Wednesday 20 December 2006

Older Men Treated For Early Prostate Cancer Live Longer Than Those Who Are Not

Recent findings from an observational study by researchers at the University of Pennsylvania School of Medicine suggest that men between 65 and 80 years of age who received treatment for early stage, localized prostate cancer lived significantly longer than men who did not receive treatment. The study is published in the December 13th issue of the Journal of the American Medical Association.
Thanks to better cancer prevention education and the resulting wide-spread increase in using prostate-specific antigen (PSA) screenings, more men are being diagnosed with early-stage and low-or intermediate-grade prostate cancer. Studies have shown that the slow-developing nature of prostate cancer during its earliest stages makes treatment options, such as a radical prostatectomy (surgical removal of the prostate) and radiation therapy, controversial with unpredictable outcomes. Often, recently diagnosed men of this group were advised to just "watch and wait" to see how their situation progressed.
"For this study we looked back over the existing data of a large population of prostate cancer patients, aged 65 to 80, with small tumors that were at a low or intermediate risk of spreading," said senior author Katrina Armstrong, MD, MSCE, who worked on the study with colleagues from Penn's Abramson Cancer Center, Center for Clinical Epidemiology and Biostatistics, Leonard Davis Institute of Health and Economics, and Division of Internal Medicine, and Fox Chase Cancer Center. "After accounting for all their differences, we discovered that the men -- who within six months of diagnosis underwent surgery or radiation therapy -- were 31 percent less likely to die than those who did not undergo treatment during that time."
Researchers acquired the necessary data for this study from the Surveillance, Epidemiology, and End Results (SEER) Medicare database, a population-based cancer registry which encompasses approximately 14 percent of the US population. Data was included on 44,630 men, aged 65 to 80, who were diagnosed between 1991-1999, with prostate cancer and had survived more than a year after diagnosis. All patients were followed-up until death or December 31st, 2002, the end of the study. Of the 44,630 men, 32,022 (71.8 percent) were actively treated with either surgery or radiation therapy during the first six months after diagnosis. The remaining group of 12,608 (28.3 percent) were classified as having received "observation" and did not undergo surgery, radiation or hormonal therapy.
During the 12-years of follow-up, researchers found that the patients who received treatment had a 31 percent lower risk of death. In the observation-only group, 37 percent of the patients died whereas only 23.8 percent of those in the treatment group died.
Since this was not a randomized, controlled study but a retrospective analysis of existing data, the researches had to perform extensive statistical adjustments to account for study participants differences. Even with all these differences taken into account, there was still a significant improvement in the overall survival of those men who received active treatment. "This benefit was also seen across the board in all subgroups examined, including African-American men and older men aged 75-80 at diagnosis," added Armstrong. "However, as we summarized in the study, because observational data can never completely adjust for potential selection bias and confounding, our results must be validated by rigorous randomized controlled trials of elderly men with localized prostate cancer before the findings can be used to influence treatment decisions."
This study was funded by the Center for Population Health and Health Disparities at the University of Pennsylvania, Public Health Services Grant P50-CA105641.

Note: This story has been adapted from a news release issued by University of Pennsylvania School of Medicine.
Source: University of Pennsylvania School of Medicine
via Sciendaily

Phototherapy For Neonatal Jaundice Associated With Increased Risk Of Skin Moles In Childhood

