According to a new study, men employed in occupations with potential exposure to high levels of sunlight have a reduced risk of kidney cancer compared with men who were less likely to be exposed to sunlight at work. The study did not find an association between occupational sunlight exposure and kidney cancer risk in women. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the study is the largest case-control study of kidney cancer to investigate the association with occupational sunlight exposure. The study, however, did not include information on non-occupational sunlight exposure and does not address directly whether sunlight exposure can help prevent kidney cancer.
Research suggests that vitamin D, which is obtained from sun exposure, some foods, and from supplements, may help prevent some cancers. Vitamin D is metabolized and most active within the kidneys. Because both the incidence of kidney cancer and the prevalence of vitamin D deficiency have increased over the past few decades, Sara Karami, PhD, of the National Cancer Institute in Rockville, MD, and her colleagues designed a study to explore whether occupational sunlight exposure is associated with kidney cancer risk.
The study included 1,097 patients with kidney cancer and 1,476 individuals without cancer from four Central and Eastern European countries. Demographic and lifetime occupational information was collected through in-person interviews and occupational sunlight exposure indices were estimated based on industry and job titles. The investigators observed a 24 percent to 38 percent reduction in kidney cancer risk with increasing occupational sunlight exposure among male participants in the study. No association between occupational sunlight exposure and kidney cancer risk was observed among females in the study.
The findings suggest that sunlight exposure may affect kidney cancer risk, although the authors have no explanation for the apparent differences in risk between men and women. They offer several hypotheses for the observed differences. Biological or behavioral differences between men and women may play a role. For example, hormonal differences may influence the body’s response to sunlight exposure, females may have a higher tendency to use sunscreen on a regular basis, and men may be prone to working outdoors while shirtless. It is also possible that the observed gender differences in risk were due to confounding by other unmeasured kidney cancer risk factors, such as recreational sunlight exposure and physical activity levels.
While this study’s findings raise the possibility of a link between sunlight exposure and kidney cancer risk, “they clearly need to be replicated in other populations and in studies that use better estimates of long-term ultraviolet exposure and vitamin D intake,” said Dr. Karami.
Everyone should know the warning signs for a heart attack, but according to Dr. Isaac Eliaz, effective prevention requires much more than a list of potential symptoms.
“Heart attacks strike quickly and without warning,” said Dr. Eliaz, an author, lecturer, researcher, clinical practitioner and product formulator for natural health supplement manufacturer EcoNugenics (www.econugenics.com). “So as the national discussion turns to preventing heart attacks during American Heart Month, the real question isn’t whether people can recognize the warning signs, but rather, whether they avoid the risks in the first place.”
According to the American Heart Association, an estimated 81 million American adults have one or more types of cardiovascular disease (CVD).
“There are a number of lifestyle options that may avert the condition,” he added, referencing a free report he wrote about it at http://cardiobalance.org/. Dr. Eliaz recommended the following tips for heart healthiness:
Heart Healthy Diet — The first step is to shed excess weight through exercise and adopting a heart-healthy diet with heavy consumption of antioxidant-rich fresh fruits and vegetables — but be sure to eat organic as often as possible, as pesticides will only introduce aggravating toxins into your body.
Watch Your Fiber — Moderate intake of high-fiber whole grains that are low on the glycemic index scale is also important, along with lean protein like chicken, turkey, and fish (as long as you beware of excess mercury in the fish).
Good Fats and Bad Fats — It’s more important that you choose “good” fats instead of “bad” fats. The saturated and trans fats that you’ll find in red meat, butter, and fast foods are more likely to clog arteries than unsaturated choices like olive oil and fish oil — the latter of which can actually boost your heart health.
“We need to understand the things about our lifestyle that contribute to our risk for heart disease,” he said. “That way, it really won’t matter whether we memorized the warning signs of a heart attack, because we may never experience them.”
