SATURDAY, Oct. 26 (HealthDay News) -- People without social support may experience more pain years after surgery, a new study suggests.
Researchers surveyed 687 patients, average age 62, with rheumatoid arthritis or osteoarthritis who underwent total hip replacement surgery. Of those patients, 8.2 percent in the rheumatoid arthritis group and 7.8 percent in the osteoarthritis group were considered to be socially isolated.
This meant that they had few people who were close to them. For example, they were not married, had fewer than six friends or relatives, or did not belong to any community or religious groups.
The socially isolated patients were almost three times more likely than those with good social support to have serious, ongoing pain two or more years after having hip replacement surgery, according to the researchers at the Hospital for Special Surgery in New York City.
The study is scheduled to be presented Tuesday at the annual meeting of the American College of Rheumatology in San Diego. Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.
"We believe further prospective studies should be done to determine whether interventions to evaluate and improve patients' social ties before surgery could lead to a better pain outcome after hip replacement," study author Dr. Lisa Mandl said in a hospital news release.
"It could be a way to improve outcomes without medication or other costly interventions. I see no downside to helping patients get the social support they may need to improve their quality of life," Mandl said.
She noted that previous studies have shown that people with poor social ties are at higher risk for heart attack, stroke and death than those with the support of family, friends and the community.
WEDNESDAY, Oct. 2 (HealthDay News) -- A high-fat, high-calorie diet may increase the risk of deadly pancreatic cancer, a new animal study suggests.
Researchers found that mice who became obese by eating high-calorie, high-fat diets developed abnormally high numbers of lesions known to be precursors to pancreatic cancer.
The study, published Sept. 30 in the journal Cancer Prevention Research, is the first to show a direct link in animals between obesity and the risk of pancreatic cancer, according to the researchers at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.
However, findings in animals do not always bear out in human trials and while the study showed an association, it did not prove a cause-and-effect link between diet and pancreatic cancer risk.
The researchers did say that their findings support eating a low-fat, low-calorie diet as a way to prevent pancreatic cancer.
"The development of these lesions in mice is very similar to what happens in humans," study leader Dr. Guido Eibl said in a UCLA news release. "These lesions take a long time to develop into cancer, so there is enough time for cancer-preventive strategies, such as changing to a lower-fat, lower-calorie diet, to have a positive effect."
The researchers found that the mice fed the high-calorie, high-fat foods gained significantly more weight than mice on a lower-fat, lower-calorie regimen. They also had metabolic abnormalities, increased insulin levels and inflammation of pancreatic tissue.
Pancreatic cancer is one of the deadliest types of cancers. Overall five-year survival rates for this type of cancer are 3 percent to 5 percent, and the average length of survival after diagnosis is four to six months.
In many cases, patients only begin to develop symptoms when pancreatic cancer is in the advanced stages. There is a lack of effective treatments, so researchers are focusing on prevention strategies.
Get customized medical news and FREE CME!Select Specialties and Topics of Interest to Customize Your NewsContinue to RegisterRegister for FREE customized news, conference, policy and practice coverage and CME tracking. Register TodayEarn Free CME Credits by reading the latest medical news in your specialty.Sign UpPublished: Jul 2, 2013By Ed Susman, Contributing Writer, MedPage TodayReviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse PlannerNote that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.In this retrospective analysis of patients started on nevirapine-based antiretroviral therapy, almost one-third discontinued therapy due to toxicities, and Malays had the highest incidence of toxicity compared with the other races.
KUALA LUMPUR -- A higher percentage of Malay people experienced treatment-limiting toxicity with the non-nucleoside reverse transcriptase anti-HIV drug nevirapine compared with other groups, and genetic differences may be the reason, researchers reported here.
"Malays had the highest incidence of treatment-limiting nevirapine toxicity amongst the different racial groups," said Joyce Yeap, MS, a clinical pharmacist at Sungai Buloh Hospital in Selangor, Malaysia. Malays had an incidence of treatment-limiting toxicity of 38.4%, compared with Indians, who had the lowest incidence of treatment-limiting nevirapine toxicities at 23.6% (P=0.016), she told MedPage Today.
