Early intestinal microbiota exerts important stimuli for immune develop- ment and a reduced microbial exposure and Caesarean section (CS) have been associated with the development of allergic disease. In this study, the authors addressed how microbiota development in infants is affected by mode of delivery, and relate differences in colonization patterns to the maturation of a balanced Th1/Th2 immune response. The study was designed such that the postnatal intestinal colonization patter was investigated in 24 infants, born vaginally (15) or by CS (9). The intestinal microbiota were characterized using pyrosequencing of 16S rRNA genes at 1 week, and 1, 3, 6, 12, and 24 months after birth. Venous blood levels of Th1- and Th2- associated chemokines were measured at 6, 12, and 24 months. The results showed that infants born through CS had lower total microbiota diversity during the first 2 years of life. CS delivered infants also had a lower abundance and diversity of the Bacteroidetes phylum and were less often colonized by the Bacteroidetes phylum. Infants born through CS had significantly lower levels of Th1- associated chemokines CXCL10 and CXCL11 found in the blood. Gut 2013 August. PMID: 23926244
ADHD associated with atopic diseases and skin infections
This study examined data to uncover whether there is a relationship between attention-deficit/hyperactivity disorder (ADHD) and allergies. In particular, the authors investigated if children with ADHD would be more likely to have a history of atopic disorders, skin infections, and medical prescriptions than those without ADHD. A nested case-control study among boys using the UK General Practice Research Database was conducted. Four controls who had neither ADHD nor ADHD drug prescriptions in their medical records were matched to each case on age and general practice. 884 boys with a first-time diagnosis of drug- treated ADHD and 3536 controls were identified. The independent odds ratios adjusted for age and presence of low birth weight or preterm delivery were 1.4 for a medical history of asthma, 1.5 for impetigo, and 1.5 for any antihistamine drug prescriptions. Other exposures that were more common in cases than controls were cow’s milk intolerance and any prescriptions from the drug categories antiasthmatics, respiratory corticosteroids, topical steroids, antibacterials, or antifungals. The authors conclude that this study lends support to the emerging evidence that childhood ADHD is associated with atopic diseases and impetigo. Ann Allergy Asthma Immunol. 2013 August. PMID: 23886227
Effects of caloric intake timing on insulin resistance in women with PCOS
In women with polycystic ovarian syndrome (PCOS), hyperinsulinaemia stimulates ovarian cytochrome P450c17α activity that stimulates ovarian androgen production. The objective of this study was to compare whether timed caloric intake differentially influences insulin resistance and hyperandrogenism in lean PCOS women. A total of 60 lean PCOS women (BMI 23.5-24) were randomized into two isocaloric maintenance diets with different meal timing distribution: a breakfast diet of 980 kcal breakfast, 640 kcal lunch and 190 kcal dinner, or a dinner diet of 190 kcal breakfast, 640 kcal lunch and 980 kcal dinner for 90 days. In the breakfast diet group, a significant decrease was observed in both glucose area under the curse, insulin area under the curve by 7 and 54% respectively. In the breakfast group, free testosterone decreased by 50% and sex hormone-binding globulin increased by 105%. Gonadotropin-releasing hormone-stimulated peak serum 17OHP decreased by 39%. No change in these parameters was observed in the dinner group. Women in the breakfast group had an increased ovulation rate. In lean PCOS women, a high caloric intake at breakfast with reduced intake at dinner results in improved insulin sensitivity indices, which ameliorates hyperandrogenism and improves ovulation rate. Clin Sci (Lond). 2013 Nov. PMID: 23688334
Gleason grade progression is uncommon
The Gleason grade is used for pathological scoring of the differen- tiation of prostate cancer. This study examined 1207 Physicians’ Health Study and Professionals Follow-up Study participants diagnosed with prostate cancer from 1982 to 2004 and treated with prostatectomy. They compared the distribution of grade and clinical stage across the pre-PSA and PSA screening eras. The authors reviewed grade using the ISUP 2005 revised criteria. The proportion of advanced staged tumors dropped more than six-fold, from the earliest period, 19.9% stage ≥T3, to latest, 3% stage T3, none T4. The proportion of Gleason score ≥8 decreased substantially less from 25.3% to 17.6%. A significant interaction between stage and diagnosis date predicting grade suggests that the relationship between grade and stage varies by time period. As the dramatic shift in stage since the introduction of PSA screening was accompanied by a more modest shift in Gleason grade, these findings suggest that grade may be established early in tumour pathogenesis. The authors conclude that this has implications for the understanding of tumour progression and prognosis and may help patients diagnosed with lower grade disease feel more comfortable choosing active surveillance. Cancer Res. 2013 August. PMID: 23946472
Prophylactic probiotics to prevent Clostridium difficile
