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Vehicle exhaust pollutants linked to near doubling in risk of common eye condition
Long term exposure to pollutants from vehicle exhaust is linked to a heightened risk of the common eye condition age-related macular degeneration, or AMD for short, suggests research published online in the Journal of Investigative Medicine.
Exposure to the highest levels of air pollutants was associated with an almost doubling in risk among those aged 50 and older, the findings show.
AMD is a neurodegenerative condition that affects the middle part of the retina, known as the macula. It is one of the most common causes of poor vision in older people, and is most likely caused by an interplay between genetic and environmental risk factors.
Long term exposure to air pollution has been linked to a heightened risk of several conditions, including respiratory and cardiovascular diseases. But less is known about its potential effects on eye health.
To explore this further, the Taiwanese researchers analysed national health insurance and air quality data from 1998 to 2010 to see if there might be a link between long term exposure to the pollutants nitrogen dioxide (NO?) and carbon monoxide (CO) and a heightened risk of AMD.
As the condition is more common among older age groups, the researchers focused only on 39,819 people aged 50 and above, most of whom lived in either highly (30%) or moderately (32.5%) urbanised areas.
Because there are seasonal variations in air pollutant levels, the researchers calculated an average annual exposure, which was categorised into four different levels.
During the monitoring period, 1442 people developed AMD.
After taking account of potentially influential factors, such as age, sex, household income, and underlying illnesses, those with the highest level of exposure to NO? (more than 9825.5 ppb) were nearly twice (91%) as likely to develop AMD as those exposed to the lowest level (less than 6563.2 ppb).
And people who were exposed to the highest level of CO (more than 297.1 ppm) were 84% more likely to develop AMD than those exposed to the lowest level (less than 195.7 ppm).
The highest rate (5.8%) of newly diagnosed AMD was among people living in the area with the highest level of CO exposure.
This is an observational study, and as such, can’t establish cause. And the authors emphasise that the data didn’t include information on other risk factors, such as smoking, genetics, and inflammation.
This is the first study of its kind to “demonstrate a significant association between AMD and high levels of ambient NO? and CO,” they write.
Recent research has implicated NO? in cardiovascular and neurological ill health, and as the retina is part of the central nervous system, there is a plausible biological explanation for its vulnerability to this pollutant, they add.
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Materials provided by BMJ. Note: Content may be edited for style and length.
Antibiotic use linked to heightened bowel cancer risk
Antibiotic use (pills/capsules) is linked to a heightened risk of bowel (colon) cancer, but a lower risk of rectal cancer, and depends, to some extent, on the type and class of drug prescribed, suggests research published online in the journal Gut.
The findings suggest a pattern of risk that may be linked to differences in gut microbiome (bacteria) activity along the length of the bowel and reiterate the importance of judicious prescribing, say the researchers.
In 2010, patients around the world took an estimated 70 billion doses of antibiotics — equivalent to 10 doses each. Antibiotics have a strong and long lasting impact on the gut microbiome, altering the balance of helpful and harmful bacteria.
The researchers wanted to find out if this might affect bowel and rectal cancer risk, and how.
They drew on data submitted to the nationally representative Clinical Practice Research Datalink (CPRD) between 1989 and 2012.
This contains the anonymised medical records of around 11.3 million people from 674 general practices — around 7% of the UK population.
The researchers collected prescribing information for 28,930 patients diagnosed with bowel (19,726 ) and rectal (9254) cancers during an average monitoring period of 8 years, and for 137,077 patients, matched for age and sex, who didn’t develop these cancers.
Antibiotics had been prescribed to 70% (20,278) of patients with bowel and rectal cancers and to 68.5% (93,862) of those without. Nearly six out of 10 study participants had been prescribed more than one class of antibiotic.
Those with bowel cancer were more likely to have been prescribed antibiotics: 71.5% vs 69%. Exposure levels were comparable among those who developed rectal cancer (67%).
The association between bowel cancer and antibiotic use was evident among patients who had taken these drugs more than 10 years before their cancer was diagnosed.
Patients who developed bowel cancer were more likely to have been prescribed antibiotics targeting anaerobes, which don’t need oxygen, as well as those targeting aerobes, which do — than patients without cancer.