It is difficult to understand why there should be a racial difference even after performing adjustments for age, sex, HIV transmission category, nadir CD4-positive cell counts, hepatitis B or C virus co-infection and other concomitant medication, Yeap said in her poster presentation at the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.
However, outcomes at 12 months were not different between the patients who developed toxicities and were switched to other regimens and those who did not have dose-limiting adverse events (P=0.456), Yeap said.
"Malays are 1.7 times more likely than Chinese or Indians or other ethnicities to develop treatment-limiting nevirapine toxicities," she noted. The researchers performed various logistic regression analyses and determined that toxicities to nevirapine were more frequent in the Malay population of Malaysia which has a polyglot of different races, including several indigenous peoples.
"We did not have resources to perform genome studies," she said, "but it could be due to some type of gene sub-types that makes the Malays more sensitive to nevirapine toxicity."
Yeap said that when treating Malays, physicians need to factor in sex and CD4 counts as well. "We might be more cautious in giving nevirapine to these individuals," she suggested.
While other treatment regimens are possible for HIV-infected individuals, Yeap noted that for a developing country with limited resources, nevirapine is one of the most cost-effective therapies available.
The average age of the 662 HIV-infected patients in her study was 37.4 years, and 75.8% of the patients were men. Their average nadir CD4 cell counts were 134.8 cells/mm3. The researchers identified 34.6% of the patients as Malay; 42.1% were Chinese; 10.9% were Indian; and 9.2% were foreigners.
Rash was the nevirapine treatment-limiting adverse event among 156 patients; flu-like illnesses were observed in 130 patients; hepatotoxicity was seen in 44 patients. She said 102 patients presented with rash, flu-like illness and liver toxicity.
A possible explanation for the treatment-limiting toxicity might have to do more with clinical observation rather than genetics, suggested Graeme Moyle, MBBS, director of research at Chelsea and Westminster Hospital, London.
"There are studies here that look at the genetic linkage between adverse events and specific drugs," Moyle told MedPage Today as he reviewed the poster presentation. "There appear to be certain alleles that are associated with nevirapine toxicity, especially the cutaneous toxicities. It may be due to allele variations across certain ethnic populations."
He said that another possibility that is often discussed is that among black patients nevirapine-associated rash appeared more severe. He said that may be caused by the fact that the rash may be more difficult to observe among darker-skinned individuals. Since the rash is non-itchy, the skin color may mask the rash until it reaches a more severe level, Moyle suggested.
"When you have darker skin you don't recognize early rash that can lead to discontinuation when the rash is mild," he said. "People continue to take therapy and the rash continues to a more severe event."
Yeap had no disclosures.
Moyle has reported commercial interests with Gilead, Ardea Biosciences, Abbott Laboratories, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Tobira Therapeutics, Panacos Pharmaceuticals, Pfizer and Tibotec.
Primary source: International AIDS Society Source reference: Yeap J, et al "Incidence and risk factors for treatment-limiting toxicities in patients starting nevirapine-containing antiretroviral therapy" IAS 2013; Abstract MOPE092.
Register TodayEarn Free CME Credits by reading the latest medical news in your specialty.Sign Up By Salynn Boyles, Contributing Writer, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse PlannerAdolescents with asthma reported worse symptoms of breathlessness when they had anxious mothers, and the link may have more to do with genes than environment.Note that maternal anxiety was not significantly associated with an increased risk for the register-based outcomes of asthma diagnosis or medication use.
Adolescents with asthma reported worse symptoms of breathlessness when they had anxious mothers, and the link may have more to do with genes than environment, researchers suggested.
Findings from a Swedish twin study shows that maternal anxiety was significantly associated with adolescent asthma (odds ratio 2.02, 95% CI 1.15-3.55) reported by the mother on one anxiety measure, and it was significantly associated with breathlessness (OR 1.74, CI 1.04-2.91) reported by the adolescent on several anxiety measures, according to Catarina Almqvist, MD, PhD, from the Karolinska Institutet in Stockholm, and colleagues.
