va a hacer posible que muchos profesionales recuperen la pasión por la Medicina”.
**Publicado en "PM FARMA"
26 January 2012
Nuevo tratamiento para el cáncer de mama disponible en Italia
Halaven(R) (eribulina), un nuevo tratamiento para pacientes con cáncer de mama localmente avanzado o metastásico que muestran progresión después de un mínimo de dos tratamientos quimioterapéuticos para enfermedad avanzada, ya está cubierto por la Seguridad Social en Italia. El tratamiento previo debe haber incluido dos tipos comunes de quimioterapia, una antraciclina y un taxano, a menos que las pacientes no fueran aptas para dichos tratamientos[1]. Eribulina es el primer agente quimioterápico que en monoterapia que demuestra una mejora prolongada de la supervivencia global de las pacientes con cáncer de mama avanzado intensamente pretratadas* en comparación con un control activo en el ensayo clínico EMBRACE.
En la actualidad, el cáncer de mama es el cáncer más común en Italia, donde se diagnostican más de 47.500 casos cada año, y es la principal causa de muerte entre las mujeres en Italia y el resto del mundo. No obstante, las tasas de mortalidad del cáncer de mama en Italia han mostrado una disminución desde principios de la década de 1990, que se debe principalmente a los avances en los tratamientos y al papel de los programas de cribado para detectar el cáncer en una fase temprana.
"Hay una necesidad clara todavía insatisfecha de nuevas opciones de tratamiento para las mujeres con cáncer de mama localmente avanzado o metastásico intensamente pretratadas. La comercialización de la eribulina en Italia supone un importante avance médico en un ámbito donde actualmente no existe un tratamiento de referencia. Eribulina es una opción eficaz y bien tolerada que ha demostrado que prolonga la vida, lo que proporciona a las mujeres un valioso tiempo para estar con su familia y sus seres queridos", comenta Profesor Stefania Gori, Miembro de la Junta Associazione Italiana di Oncologia Medica (AIOM).
"La cobertura de la eribulina en Italia constituye un paso positivo para las mujeres que viven con cáncer de mama metastásico, que de otro modo solo dispondrían de limitadas opciones de tratamiento. El acceso a esta nueva quimioterapia significa que las pacientes candidatas se beneficiarán de un nuevo tratamiento que aumenta significativamente su supervivencia, lo que les ofrece un valioso tiempo para estar con sus familias. Estamos muy orgullosos de presentar este nuevo tratamiento en Italia y mantenemos nuestro compromiso con la mejora de las vidas de nuestras pacientes", comenta Laura Forni, directora de la unidad de negocio de oncología en Italia de Eisai Europe Ltd.
La eribulina, descubierta y desarrollada por la compañía farmacéutica internacional Eisai, es un inhibidor no taxano de la dinámica de los microtúbulos y un análogo sintético de la halicondrina B, un producto natural que se obtiene de la esponja marina Halichondria okadai. Los resultados del estudio fundamental de fase III EMBRACE (Estudio Eisai del cáncer de mama con metástasis que evalúa el tratamiento de elección del médico (TEM) frente a eribulina (E7389), mostraron que las pacientes tratadas con eribulina presentaban una mediana supervivencia de 2,5 meses más larga que las pacientes que recibieron el tratamiento de preferencia del médico (supervivencia global de 13,1 meses frente al tratamiento de preferencia del médico 10,6 meses, respectivamente, p=0,014). Un análisis posterior demostró que las pacientes tratadas con eribulina sobrevivieron una mediana de 2,7 meses más que las que reciben el tratamiento de elección del médico (eribulina 13,2 frente al tratamiento de preferencia del médico 10,5 meses, p nominal=0,014). El tratamiento de elección del médico representa las opciones de tratamiento activo que utilizan actualmente los médicos en la práctica clínica real.
Las reacciones adversas más comunes observadas en pacientes tratadas con eribulina fueron astenia (fatiga), neutropenia, alopecia (caída del cabello), neuropatía periférica (insensibilidad y hormigueo en brazos y piernas), nauseas y estreñimiento.
Eribulina recibió la aprobación de la Comisión Europea el 17 de marzo de 2011 atrás la valoración de los resultados del estudio EMBRACE. Eribulina está aprobada en la Unión Europea, Estados Unidos, Suiza, Japón y Singapur. En la actualidad, eribulina se comercializa en Alemania, Austria, Dinamarca, Estados Unidos, Finlandia, Japón, Noruega, Reino Unido, Singapur, Suecia y Suiza.
