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A new German study has found that taller people are at a lower risk of developing type 2 diabetes. The study titled, “Associations of short stature and components of height with incidence of type 2 diabetes: mediating effects of cardiometabolic risk factors,” was published in the latest issue of the journal Diabetologia.
For this large study the team included participants who were part of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study that recruited 27,548 participants with 16,644 women and 10,904 men between 1994 and 1998. The women were between ages 35 and 65 years and the men were aged between 40 and 65 years. A sub population was derived from the study population comprising of 2,500 individuals. Of these 2,029 were free of diabetes at the start of the study.
Over a seven years of follow up they found that there were 820 new cases of diabetes among the individuals. The researchers took into account not only the height of the patients but also their age, body weight, waist circumference, lifestyle habits and factors that may affect risk of type 2 diabetes. They looked at total body height as well as components of height such as sitting height and leg length as well in association with incidence of type 2 diabetes. The participants were provided with questionnaires every two to three years for assessment.
For the assessment the blood samples of the participants were assessed for “total cholesterol, HDL-cholesterol, triacylglycerols and CRP; erythrocyte levels of HbA1c; and activity of γ-glutamyl transferase (GGT)”. Fatty liver index (FLI) was measured using “BMI, waist circumference, GGT and triacylglycerols”, the team wrote.
The researchers have found that for each 10 cm increase in height of an individual, there was a 41 percent and 33 percent reduction in the risk of type 2 diabetes among men and women respectively. They also noted that leg length was associated with a lowered risk of type 2 diabetes among both men and women. When adjusted for total height however, the benefit of longer legs was only seen among men and was nullified among women.
Among overweight individuals, every additional 10 cm in height meant 36 percent and 30 percent reduction in risk of type 2 diabetes among men and women respectively, the researchers found. The team wrote, “This may indicate that a higher diabetes risk with larger waist circumference counteracts beneficial effects related to height, irrespective of whether larger waist circumference is due to growth or due to consuming too many calories.”
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According to the authors this is the first study that connects height of an individual with the risk of long term health conditions. A similar study few months back showed raised risk of cancers among tall persons. The experts have said that since the number of cells in tall persons is greater, they may be at a greater risk of cancers. What is baffling is the raised risk of type 2 diabetes among shorter individuals.
According to the researchers, raised liver fat content among persons who are shorter could be one of the reasons behind the raised diabetes risk. On the other hand those who are taller have a better “cardiometabolic profile” the team wrote. They added, “Our findings suggest that short people might present with higher cardiometabolic risk factor levels and have higher diabetes risk compared with tall people. Our study also suggests that early interventions to reduce height-related metabolic risk throughout life likely need to focus on determinants of growth in sensitive periods during pregnancy, early childhood, puberty and early adulthood, and should take potential sex-differences into account.”
They had taken into consideration the liver fat of the participants as well as “triacylglycerols, adiponectin and C-reactive protein”. When these features of liver fat and other parameters were considered, the benefit of height and risk of type 2 diabetes was found to be nullified said the researchers. This was especially true among women, the researchers wrote.
According to the researchers as a person achieves his or her full adult height, this parameters is unmodifiable. This means that in order to reduce the risk of heart disease and diabetes among shorter individuals, there should be appropriate monitoring and screening for diabetes. In addition liver fat seems to play an important role in raising the risk of diabetes among shorter individuals. Therapeutic measures as well as lifestyle factors that reduce the liver fat could be adopted for shorter individuals to lower their risk of type 2 diabetes, the authors wrote.
The authors concluded, “We observed inverse associations between height and risk of type 2 diabetes, which was largely related to leg length among men. The inverse associations may be partly driven by lower liver fat content and a more favourable cardiometabolic profile.”
Review:Dr. Ananya Mandal, MD
Image Credit: Montri Thipsorn / Shutterstock
Journal reference:
Wittenbecher, C., Kuxhaus, O., Boeing, H. et al. Diabetologia (2019). https://doi.org/10.1007/s00125-019-04978-8, https://link.springer.com/article/10.1007%2Fs00125-019-04978-8
Vitamin D is essential for strong bones. This is universally agreed upon. We also know vitamin D is manufactured in our skin cells when exposed to as little as 10-15 minutes of the summer sun over most of the body surface.
However, for people in cold northern climes, this kind of sun is rare for six or more months of winter, leading to possible vitamin D deficiency. This means that they take supplements instead, to prevent bone weakening.
The recommended daily intake for vitamin D by Health Canada is 600 IU (International Units) up to the age of 70 years, after which it goes up to 800 IU. However, some experts disagree, suggesting that people with osteoporosis, a condition in which the bone becomes thinner, need anywhere from 400 to 2000 IU a day.