Several previous investigators have shown an association between maternal anxiety and asthma occurrence and symptom severity in offspring, but the study is the first to examine the issue in twins, the researchers said in the June issue of the journal PLOS ONE.
The study included data from the two-part, cross-sectional Twin and Offspring Study of Sweden (TOSS), which contains information on more than 195,000 twins born in that country since 1885.
"The children-of-twins design was used to address the issue of whether an association between maternal anxiety and offspring asthma is caused by family-side, environmental and/or genetic factors," they wrote.
They also utilized child reports and objective measures of asthma in an effort to address the issue of rater bias.
The analysis included 1,691 mothers who were either twins or partners of male twins and their adolescent children (mean age of about 16). Maternal anxiety was assessed using three questionnaire-based measures: the Karolinska Scales of Personality (KSP) somatic and psychic anxiety, as well as the Beck Anxiety Inventory (BAI).
Asthma and asthma symptom severity assessments were assessed using subjective (maternal or child report) or objective (register-based diagnosis and medication) measures.
Among the study's findings, maternal anxiety was not significantly associated with an increased risk for the register-based outcomes of asthma diagnosis or medication use. In fact, an inverse association was shown for medication use on the KSP somatic anxiety questionnaire (OR=0.56, 95% CI 0.34-0.92).
For levels of KSP somatic anxiety, there was no difference in the prevalence of asthma reported by the mother -- low anxiety level 9.6%, moderate 8.4%, and high 8.8% of asthma) or asthma reported by the child. This was also true for KSP psychic anxiety.
When maternal anxiety was assessed with BAI, however, asthma reported by mother (low 6.5%, moderate 7.5%, and high 12.3%) and child, as well as breathlessness reported by the child, increased with increasing maternal anxiety.
All measures showed increasing prevalence of breathlessness reported by the child to be significantly associated with increased maternal anxiety.
The study had some limitations, namely the cross-sectional design, which prevented any analysis of causal direction of the associations. Also, single parents were excluded from TOSS leading to a study population with a slightly higher economic status.
Almqvist said it appears from the findings that the modest association between maternal anxiety and asthma in offspring is caused by genetic factors and not shared environment, but she told MedPage Today that the study was not powered to prove this.
"It will take a larger study to answer the question," she said. "With a big enough sample we can look at the difference in monozygotic and dizygotic twins. If the association is stronger in the monozygotic twins that would certainly point to genes."
The researchers concluded that future studies should have a longitudinal perspective and take all known aspects of asthma into consideration.
"Combined with aspects of changes in gene expression, and a clearer understanding of the genetics of asthma, this can facilitate attempts to suggest future public health interventions," they wrote.
The study was supported by grants from the National Institute of Mental Health, the Swedish Research Council, the Swedish Heart and Lung Foundation, and the Strategic Research Program in Epidemiology at Karolinska Institutet. Financial support was provided by the Stockholm County Council and Karolinska Institutet.
Register TodayEarn Free CME Credits by reading the latest medical news in your specialty.Sign UpBy Cole Petrochko, Staff Writer, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of PennsylvaniaThis study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.Almost half of patients with COPD had insomnia symptoms, although most did not address the symptoms with their physician, a study found.
BALTIMORE -- Chronic obstructive pulmonary disease (COPD) was associated with increased risks of insomnia symptoms and hospitalizations, researchers reported here.
Based on survey data of noninstitutionalized participants, roughly half of those with COPD had insomnia symptoms (48.1%), twice the rate of those without COPD, according to Maurice Ohayon, MD, PhD, of the Stanford Sleep Epidemiology Research Center in Palo Alto, Calif.
Co-occurrence of mental disorders with insomnia symptoms also increased likelihood of hospitalization by four times among those with COPD, Ohayon said in a poster session during the SLEEP meeting.
COPD is a major cause of disability, and it is estimated that sleep disturbance is highly prevalent among patients with COPD, though no prior research had examined the relationship between the two.