El compromiso de Eisai de realizar avances significativos en la investigación oncológica, basada en los conocimientos científicos, se apoya en su capacidad mundial de llevar a cabo investigación preclínica y básica para desarrollar compuestos orgánicos de bajo peso molecular, vacunas terapéuticas, terapias basadas en anticuerpos monoclonales, agentes biológicos y tratamientos paliativos contra el cáncer para diversas indicaciones. Mediante estos esfuerzos, Eisai realizará nuevas aportaciones para dar respuesta a las distintas necesidades de los pacientes y sus familias y aumentar los beneficios que reciben tanto ellos como sus familias y los profesionales sanitarios que desean desarrollar su misión de atención sanitaria humana (hhc).
En la actualidad, el cáncer de mama es el cáncer más común en Italia, donde se diagnostican más de 47.500 casos cada año, y es la principal causa de muerte entre las mujeres en Italia y el resto del mundo. No obstante, las tasas de mortalidad del cáncer de mama en Italia han mostrado una disminución desde principios de la década de 1990, que se debe principalmente a los avances en los tratamientos y al papel de los programas de cribado para detectar el cáncer en una fase temprana.
"Hay una necesidad clara todavía insatisfecha de nuevas opciones de tratamiento para las mujeres con cáncer de mama localmente avanzado o metastásico intensamente pretratadas. La comercialización de la eribulina en Italia supone un importante avance médico en un ámbito donde actualmente no existe un tratamiento de referencia. Eribulina es una opción eficaz y bien tolerada que ha demostrado que prolonga la vida, lo que proporciona a las mujeres un valioso tiempo para estar con su familia y sus seres queridos", comenta Profesor Stefania Gori, Miembro de la Junta Associazione Italiana di Oncologia Medica (AIOM).
"La cobertura de la eribulina en Italia constituye un paso positivo para las mujeres que viven con cáncer de mama metastásico, que de otro modo solo dispondrían de limitadas opciones de tratamiento. El acceso a esta nueva quimioterapia significa que las pacientes candidatas se beneficiarán de un nuevo tratamiento que aumenta significativamente su supervivencia, lo que les ofrece un valioso tiempo para estar con sus familias. Estamos muy orgullosos de presentar este nuevo tratamiento en Italia y mantenemos nuestro compromiso con la mejora de las vidas de nuestras pacientes", comenta Laura Forni, directora de la unidad de negocio de oncología en Italia de Eisai Europe Ltd.
La eribulina, descubierta y desarrollada por la compañía farmacéutica internacional Eisai, es un inhibidor no taxano de la dinámica de los microtúbulos y un análogo sintético de la halicondrina B, un producto natural que se obtiene de la esponja marina Halichondria okadai. Los resultados del estudio fundamental de fase III EMBRACE (Estudio Eisai del cáncer de mama con metástasis que evalúa el tratamiento de elección del médico (TEM) frente a eribulina (E7389), mostraron que las pacientes tratadas con eribulina presentaban una mediana supervivencia de 2,5 meses más larga que las pacientes que recibieron el tratamiento de preferencia del médico (supervivencia global de 13,1 meses frente al tratamiento de preferencia del médico 10,6 meses, respectivamente, p=0,014). Un análisis posterior demostró que las pacientes tratadas con eribulina sobrevivieron una mediana de 2,7 meses más que las que reciben el tratamiento de elección del médico (eribulina 13,2 frente al tratamiento de preferencia del médico 10,5 meses, p nominal=0,014). El tratamiento de elección del médico representa las opciones de tratamiento activo que utilizan actualmente los médicos en la práctica clínica real.
Las reacciones adversas más comunes observadas en pacientes tratadas con eribulina fueron astenia (fatiga), neutropenia, alopecia (caída del cabello), neuropatía periférica (insensibilidad y hormigueo en brazos y piernas), nauseas y estreñimiento.
Eribulina recibió la aprobación de la Comisión Europea el 17 de marzo de 2011 atrás la valoración de los resultados del estudio EMBRACE. Eribulina está aprobada en la Unión Europea, Estados Unidos, Suiza, Japón y Singapur. En la actualidad, eribulina se comercializa en Alemania, Austria, Dinamarca, Estados Unidos, Finlandia, Japón, Noruega, Reino Unido, Singapur, Suecia y Suiza.