But patients with rectal cancer were less likely to have been prescribed antibiotics targeting aerobic bacteria.
Cancer site was also associated with antibiotic use. Cancer of the proximal colon — the first and middle parts of the bowel — was associated with the use of antibiotics targeting anaerobes, when compared to people without cancer.
But antibiotic use was not associated with cancer of the distal colon — the last part of the bowel.
After taking account of potentially influential factors, such as overweight, smoking, and moderate to heavy drinking, cumulative use of antibiotics for a relatively short period (16+ days) was associated with a heightened risk of bowel cancer, with the impact strongest for cancers of the proximal colon.
The reverse was true for rectal cancers, where antibiotic use exceeding 60 days was associated with a 15% lower risk compared with no use.
When the analysis was restricted to patients who had been prescribed only one class of antibiotic, as opposed to none, penicillins were consistently associated with a heightened risk of bowel cancer of the proximal colon. Ampicillin/amoxicillin was the penicillin most commonly prescribed to these patients.
By contrast, the lower risk of rectal cancer was associated with prescriptions of tetracyclines.
This is an observational study, and as such, can’t establish cause, and the researchers weren’t able to capture potentially influential lifestyle factors for all the participants, nor hospital treatment, which may have affected overall cancer risk.
Nevertheless, their findings suggest “substantial” variation in the size and pattern of antibiotic effects along the length of the bowel, they say, concluding: “Whether antibiotic exposure is causal or contributory to colon cancer risk, our results highlight the importance of judicious antibiotic use by clinicians.”
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Lifestyle counselling and mobile application helped people change their lifestyle
Finnish StopDia study yielded promising preliminary results in reducing the risk of type 2 diabetes. Lifestyle guidance in a group and application that supports the adoption of healthy lifestyle habits helped StopDia participants to reduce their waist circumference and improve their dietary habits. For example, their fruit and vegetable consumption increased.
“Using the BitHabit application that supports the adoption of healthy lifestyles for a year combined with group guidance improved the diets of the participants and narrowed their waist circumference. These preliminary results are promising and encourage us to continue the development and use of the model,” says Professor Timo Lakka, Co-Principal Investigator of the StopDia study, from University of Eastern Finland.
The purpose of the BitHabit application is to automate the adoption of new habits and to generate a sustainable behaviour change. The application allowed the participants to make healthy choices that suited them and tick them as accomplished.
The new habit may be e.g. taking healthy snacks to eat between meals at work, so that hunger in the afternoon does not cause fatigue and unhealthy choices.
“Surprisingly, the application was used more actively by the older participants. In other words, it is worthwhile to offer digital alternatives to people in an unprejudiced manner, regardless of their age,” explains Marja Harjumaa, Senior Scientist at VTT Technical Research Centre of Finland, who is involved in the development of the application.
The study showed that the Finnish Diabetes Risk Score (FINDRISC), the most widely used risk test for type 2 diabetes in the world, effectively identified people at increased risk without laboratory testing.
More than half of the StopDia participants with an elevated FINDRISC score in the digital screening already had a glucose metabolism disorder. In addition, five per cent were diagnosed with previously undetected diabetes. The study also revealed that healthcare reaches only a small proportion of people who would benefit from preventive activities.
The best way to reach people and get them involved in the study was through social media and the editorial content of newspapers. In particular, journalistic articles with personal interviews brought vast numbers of people to the risk screening website. The visibility acquired through social media, on the other hand, is mostly subject to a charge. In any case, to be successful, informing still requires contents that the target group finds interesting.
“Men traditionally are less interested to take part in health promotion campaigns and studies. Their participation was most effectively promoted by a word from a friend or a relative. Many men pointed out that ‘the wife urged me to come,” says Jaana Lindström, Research Manager and developer of the FINDRISC test.
In StopDia, the information disseminated in workplaces reached women in particular.
The StopDia study examined how to reduce the risk of type 2 diabetes not only by providing individual lifestyle support but also by targeting the living environment and at the level of society. Environment has a powerful impact on decision-making and behaviour. Decisions are only partly based on conscious deliberation. A great deal of daily choices occur automatically — often unnoticed.
The StopDia at Work study aimed at altering the choice architecture of working environments to facilitate healthy dietary choices and physical activity at the workplace. This approach, also known as nudging, differs from the more conventional methods used for promoting wellbeing at work, such as campaigns and sports benefits.