About Dr. Isaac Eliaz
Dr. Isaac Eliaz is a respected author, lecturer, researcher, product formulator, and clinical practitioner. He has been a pioneer in the field of integrative medicine since the early 1980s.
Hypnosis can help alleviate the pain and suffering experienced by women being treated for breast cancer, according to a study by a University at Buffalo School of Social Work professor.
The randomized trial measured pain and suffering, frequency of pain and degree of constant pain among 124 women with metastatic breast cancer, according to Lisa D. Butler, associate professor in UB’s School of Social Work, a faculty member in the Buffalo Center for Social Research and first author of the study.
Researchers recorded levels of pain at four-month intervals for a year. Women who were assigned to the treatment group received group psychotherapy, as well as instruction and practice in hypnosis to moderate their pain symptoms. They reported “significantly less increase in the intensity of pain and suffering over time,” compared with a control group, who did not receive the group psychotherapy intervention.
However, those using hypnosis reported no significant reduction in the frequency or constancy of pain episodes.
“The results of this study suggest that the experience of pain and suffering for patients with metastatic breast cancer can be successfully reduced with an intervention that includes hypnosis in a group therapy setting,” according to Butler. “These results augment the growing literature supporting the use of hypnosis as an adjunctive treatment for medical patients experiencing pain.”
The study was published last year in an issue of the American Psychological Association journal Health Psychology.
The researchers also found that, within the treatment group, those patients who could be hypnotized more easily — a group the researchers said demonstrated “high hypnotizability” — reported greater benefits from hypnosis. These patients used hypnosis more overall, including outside of the group sessions, and in some cases used it to address other symptoms related to their cancer.
“These results suggest that although hypnosis is not at present standard practice for treating a wide range of symptoms that trouble cancer patients, it is worth examining that potential,” Butler says. “Together, these findings suggest that there may be a number of benefits to the use of hypnosis in cancer care including, but not necessarily limited to, its more traditional application for pain control.”
Butler joined the UB faculty in January 2009, after doing research at Stanford University’s School of Medicine. She was hired at UB to strengthen the university’s research focus on “extreme events” as part of the UB 2020 strategic planning initiative. She recently published a nationally recognized study on how some people living through an extremely traumatic event – including the 9/11 terrorist attacks — have the ability to recover or even grow in personal and interpersonal functioning.
The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB’s more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.
Two stroke-prevention procedures are safe and equally beneficial for men and women at risk for stroke, but the effectiveness does vary by age, say researchers at the University of Alabama at Birmingham (UAB) in collaboration with other North American stroke investigators.
In findings reported Feb. 26 at the International Stroke Conference in San Antonio, Texas, the researchers say physicians now have better information when tailoring their treatment plans for patients at risk for stroke. The study is called the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST).
Stroke, the third leading cause of death in the nation, is caused by an interruption in blood flow to the brain by a clot or bleeding. The carotid arteries on each side of the neck are the major source of blood flow to the brain. The buildup of cholesterol in the wall of the carotid artery, called atherosclerotic plaque, is one cause of stroke.
CREST compares endarteroctomy, a surgical procedure to clear blocked blood flow and prevent stroke, with carotid stenting, a newer procedure that involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture dislodged plaque.
The overall safety and efficacy of the two procedures essentially is the same with equal benefits for men and women, for patients who previously have had a stroke and for those who had not, researchers say. The most notable finding was the role of patient age in accounting for differences in comparing the two prevention procedures, says George Howard, Dr.PH., chair of biostatistics in UAB’s School of Public Health and a CREST co-investigator.
“The fascinating finding is that in young people, say age 69 and younger, the stenting is better than the surgery. The younger the patient, the better stenting works,” Howard says. “In contrast, in older people, defined as greater than age 70, the surgery is better than the stenting, and the benefits are greater as the age of the patient increases.”
