Tobacco retailers target poor suburbs
IN an Australian first, researchers have found a strong association between the density of tobacco outlets and the economic status of suburbs and towns. The study, published in the MJA, found that in WA overall, suburbs with a very low socioeconomic status (SES) had more than four times the number of tobacco outlets compared with those with a very high SES. The authors did a cross-sectional study using economic data from the 2006 Australian Bureau of Statistics Index of Relative Socioeconomic Advantage and Disadvantage, and tobacco outlet data from the WA Department of Health register of retailers licensed to sell tobacco in May 2011. “Findings are consistent with a number of United States studies”, the authors wrote. “Overall vulnerability to poor health is exacerbated if tobacco outlets are more concentrated in areas where people at higher risk of negative outcomes live. The results underscore the importance of policy approaches to limit the number of tobacco retail licenses granted, and to reduce the geographic density of outlets in more disadvantaged suburbs and towns”, they concluded.

Depression linked to stroke in women
AUSTRALIAN researchers have found that depression is a strong risk factor for stroke in middle-aged women, with the association partially explained by lifestyle and physiological factors. The research, published in Stroke, included 10 547 women from the Australian Longitudinal Study on Women’s Health without a history of stroke and aged 47–52 years, with 24% defined as having depression using the Center for Epidemiological Studies Depression scale. The women were surveyed every 3 years from 1998 to 2010. Depression was defined at each survey and antidepressant use in the previous month, and stroke was ascertained through self-report and mortality data. During follow-up, 177 women had strokes, including five fatal events. Depression was associated with greater than twofold increased odds of stroke, which reduced after adjusting for age, socioeconomic status, lifestyle and physiological factors, but remained statistically significant. “Further research investigating age differences within the same cohort is needed, since the identification of such differences will have important implications for policy and practice”, the authors wrote. “In particular, this will inform the development of effective targeted prevention and intervention approaches.”

Vitamin C no help in gout
A SMALL New Zealand study has found vitamin C has no significant effect on serum urate (SU) reduction in patients with gout taking allopurinol. The research, published in Arthritis & Rheumatism, included 20 patients already taking allopurinol and randomly allocated to receive an increased allopurinol dose or started on vitamin C 500 mg/d, and 20 patients not receiving allopurinol randomly allocated to start allopurinol or vitamin C 500 mg/d. The researchers found no significant difference in baseline SU or estimated glomerular filtration rate (eGFR) between those who received vitamin C and those who did not. In the patients receiving vitamin C there was a significant increase between Week 0 and 8 in plasma ascorbate but the reduction in SU was significantly less compared with those who started or increased the dose of allopurinol (0.014 mmol/L vs. 0.118mmol/L, p < 0.001). The researchers said previous studies that had found vitamin C reduced SU involved patients without gout. “While vitamin C may reduce SU and the risk of developing gout, our data does not support the use of vitamin C supplementation as a urate lowering therapy in patients with established gout”, they wrote.

Art benefits cancer patients
A SYSTEMATIC review of 27 randomised controlled trials involving 1576 patients has found that creative arts therapies (CATs) can reduce anxiety, depression and pain and improve quality of life among cancer patients. However, the review, published in the latest edition of JAMA Internal Medicine, found no reduction in fatigue. CATs include art, music, dance/movement, drama, psychodrama, poetry and expressive therapy. In an unusual finding, the authors reported that for anxiety, a more significant effect was found when the therapy was administered by a non-CAT therapist, rather than a qualified CAT therapist. An accompanying editorial was critical of the systematic review, saying the authors had failed to offer an “operational definition of CATs” and that the limitation “compromises the analysis at its foundation: the understanding of the independent variable in the included studies”. “Relying on the distinction of therapist present vs no therapist remains problematic when no definition of therapist is provided”, the editorial authors wrote.

Agent Orange exposure a prostate cancer risk
EXPOSURE to the toxic defoliant Agent Orange by veterans of the Vietnam War is associated with an increased risk of potentially lethal prostate cancer (Gleason score of 7 or above) by as much as 75%, according to research published in Cancer. Of 2720 veterans who had a biopsy, 896 (32.9%) had prostate cancer, 459 (16.9%) had high-grade prostate cancer and 203 had been exposed to Agent Orange,. Exposure to Agent Orange was associated with a 52% increase in the overall risk of detecting prostate cancer. The study also found a 2.1-fold increase in the risk of finding prostate cancer with a Gleason score of 8 or more. Veterans with exposure to Agent Orange presented with abnormal prostate screening results and underwent biopsy roughly 5 years earlier than those not exposed to the defoliant. “[Exposure to Agent Orange] may be a readily identifiable clinical biomarker for the prediction of lethal prostate cancer and would likely increase the sensitivity for detecting cancers in the veteran population that are more likely to be aggressive and potentially lethal without adding to the problem of overdiagnosis of low-risk cancers”, the authors wrote.

Reduced Alzheimer’s risk with skin cancer
A POPULATION-based study has found that people older than 70 years with a non-melanoma skin cancer (NMSC) have a significantly reduced risk of developing Alzheimer disease compared with those without NMSC. The research, published in Neurology, involved 1102 people initially free of dementia and with an average age of 79 years. They were followed for an average of 3.7 years. At baseline, 109 had a history of NMSC and a further 32 participants developed incident NMSC. “We deduce Alzheimer-specific neuroprotection, because the effect is attenuated or eliminated when considering inclusive outcomes such as all-cause dementia”, the researchers wrote. “It is also possible that the protective effect of NMSC is conferred by biological factors. None of the psychosocial factors discussed [in the article] are known to confer a risk reduction near the magnitude we report for NMSC.”



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