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Archive for August, 2008

Nurturing Parents Can Cut Risk of Aggression in Girls

Teens who mature early without positive feedback more likely to choose bullying behavior

From healthday.com
Positive parenting can help ease aggression in adolescent girls who go through puberty early, says a study by researchers at the University of Alabama at Birmingham.

On the other hand, precocious teen girls whose parents don’t nurture them, communicate with them, or keep track of their activities are more likely to be display aggressive behavior, they also found.

The study included 330 fifth-grade girls (average age 11) and their parents. The girls were asked how often they engaged in aggressive behavior (hitting, teasing, spreading rumors) and in delinquency (fighting at school, getting injured in a fight, or inflicting injuries).

The girls were also asked about how often their mother was affectionate, how often they did things together, whether their parents had talked to them about violence, tobacco and sex, and whether they’d started their periods.

The parents were asked about several items, including how much they knew about their children’s friends and how their child spent their free time.

One-quarter of the girls in the study had matured early — defined as beginning their period one year before the average age for females of their racial and ethnic group. The study found that these girls were more likely to be delinquent, but not aggressive.

However, early-maturing girls who had low levels of parent nurturing, communication and knowledge were more likely to be aggressive.

The findings were published in the August issue of the Archives of Pediatrics & Adolescent Medicine.

Parental nurturing may decrease girls’ susceptibility to negative peer influence. Also, it may help girls cope with challenges associated with early puberty. By listening to their daughters’ difficulties and providing support and encouragement, nurturing parents can help them develop better coping skills and diffuse negative emotions that might otherwise manifest as aggression, the study authors wrote.

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Breastfeeding protects against triple-negative breast cancer

From medwire-news.md
Women who breastfeed for at least 6 months have a diminshed risk for developing triple-negative breast cancer, US study results show.

The research team, from the Fred Hutchinson Cancer Research Center in Seattle, Washington, also found that certain other reproductive factors appeared to be differentially associated with certain breast cancer subtypes.

Gene expression studies have identified and validated the existence of four “intrinsic” breast cancer subtypes: luminal A, luminal B, human epidermal growth factor receptor (HER)-2-overexpressing, and basal-like.

Luminal tumors express hormone receptors while nonluminal subtypes lack these markers. The triple negative phenotype - which expresses neither estrogen receptor, progesterone receptor, nor HER-2 - is often used a surrogate marker for the basal subtype.

The five-year survival rate for triple negative breast cancer is 15% lower than for other types of the disease, in part because the disease responds poorly to most breast cancer treatments. Notably, nearly 50% of Black women younger than 55 years who are diagnosed with breast cancer have the triple negative type, compared with 22% of White women with the disease.

In the current study, lead researcher Amanda Phipps and colleagues sought to determine what puts women at risk for the triple negative type of breast cancer.

The authors pooled two population-based, case-control studies of breast cancer in women aged 55 to 79 years for analysis. These included 1476 controls and 1023 cases of luminal breast cancer, 39 cases of HER-2-overexpressing breast cancer, and 78 cases of triple-negative breast cancer.

Clinical and lifestyle factors were obtained and analyzed using the polytomous logistic regression method.

As reported in the journal Cancer, breastfeeding for at least 6 months was found to reduce the risk for triple-negative disease (odds ratio [OR]=0.5) and to a lesser extent luminal breast cancer (OR=0.80) compared with breastfeeding for less than 6 months.

The researchers say it is unclear why breastfeeding influenced hormonal cancer risks. One possible explanation is that while women are breastfeeding, they are not menstruating and thus their hormones are not cycling. Alternatively, breastfeeding may alter the structure of breast cells in a way that makes them less prone to develop into cancer cells, Phipps and team said.

Another finding of the study was that early age at menarche was associated with risk for HER-2-overexpressing disease only (OR=2.7, relative to population average menarche) whereas both late age at menopause and the use of estrogen plus progestin hormone therapy were found to be associated with risk of luminal disease only (OR=1.6, 1.7)

Phipps and collegues comment: “Certain reproductive factors may have a greater impact on the risk of certain molecular subtypes of disease compared with others.

“Future studies that further define the etiology of breast cancer subtypes will add to the biologic understanding of this disease.”