CREST is one of the largest randomized stroke-prevention trials in history, involving 2,502 patients at 117 centers in the United States and Canada during a nine-year period. It is funded by the National Institute of Neurological Disorders and Stroke (NINDS) and led by Thomas G. Brott, M.D., of the Mayo Clinic in Jacksonville, Fla. Twenty-one CREST patients are enrolled in Alabama under the medical direction of William D. Jordan, M.D., chief of vascular surgery at UAB.
“The magnitude of the operation and the stent procedure is really about the same because even though it seems minimally invasive to use a stent, the surgical procedure really isn’t that invasive, so most patients can tolerate either procedure,” Jordan says. “We counsel our patients on which one to do based upon a lot of factors, including their age, their overall medical condition, and actually about the anatomy of the stenosis, about where it is, how severe it is, and what the plaque morphology is.”
“The CREST trial provides doctors and patients with much needed risk/benefit information to help choose the best carotid procedure based on an individual’s health history,” says Walter J. Koroshetz, M.D., deputy director of NINDS. “This personalized decision-making should translate into improved patient outcomes.”
Because people with carotid atherosclerosis also usually have atherosclerosis in the coronary arteries that supply the heart, the CREST trial tracks the rate of heart attacks, in addition to stroke and death.
In CREST, approximately half of the 2,502 patients had recent symptoms due to carotid disease such as a minor stroke, often called a transient ischemic attack (TIA), indicating a high risk for future stroke. The other half of patients had no symptoms but was found to have narrowing of the carotid artery on one of a variety of tests assessing narrowness and plaque.
CREST investigators did see more heart attacks in the surgical group, 2.3 percent compared to 1.1 percent in the stenting group, and they did see more strokes in the stenting group, 4.1 percent versus 2.3 percent for the surgical group in the weeks following the procedure. Overall the study found a lower stroke rate following surgery and a lower heart-attack rate after stenting a year after their procedure. The average age of CREST patients is 69.
NINDS is committed to long-term follow-up of CREST patients to learn how best to prevent stroke. Partial funding for the study is supplied by Abbott, of Abbott Park, Ill., the maker of the stents.
Others from UAB involved in the study are Virginia Howard, Ph.D., an associate professor of epidemiology, and Jenifer Voeks, Ph.D., an assistant professor of epidemiology, both in the School of Public Health. Also involved are researchers at Lenox Hill Hospital in New York; Oregon Health Science University in Portland; Central Baptist Hospital in Lexington, Ky.; Hop de L’Enfant Jesus in Quebec City, Canada; University of Medicine and Dentistry of New Jersey in Newark; University of Maryland in Baltimore; Harvard Clinical Research Institute in Boston; University of California, Los Angeles.
PCI-32765 is a new drug being assessed in a Phase I clinical trial at the Virginia G. Piper Cancer Center in collaboration with the Clinical Division of the Translational Genomics Research Institute
Cancer researchers have high hopes for a new therapy for patients with certain types of lymphoma and leukemia.
PCI-32765 is a new drug being assessed in a Phase I clinical trial at the Virginia G. Piper Cancer Center in collaboration with the Clinical Division of the Translational Genomics Research Institute (TGen).
This is one of 35 such trials under way through a partnership between the Virginia G. Piper Cancer Center at Scottsdale Healthcare and TGen, which enables molecular and genomic discoveries to reach patients through Phase I trials as quickly as possible.
“Progress in developing new treatments for cancer has been painfully slow as only 2-4 percent of all cancer patients enroll in clinical trials. This is especially true for uncommon cancers such as leukemia’s and lymphomas,” said Dr. Raoul Tibes, Director of the Hematological Malignancies Program at the Virginia G. Piper Cancer Center and an Associate Investigator at TGen.
Clinical trials test the safety and effectiveness of new drugs prior to approval by the U.S. Food and Drug Administration. Participants are volunteers for whom other cancer treatments have failed. Arizona is one of many states in which clinical trials often are covered by health insurance.
“This study is going very well. It is a very promising agent,” Dr. Tibes said of PCI-32765, which uniquely targets the molecular abnormalities of lymphoma cells. “This is a recently identified cancer mechanism that we are going after with this drug in lymphoma cells.”