Preliminary results suggest that the consumption of vegetables, fruit and nuts during working hours among the employees of participating workplaces was greater at the end of the study compared to the beginning of the study. No difference was observed in the consumption of savoury and sweet delicacies. Performing restoring break exercise, such as stretching, was also more common at the end of the study.
The Stop Diabetes (StopDia) study is funded by the Strategic Research Council (SRC), operating in conjunction with the Academy of Finland. The project is part of the Health, Welfare and Lifestyles (HEALTH) programme that ended this year. The study was conducted by the University of Eastern Finland, the National Institute for Health and Welfare (THL) and VTT in collaboration with local and regional authorities, and regional healthcare operators. There were also more than 20 societal operators involved in the activities, including such organisations as the Finnish Diabetes Association and the Finnish Heart Association, as well as approximately 40 employers.
These preliminary results of the study are published at StopDia National Seminar on 21 August.
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Health24.com | How ‘Dr Google’ helps some patients diagnose a rare disease
A middle-aged woman had persistent symptoms that doctors couldn’t explain. Frustrated, she took an increasingly common route: a search through the internet.
“Dr Google” led the woman to specialists at Wake Forest University Medical Center in Winston-Salem, North Carolina. There, she was diagnosed with a rare genetic condition called autosomal dominant tubulointerstitial kidney disease (ADTKD). This gradually causes the kidneys to stop working.
Incorrect diagnosis
“My two brothers, mother, cousin, second cousin, uncle, and two great uncles suffered from kidney disease, but no doctor had made a diagnosis,” recalled the woman, who prefers to remain anonymous.
“Two nephrologists I saw did not know about this condition,” she said. Another doctor made an incorrect diagnosis and treatment, while advising her to “just let me do the worrying”.
The patient didn’t take that advice. “We were prompted to search the internet when several family members had worsening kidney disease, and no one could diagnose it,” she said. So her brother searched “gout” and “kidney disease” online, and found Wake Forest’s specialists.
As her situation indicates, figuring out what’s going on when a rare disease strikes can be tricky. Most primary care physicians are not trained to spot a rare disease. And even specialists can have a tough time unravelling the mysteries of an illness they may not have seen before.
For many patients, this means going months, if not years, undiagnosed or misdiagnosed.
“A rare disorder is usually defined as a disorder affecting fewer than one in 200 000 individuals,” explained study lead author Dr Anthony Bleyer, a professor of nephrology at Wake Forest. About eight in 10, he said, are inherited.
More than 7 000 rare diseases
Although on their own each disease affects very few people, Bleyer pointed out that collectively such rare illnesses touch the lives of an estimated 25 million Americans.
“There are many reasons for diagnosis delay,” said Mary Dunkle, a senior adviser for the National Organization for Rare Disorders (NORD) in Danbury, Connecticut.
“Rare diseases can resemble more common ones. They also tend to be complex and often involve multiple systems within the body,” she added.
Given that there are more than 7 000 rare diseases, “it’s simply not realistic to expect community physicians to be familiar with all of these,” said Dunkle, who was not involved in Bleyer’s investigation.
Bleyer added that testing can be expensive and not covered by insurance.
In the current issue of Genetics in Medicine, Bleyer and colleagues reported that some patients are finding specialist websites online, and contacting them without any guidance from a medical professional.
Rare specialists on internet
Such “self-referrals” are just as likely to produce an accurate diagnosis as referrals made by a doctor, Bleyer believes.
While online searches aren’t always productive, “the internet does offer those with a rare condition a way to find the rare specialists interested in a particular condition,” he said.
Bleyer’s conclusion is based on an analysis of 665 referrals received by a Wake Forest research centre that specialises in ADTKD.
All the referrals came in between 1996 and 2017. Of those, 40% were made by an academic medical centre 33% were made by a non-academic doctor, and 27% came directly from an undiagnosed rare disease patient or his/her family.
In the end, a firm ADTKD diagnosis was made in roughly a quarter of all cases. And the diagnostic success rate was nearly identical regardless of how a referral was made.
Still, Bleyer cautioned that patients should not self-diagnose without the help of a doctor – “and above all do not self-medicate based on their self-diagnosis.”