El compromiso de Eisai de realizar avances significativos en la investigación oncológica, basada en los conocimientos científicos, se apoya en su capacidad mundial de llevar a cabo investigación preclínica y básica para desarrollar compuestos orgánicos de bajo peso molecular, vacunas terapéuticas, terapias basadas en anticuerpos monoclonales, agentes biológicos y tratamientos paliativos contra el cáncer para diversas indicaciones. Mediante estos esfuerzos, Eisai realizará nuevas aportaciones para dar respuesta a las distintas necesidades de los pacientes y sus familias y aumentar los beneficios que reciben tanto ellos como sus familias y los profesionales sanitarios que desean desarrollar su misión de atención sanitaria humana (hhc).
New standard for vitamin D testing to ensure accurate test results
At a time of increasing concern about low vitamin D levels in the world's population and increased use of blood tests for the vitamin, scientists are reporting development of a much-needed reference material to assure that measurements of vitamin D levels are accurate. The report appears in ACS' journal Analytical Chemistry.
Karen Phinney and colleagues explain that medical research suggests vitamin D deficiency or insufficiency may be even more common than previously thought and a risk factor for more than just bone diseases. An estimated 50-75 percent of people in the U.S. may not have enough vitamin D in their bodies. Low levels of vitamin D have been linked to the development of several conditions, including rickets (soft and deformed bones), osteoporosis, some cancers, multiple sclerosis and Parkinson's disease. People can make their own vitamin D simply by rolling up their shirt sleeves and exposing their skin to sunlight. But for those cooped up in offices all day long, food and dietary supplements also can provide vitamin D. With this renewed interest in vitamin D, scientists need an accurate way to measure its levels in the blood. Measuring vitamin D itself doesn't work because it is rapidly changed into another form in the liver. That's why current methods detect levels of a vitamin D metabolite called 25(OH)D. However, the test methods don't always agree and produce different results. To help laboratories come up with consistent and accurate methods, the researchers developed a Standard Reference Material called SRM 972, the first certified reference material for the determination of the metabolite in human serum (a component of blood).
The researchers developed four versions of the standard, with different levels of the vitamin D metabolites 25(OH)D2 and 25(OH)D3 in human serum. They also determined the levels of 3-epi-25(OH)D in the adult human serum samples. Surprisingly, they found that this metabolite -- previously thought to only exist in the blood of infants -- was present in adult serum. "This reference material provides a mechanism to ensure measurement accuracy and comparability and represents a first step toward standardization of 25(OH)D measurements," say the researchers.
**Source: American Chemical Society
Karen Phinney and colleagues explain that medical research suggests vitamin D deficiency or insufficiency may be even more common than previously thought and a risk factor for more than just bone diseases. An estimated 50-75 percent of people in the U.S. may not have enough vitamin D in their bodies. Low levels of vitamin D have been linked to the development of several conditions, including rickets (soft and deformed bones), osteoporosis, some cancers, multiple sclerosis and Parkinson's disease. People can make their own vitamin D simply by rolling up their shirt sleeves and exposing their skin to sunlight. But for those cooped up in offices all day long, food and dietary supplements also can provide vitamin D. With this renewed interest in vitamin D, scientists need an accurate way to measure its levels in the blood. Measuring vitamin D itself doesn't work because it is rapidly changed into another form in the liver. That's why current methods detect levels of a vitamin D metabolite called 25(OH)D. However, the test methods don't always agree and produce different results. To help laboratories come up with consistent and accurate methods, the researchers developed a Standard Reference Material called SRM 972, the first certified reference material for the determination of the metabolite in human serum (a component of blood).
The researchers developed four versions of the standard, with different levels of the vitamin D metabolites 25(OH)D2 and 25(OH)D3 in human serum. They also determined the levels of 3-epi-25(OH)D in the adult human serum samples. Surprisingly, they found that this metabolite -- previously thought to only exist in the blood of infants -- was present in adult serum. "This reference material provides a mechanism to ensure measurement accuracy and comparability and represents a first step toward standardization of 25(OH)D measurements," say the researchers.
**Source: American Chemical Society
Researchers induce Alzheimer's neurons from pluripotent stem cells
Led by researchers at the University of California, San Diego School of Medicine, scientists have, for the first time, created stem cell-derived, in vitro models of sporadic and hereditary Alzheimer's disease (AD), using induced pluripotent stem cells from patients with the much-dreaded neurodegenerative disorder. "Creating highly purified and functional human Alzheimer's neurons in a dish -- this has never been done before," said senior study author Lawrence Goldstein, PhD, professor in the Department of Cellular and Molecular Medicine, Howard Hughes Medical Institute Investigator and director of the UC San Diego Stem Cell Program. "It's a first step. These aren't perfect models. They're proof of concept. But now we know how to make them. It requires extraordinary care and diligence, really rigorous quality controls to induce consistent behavior, but we can do it."