Health Canada recommendations are aimed at preventing bone disease due to vitamin D deficiency but do not provide the optimal dose. As a result, it’s unclear whether taking more of vitamin D contributes to better health, as many believe.
The current study (Examining the effects of excessive vitamin D supplementation on bone health) examined the question: Can you take too much vitamin D? And if so, how much is too much?
The study looked at the bone health of 300 volunteers aged 55-70 years for three years, with an average age of 62 years. The participants were randomly allocated one of three groups: those who got 400 IU vitamin D, those on 4000 IU and those on 10 000 IU.
The estimated addition of 200 IU on average through the diet brought up all three groups to the recommended dose or above. Calcium citrate at up to 600 mg elemental calcium was also given to achieve a daily intake of about 1200 mg calcium on average.
The study aimed to examine bone strength and density at higher doses of vitamin D to test if the health benefits increased with increasing doses of vitamin D.
At the beginning of the study, a new scan called high-resolution computed tomography was carried out to assess bone density and bone health at the wrist and ankle. This is called the XtremeCT and is available only in research laboratories. The advantage of using this is the detailed visualization of bone microarchitecture that it offers.
Another tool called dual X-ray absorptiometry (DXA) was also used to assess bone density at the initiation of the study, and then at 6, 12, 24 and 36 months. Yearly urine samples were also taken.
Bone mineral density (BMD) is calculated from the concentration of calcium and other minerals in a bit of bone. A higher BMD reduces fracture risk, however, BMD typically goes down with age.
Findings from the study
The study found a small decline in BMD over the three years using DXA scans. However, when XtremeCT was used, it proved to be much more sensitive, reflecting a significant bone loss in all three groups.
In the 400 IU, 4000 IU and 10 000 IU groups, the BMD went down by 1.4%, 2.6%, and 3.6% respectively, mainly at the radius, but also in the tibia at the highest dose. Bone strength was not significantly decreased in any group.
The increased sensitivity of XtremeCT compared to DXA held no surprises for the researchers, but the finding that higher doses of vitamin D were linked to the greatest bone loss was surprising. This could be due to increased bone resorption with suppressed secretion of parathyroid hormone (which is important for new bone formation).
Previous studies have shown that high doses of vitamin D did result in increased resorption of bone unless calcium was also supplemented. The active form of vitamin D called calcitriol increases the production of osteoclasts which enhance bone resorption.
The study also looked at whether high doses of vitamin D would cause any other adverse effects. The findings showed that the incidence of hypercalciuria (excessive levels of calcium in the urine) went up with higher doses, namely, 4000 IU and 10 000 IU daily. While 87 participants had hypercalciuria overall, the incidence was 17% in the first group, 22% in the second 22% and 31% in the third.
Hypercalciuria is relatively common in the population but increases the chances of kidney stones. In the study population, calcium intake in the diet was reduced in the 87 patients and this resulted in a reduction in urinary calcium on a second test.
The study concluded that taking vitamin D at doses above the recommended daily dose is really not useful in pushing up the bone density or increasing the bone strength. In fact, the bone density went down, as shown by the above figures, with the greatest loss seen in the group taking the highest dose.
Lessons from the study
“That amount of bone loss is not enough to risk a fracture over a three-year period, but our findings suggest that for healthy adults, vitamin D doses at levels recommended by Osteoporosis Canada (400-2,000 IU daily) are adequate for bone health.” Steve Boyd, Senior Author.
In researcher Emma Billington’s words, “Large doses of vitamin D don’t come with a benefit to the skeleton. For healthy adults, 400 IU daily is a reasonable dose. Doses of 4,000 IU or higher are not recommended for the majority of individuals.”
Source: Dr. Liji Thomas, MD
Picture: Leslie Samuel
Journal reference:
Effect of high-dose vitamin D supplementation on volumetric bone density and bone strength: a randomized clinical trial. Lauren A. Burt, Emma O. Billington, Marianne S. Rose, Duncan A. Raymond, David A. Hanley, & Steven K. Boyd. JAMA 2019;322(8):736-745. doi:10.1001/jama.2019.11889. https://jamanetwork.com/journals/jama/article-abstract/2748796
Modest and sustained decreases in blood pressure and cholesterol levels reduces the lifetime risk of developing fatal heart and circulatory diseases, such as heart attack and stroke, according to research part-funded by the British Heart Foundation (BHF) and supported by the National Institute for Health Research (NIHR).