This study was a prospective cohort study evaluating the effect on Clostridium difficile infections following antibiotic administration (CDIAA) of a probiotic added to existing C. difficile infection (CDI) standard preventative measure in 31,832 hospitalized patients receiving antibiotics. Phase I (1580) measured the impact of standard preventative measures alone. In Phase II, 50 to 60 × 109 cfu daily dose of oral Lactobacillus acidophilus CL1285 and L. casei LBC80R probiotic formula was administered to all patients receiving antibiotics. Phase III included the same intervention after a move to a new hospital facility. Phases II and III included 4968 patients. During Phase IV, 25,284 patients were submitted to the same regimen but outcome data were compared to those of similar hospitals in Quebec. At the end of Phase III, CDIAA had decreased from more than 18 cases per 1000 patient admissions in Phase I to less than 5 cases. Reductions of CDI cases (73%) were observed. CDI recurrence rate was reduced by 39%. During the following 6 years, the CDI rate averaged 2.71 cases per 10,000 patient-days compared to 8.50 cases per 10,000 patient-days in equivalent hospitals located in Quebec. Curr Med Res Opin. 2013 August. PMID: 23931498
Efficiency and safety of electronic cigarette as tobacco cigarette substitute
Electronic cigarettes (e-cigarettes) are becoming popular since their introduction a few years ago. This study was a prospective 12-month randomized, controlled trial that evaluated smoking reduction and abstinence in 300 smokers not intending to quit, experimenting two different nicotine strengths of a popular e-cigarette, compared to its non-nicotine choice. One group (n = 100) received 7.2mg nicotine cartridges for 12 weeks, the second group (n = 100) received 6 weeks of 7.2mg followed by 6 weeks of 5.4mg, and the third group (n = 100) received no-nicotine cartridges for 12 weeks. The study consisted of nine visits during which cig/day use and exhaled carbon monoxide levels were measured. Smoking reduction and abstinence rates were calculated. The results showed that there were declines in cig/day use and exhaled carbon monoxide in all three groups, with no consistent differences among study groups. Smoking reduction was documented in 22.3% and 10.3% at week-12 and week-52 respectively. Withdrawal symptoms were infrequently reported. The authors conclude that in smokers not intending to quit, the use of e-cigarettes, with or without nicotine, decrease cigarette consumption and elicited enduring tobacco abstinence with minimal side effects. PLoS One. June 2013. PMID: 23826093.
The role of Mediterranean diet on the risk of pancreatic cancer
This study analyzed data from two case-control studies from Italy between 1983 and 2008, including 362 and 326 pancreatic cancer cases and 1552 and 652 hospital controls. A Mediterranean Diet Score (MDS) summarizing the major characteristics of the Mediterranean diet was used in the two studies separately and overall. Two further scores of adherence to the diet were applied in the second study, using the Mediterranean Dietary Pattern Adherence Index (MDP) and the Mediterranean Adequacy Index (MAI). The results showed that the odds ratios for increasing levels of scores (indicating increasing adherence) were estimated using multiple logistic regression models. Odds ratio for a MDS score of 6 compared with less than 3 was 0.57 in the first study, 0.51 in the second study, and 0.48 overall. A trend of decreasing risk was observed also for the MDP and MAI the odds ratios for the highest versus the lowest quintile being 0.44 for MDP and 0.68 for the MAI. The results were consistent across strata of age, sex, education, body mass index, alcohol drinking, tobacco smoking, and diabetes. The authors conclude that the Mediterranean diet is favourably associated with decreased pancreatic cancer risk. Br J Cancer. 2013 August. PMID: 23928660
Royal College discusses national leadership approaches to Canadian health care with Federal Minister of Health
The Royal College welcomes recent efforts by the federal Minister of Health, Rona Ambrose, to engage and collaborate with Canada’s national health organizations and leaders. With growing illness complexity, budget limitations and an aging population challenging Canada’s health system, national leadership is vital. The Royal College’s senior leaders met with Minister Ambrose today at the Canadian Medical Association’s General Council meeting to discuss specialist employment issues, indigenous health, and the importance of innovation to the long-term sustainability of our health care system. “The Royal College agrees with the important role of innovation in health care,” said Royal College President, Cecil Rorabeck, MD, OC, FRCSC. “We believe leadership is needed to explore how our health care system can best benefit by employing technologies and innovation so Canadians can receive timely and high quality care. The federal government must also take the leadership to develop a national human resources for health strategy and a permanent agency to support ongoing health workforce planning.” The Royal College, along with its 44,000 members practising across Canada and abroad, looks forward to working with its government partners to enhance the efficiency, safety and quality of health and health care services. “Collaboration and open dialogue with the federal government are essential,” said Royal College CEO Andrew Padmos, MD, FRCPC. “To improve the effectiveness of the Canadian health care system, we urge the minister to lead an innovative approach to health workforce research and make national health human resources planning a top priority.” Moving forward, the Royal College encourages Minister Ambrose to continue this dialogue and engage in sustained collaborative efforts with health care providers to ensure that all Canadians have access to high quality health and care.
