Cancer survivors face persistent disease risks
A LARGE population cohort study has found that survivors of adolescent and young adult cancers face persistent risks for a broad range of somatic diseases that require hospitalisation. The population-based cohort study, published in JAMA Oncology, included 33 555 5-year survivors of adolescent or young adult cancer, diagnosed from 1943 to 2004 at ages 15‒39 years, and 228 447 population comparisons matched by sex and year of birth. After a median follow-up of 14 years, the researchers identified 53 032 hospitalisations of cancer survivors for one or more of 97 disease categories, compared with the 38 423 they had expected, resulting in a standardised hospitalisation rate ratio (RR) of 1.38. The highest risks were found for the main diagnostic groups of diseases of blood and blood-forming organs (RR, 2.00), infectious and parasitic diseases (RR, 1.69) and malignant neoplasms (RR, 1.63). The highest absolute excess risks were found for malignant neoplasms, diseases of digestive organs and diseases of the circulatory system. “It is clear that the highest overall risks for diseases requiring treatment at hospital were seen in survivors of leukemia, brain cancer, and Hodgkin and non-Hodgkin lymphoma (ie, cancers often characterized by particularly intensive and lengthy treatments)”, the researchers wrote. They said that their findings “underscore a great diversity of cancer-related health problems that physicians and patients should be knowledgeable about”. An accompanying editorial said that while progress in managing cancer in children and young adults “has been gratifying, we must remember the words of Giulio D’Angio, who reminds us that ‘cure is not enough’”.
 
Exercise barriers impact on heart failure patients
DOCTORS should consider social support and barriers that prevent patients with heart failure (HF) from exercising, according to researchers investigating the association between clinical outcomes and social support and barriers to exercise adherence. The research, published in Circulation: Heart Failure, included 2279 patients with HF who completed surveys to assess social support and barriers to exercise, which were used to develop a perceived social support score and a barriers to exercise score. Of the study participants, 1090 were randomly assigned to exercise training. The researchers found that, as expected, social support and barriers to exercise correlated with exercise adherence. However, they were not independently associated with clinical outcomes, although barriers to exercise had an impact on the effect of exercise training on cardiovascular death or HF hospitalisation. They found patients with poor exercise adherence throughout the study period had worse functional class and exercise capacity at baseline, as measured by peak VO2 and 6-minute walk distance, while those with higher perceived social support exercised more than those with lower perceived social support. Similarly, patients with fewer barriers to exercise exercised more than those with more barriers to exercise. The researchers said the perceived social support scale and barriers to exercise scale were two tools doctors could use to assess patients’ psychosocial health status, which might affect adherence to treatment recommendations. “Because exercise training has been shown to improve outcomes in this population, increasing exercise adherence is an important goal in the care of patients with HF”, they wrote. “Assessment of patient-reported social support and perceived barriers may facilitate individualized approaches to implement and sustain exercise training therapy in clinical practice.”
 
Melatonin recommended for children with atopic dermatitis
MELATONIN significantly reduced severity of dermatitis and sleep-onset latency in children with atopic dermatitis (AD) and sleep disturbance, according to research published in JAMA Pediatrics. The randomised clinical trial included 48 children and adolescents aged 1‒17 years with physician-diagnosed AD covering at least 5% of their body. The participants were randomly assigned to 3 mg/day of melatonin or placebo treatment for 4 weeks, followed by a 2-week washout before a crossover to the alternate treatment for 4 weeks. The primary outcome measured was AD severity, which was evaluated using the Scoring Atopic Dermatitis (SCORAD) index, which scored 0‒103, with greater scores indicating worse symptoms. The researchers said melatonin significantly reduced AD severity by a mean reduction of the SCORAD index of 9.9 in 4 weeks. They also found that melatonin significantly shortened sleep-onset latency by a mean of 23.4 minutes (52.1%). Sleep disturbance was “highly prevalent” in children with AD and “is a troubling problem that leads to impaired quality of life for the patients and their families”, the researchers wrote. “This magnitude of effect is comparable to melatonin’s effect on children with attention-deficit/hyperactivity disorders or neurodevelopmental disabilities with impaired sleep onset.” The researchers noted the limitations of their study but said melatonin supplementation was recommended “for these patients because it is a potentially safe and effective way to improve their sleep and skin condition simultaneously”.
 
Bilingualism may be protective in post-stroke cognition
PEOPLE who speak two or more languages are significantly more likely to have normal cognition after stroke than those who are not bilingual, a study published in Stroke has found. Researchers examined cognitive outcomes of 608 patients aged older than 18 years with ischaemic stroke, who were evaluated 3‒24 months after stroke. Patients with disabling stroke, severe comorbidities, inadequate data and pre-existing dementia were excluded. To determine factors associated with post-stroke cognitive impairment, the researchers compared patients with normal (n = 193; 35.7%) and impaired (n = 348; 64.3%) cognition, and found that older age, lower educational and occupational status, monolingualism, and vascular risk factors were significant. To determine whether bilingualism was independently associated with post-stroke cognitive impairment, they performed a series of logistic regressions. The researchers found that 40.5% of patients who were bilingual had normal cognition after stroke, compared with 19.6% of those who spoke only one language. Of those who had cognitive impairment, 49.0% were bilingual and 77.7% were monolingual. They said bilingualism did not influence the incidence of aphasia after stroke, suggesting the protective effect was not due to linguistic skills but was related to “executive functions acquired through a lifelong practice of language switching”, which enhanced cognitive reserve. “The higher scores of bilinguals on attention and fluency domains … support this hypothesis”, they wrote. No differences were found between bilingual and monolingual patients’ in vascular risk factors or in the age at stroke, suggesting the results were not due to bilingual patients having a healthier lifestyle. “Our results support the notion of a protective role of bilingualism in the development of poststroke cognitive impairment.”
 
Genetic tests have no role in identifying sporting talent
NO CHILD or young athlete should be exposed to direct-to-consumer genetic testing to predict sports performance or identify talent, according to an international consensus statement published in the British Journal of Sports Medicine. The statement was drafted by an international group of experts in the fields of genomics, exercise, sport performance, disease, injury and antidoping who had attended a symposium of the International Federation of Sports Medicine Scientific Commission earlier this year. One key concern was the misuse of research evidence and misinformation about genetic testing, “particularly when marketed directly to the public, coaches or parents”. The statement noted that Australia had amended the Therapeutic Goods Act in July 2014 to regulate the supply and advertising of direct-to-consumer genetic testing. “This testing is prohibited in Australia, except where specifically approved by the Therapeutic Goods Administration, which includes proof that it is being performed in an accredited laboratory with sufficient clinical validity and utility”, it said.  However, the authors wrote that genetic testing was not regulated by legislation in any consistent way worldwide. Companies providing the tests were most frequently testing genetic variants associated with physical performance, especially endurance, and speed and power performance. However, in isolation these genes were “virtually meaningless for talent identification”. The statement said that among the UK’s population of about 65 million, about 20 million people had the genotype associated with speed and power, “but only a tiny fraction of those people are elite athletes”. The experts agreed that the “predictive value of such tests in the context of training responses or talent identification in sport is virtually zero”.
 
 

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