Multidimensional rehabilitation programmes for adult cancer survivors

This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the effectiveness of multidimensional rehabilitation programs in terms of maintaining or improving the physical and psychosocial well-being of adult cancer survivors.

The review will evaluate the extent to which:

Professionally led multidimensional rehabilitation programs achieve better outcomes than standard services for patients with cancer and their caregivers
Rehabilitation programmes exert a different impact on different domains (e.g. psychological health, physical functioning)
Different modes of delivery and different settings influence outcomes
There is relationship between the number, duration and intensity of rehabilitation sessions and degree of change in measured outcomes.

The effect of increasing fruit and vegetable consumption on overall diet: a systematic review and meta-analysis

Increasing fruit and vegetable (FV) consumption is associated with reduced risk of major diseases. However, it is unclear if health benefits are related to increased micronutrient intake or to improvements in overall diet profile. This review aimed to assess if increasing FV consumption had an impact on diet profile. In the systematic review, twelve studies revealed increases in micronutrient intakes, whilst the meta-analysis confirmed macronutrient findings from the systematic review showing no significant difference between the intervention and control groups in energy (kcals) in seven studies (mean difference = 1 kcals [95% CI = -115, 117]; P = 0.98), significant decreases in total fat (% energy) in 5 studies (Mean difference = -4% [95% CI = -5, -3]; P = <0.00001) and significant increases in fibre in 6 studies (Mean difference = 5.36 grams [95% CI = 4, 7]; P = <0.00001) and total carbohydrate (% energy) in 4 studies (Mean = 4% [95% CI = 2, 5]; P = <0.00001). In conclusion, results indicate that increased FV consumption increases micronutrient, carbohydrate and fibre intakes and possibly reduces fat intake, with no overall effect on energy intake. Therefore health benefits may act through an improvement in overall diet profile alongside increased micronutrient intakes.

Dietary fat and breast cancer survival: a systematic review and meta-analysis

As the number of breast cancer survivors increases worldwide(1), there is growing interest in the potential effect of dietary and lifestyle behaviours on overall prognosis. This is especially important as a cancer diagnosis is often referred to as a ‘teachable moment’(2) as patients seek information about lifestyle behaviours and so provision of evidence-based guidelines is essential. A positive association between dietary fat and breast cancer risk has been previously reported(3) but its influence upon breast cancer survival is unclear. The aim of this review and meta-analysis is to critically appraise the literature published to date and to conduct meta-analyses to pool the results of studies to clarify the association between dietary fat and breast cancer survival.
Relevant articles published up to March 2011 that examined dietary fat and breast cancer recurrence and survival were identified from searches in MEDLINE and EMBASE. Meta-analyses were conducted in which we evaluated the risk of all-cause or breast cancer death in women in the highest compared with the lowest categories of total fat intake (g/d) and per 20 g increase in intake of dietary fat. Multivariable adjusted relative risks (RR) and 95% CI from individual studies were weighted and combined using a random-effects model to produce a pooled estimate.
Twelve prospective cohort studies that investigated total fat intake (g) and breast cancer survival, and/or provided information on fat intake from which a linear trend could be estimated, were included in the analyses. There was no evidence of a difference in risk of breast cancer death (RR=1.14; 95% CI 0.86, 1.52; P=0.34) or all cause death (RR=1.73; 95% CI 0.82, 3.6; P=0.15) between the highest and lowest categories of total fat intake. Similarly, no significant difference in risk of breast cancer death (RR=1.03; 95% CI 0.97, 1.10; P=0.261) or all-cause death (RR=1.06; 95% CI 0.88, 1.28; P=0.52) was found per linear (20 g) increase in total fat intake.
The results of this systematic review and meta-analysis do not support an association between total dietary fat and breast cancer survival. Further investigation into the effect of specific types of dietary fat and breast cancer survival is of interest.