Most Online Tests For Alzheimer’s Disease Fail On Scientific Validity, Reliability And Ethical Factors
An expert panel found that 16 freely accessible online tests for Alzheimer’s disease scored poorly on scales of overall scientific validity, reliability and ethical factors, according to new data reported at the Alzheimer’s Association International Conference® 2013 (AAIC® 2013) in Boston. “As many as 80 percent of Internet users, including a growing proportion of older adults, seek health information and diagnoses online,” said Julie Robillard, Ph.D., a postdoctoral fellow at the National Core for Neuroethics at the University of British Columbia in Vancouver, British Columbia, Canada, who presented the data at AAIC 2013. “Self-diagnosis behavior in particular is increasingly popular online, and freely accessible quizzes that call themselves ‘tests’ for Alzheimer’s are available on the Internet. However, little is known about the scientific validity and reliability of these offerings and ethics-related factors including research and commercial conflict of interest, confidentiality and consent. Frankly, what we found online was distressing and potentially harmful,” Robillard added. According to the Alzheimer’s Association 2013 Alzheimer’s Disease Facts and Figures report, more than five million Americans are living with Alzheimer’s disease. By 2050, the number of people with Alzheimer’s could reach 13.8 million. Other estimates suggest that number could be high as 16 million. “The number of people with Alzheimer’s is projected to rise significantly as more and more people age into greater risk for developing the disease,” said Maria Carrillo, Ph.D., Alzheimer’s Association vice president of medical and scientific Relations. “Especially in that context, active promotion of healthy aging is a priority for the Alzheimer’s Association, as is the delivery of accurate, reliable and ethical information and services.” All 16 tests scored “poor” or “very poor” on the evaluation criteria for ethical factors. According to Robillard, ethical issues with the tests included overly dense or absent confidentiality and privacy policies, failure to disclose commercial conflicts of interests, failure to meet the stated scope of the test and failure to word the test outcomes in an appropriate and ethical manner.
Poverty the Greatest Barrier to Good Health, Canadians tell CMA Consultation
Poverty kills. That’s the key message in What Makes us Sick, a report released today by the Canadian Medical Association (CMA) based on what Canadians said during a series of town hall meetings and an online consultation held earlier this year. The national dialogue with Canadians asked them about their experiences with the social determinants of health – the factors that cause people to suffer poor health in the first place. “Many factors outside the health care system affect a person’s health, from inadequate housing to a lack of healthy food to sub-optimal early childhood experiences,” said Dr. Anna Reid, past CMA president. “What Canadians told us is that poverty is the recurring theme that underpins most of these social determinants of health.” The CMA report included recommendations for action, again, based on what Canadians said. However, Dr. Reid stressed that the report does not lay blame. “We aren’t pointing fingers,” she said. “We listened to Canadians and what we heard was that they want sincere, legitimate and real action. As a country we can do better in tackling issues around poverty, housing, early childhood development, food security and culture that can hinder a person’s chances to be healthy. There is no one sector responsible for making this happen. It has to be a joint effort, involving health care providers, governments, patients and Canadians from all backgrounds.”