Children who received light therapy (phototherapy) for jaundice as infants appear to have an increased risk of developing skin moles in childhood, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals. Some types of moles are risk factors for developing the skin cancer melanoma.
Jaundice or hyperbilirubinemia occurs when bilirubin, a yellow pigment created as a byproduct of the normal breakdown of red blood cells, cannot yet be processed by a newborn's liver and builds up in the blood, turning the skin, whites of the eyes and mucous membranes yellow. The condition affects between 45 percent and 60 percent of healthy babies and as many as 80 percent of infants born prematurely, according to background information in the article. During phototherapy, the treatment of choice for jaundice, babies are placed under blue lights (bili lights) that convert the bilirubin into compounds that can be eliminated from the body. Studies have been performed to assess the safety of this therapy, but many have not focused on its effects on the skin, the authors write.
Emmanuelle Matichard, M.D., Bichat-Claude Bernard Hospital, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, and colleagues assessed the presence of melanocytic nevi (moles) in 58 French children who were 8 or 9 years old at the time of the study. Eighteen children had phototherapy as newborns; 40 who were the same age but did not have phototherapy were recruited from a public school and served as controls. All the children and their parents were interviewed about the use of phototherapy, history of sun exposure and sunscreen use. A dermatologist performed physical examinations on the children and recorded their skin color, eye color, hair color, skin type and the number and size of moles.
Thirty-seven children (63 percent) had moles that were 2 millimeters or larger, and there was an average of 2.09 moles per child. Those who were exposed to phototherapy had significantly more moles of this size than those who did not--an average of 3.5 vs. 1.45 per child. When the analysis was limited to moles between 2 millimeters and 5 millimeters, the association was stronger. "Lentigo simplex [moles smaller than 2 millimeters in diameter] may represent more recent nevi, whereas those nevi due to early events should be larger," the authors write. "Nevi larger than 5 millimeters probably are congenital nevi and are most probably associated with genetic predisposition." These associations did not change when other risk factors for the frequency of moles, including skin type and light hair, were considered. Sun exposure, particularly during vacations, was also associated with the number of moles of all sizes, and light hair color was correlated with the number of moles smaller than 2 millimeters.
The study did not examine whether phototherapy increases the risk for melanoma in adults, and it is possible that the small difference in the number of moles between the two groups would not change their risk of developing cancer. However, further study could help illuminate the association. "Higher numbers of acquired benign nevi are associated with increased risk of melanoma," they conclude. "A detailed evaluation of the factors responsible for the development of nevi in children would be useful to identify high-risk groups to be targeted for prevention. The link between melanoma and phototherapy should be the focus of such a study."

Note: This story has been adapted from a news release issued by JAMA and Archives Journals.
Source: University of Pennsylvania School of Medicine

Low To Moderate Blood Alcohol Level Linked To Reduced Mortality Following Traumatic Head Injury

Patients who have low to moderate blood alcohol levels may be less likely to die after arriving at the hospital with a traumatic brain injury than those with no alcohol in their bloodstream, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals. However, those with the highest alcohol levels appear to have an increased risk of dying in the hospital.
Alcohol use is a major risk factor for trauma, according to background information in the article. About one-third to one-half of all patients hospitalized with trauma are intoxicated at the time of injury. However, the effect of alcohol on how patients fare after a traumatic brain injury--a leading cause of disability and death among young people--is unclear. Some human and animal studies suggest that alcohol may be neuroprotective, keeping the injury from worsening once it has occurred.
Homer C. N. Tien, M.D., F.R.C.S.C., Sunnybrook Health Sciences Centre, University of Toronto, and colleagues studied 1,158 consecutive patients who were evaluated at an academic level I trauma center for severe brain injury caused by blunt trauma between 1988 and 2003. Tests done when the patients were admitted determined blood alcohol concentration (BAC). This information, as well as data on demographics, type of injury, severity of the injury, length of hospital stay and whether the patient died or left the hospital, was gathered from the hospital's trauma registry. The researchers also assessed a group of 528 patients with severe torso injuries, but no or mild head injuries, as a comparison.
Of the 1,158 traumatic brain injury patients, 740 had a BAC of zero, 315 had low to moderate BAC (0 to 230 milligrams per deciliter) and 103 had high BAC (230 milligrams per deciliter or higher); 403 died in the hospital. Those with a low to moderate BAC were less likely to die than those with no BAC (27.9 percent died vs. 36.3 percent). After adjusting for other factors that could influence the risk of death--including injury severity, blood transfusions and whether the trauma occurred in a motor vehicle crash--BAC was still associated with the risk of death. Those with a low to moderate BAC had 24 percent lower odds of dying in the hospital than those with no BAC. In contrast, those with a high BAC had 73 percent higher odds of dying than those with no BAC. Among patients with torso injuries, BAC was not related to the risk of death.
The authors mention that low to moderate doses of alcohol may protect the brain by stopping the mechanisms that contribute to secondary brain injury, which occurs when traumatized brain cells continue to be deprived of oxygen and worsens the damage caused by the initial event.
"There are major sociologic implications from implying that intoxicated patients with severe traumatic brain injury have better outcomes than non-intoxicated patients," the authors write. "We stress that our study only examined the role of alcohol on outcome in the post-injury phase because we examined only in-hospital deaths." About half of all individuals who die from trauma do so before they arrive at the hospital, they continue. Because alcohol use increases the likelihood of a severe injury, alcohol-related deaths comprise a large percentage of those who die before they have a chance to get to the hospital.
"Overall, people are still at much greater risk of dying if they drive while intoxicated," the authors conclude. "What our study implies is that there may be a role for an alcohol-based resuscitation fluid in improving outcomes in adequately resuscitated patients with severe head injury."
Note: This story has been adapted from a news release issued by JAMA and Archives Journals.