Bruton-tyrosine-kinase, or Btk, is an enzyme needed to maintain B-lymphocytes function. B- lymphocytes are the cells that make antibodies for the immune system.
Too little Btk causes a disease called Bruton’s agammaglobulinemia, in which the B-lymphocytes fail to mature and produce antibodies, leading to infections.
Too much Btk is involved in constantly stimulating the proliferation and spread of lymphoma and leukemia cells.
PCI-32765, produced by Pharmacyclics of Sunnyvale, Calif., inhibits Btk. Preclinical studies showed PCI-32765 arrested cancer cell growth and caused cancer cell death.
“This is the Yin and Yang of two diseases,” said Dr. Tibes. In one there is not enough Btk; in the other, too much. “We are exploiting a natural occurring phenomenon, an enzyme that is turned around in cancer, and now we have a drug against it.”
Dr. Tibes, the principal investigator for the clinical trial, said PCI-32765 is at the frontier of research and offers a new therapy option for patients with advanced lymphomas and chronic lymphocytic leukemia.
Patients with a variety of lymphomas can participate in the clinical trial, including those with aggressive diffuse large B-Cell and mantle cell lymphoma, as well as patients with follicular lymphoma.
“Perhaps there is a genetic context under which certain patients may be more responsive. We want to find those patients and explore the possibilities for their benefit in this ongoing study,” said Dr. Ramesh K. Ramanathan, research medical director.
When stroke strikes, choking off blood supply to the brain, every minute counts: Nearly 2 million neurons die each minute a stroke is left untreated, making it a race to recognize symptoms so that lifesaving “clot-busting” drugs can be administered. Forty-five percent of Americans – 135 million people — are more than an hour away from primary stroke centers, the facilities that are best equipped to care for them if they are stricken by the condition, according to new research led by the University of Pennsylvania School of Medicine that will be presented February 24 at the American Stroke Association’s International Stroke Conference in San Antonio. Less than a quarter of U.S. residents can reach one of those facilities in less than a half hour. The authors say the identification of these gaps in access is an important step in cutting the deadly toll of stroke, which is the third leading cause of death and the leading cause of long-term disability in the United States. The study revealed one existing way to narrow these disparities: Using existing air ambulance resources to fly stroke patients to appropriate care would cut the number of Americans without 60-minute access to a primary stroke center by half.
“Our findings show that many people do not have timely access to the type of care that they would need to save their life or minimize damage from a stroke,” says senior author Brendan G. Carr, MD, MS, an assistant professor of Emergency Medicine and Biostatistics and Epidemiology at Penn. “The challenge here is to think about how we can design a system that give everyone their best chance of survival.”
Distance from primary stroke centers a key factor in how well patients fare. Currently, less than 10 percent of ischemic stroke patients – those with blood clots blocking blood flow to the brain — receive tPA, the IV clot-dissolving drug that is proven to slash both the cognitive and physical disabilities associated with stroke. Typically, the drug must be given within three hours of symptom onset in order to be most effective. Unfortunately, precious time may be lost even before the patient decides to come to the hospital, since many patients fail to quickly recognize or act upon stroke symptoms – which can include weakness, strange sensations on one side of the body, confusion, difficulty speaking, visual problems and dizziness.
The new study results showed that overall, fewer than 1 in 4 Americans (22 percent) have access to a primary stroke center within 30 minutes, and just over half (55 percent) can reach one within an hour when ambulances are not permitted to cross state lines. Patients are most able to get to a primary stroke center by ground within 60 minutes if they live in the Northeast (64 percent), followed by the Midwest (61 percent). In the South and West portions of the country, just over half (52 percent and 51 percent) of patients can reach those advanced facilities within an hour. Five states had no in-state ground access to primary stroke centers within 60 minutes, and only in the District of Columbia could all residents reach such a facility in an hour. The addition of air ambulances, however, boosts access substantially: within a half hour, 26 percent of the population could reach a primary stroke center, and 79 percent could be transported to one within 60 minutes. The improvement found was most dramatic in the western U.S., where the number of patients transported within an hour would rise to 81 percent if helicopters were used.