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New guidelines for taking antibiotics before dental procedures

From deltadentalins.com
Taking a precautionary antibiotic before a trip to the dentist isn’t necessary for most people and, in fact, might do more harm than good, according to updated recommendations from the American Heart Association.

Good news in the new guidelines

The AHA’s guidelines were published in its scientific journal, Circulation, earlier this year and there is good news: the AHA recommends that only people who are at the greatest risk of bad outcomes from infective endocarditis (IE) should receive short-term preventive antibiotics before routine dental procedures. Infective endocarditis is an infection of the heart’s inner lining or the heart valves, which results when bacteria enter the bloodstream and travel to the heart.

The guidelines say that many patients who have taken preventive antibiotics regularly in the past no longer need them, including people with the following conditions:

Mitral valve prolapse
Rheumatic heart disease
Bicuspid valve disease
Calcified aortic stenosis
Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

Delta Dental played an important role in the development of these new treatment guidelines by providing data to the AHA on the frequency of dental procedures received by millions of patients over the course of a year.

Risks of preventive antibiotics outweigh the benefits

The revised guidelines are based on a growing body of scientific evidence that shows that the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics and, more significantly, the development of drug-resistant bacteria.

In addition, a comprehensive review of published studies suggests that IE is more likely to occur as a result of everyday activities than from a dental procedure. Scientists found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection, as their hearts already are exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing.

The AHA guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.

Some conditions still warrant preventive antibiotics

There are, however, some patients who should still take antibiotics prior to dental procedures. Patients at the greatest risk of bad outcomes if they developed a heart infection, and for whom preventive antibiotics prior to a dental procedure are worth the risks, include those with the following conditions:

Artificial heart valves
A history of having had IE
Certain specific, serious congenital (present from birth) heart conditions
A cardiac transplant which develops a problem in a heart valve.

Patients and their families should ask their primary care doctor or their cardiologist if there is any question at all as to whether they should continue to take preventive antibiotics based on the new guidelines. Patients and their families should ask careful questions of their doctors and dentists anytime antibiotics are suggested before a medical or dental procedure.

They should also be aware that overuse of antibiotics many times can lead to a worse outcome than if they were not used at all. Because of the overuse of antibiotics, there has been a huge increase in the number of bacteria that are now resistant to them. When this happens, new antibiotics must be created to kill these new bacteria. The new bacteria are typically more severe and can cause more serious illnesses.

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More Juices Found to Affect Drugs’ Effectiveness: Study

Orange and apple join grapefruit on list of drinks that may pose problems

From healthday.com

Grapefruit juice, long known to boost the absorption of certain medications, isn’t the only juice that doesn’t mix well with drugs, according to the Canadian researcher who first identified the ill effects of grapefruit juice.

Other common juices, including orange and apple, may limit the body’s absorption of drugs, compromising their effectiveness, said David Bailey, a professor of medicine and pharmacology at the University of Western Ontario, in London, Ontario, Canada.

Bailey was expected to present his research Tuesday at the American Chemical Society’s national meeting, in Philadelphia.

“The original finding is that [grapefruit juice] markedly boosts the amount of drug that gets into the bloodstream,” Bailey said. He first reported that nearly 20 years ago when he discovered that grapefruit juice increased the body’s blood levels of the drop felodipine (Plendil), used to treat high blood pressure.

Since the original finding, other researchers have identified dozens of other medications that could interact adversely with grapefruit juice, Bailey said.

Doctors traditionally warn against drinking grapefruit juice if you’re taking certain medications for high cholesterol, high blood pressure and heart rhythm problems, according to the American Academy of Family Physicians.

In his latest research, Bailey found that grapefruit juice, as well as orange and apple juice, can lower the body’s absorption of some medications. Those drugs include the anti-cancer drugs etoposide (Etopophos, Vepesid); certain beta blockers like tenormin (Atenolol) and talinolol (Cordanum), used to treat high blood pressure and prevent heart attacks; cyclosporine, which is used to prevent organ transplant rejection; and some antibiotics, including ciprofloxacin (Cipro), levofloxacin (Levaquin), and itraconazole (Sporanox).