Source: JAMA and Archives Journals
via Sciencedaily

High Levels Of Blindness In Southern Sudan Following Years Of War

Surveys conducted in southern Sudan, after conflict there ended in 2004, found much higher levels of blindness than anticipated. The results, published in PLoS Medicine, have major implications for the provision of health services in the region.
Sudan is the largest country in Africa and one of the poorest in the world. The southern region of the country is very remote and was devastated by a civil war that went on for nearly half a century, with only short intervals of peace.
An international team of researchers conducted a survey in May 2005 in Mankien--a district of Sudan with a total population estimated to be around 50,000. Their aim was to estimate how many people were blind or had ''low vision'' and to find out the main causes. Working under very difficult conditions, the researchers selected villages to be visited at random. A house in each village visited was selected by spinning a pen in the middle of the village. The people in this house were examined and then other houses were chosen, also at random. Around 2500 people were examined. Children under five years were not included in survey. A very high rate of blindness was found--4%. This is more than twice the level that would be expected, given what is known about the prevalence of blindness in other parts of rural Africa. The two most common causes of blindness and low vision were cataract and trachoma, each accounting for over one-third of cases. Trachoma, which is caused by an infection, was responsible for a greater proportion of the cases of blindness than has been found in studies in other parts of rural Africa.
In a second survey in the same district, the researchers looked specifically for cases of trachoma, both in its early stages and later when it has led to blindness. Some 3500 people were examined, of whom 2000 were children aged less than 15 years. The earliest stages of infection were very common indeed, particularly in children aged 1--9, over half of whom had some sign of infection. In adults, one in five had trichiasis caused by trachoma.
Trachoma can be passed from one person to another through contact with hands and clothes, and by flies. The disease develops gradually--while children are most susceptible to infection, they may not note its effects until adulthood, when scarring from repeated infections causes the eyelashes to turn inward (''trichiasis''). The cornea--the transparent front part of the eye--becomes damaged by the eyelashes and develops ulcers, and eventually blindness results.
The situation revealed by the researchers is particularly tragic as improved living conditions, better hygiene, and early treatment of the infection with antibiotics can prevent trachoma. Surgery for trichiasis is also very effective. The World Health Organization recommends a strategy for trachoma control known as 'SAFE': surgery, antibiotics, facial cleanliness, and environmental change. The authors call for its urgent implementation in southern Sudan.
The surveys are also discussed in two 'Perspective' articles in the same issue of PLoS Medicine. One article discusses the possibility that the methods used in these (and other) health surveys could over-estimate the level of blindness.
Citation: Ngondi J, Ole-Sempele F, Onsarigo A, Matende I, Baba S, et al. (2006) Prevalence and causes of blindness and low vision in southern Sudan. PLoS Med 3(12): e477. (http://dx.doi.org/10.1371/journal.pmed.0030477)
Note: This story has been adapted from a news release issued by Public Library of Science.
Source: Public Library of Science

High Levels Of Blindness In Southern Sudan Following Years Of War

Surveys conducted in southern Sudan, after conflict there ended in 2004, found much higher levels of blindness than anticipated. The results, published in PLoS Medicine, have major implications for the provision of health services in the region.Sudan is the largest country in Africa and one of the poorest in the world. The southern region of the country is very remote and was devastated by a civil war that went on for nearly half a century, with only short intervals of peace.
An international team of researchers conducted a survey in May 2005 in Mankien--a district of Sudan with a total population estimated to be around 50,000. Their aim was to estimate how many people were blind or had ''low vision'' and to find out the main causes. Working under very difficult conditions, the researchers selected villages to be visited at random. A house in each village visited was selected by spinning a pen in the middle of the village. The people in this house were examined and then other houses were chosen, also at random. Around 2500 people were examined. Children under five years were not included in survey. A very high rate of blindness was found--4%. This is more than twice the level that would be expected, given what is known about the prevalence of blindness in other parts of rural Africa. The two most common causes of blindness and low vision were cataract and trachoma, each accounting for over one-third of cases. Trachoma, which is caused by an infection, was responsible for a greater proportion of the cases of blindness than has been found in studies in other parts of rural Africa.
In a second survey in the same district, the researchers looked specifically for cases of trachoma, both in its early stages and later when it has led to blindness. Some 3500 people were examined, of whom 2000 were children aged less than 15 years. The earliest stages of infection were very common indeed, particularly in children aged 1--9, over half of whom had some sign of infection. In adults, one in five had trichiasis caused by trachoma.
Trachoma can be passed from one person to another through contact with hands and clothes, and by flies. The disease develops gradually--while children are most susceptible to infection, they may not note its effects until adulthood, when scarring from repeated infections causes the eyelashes to turn inward (''trichiasis''). The cornea--the transparent front part of the eye--becomes damaged by the eyelashes and develops ulcers, and eventually blindness results.
The situation revealed by the researchers is particularly tragic as improved living conditions, better hygiene, and early treatment of the infection with antibiotics can prevent trachoma. Surgery for trichiasis is also very effective. The World Health Organization recommends a strategy for trachoma control known as 'SAFE': surgery, antibiotics, facial cleanliness, and environmental change. The authors call for its urgent implementation in southern Sudan.
The surveys are also discussed in two 'Perspective' articles in the same issue of PLoS Medicine. One article discusses the possibility that the methods used in these (and other) health surveys could over-estimate the level of blindness.
Citation: Ngondi J, Ole-Sempele F, Onsarigo A, Matende I, Baba S, et al. (2006) Prevalence and causes of blindness and low vision in southern Sudan. PLoS Med 3(12): e477. (http://dx.doi.org/10.1371/journal.pmed.0030477)
Note: This story has been adapted from a news release issued b
Source:
Public Library of Science
via
Sciencedaily