Ohayon studied sleeping habits, life habits, health, DSM-IV mental disorders, DSM-IV and ICSD sleep disorders in relation to COPD in a population of 8,768 noninstitutionalized participants in Germany, Spain, and the U.S. through telephone interviews.
COPD was defined as physician-diagnosed chronic bronchitis or emphysema that was treated or untreated.
Of those sampled, 2.5% reported receiving a COPD diagnosis.
Those who reported a COPD diagnosis had greater than twofold odds of co-presenting with insomnia symptoms versus those without COPD (OR 2.4). Common symptoms -- versus those without COPD -- included nocturnal awakenings (37.6% versus 22%, aOR 1.9) and global sleep dissatisfaction (30.3% versus 8.8%, aOR 4.3).
After adjusting for age, sex, and weight, breathing pauses during sleep and snoring were not significantly associated with COPD.
Of participants with COPD and sleep difficulties, 11.8% reported insomnia symptoms to a healthcare professional, and the odds of hospitalization due to related mental disorders were raised fourfold, he reported.
Participants with COPD also reported that insomnia and psychiatric disorders were tied to diminished quality of life.
Ohayon concluded that the condition was "a debilitating disease accompanied with sleep disturbances in the overwhelming majority of cases."
He added that comorbidity associated with insomnia symptoms accompanying COPD increased healthcare utilization and had a detrimental impact on quality of life among sufferers.
The study was supported by the Arrillaga Foundation and GlaxoSmithKline.
Primary source: Associated Professional Sleep Societies Source reference: Ohayon MM "COPD and associated sleep disturbances" SLEEP 2013; Abstract 0795.
Cole Petrochko
Staff Writer
Cole Petrochko started his journalism career at MedPage Today in 2009, after graduating from New York University with B.A.s in Journalism and Psychology. When not writing for MedPage Today, he blogs about nerd culture, designs websites, and buys and sells collectible card game cards. He is based out of MedPage Today's Little Falls, N.J. Headquarters.
Register TodayEarn Free CME Credits by reading the latest medical news in your specialty.Sign Up By John Gever, Deputy Managing Editor, MedPage Today
SILVER SPRING, Md. -- Two patients died 3-4 days after injections with the long-acting antipsychotic drug olanzapine pamoate (Zyprexa Relprevv), prompting an FDA investigation.
The agency has not determined whether the drug caused the fatalities. "At this time, FDA is continuing to evaluate these deaths and will provide an update when more information is available," it said in a statement Tuesday.
Both patients received intramuscular injections of the drug at appropriate doses, the FDA said, but tests showed "very high olanzapine blood levels after death."
High doses are known to induce delirium, cardiopulmonary arrest, cardiac arrhythmias, and impaired consciousness ranging from sedation to coma.
The long-acting form of olanzapine was approved with a risk evaluation and mitigation strategy that requires patients to remain in the clinic for a 3-hour monitoring period and to be escorted home afterward. The requirement was imposed after some patients in clinical trials became delirious or lost consciousness shortly after receiving injections.
These events, dubbed post-injection delirium-sedation syndrome (PDSS), were traced to an unexpectedly rapid release of olanzapine into circulation leading to very high blood levels of the drug.
However, all those cases occurred within hours of injection, not days, and no deaths were attributed to the syndrome, the FDA said.
Olanzapine pamoate is approved for injection every 2-4 weeks for treating patients with schizophrenia. It is one of several long-acting formulations of "atypical" antipsychotic drugs currently available. PDSS has not been seen with those other products.
John Gever
Senior Editor
John Gever, Senior Editor, has covered biomedicine and medical technology for 30 years. He holds a B.S. from the University of Michigan and an M.S. from Boston University. Now based in Pittsburgh, he is the daily assignment editor for MedPage Today as well as general factotum on the reporting side. Go Pirates/Penguins/Steelers!
Register TodayEarn Free CME Credits by reading the latest medical news in your specialty.Sign Up
By Cole Petrochko, Staff Writer, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of PennsylvaniaThis study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.Almost half of patients with COPD had insomnia symptoms, although most did not address the symptoms with their physician, a study found.