Adiponectin multimers, body weight and markers of cardiovascular risk in adolescence: Northern Ireland Young Hearts Project:Northern Ireland Young Hearts Project

Background:Research examining the relationship between adiponectin (AN) isoforms, body weight and cardiovascular (CV) risk factors is limited, particularly in younger populations. Objectives:To investigate the inter-relationships between AN isoforms and CV risk factors, and their dependence on body weight status, in adolescents. Design:Blood samples from 92 obese, 92 overweight and 92 normal weight age- and sex-matched adolescents were analysed for traditional cardiovascular disease (CVD) risk biomarkers and also total, high molecular weight (HMW), medium and low molecular weight (LMW) AN. Results:A significant inverse association was observed between total and HMW AN and waist-hip ratio (P=0.015, P=0.006, respectively), triglycerides (P=0.003, P=0.003, respectively) and systolic blood pressure (P=0.012, P=0.024, respectively) and a significant positive association with high-density lipoprotein (P<0.001, P<0.001, respectively) in multi-adjusted analyses. There was no evidence of a relationship between multimeric AN and high-sensitivity C-reactive protein. There was also little evidence of a relationship between LMW AN and CVD risk factors. There was a strong, body mass index (BMI)-independent, association between AN, CVD biomarkers and the hypertriglyceridemic waist phenotype. Conclusion:Prominent, BMI-independent associations between total and HMW AN, but not LMW AN, and CVD risk factors were already evident in this young population. This research in adolescents supports the contention that AN subfractions may have different biological actions. These associations in apparently healthy adolescents suggest an important role for AN and its subfractions in the pathogenesis of metabolic syndrome traits and indicate that the potential for total or HMW AN to act as early universal biomarkers of CV risk warrants further study.

Lung Microbiota and Bacterial Abundance in Patients with Bronchiectasis when Clinically Stable and during Exacerbation

RATIONALE: Characterization of bacterial populations in infectious respiratory diseases will provide improved understanding of the relationship between the lung microbiota, disease pathogenesis and treatment outcomes.

OBJECTIVES: To comprehensively define lung microbiota composition during stable disease and exacerbation in bronchiectasis patients.

METHODS: Sputum was collected from patients when clinically stable and before and after completion of antibiotic treatment of exacerbations. Bacterial abundance and community composition were analyzed using anaerobic culture and 16S rDNA pyrosequencing.

MEASUREMENTS AND MAIN RESULTS: In clinically stable patients, aerobic and anaerobic bacteria were detected in 40/40 (100%) and 33/40 (83%) sputum samples, respectively. The dominant organisms cultured were P. aeruginosa (n=10 patients), H. influenzae (n=12), Prevotella (n=18) and Veillonella (n=13). Pyrosequencing generated over 150,000 sequences, representing 113 distinct microbial taxa; the majority of observed community richness resulted from taxa present in low abundance with similar patterns of phyla distribution in clinically stable patients and patients at the onset of exacerbation. Following treatment of exacerbation, there was no change in total (p=0.925), aerobic (p=0.917) or anaerobic (p=0.683) load and only a limited shift in community composition. Agreement for detection of bacteria by culture and pyrosequencing was good for aerobic bacteria such as P. aeruginosa (kappa=0.84) but poorer for other genera including anaerobes. Lack of agreement was largely due to bacteria been detected by pyrosequencing but not by culture.

CONCLUSIONS: A complex microbiota is present in the lungs of bronchiectasis patients which remains stable through treatment of exacerbations suggesting that changes in microbiota composition do not account for exacerbations.

Do perinatal and early life exposures influence the risk of malignant melanoma?:A Northern Ireland birth cohort analysis

Aim: Intrauterine, early life and maternal exposures may have important consequences for cancer development in later life. The aim of this study was to examine perinatal and birth characteristics with respect to Cutaneous malignant melanoma (CMM) risk. Methods: The Northern Ireland Child Health System database was used to examine gestational age adjusted birth weight, infant feeding practices, parental age and socioeconomic factors at birth in relation to CMM risk amongst 447,663 infants delivered between January 1971 and December 1986. Follow-up of histologically verified CMM cases was undertaken from the beginning of 1993 to 31st December 2007. Multivariable adjusted unconditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) of CMM risk. Results: A total of 276 CMM cases and 440,336 controls contributed to the final analysis. In reference to normal (gestational age-adjusted) weight babies, those heaviest at birth were twice as likely to develop CMM OR 2.4 (95% CI 1.1-5.1). Inverse associations with CMM risk were observed with younger (