Dunkle agreed, adding that patients and caregivers should always “be aware of the sources of information they find online.” She recommended that people use only trusted sources such as the US National Institutes of Health, teaching hospitals and patient organisations whose information is reviewed by medical experts.
Image credit: iStock
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Health24.com | What is kratom and why is its safety being questioned?
The herbal supplement kratom regularly causes serious side effects and doesn’t appear safe for use, a new study argues.
Kratom, made from the leaves of a Southeast Asian plant, is usually used to treat pain and addiction. But poison control centre data shows it has been tied to seizures, withdrawal, hallucinations, agitation and rapid heart rate, researchers report.
Acts on opioid receptors
Kratom is “probably not something that’s safe enough to be available as an herbal supplement”, concluded lead researcher William Eggleston, a clinical assistant professor with the Binghamton University School of Pharmacy in New York.
Kratom contains compounds that act on the opioid receptors in the brain and the body, according to the US National Institute on Drug Abuse.
And while it’s a legal herbal supplement, the US Food and Drug Administration has already issued a warning against using kratom. The FDA has called the drug “opioid-like” and cited concerns that it might pose an addiction risk.
In the new study, poison control centres received more than 2 300 calls related to kratom between 2011 and 2018.
Those calls increased from 18 in 2011 to 357 in the first seven months of 2018, according to stats drawn from the US National Poison Data System.
The research team zeroed in on 935 cases where kratom was the only substance involved.
Severe side effects
About 56% of cases involved kratom taken as a pill, capsule or powder, and in nearly 9 in 10 cases people ate the kratom that had affected them.
The most commonly reported adverse effects were agitation (in almost 20% of cases), rapid heart rate (17%), drowsiness (14%) and vomiting (11%), the data showed.
Severe side effects included seizures (6%), hallucinations (5%), respiratory depression (3%), and coma (2%). Cardiac or respiratory arrest was reported in 0.6% of cases.
The researchers also identified four cases of neonatal abstinence syndrome, where babies were born addicted to kratom after their mothers took the supplement during pregnancy. They said it caused two deaths.
The National Poison Data System statistics indicated that kratom has a lower risk for fatal overdose than opioids like heroin or fentanyl, Eggleston said.
“The risk for things like serious respiratory depression is probably less with kratom than it is with other opioids,” Eggleston said. “We saw a very low incidence of this in our data.”
Substance use disorder
However, other studies also have shown that users can experience withdrawal symptoms, Eggleston said.
“That suggests that patients could develop a dependence or a substance use disorder, as you would with other opioids,” Eggleston said. “To me, that exceeds what I would consider a reasonable risk for an herbal supplement you can buy at a local convenience store or head shop.”
Kratom proponents argue that the new study is flawed because it relies on poison control and medical examiner data, which tags kratom as the main suspect and could fail to consider other possible explanations.
“If a person dies and the tox screen identifies kratom in the bloodstream, that is labelled as a kratom-associated death,” said Mac Haddow, a senior fellow on public policy at the American Kratom Association. “It is just as plausible you could identify caffeine in the bloodstream as a result of drinking a cup of coffee that morning.”
Susruta Majumdar, an associate professor with the St. Louis College of Pharmacy in Missouri, said the new study adds a bit more evidence regarding kratom’s safety, but agreed that its reliance on poison control centre data makes for a flawed approach.
Based on available data, Majumdar said, kratom probably is safer that prescription and illicit opioids, but “I think we are getting to a point where we can say it’s addictive.”
Clinical trials are needed
Majumdar added that he believes kratom-related deaths are not caused by kratom alone, but kratom combined with other substances.
“People are on multiple drugs, and it’s the synergy between those drugs that is causing the toxicity,” Majumdar said.
Eggleston said he does not advocate a ban on kratom, since studies suggest it might have a role in treating chronic pain and addiction.
Instead, clinical trials are needed to assess kratom’s usefulness and establish its safety at certain doses, Eggleston said.
“Our research is not coming from a place where we want to hinder access,” Eggleston said. “We want the public to have all the information they need and be transparent, so they know what works and what’s safe.”
The study findings were published in the journal Pharmacotherapy.
Image credit: iStock