The findings are being presented at the European Society of Cardiology (ESC) Congress in Paris and published in the Journal of the American Medical Association (JAMA).
Researchers have found that a long-term reduction of 1 mmol/L low-density lipoprotein (LDL), or ‘bad’ cholesterol, in the blood with a 10 mmHg reduction in blood pressure led to an 80 per cent lower lifetime risk of developing heart and circulatory disease.
This combination also reduced the risk of death from these conditions by 67 per cent.
The team found that even small reductions can provide health benefits. A decrease of 0.3 mmol/L LDL cholesterol in the blood and 3 mmHg lower blood pressure was associated with a 50 per cent lower lifetime risk of heart and circulatory disease.
Scientists have previously found that lowering both blood pressure and the amount of ‘bad’ cholesterol in the blood are two ways which can prevent the onset of heart and circulatory disease. However, the risk, which accumulates over time, has not been quantified before.
In this study, Professor Brian Ference and his team studied 438,952 participants in the UK Biobank, who had a total of 24,980 major coronary events – defined as the first occurrence of non-fatal heart attack, ischaemic stroke or death due to coronary heart disease. They used an approach called Mendelian randomization, which uses naturally occurring genetic differences to randomly divide the participants into groups, mimicking the effects of running a clinical trial.
People with genes associated with lower blood pressure, lower LDL cholesterol and a combination of both were put into different groups, and compared against those without these genetic associations. Differences in blood LDL cholesterol and systolic blood pressure (the highest level that blood pressure reaches when the heart contracts), along with the number of cardiovascular events was compared between groups.
Professor Brian Ference now hopes that these findings can bring about change in the healthcare of people at greater risk of developing heart and circulation complications, and improved guidance for those requiring lifestyle changes.
Professor Brian A Ference, lead researcher of the study at University of Cambridge, said:
Heart and circulatory diseases steal the lives of 168,000 people each year in the UK, which is just greater than the population of the city of Cambridge. It’s vital we do everything possible to help prevent people developing these life-threating conditions.
Even small reductions in both ‘bad’ cholesterol and blood pressure for sustained periods of time can pay very big health dividends, and dramatically reduce the lifetime risk of developing heart and circulatory disease.
We now plan to take the results from this study to create a lifetime cardiovascular risk calculator and to support the development of new prevention guidelines.”
Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation said:
“This research again demonstrates that high blood pressure and raised cholesterol are key risk factors for heart attacks and strokes. But how many of us know our numbers for these, or have made sustained efforts to lower them? Hopefully, the findings reported today that the risk could be reduced by as much as 80 per cent, can act as a motivator for long-term change.
Millions of people are living with untreated high blood pressure or raised cholesterol, both of which can be lowered with lifestyle changes and medication. Huge numbers of heart attacks and strokes can be prevented simply by getting to know your numbers and taking your health into your own hands.
Simple devices are now available for measuring blood pressure. Also, everyone between the ages of 40-74 is eligible for a free NHS health check, which assesses your risk of developing heart and circulatory diseases, and includes cholesterol and a blood pressure reading. It’s important that we all take advantage of this.”
Source: British Heart Foundation
Reviewer: James Ives, M.Psych. (Editor)
Progress in suicide prevention activities in some countries, but much more is needed
The number of countries with national suicide prevention strategies has increased in the five years since the publication of WHO’s first global report on suicide, said the World Health Organization in the lead-up to World Suicide Prevention Day on 10 September. But the total number of countries with strategies, at just 38, is still far too few and governments need to commit to establishing them.
“Despite progress, one person still dies every 40 seconds from suicide,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Every death is a tragedy for family, friends and colleagues. Yet suicides are preventable. We call on all countries to incorporate proven suicide prevention strategies into national health and education programmes in a sustainable way.”
Suicide rate highest in high-income countries; second leading cause of death among young people
The global age-standardized suicide rate [1] for 2016 [2] was 10.5 per 100 000. Rates varied widely, however, between countries, from 5 suicide deaths per 100 000, to more than 30 per 100 000. While 79% of the world’s suicides occurred in low- and middle-income countries, high-income countries had the highest rate, at 11.5 per 100 000. Nearly three times as many men as women die by suicide in high-income countries, in contrast to low- and middle-income countries, where the rate is more equal.
Suicide was the second leading cause of death among young people aged 15-29 years, after road injury. Among teenagers aged 15-19 years, suicide was the second leading cause of death among girls (after maternal conditions) and the third leading cause of death in boys (after road injury and interpersonal violence).