The feat, published in the January 25 online edition of the journal Nature, represents a new and much-needed method for studying the causes of AD, a progressive dementia that afflicts approximately 5.4 million Americans. More importantly, the living cells provide an unprecedented tool for developing and testing drugs to treat the disorder.
"We're dealing with the human brain. You can't just do a biopsy on living patients," said Goldstein. "Instead, researchers have had to work around, mimicking some aspects of the disease in non-neuronal human cells or using limited animal models. Neither approach is really satisfactory."
Goldstein and colleagues extracted primary fibroblasts from skin tissues taken from two patients with familial AD (a rare, early-onset form of the disease associated with a genetic predisposition), two patients with sporadic AD (the common form whose cause is not known) and two persons with no known neurological problems. They reprogrammed the fibroblasts into induced pluripotent stem cells (iPSCs) that then differentiated into working neurons.
The iPSC-derived neurons from the Alzheimer's patients exhibited normal electrophysiological activity, formed functional synaptic contacts and, critically, displayed tell-tale indicators of AD. Specifically, they possessed higher-than-normal levels of proteins associated with the disorder.
With the in vitro Alzheimer's neurons, scientists can more deeply investigate how AD begins and chart the biochemical processes that eventually destroy brain cells associated with elemental cognitive functions like memory. Currently, AD research depends heavily upon studies of post-mortem tissues, long after the damage has been done.
"The differences between a healthy neuron and an Alzheimer's neuron are subtle," said Goldstein. "It basically comes down to low-level mischief accumulating over a very long time, with catastrophic results."
The researchers have already produced some surprising findings. "In this work, we show that one of the early changes in Alzheimer's neurons thought to be an initiating event in the course of the disease turns out not to be that significant," Goldstein said, adding that they discovered a different early event plays a bigger role.
The scientists also found that neurons derived from one of the two patients with sporadic AD exhibited biochemical changes possibly linked to the disease. The discovery suggests that there may be sub-categories of the disorder and that, in the future, potential therapies might be targeted to specific groups of AD patients.
Though just a beginning, Goldstein emphasized the iPSC-derived Alzheimer's neurons present a huge opportunity in a desperate fight. "At the end of the day, we need to use cells like these to better understand Alzheimer's and find drugs to treat it. We need to do everything we can because the cost of this disease is just too heavy and horrible to contemplate. Without solutions, it will bankrupt us -- emotionally and financially."
Funding for this research came, in part, from the California Institute for Regenerative Medicine, the Weatherstone Foundation, the National Institutes of Health, the Hartwell Foundation, the Lookout Fund and the McDonnell Foundation.
A patent application has been filed on this technology by the University of California, San Diego. For more information, go to: techtransfer.universityofcalifornia.edu/NCD/22199.html
The feat, published in the January 25 online edition of the journal Nature, represents a new and much-needed method for studying the causes of AD, a progressive dementia that afflicts approximately 5.4 million Americans. More importantly, the living cells provide an unprecedented tool for developing and testing drugs to treat the disorder.
"We're dealing with the human brain. You can't just do a biopsy on living patients," said Goldstein. "Instead, researchers have had to work around, mimicking some aspects of the disease in non-neuronal human cells or using limited animal models. Neither approach is really satisfactory."
Goldstein and colleagues extracted primary fibroblasts from skin tissues taken from two patients with familial AD (a rare, early-onset form of the disease associated with a genetic predisposition), two patients with sporadic AD (the common form whose cause is not known) and two persons with no known neurological problems. They reprogrammed the fibroblasts into induced pluripotent stem cells (iPSCs) that then differentiated into working neurons.
The iPSC-derived neurons from the Alzheimer's patients exhibited normal electrophysiological activity, formed functional synaptic contacts and, critically, displayed tell-tale indicators of AD. Specifically, they possessed higher-than-normal levels of proteins associated with the disorder.
With the in vitro Alzheimer's neurons, scientists can more deeply investigate how AD begins and chart the biochemical processes that eventually destroy brain cells associated with elemental cognitive functions like memory. Currently, AD research depends heavily upon studies of post-mortem tissues, long after the damage has been done.