The authors used data from the U.S. Census Bureau combined with an inventory of hospitals that have received certification as primary stroke centers by the hospital accrediting body known as The Joint Commission, and they calculated driving times and ambulance dispatch and response times between each population “block group” and the nearest stroke center. They also obtained data showing the location of all helipad depots operated by air medical service providers across the United States and calculated similar dispatch and response times to illustrate how utilizing helicopters could speed access for more patients.
The goal of the new research, Carr says, was to think differently about how to deliver stroke care, perhaps by policy solutions such as allowing ambulances to cross state lines, or using helicopters to more rapidly transfer patients to stroke centers. No national system for acute care of stroke patients currently exists, unlike the regionalized system for transport of trauma patients – those who’ve had car crashes, suffered falls, or been stabbed or shot – to hospitals that meet specific care benchmarks, making it possible for 83 percent of the U.S. population to reach trauma care within an hour.
In addition to air transport of stroke patients to high-level facilities, the authors suggest that other, lower-cost solutions could also be employed to extend the net of optimal care to a greater number of patients across the nation. Among suggestions: the development of inter-hospital referral networks, using telemedical technology to connect smaller or rural hospitals with guidance from specialty physicians trained in stroke care, and offering incentives for the development of stroke centers in underserved areas.
“Strokes often strike without warning. We are all at risk, and the therapy is time-critical. Data like these brings us closer to taking a big step in the development of not only a more robust stroke system, but of an emergency care system that can serve anyone, no matter where they are in the country,” Carr says. “Using technology, we hope to develop new ways to connect hospitals to each other so that instead of always delivering the patient to the doctor, we will be able to deliver the doctor to the patient.”
As the world watches the Vancouver Olympics, researchers at St. Michael’s Hospital in Toronto and Children’s Hospital Boston have teamed up to monitor and assess potential infectious disease threats to Vancouver during the Winter Games by integrating two independently developed intelligence systems that focus on global infectious diseases; bio.DIASPORA and HealthMap.
The communicating systems, developed by two Canadians – Dr. Kamran Khan at St. Michael’s and Dr. John Brownstein of the Informatics Program at Children’s Hospital Boston – are now producing the first, real-time analyses on potential threats to mass gatherings. The collaboration, and corresponding analysis of threats to the Olympic Games, is described in an article published online by the Canadian Medical Association Journal today.
“Mass gatherings can potentially amplify and disperse infectious disease threats globally because they can draw millions of people from around the world into a single space,” says Dr. Kamran Khan, an infectious disease physician and scientist at St. Michael’s Hospital. “By enabling our two systems to communicate in real-time, we are exploring new ways to generate actionable intelligence to organizers of mass gatherings.”
Dr. Khan is the developer of bio.DIASPORA, which enables the study of global air traffic patterns and applies this knowledge to help the world’s cities and countries better prepare for and respond to emerging infectious diseases threats. Dr. Brownstein is a co-founder of HealthMap, an online global disease-tracking and mapping tool which leverages information sources on the Internet to detect infectious disease outbreaks around the world.
For the 2010 Winter Olympic Games, Dr. Khan analyzed recent worldwide air traffic patterns during the month of February, to predict where passengers travelling into Vancouver would be originating from. His team found that nearly two-thirds of all international passengers traveling to Vancouver came from just 25 cities. Dr. Brownstein’s team then concentrated its infectious disease surveillance efforts on those cities, which it continues to do on an hourly basis during the course of the Winter Games (a real-time view of this analysis is available online at http://www.healthmap.org/olympics).