Bailey also found that healthy volunteers who took the allergy drug fexofenadine (Allegra) with grapefruit juice absorbed only half the amount of the drug, compared with volunteers who took the medicine with water.

In each case, substances in the juices affected the absorption of the drugs. Some chemicals block a drug uptake transporter, reducing drug absorption; other chemicals block a drug metabolizing enzyme that normally breaks down the drugs, he said.

“We don’t [yet] know all the drugs affected,” Bailey said.

Michael Gaunt is a medication safety analyst at the Institute for Safe Medication Practices in Horsham, Pa. He said, “If this study holds true [in future research], you are going to have to warn people in a similar fashion” about other juices.

Gaunt’s advice for now: “In general, it’s safest to take medication with water.”

Bailey agreed. If you opt for water, he said, “a glass is better than a sip. It helps dissolve the tablet.” And cool water is better than hot, he added, because your stomach empties cool water faster, sending the medication on its way to the small intestine and finally the blood stream.

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Incense Use Increases Risk of Squamous-Cell Respiratory Cancers

medpagetoday.com
Long-term exposure to incense may increase the risk of respiratory-tract cancers, according to data from a large Chinese cohort study.
Action Points
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Explain to patients that use of incense has been associated with an increased risk of certain types of respiratory-tract cancers.

Note that the findings came from an observational study and do not prove that incense exposure increases cancer risk.
Incense users had an 80% increased risk of squamous-cell respiratory-tract cancers compared with nonusers, Jeppe T. Friborg, M.D., Ph.D., of Statens Serum Institut in Copenhagen, Denmark, and formerly of the University of Minnesota, and colleagues reported in the October issue of Cancer.

The risk increased with intensity and duration of exposure to incense and was greatest in the upper respiratory tract, the researchers said.

“This association is consistent with a large number of studies identifying carcinogens in incense smoke, and given the widespread and sometimes involuntary exposure to smoke from burning incense, these findings carry significant public health implications,” they added.

Incense smoke has long been known to contain multiple potentially carcinogenic substances, including polyaromatic hydrocarbons, carbonyls, and benzene. Additionally, incense smoke condensates have been found to have mutagenic and genotoxic activity, some of which exceeds that of tobacco smoke in mammalian cells, the authors said.

Incense use in the home has been associated with childhood leukemia and brain tumors. However, studies of potential associations between the smoke and lung cancer have yielded inconsistent results, the authors continued.

So, to examine potential associations between incense smoke and respiratory-tract cancers, investigators reviewed data from a population-based cohort study of 61,320 Chinese residents of Singapore. From 1993 through 1998, each completed a comprehensive interview regarding living conditions and dietary and lifestyle factors.

The study participants were ages 45 to 74 when interviewed, and all were cancer free. About three-fourths of participants were current users of incense.

Among current users, 92.7% used incense daily and 83.9% had used incense for more than 40 years.

During follow-up through 2005, 325 upper respiratory tract cancers and 821 lung cancers were diagnosed in the cohort.

Nasopharyngeal cancers accounted for more than half of all upper respiratory-tract cancers (175 of 325).

Nasopharyngeal cancers were predominately undifferentiated carcinomas (89%), whereas squamous histology predominated in the non-nasopharyngeal cancers (88%).

Adenocarcinoma accounted for 42% of lung cancers, followed by squamous-cell carcinomas (24%).

Exposure to incense smoke was associated with a significantly increased risk of non-nasopharyngeal upper respiratory-tract cancers (P=0.04).

Among current users, the hazard ratios were:

1.4 for less than daily use
1.3 for daily use for 40 years or less
1.7 for daily use for 41+ years

Nightly or intermittent use of incense increased the risk of non-nasopharyngeal cancers by 50% compared with noncurrent users, and daily or continuous use increased the risk by more than two-fold (P=0.02 for trend).

Duration and intensity of incense use combined significantly increased the risk of squamous-cell carcinomas throughout the respiratory tract (HR 1.8, P=0.004).

Incense use did not affect the risk of nasopharyngeal cancers or the risk of lung cancer.

Limitations of the study included the small size of the group that had never been exposed to incense and the fact that incense use was based on a questionnaire at the baseline evaluation, which did not ensure accuracy of lifetime exposure

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