"The differences between a healthy neuron and an Alzheimer's neuron are subtle," said Goldstein. "It basically comes down to low-level mischief accumulating over a very long time, with catastrophic results."
The researchers have already produced some surprising findings. "In this work, we show that one of the early changes in Alzheimer's neurons thought to be an initiating event in the course of the disease turns out not to be that significant," Goldstein said, adding that they discovered a different early event plays a bigger role.
The scientists also found that neurons derived from one of the two patients with sporadic AD exhibited biochemical changes possibly linked to the disease. The discovery suggests that there may be sub-categories of the disorder and that, in the future, potential therapies might be targeted to specific groups of AD patients.
Though just a beginning, Goldstein emphasized the iPSC-derived Alzheimer's neurons present a huge opportunity in a desperate fight. "At the end of the day, we need to use cells like these to better understand Alzheimer's and find drugs to treat it. We need to do everything we can because the cost of this disease is just too heavy and horrible to contemplate. Without solutions, it will bankrupt us -- emotionally and financially."
Funding for this research came, in part, from the California Institute for Regenerative Medicine, the Weatherstone Foundation, the National Institutes of Health, the Hartwell Foundation, the Lookout Fund and the McDonnell Foundation.
A patent application has been filed on this technology by the University of California, San Diego. For more information, go to: techtransfer.universityofcalifornia.edu/NCD/22199.html
High animal fat diet increases gestational diabetes risk
Women who consumed a diet high in animal fat and cholesterol before pregnancy were at higher risk for gestational diabetes than women whose diets were lower in animal fat and cholesterol, according to researchers at the National Institutes of Health and Harvard University. Gestational diabetes is a form of diabetes seen during pregnancy. Gestational diabetes increases the risk for certain pregnancy complications and health problems in the newborn.
Women whose diets were high in total fat or other kinds of fats -- but not in animal fat or cholesterol -- did not have an increased risk.
Moreover, the increased risk for gestational diabetes seen with animal fat and cholesterol appeared to be independent of other, dietary and non-dietary, risk factors for gestational diabetes. For example, exercise is known to reduce the risk of gestational diabetes. Among women who exercised, however, those who consumed higher amounts of animal fat and cholesterol had a higher risk than those whose diets were lower in these types of fat.
"Our findings indicate that women who reduce the proportion of animal fat and cholesterol in their diets before pregnancy may lower their risk for gestational diabetes during pregnancy," said senior author Cuilin Zhang, M.D., M.P.H., Ph.D., of the Epidemiology Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), one of three NIH institutes supporting the study.
The researchers concluded that changing the source of 5 percent of dietary calories from animal fat to plant-derived sources could decrease a woman's risk for gestational diabetes by 7 percent.
The U.S. Department of Agriculture website, ChooseMyPlate.gov, contains information on healthy eating for children and adults, as well as health and nutrition information for pregnant and breast feeding women.
First author Katherine Bowers, Ph.D., conducted the research with NICHD colleagues Dr. Zhang and Edwina Yeung, Ph.D., and with Deirdre K. Tobias and Frank B. Hu, M.D., M.P.H., Ph.D., of Harvard University, in Boston.
Their findings appear online in the American Journal of Clinical Nutrition.
The research was also funded by the National Cancer Institute and the National Institute of Diabetes and Digestive and Kidney Diseases.
The researchers utilized information from more than 13,000 women participating in the Nurses' Health Study II. The women were 22 to 45 years old when they enrolled in the study. Every two years they responded to questions on their general health, pregnancy status, and lifestyle habits, such as consuming alcohol or smoking. In addition, every four years they completed a comprehensive survey about the kinds of food and drink they consumed.
About 6 percent of the participants reported having been diagnosed with gestational diabetes. The researchers calculated the amount of animal fat in participants' diets as a percentage of total calories and divided participants into five groups, or quintiles, based on those percentages. Then the researchers compared the risk for developing gestational diabetes for each group. Women in the highest quintile of intake had almost double the risk for gestational diabetes compared to women in the lowest quintile.
They also observed that women in the highest quintile for cholesterol consumption were 45 percent more likely to develop gestational diabetes than were women in the lowest quintile.
"This is the largest study to date of the effects of a pre-pregnancy diet on gestational diabetes," Dr. Bowers said. "Additional research may lead to increased understanding of how a mother's diet before and during pregnancy influences her metabolism during pregnancy, which may have important implications for the baby's health at birth and later in life."
