Open Reading Frame: typhoid vaccination, home care exercise & reducing pill burden

Posted by Biome on 17th January 2014 - 0 Comments


Open Reading Frame brings together a selection of recent publication highlights from elsewhere in the open access ecosystem. This week we take a look at the past few weeks in medicine.

 

Insights into factors associated with childhood cancer
Despite the development of better treatments for childhood cancer in recent years, its etiopathology remains poorly understood. A record linkage study has been carried out to assess the maternal and perinatal factors associated with childhood cancer, finding that younger maternal age, maternal smoking and delivery by caesarean section are all associated  with greater risk. The authors caution that the study did not have sufficient power to detect association between these factors and different cancer types, but the findings suggest that maternal and perinatal factors merit further investigation in the endeavor to better understand childhood cancer and develop preventative strategies.
Bhattacharya et al. BMJ Open

 

Elevated breast cancer risk in late pregnancy: targeting STAT5 signaling
A first pregnancy after age 35 increases a woman’s risk of developing breast cancer, but the reasons are unknown. There is a greater urgency to understand this difference as many women now wait until their late 30s to start a family. New research carried out in mice suggests that the increased risk could be due to the effects of pregnancy on pre-cancerous lesions. The researchers inserted cancer-causing genes into mice, and half were made pregnant. Both groups had similar numbers of pre-cancerous lesions in the early stages of pregnancy, but being pregnant weakened the protective processes that destroy early lesions through effects on the STAT5 signaling pathway. The researchers also found increased levels of STAT5 in tumors from breast cancer patients who had been pregnant compared with those who had not, and treating pregnant mice with an inhibitor of STAT5 reduced the elevated breast cancer risk. These findings provide insights into the mechanism of increased breast cancer risk in later pregnancy, and suggest that STAT5 signaling could be targeted to prevent this elevated risk.
Haricharan et al. eLife

 

Daily activities versus structured exercises in the elderly
Restorative home care services employ a multi-dimensional approach to help older people maximize their independence. While these programs typically involve structured exercises to improve muscle strength and balance, it has been suggested that some older people receiving home care services prefer to be active through daily activities such as gardening and housework. Now, a randomized clinical trial has been carried out to assess the effect of modified restorative home care services involving a lifestyle functional exercise program (LiFE), compared with structured exercises. Over a six-month period, the LiFE group made significantly better progress for 25 percent of outcomes, including measures of gait and body composition. These results suggest that restorative home care services involving lifestyle exercises instead of structured programs should be considered for older people who prefer to be active through daily living.
Burton et al. Healthy Aging & Clinical Care in the Elderly

 

Towards typhoid elimination
Although it has been eliminated from most developed countries, typhoid infection is endemic in areas with poor sanitation, and has a particularly high disease burden in South Asia. Problems with antimicrobial resistance and treatment failure have hampered efforts to prevent the spread of infection in countries such as India, where disease complications are becoming more common. Vaccination programs have been successfully employed in Thailand and China, and now a mathematical modeling study suggests that vaccination could help confer short-term protection in India. The model suggests that employing a vaccination program in India would lead to a decrease in typhoid incidence through herd immunity, but vaccination alone is unlikely to eliminate the disease completely. The authors conclude that in order to reduce the burden of typhoid in endemic settings such as India ,vaccination should be considered for use in combination with improvements in detection, treatment and sanitation.
Pitzer et al. PLOS Neglected Tropical Diseases

 

Reducing pill burden to improve transplant success
In renal transplant recipients, nonadherence to immunosuppressive agents is the third leading cause of transplant failure, and improving adherence could have a dramatic impact on transplant outcomes. An exploration of the reasons for nonadherence has found that nonadherent patients are less satisfied with their medical care and relationships with healthcare staff. The researchers also showed that shifting the treatment regimen in these patients from twice daily to once daily tacrolimus improved adherence at 3 and 6 months. While further validation is required in a randomized study, these results suggest that reducing pill burden should be considered alongside efforts to improve satisfaction with medical care in order to improve adherence to treatment in renal transplant recipients.
Sabbatini et al. Patient Preference and Adherence

 

The importance of smoking cessation for COPD patients
Chronic obstructive pulmonary disease (COPD), characterized by poor airflow and shortness of breath, is most commonly caused by smoking, but other factors such as air pollution and genetics also play a role in disease development. New research has compared the clinical characteristics of COPD in smokers and non-smokers, showing that non-smokers have less chronic cough and sputum, reduced emphysema and better lung function than smokers with the disease. These results indicate that smokers with COPD have more severe disease than non-smokers, emphasizing the importance of stopping smoking in patients with COPD.
Zhang et al. International Journal of Chronic Obstructive Pulmonary Disease

 

Written by Claire Barnard, Senior Editor for BMC Medicine.