A review of scientific literature on inherited disorders in domestic horse breeds

The full extent to which inherited disorders occur in different breeds of domestic horse (Equus caballus) has not been previously been investigated. A systematic search was carried out to review scientific literature on inherited disorders in domestic horse breeds and examine patterns in potentially inherited disorders. A two-part search was conducted: (i) electronic bibliographic databases for published studies; and (ii) existing online databases of inherited disorders in animals. A total of 230 papers were identified, discussing 102 inherited disorders in the horse. Few cases (17) were found in which disorders were reported to have a direct link to a conformational or phenotypic trait. Forty-nine breeds of domestic horse were described as being predisposed to one or more inherited disorders, but such predispositions did not distinguish between genetic or environmental causes. There were few patterns in the number of disorders to which breeds were reportedly predisposed or in the extent to which disorders were researched. The structure and grouping of disorders presented here could assist with standardisation in the terminology used for describing inherited disorders. © 2012 Universities Federation for Animal Welfare The Old School.

Dietary exposure to aflatoxin from maize and groundnut in young children from Benin and Togo, West Africa

Aflatoxins are a family of fungal toxins that are carcinogenic to man and cause immunosuppression, cancer and growth reduction in animals. We conducted a cross-sectional study among 480 children (age 9 months to 5 years) across 4 agroecological zones (SS, NGS, SGS and CS) in Benin and Togo to identify the effect of aflatoxin exposure on child growth and assess the pattern of exposure. Prior reports on this study [Gong, Y.Y., Cardwell, K., Hounsa, A., Egal, S., Turner, Hall, A.J., Wild, C.P., 2002. Dietary aflatoxin exposure and impaired growth in young children from Benin and Togo: cross sectional study. British Medical Journal 325, 20-21, Gong, Y.Y., Egal, S., Hounsa, A., Turner, P.C., Hall, A.J., Cardwell, K., Wild, C.P., 2003. Determinants of aflatoxin exposure in young children from Benin and Togo, West Africa: the critical role of weaning and weaning foods. International Journal of Epidemiology, 32, 556-562] showed that aflatoxin exposure among these children is widespread (99%) and that growth faltering is associated with high blood aflatoxinalbumin adducts (AF-alb adducts), a measure of recent past exposure. The present report demonstrates that consumption of maize is an important source of aflatoxin exposure for the survey population. Higher AF-alb adducts were correlated with higher A. flavus (CFU) infestation of maize (p=0.006), higher aflatoxin contamination (ppb) of maize (p<0.0001) and higher consumption frequencies of maize (p=0.053). The likelihood of aflatoxin exposure from maize was particularly high in agro-ecological zones where the frequency of maize consumption (SGS and CS), the presence of allatoxin in maize (SGS) or the presence of A. flavus on maize (NGS and SGS) was relatively high. Socio-economic background did not affect the presence of A. flavus and aflatoxin in maize, but better maternal education was associated with lower frequencies of maize consumption among children from the northernmost agro-ecological zone (SS) (p=0.001). The impact of groundinit consumption on aflatoxin exposure was limited in this population. High AF-alb adduct levels were correlated with high prevalence of A. flavus and aflatoxin in groundinit, but significance was weak after adjustment for weaning status, agro-ecological zone and maternal socio-economic status (resp. p = 0.091 and p = 0.083). Ingestion of A. flavus and aflatoxin was high in certain agro-ecological zones (SS and SGS) and among the higher socio-economic strata due to higher frequencies of groundnut consumption. Contamination of groundnuts was similar across socio-economic and agroecological boundaries.

In conclusion, dietary exposure to aflatoxin from groundnut was less than from maize in young children from Benin and Togo. Intervention strategies that aim to reduce dietary exposure in this population need to focus on maize consumption in particular, but they should not ignore consumption of groundnuts. (c) 2005 Elsevier B.V. All rights reserved.