**Source: NIH/National Institute of Child Health and Human Development
Women whose diets were high in total fat or other kinds of fats -- but not in animal fat or cholesterol -- did not have an increased risk.
Moreover, the increased risk for gestational diabetes seen with animal fat and cholesterol appeared to be independent of other, dietary and non-dietary, risk factors for gestational diabetes. For example, exercise is known to reduce the risk of gestational diabetes. Among women who exercised, however, those who consumed higher amounts of animal fat and cholesterol had a higher risk than those whose diets were lower in these types of fat.
"Our findings indicate that women who reduce the proportion of animal fat and cholesterol in their diets before pregnancy may lower their risk for gestational diabetes during pregnancy," said senior author Cuilin Zhang, M.D., M.P.H., Ph.D., of the Epidemiology Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), one of three NIH institutes supporting the study.
The researchers concluded that changing the source of 5 percent of dietary calories from animal fat to plant-derived sources could decrease a woman's risk for gestational diabetes by 7 percent.
The U.S. Department of Agriculture website, ChooseMyPlate.gov, contains information on healthy eating for children and adults, as well as health and nutrition information for pregnant and breast feeding women.
First author Katherine Bowers, Ph.D., conducted the research with NICHD colleagues Dr. Zhang and Edwina Yeung, Ph.D., and with Deirdre K. Tobias and Frank B. Hu, M.D., M.P.H., Ph.D., of Harvard University, in Boston.
Their findings appear online in the American Journal of Clinical Nutrition.
The research was also funded by the National Cancer Institute and the National Institute of Diabetes and Digestive and Kidney Diseases.
The researchers utilized information from more than 13,000 women participating in the Nurses' Health Study II. The women were 22 to 45 years old when they enrolled in the study. Every two years they responded to questions on their general health, pregnancy status, and lifestyle habits, such as consuming alcohol or smoking. In addition, every four years they completed a comprehensive survey about the kinds of food and drink they consumed.
About 6 percent of the participants reported having been diagnosed with gestational diabetes. The researchers calculated the amount of animal fat in participants' diets as a percentage of total calories and divided participants into five groups, or quintiles, based on those percentages. Then the researchers compared the risk for developing gestational diabetes for each group. Women in the highest quintile of intake had almost double the risk for gestational diabetes compared to women in the lowest quintile.
They also observed that women in the highest quintile for cholesterol consumption were 45 percent more likely to develop gestational diabetes than were women in the lowest quintile.
"This is the largest study to date of the effects of a pre-pregnancy diet on gestational diabetes," Dr. Bowers said. "Additional research may lead to increased understanding of how a mother's diet before and during pregnancy influences her metabolism during pregnancy, which may have important implications for the baby's health at birth and later in life."
**Source: NIH/National Institute of Child Health and Human Development
El deporte y las bajas temperaturas activan el tejido adiposo que adelgaza
Una de las líneas de trabajo más prometedoras e interesantes en la investigación contra la obesidad se centra en la grasa. Pero no en la responsable del sobrepeso, de color blanquecino y amarillento, sino en la parda o marrón, que, curiosamente, quema calorías y adelgaza.
El gran reto en el que trabajan distintos laboratorios consiste en saber activar su funcionamiento, es decir, descubrir el interruptor que permita adelgazar a voluntad. Dos relevantes artículos recién publicados apuntan en dos direcciones: pasar frío y hacer ejercicio.
Estas dos pistas son más importantes de lo que pueden parecer a simple vista (es conocida la relación del frío y el ejercicio en el adelgazamiento).
En el caso del frío, nunca se había demostrado en humanos (sí en ratones) que una exposición a bajas temperaturas sirviera para activar la grasa parda. Hasta 2009 tampoco se había descrito la presencia y actividad de este nuevo tejido en adultos humanos. Se creía que solo estaba presente en ratas y bebés, que lo usan para mantener su temperatura corporal.
-Hasta 2009 no se describió la presencia de grasa parda en adultos
Un artículo publicado en el Journal of clinical investigation, coordinado por André Carpentier, de la Universidad de Sherbrooke, en Quebec, ha dado este paso en un ensayo en el que participaron seis hombres de entre 23 y 42 años a los que se sometió a frío moderado durante fracciones de dos horas (su temperatura en la piel cayó entre 3,8 y 0,4 grados).