“Internet-based, geographically-directed infectious disease surveillance may greatly compliment traditional preparations for infectious disease threats at mass gatherings by identifying infectious disease at their source and potentially preventing importation/exportation of infection among attendees,” explains Dr. Brownstein at Children’s Hospital. “We look forward to continued research and dialogue in this area and seeing how the information we glean from monitoring these Games may be useful in terms of preparing for future mass gatherings like the upcoming G20 Summit in Ontario, Canada and this year’s FIFA World Cup in South Africa.”
Hypnosis has potential therapeutic value in children with respiratory disorders for alleviating symptoms such as habit cough or unexplained sensations of difficulty breathing and for lessening a child’s discomfort during medical procedures. Proper utilization of hypnosis as an adjunct to conventional treatment and its ability to use the mind-body connection to bring about physiological changes are explored in a provocative paper in Pediatric Asthma, Allergy & Immunology, a peer-reviewed journal published by Mary Ann Liebert, Inc. The paper is available free online.
Ran D. Anbar, MD, Professor of Pediatrics at SUNY Upstate Medical University, in Syracuse, NY, recommends hypnosis as a treatment option when a child’s respiratory symptoms appear to have a psychological component. In his paper, “Adding Hypnosis to the Therapeutic Toolbox of Pediatric Respiratory Care,” Dr. Anbar points to symptoms such as difficulty taking a breath, a disruptive cough, hyperventilation, noise on inspiration such as a gasp or squeak, and difficulty swallowing despite normal lung function as possible indications for the use of hypnosis to supplement medical therapy. Symptoms that are absent during sleep, can be associated with a particular activity or location, or are linked to or triggered by an emotional response may be particularly responsive to hypnosis.
Published data support the benefit of hypnosis in children with respiratory disorders with a large mind-body component such as vocal cord dysfunction and habit cough. Hypnosis can also help lessen sensations of difficulty breathing and anxiety in other respiratory diseases such as cystic fibrosis and asthma. Hypnosis is also a valuable tool for easing a child’s anxiety and helping patients control their response to discomfort.
Dr. Anbar cautions that hypnosis should not be attempted or considered for use by someone who is not a health care provider and has not received appropriate training in the technique.
“Dr. Anbar has added hypnosis to our therapeutic toolbox. When breathing problems have a large mind-body component, resolution with hypnosis can dramatically reduce the need for expensive testing and medications,” says Harold Farber, MD, MSPH, Editor of Pediatric Asthma, Allergy Immunology, and Associate Professor of Pediatrics, Section of Pulmonology, at Baylor College of Medicine, Houston, TX.
If you gave chocolates to your Valentine on February 14th you may have helped lower their risk of stroke based on a preliminary study from researchers at St. Michael’s Hospital. The study, which is being presented at the American Academy of Neurology in April, also found that eating chocolate may lower the risk of death after suffering a stroke.
“Though more research is needed to determine whether chocolate is the contributing factor to lowering stroke risk, it is rich in anti-oxidants and that may have a protective effect against stroke,” explains Dr. Gustavo Saposnik, a neurologist at St. Michael’s Hospital.
Chocolate is rich in antioxidants called flavonoids which may help lower the risk of strokes.
Authored by Sarah Sahib, the research analyzed three studies involving chocolate consumption and stroke risk. One showed there was no association between flavonoid intake and risk of stroke or death. In contrast, a second study found an association with stroke for chocolate consumption once a week as opposed to none per week. The third study suggested flavonoid intake from eating chocolate weekly lowered death caused by a stroke.
“We are continuing to investigate the correlation between chocolate and the risk of stroke,” says Dr. Saposnik. “The preliminary data is interesting but we need to determine whether consumption truly lowers the risk of a stroke or whether the benefit is biased based on those who are on average healthier than the general population when enrolling in a clinical trial.”
Parents of young children with asthma often recognize signs that their child is about to have an asthma attack but delay home treatment until the attack occurs, researchers at Washington University School of Medicine in St. Louis report.