Low To Moderate Blood Alcohol Level Linked To Reduced Mortality Following Traumatic Head Injury

Patients who have low to moderate blood alcohol levels may be less likely to die after arriving at the hospital with a traumatic brain injury than those with no alcohol in their bloodstream, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals. However, those with the highest alcohol levels appear to have an increased risk of dying in the hospital.Alcohol use is a major risk factor for trauma, according to background information in the article. About one-third to one-half of all patients hospitalized with trauma are intoxicated at the time of injury. However, the effect of alcohol on how patients fare after a traumatic brain injury--a leading cause of disability and death among young people--is unclear. Some human and animal studies suggest that alcohol may be neuroprotective, keeping the injury from worsening once it has occurred.
Homer C. N. Tien, M.D., F.R.C.S.C., Sunnybrook Health Sciences Centre, University of Toronto, and colleagues studied 1,158 consecutive patients who were evaluated at an academic level I trauma center for severe brain injury caused by blunt trauma between 1988 and 2003. Tests done when the patients were admitted determined blood alcohol concentration (BAC). This information, as well as data on demographics, type of injury, severity of the injury, length of hospital stay and whether the patient died or left the hospital, was gathered from the hospital's trauma registry. The researchers also assessed a group of 528 patients with severe torso injuries, but no or mild head injuries, as a comparison.
Of the 1,158 traumatic brain injury patients, 740 had a BAC of zero, 315 had low to moderate BAC (0 to 230 milligrams per deciliter) and 103 had high BAC (230 milligrams per deciliter or higher); 403 died in the hospital. Those with a low to moderate BAC were less likely to die than those with no BAC (27.9 percent died vs. 36.3 percent). After adjusting for other factors that could influence the risk of death--including injury severity, blood transfusions and whether the trauma occurred in a motor vehicle crash--BAC was still associated with the risk of death. Those with a low to moderate BAC had 24 percent lower odds of dying in the hospital than those with no BAC. In contrast, those with a high BAC had 73 percent higher odds of dying than those with no BAC. Among patients with torso injuries, BAC was not related to the risk of death.
The authors mention that low to moderate doses of alcohol may protect the brain by stopping the mechanisms that contribute to secondary brain injury, which occurs when traumatized brain cells continue to be deprived of oxygen and worsens the damage caused by the initial event.
"There are major sociologic implications from implying that intoxicated patients with severe traumatic brain injury have better outcomes than non-intoxicated patients," the authors write. "We stress that our study only examined the role of alcohol on outcome in the post-injury phase because we examined only in-hospital deaths." About half of all individuals who die from trauma do so before they arrive at the hospital, they continue. Because alcohol use increases the likelihood of a severe injury, alcohol-related deaths comprise a large percentage of those who die before they have a chance to get to the hospital.
"Overall, people are still at much greater risk of dying if they drive while intoxicated," the authors conclude. "What our study implies is that there may be a role for an alcohol-based resuscitation fluid in improving outcomes in adequately resuscitated patients with severe head injury."
Note: This story has been adapted from a news release issued by JAMA and Archives Journals.

Source:
JAMA and Archives Journals
via Sciencedaily

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