“El trabajo tiene una gran importancia clínica”, apunta Francesc Villarroya, miembro del Centro de Investigación Biomédica en Red (Ciber) de Fisiopatología de la Obesidad y Nutrición. “Un estímulo tan simple como un ambiente frío genera un impacto y pone en marcha el funcionamiento de esta grasa buena que consume calorías”, indica. Además, va más lejos: “Se podría inducir una relación entre la obesidad y temperaturas excesivamente altas en las casas”.
El deporte también activa el tejido adiposo marrón —en sus células abundan las mitocondrias, de ahí su tonalidad—, según un trabajo publicado en Nature entre cuyos autores figura Bruce Spiegelman, profesor de Biología y Medicina en el Dana-Faber Cancer Institute de la Universidad de Harvard.
Este equipo de investigadores ha descubierto (esta vez sí, en ratones) una hormona nueva (que han bautizado como irisina) que genera el músculo cuando se ejercita y que se dirige a la grasa parda con la misión de despertar su funcionamiento.
De esta forma, al hacer deporte, “no solo se queman calorías por el movimiento, sino que además existe un consumo extra por la activación de este tejido” que, también, pero de forma paralela, consume las reservas de lípidos, comenta Francesc Villarroya. Este investigador promete nuevos hallazgos: “Esta área del metabolismo está estallando.
**Publicado en "EL PAIS"
El gran reto en el que trabajan distintos laboratorios consiste en saber activar su funcionamiento, es decir, descubrir el interruptor que permita adelgazar a voluntad. Dos relevantes artículos recién publicados apuntan en dos direcciones: pasar frío y hacer ejercicio.
Estas dos pistas son más importantes de lo que pueden parecer a simple vista (es conocida la relación del frío y el ejercicio en el adelgazamiento).
En el caso del frío, nunca se había demostrado en humanos (sí en ratones) que una exposición a bajas temperaturas sirviera para activar la grasa parda. Hasta 2009 tampoco se había descrito la presencia y actividad de este nuevo tejido en adultos humanos. Se creía que solo estaba presente en ratas y bebés, que lo usan para mantener su temperatura corporal.
-Hasta 2009 no se describió la presencia de grasa parda en adultos
Un artículo publicado en el Journal of clinical investigation, coordinado por André Carpentier, de la Universidad de Sherbrooke, en Quebec, ha dado este paso en un ensayo en el que participaron seis hombres de entre 23 y 42 años a los que se sometió a frío moderado durante fracciones de dos horas (su temperatura en la piel cayó entre 3,8 y 0,4 grados).
“El trabajo tiene una gran importancia clínica”, apunta Francesc Villarroya, miembro del Centro de Investigación Biomédica en Red (Ciber) de Fisiopatología de la Obesidad y Nutrición. “Un estímulo tan simple como un ambiente frío genera un impacto y pone en marcha el funcionamiento de esta grasa buena que consume calorías”, indica. Además, va más lejos: “Se podría inducir una relación entre la obesidad y temperaturas excesivamente altas en las casas”.
El deporte también activa el tejido adiposo marrón —en sus células abundan las mitocondrias, de ahí su tonalidad—, según un trabajo publicado en Nature entre cuyos autores figura Bruce Spiegelman, profesor de Biología y Medicina en el Dana-Faber Cancer Institute de la Universidad de Harvard.
Este equipo de investigadores ha descubierto (esta vez sí, en ratones) una hormona nueva (que han bautizado como irisina) que genera el músculo cuando se ejercita y que se dirige a la grasa parda con la misión de despertar su funcionamiento.
De esta forma, al hacer deporte, “no solo se queman calorías por el movimiento, sino que además existe un consumo extra por la activación de este tejido” que, también, pero de forma paralela, consume las reservas de lípidos, comenta Francesc Villarroya. Este investigador promete nuevos hallazgos: “Esta área del metabolismo está estallando.
**Publicado en "EL PAIS"
Brachytherapy reduced death rates in high-risk prostate cancer patients, study finds
Brachytherapy for high-risk prostate cancers patients has historically been considered a less effective modality, but a new study from radiation oncologists at the Kimmel Cancer Center at Jefferson suggests otherwise. A population-based analysis looking at almost 13,000 cases revealed that men who received brachytherapy alone or in combination with external beam radiation therapy (EBRT) had significantly reduced mortality rates. Their findings are reported online January 23 in the International Journal of Radiation Oncology*Biology*Physics.
Brachytherapy involves the precise placement of radiation sources directly at the site of a tumor and is typically used to treat low and intermediate risk prostate cancers. However, brachytherapy treatment for high-risk patients is less common and controversial, given in part to early retrospective studies that found it to be associated with lower cure rates compared to EBRT.