Results of the study, published in the Annals of Allergy, Asthma and Immunology, show there are missed opportunities to intervene early and thus relieve a child’s symptoms, possibly reduce the extent of the attack and prevent visits to the emergency room.
The study stems from comments received by two lay asthma coaches employed by Washington University School of Medicine. The coaches are trained to help educate families dealing with asthma by offering information and social support. They also have asthma themselves or a family member who has it.
While talking to parents of children with asthma, the coaches noticed that parents were often unsure of exactly how to use albuterol, a bronchodilator that relaxes muscles in the airways and increases airflow to the lungs, when they noticed signs that their child’s asthma symptoms were worsening. The study followed up on those observations to determine if they are true among a larger group.
Asthma is one of the most common childhood diseases in the United States. Every year, two of every three children with asthma have at least one attack, or exacerbation. These exacerbations often result in missed school days, visits to the emergency room and hospitalizations. But researchers at the School of Medicine say some of these exacerbations could be prevented with early home treatment with albuterol.
For the study, the coaches telephoned 101 parents of children ages 2-12 who had recent visits to the emergency department at St. Louis Children’s Hospital with an asthma exacerbation or who had called the hospital’s After Hours Call Center. More than 60 percent of the families had Medicaid insurance. The coaches surveyed the parents about how they detected that their child was about to have an asthma attack and what they did to prevent or treat it.
Parents reported noticing signs such as coughing, wheezing, shortness of breath, chest tightness or pain, cold or allergy symptoms, or even behavioral signs such as becoming quiet or more temperamental.
“Every time the child had an exacerbation, many parents noticed the same medley of signs preceding it,” says Jane Garbutt, M.B., Ch.B., associate professor of medicine and of pediatrics. “But even though they noticed the signs consistently, they often didn’t do anything about it. If parents had known to give albuterol earlier, they may have been able to manage things at home and avoid a trip to the emergency room,” says Garbutt, also director of the Washington University Pediatric and Adolescent Ambulatory Research Consortium.
Garbutt says one of the reasons parents may not begin treatment is that they believe they are following doctor’s instructions.
“The asthma plan from the doctor often says to start using albuterol when parents notice the child is wheezing or coughing or short of breath, but the doctor may have a different definition for those symptoms than the parent,” Garbutt says.
Another problem the researchers found was that parents may not notice some of the early signs that predict an exacerbation. One in four parents who was interviewed reported seeing late signs of an exacerbation in the child, including gasping for breath or sucking in the rib muscles when breathing.
“Those kids have to go to the emergency department because they are too far along in their exacerbation to do anything at home,” Garbutt says. “If we can talk to parents and find out that’s the issue, we can teach them to take action sooner.”
In some instances, parents knew they needed to give their child albuterol, but weren’t sure how much or how often.
“Parents varied in terms of how often they used it, if they used it with a nebulizer, how often they repeated it and how they determined if it was working,” Garbutt says. “A careful assessment of exactly which medicines are used and how they are administered and dosed could identify problems. We think that is something that can be addressed with education.”
Prednisone is a corticosteroid that prevents the release of inflammatory-causing substances in the body. Many parents said they kept the drug on hand at home in case of an asthma attack, but few parents in this study used it, instead calling the doctor’s office or going to the emergency room.
Garbutt and fellow researchers are conducting a follow-up study in which the asthma coaches are working with physicians to promote earlier use of albuterol as well as other effective self-management behaviors. In addition, the coaches are working with parents to help them identify the early signs of an asthma exacerbation by giving parents a symptom diary to help parents see symptom patterns.
According to a new study, men employed in occupations with potential exposure to high levels of sunlight have a reduced risk of kidney cancer compared with men who were less likely to be exposed to sunlight at work. The study did not find an association between occupational sunlight exposure and kidney cancer risk in women. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the study is the largest case-control study of kidney cancer to investigate the association with occupational sunlight exposure. The study, however, did not include information on non-occupational sunlight exposure and does not address directly whether sunlight exposure can help prevent kidney cancer.