Many experts believe that these early series were limited by poor brachytherapy technique, and that high-quality contemporary brachytherapy may be an effective tool against high-risk prostate cancer.
"The study contradicts traditional policies of using brachytherapy in just low and intermediate risk patients by suggesting there may instead be an improvement in prostate cancer survival for high-risk patients," said co-author Timothy Showalter, M.D., assistant professor in the Department of Radiation Oncology at Thomas Jefferson University Hospital, and associate research member of Jefferson's Kimmel Cancer Center. "Although studies like this cannot prove an advantage for brachytherapy, our report does suggest that brachytherapy is no less effective than EBRT and should be considered for some men with high-risk prostate cancer."
Researchers identified 12,745 Surveillance, Epidemiology and End Results database patients diagnosed from 1988 to 2002 with high-grade prostate cancer of poorly differentiated grade and treated with brachytherapy (7.1 percent), EBRT alone (73.5 percent) or brachytherapy plus EBRT (19.1 percent). The team used multivariate models to examine patient and tumor characteristics associated with the likelihood of treatment with each radiation modality and the effect of radiation modality on prostate cancer-specific mortality.
Treatment with brachytherapy alone or brachytherapy in combination with EBRT, the researchers found, was associated with significant reduction in prostate cancer-specific mortality rates compared to EBRT alone.
Significant predictors of use of brachytherapy or brachytherapy plus EBRT were younger age, later year of diagnosis, urban residence and earlier T-stage.
According to the researchers, including lead author Xinglei Shen, M.D., a resident in Jefferson's Department of Radiation Oncology and a part-time master's degree student in the Jefferson School of Population Health, the study's findings provide ample evidence to further study brachytherapy as part of an effective treatment strategy for men with high-grade prostate cancer.
"Today, for the most part, brachytherapy is not being used for these high-risk patients or even recommended," Dr. Shen said. "But if you look at the biology and theory behind it, it makes sense: you can really give a lot more dose with brachytherapy than with EBRT alone to the prostate. And this presents an opportunity for high-risk patients."
**Source: Thomas Jefferson University
Brachytherapy involves the precise placement of radiation sources directly at the site of a tumor and is typically used to treat low and intermediate risk prostate cancers. However, brachytherapy treatment for high-risk patients is less common and controversial, given in part to early retrospective studies that found it to be associated with lower cure rates compared to EBRT.
Many experts believe that these early series were limited by poor brachytherapy technique, and that high-quality contemporary brachytherapy may be an effective tool against high-risk prostate cancer.
"The study contradicts traditional policies of using brachytherapy in just low and intermediate risk patients by suggesting there may instead be an improvement in prostate cancer survival for high-risk patients," said co-author Timothy Showalter, M.D., assistant professor in the Department of Radiation Oncology at Thomas Jefferson University Hospital, and associate research member of Jefferson's Kimmel Cancer Center. "Although studies like this cannot prove an advantage for brachytherapy, our report does suggest that brachytherapy is no less effective than EBRT and should be considered for some men with high-risk prostate cancer."
Researchers identified 12,745 Surveillance, Epidemiology and End Results database patients diagnosed from 1988 to 2002 with high-grade prostate cancer of poorly differentiated grade and treated with brachytherapy (7.1 percent), EBRT alone (73.5 percent) or brachytherapy plus EBRT (19.1 percent). The team used multivariate models to examine patient and tumor characteristics associated with the likelihood of treatment with each radiation modality and the effect of radiation modality on prostate cancer-specific mortality.
Treatment with brachytherapy alone or brachytherapy in combination with EBRT, the researchers found, was associated with significant reduction in prostate cancer-specific mortality rates compared to EBRT alone.
Significant predictors of use of brachytherapy or brachytherapy plus EBRT were younger age, later year of diagnosis, urban residence and earlier T-stage.
According to the researchers, including lead author Xinglei Shen, M.D., a resident in Jefferson's Department of Radiation Oncology and a part-time master's degree student in the Jefferson School of Population Health, the study's findings provide ample evidence to further study brachytherapy as part of an effective treatment strategy for men with high-grade prostate cancer.
"Today, for the most part, brachytherapy is not being used for these high-risk patients or even recommended," Dr. Shen said. "But if you look at the biology and theory behind it, it makes sense: you can really give a lot more dose with brachytherapy than with EBRT alone to the prostate. And this presents an opportunity for high-risk patients."
**Source: Thomas Jefferson University
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