The most common methods of suicide are hanging, pesticide self-poisoning, and firearms. Key interventions that have shown success in reducing suicides are restricting access to means; educating the media on responsible reporting of suicide; implementing programmes among young people to build life skills that enable them to cope with life stresses; and early identification, management and follow-up of people at risk of suicide.
Pesticide regulation: an under-used but highly effective strategy
The intervention that has the most imminent potential to bring down the number of suicides is restricting access to pesticides that are used for self-poisoning. The high toxicity of many pesticides means that such suicide attempts often lead to death, particularly in situations where there is no antidote or where there are no medical facilities nearby.
As indicated in the WHO publication released today, Preventing suicide: a resource for pesticide registrars and regulators, there is now a growing body of international evidence indicating that regulations to prohibit the use of highly hazardous pesticides can lead to reductions in national suicide rates. The best-studied country is Sri Lanka, where a series of bans led to a 70% fall in suicides and an estimated 93 000 lives saved between 1995 and 2015. In the Republic of Korea – where the herbicide paraquat accounted for the majority of pesticide suicide deaths in the 2000s – a ban on paraquat in 2011-2012 was followed by a halving of suicide deaths from pesticide poisoning between 2011 and 2013.
Data quality needs to improve
The timely registration and regular monitoring of suicide at the national level are the foundation of effective national suicide prevention strategies. Yet, only 80 of the 183 WHO Member States for which estimates were produced in 2016 had good quality vital registration data. Most of the countries without such data were low- and middle-income. Better surveillance will enable more effective suicide prevention strategies and more accurate reporting of progress towards global goals.
Note:
On 10 September, WHO, in collaboration with global partners, the World Federation for Mental Health, the International Association for Suicide Prevention and United for Global Mental Health, is launching the 40 seconds of action campaign. The culmination of the campaign will be on World Mental Health Day, 10 October, the focus of which is also suicide prevention this year.
Source: World Health Organisation(WHO)
References:
[1] Assumes one standard age distribution of the population in all countries, to enable comparison between countries[2] World Health Organization (2018). Global Health Estimates 2016: Deaths by cause, age, sex, by country and by region, 2000-2016. World Health Organization, Geneva.
Modest and sustained decreases in blood pressure and cholesterol levels reduce the lifetime risk of developing fatal heart and circulatory diseases, such as heart attack and stroke, according to research part-funded by the British Heart Foundation (BHF) and supported by the National Institute for Health Research (NIHR).
The findings are being presented at the European Society of Cardiology (ESC) Congress in Paris and published in the Journal of the American Medical Association (JAMA).
Researchers have found that a long-term reduction of 1 mmol/L low-density lipoprotein (LDL), or ‘bad’ cholesterol, in the blood with a 10 mmHg reduction in blood pressure led to an 80 percent lower lifetime risk of developing heart and circulatory disease.
This combination also reduced the risk of death from these conditions by 67 percent.
The team found that even small reductions can provide health benefits. A decrease of 0.3 mmol/L LDL cholesterol in the blood and 3 mmHg lower blood pressure was associated with a 50 percent lower lifetime risk of heart and circulatory disease.
Scientists have previously found that lowering both blood pressure and the amount of ‘bad’ cholesterol in the blood are two ways that can prevent the onset of heart and circulatory disease. However, the risk, which accumulates over time, has not been quantified before.
In this study, Professor Brian Ference and his team studied 438,952 participants in the UK Biobank, who had a total of 24,980 major coronary events – defined as the first occurrence of non-fatal heart attack, ischeamic stroke or death due to coronary heart disease. They used Mendelian randomization, which uses naturally occurring genetic differences to randomly divide the participants into groups, mimicking the effects of running a clinical trial.
People with genes associated with lower blood pressure, lower LDL cholesterol, and a combination of both were put into different groups and compared against those without these genetic associations. Differences in blood LDL cholesterol and systolic blood pressure (the highest level that blood pressure reaches when the heart contracts) and the number of cardiovascular events were compared between groups.
Professor Brian Ference now hopes that these findings can change the healthcare of people at greater risk of developing heart and circulation complications, and improve guidance for those requiring lifestyle changes.
Conclusively, limiting or avoiding meals that can increase the level of bad cholesterol is highly recommended. They include fried foods, red meat, baked foods, sausage, bacon, organ meats (liver, kidney), full-fat dairy products (whole milk, full-fat yoghurt, cheese)
Source:
British Heart Foundation
Reviewer:
James Ives
In wealthy countries that have vaccination programs, the Human Papillomavirus (HPV) vaccine has significantly reduced the rate of HPV-related infections.
Researchers at the Université Laval in Quebec who looked at 66 million young men and women found that the problems caused by the virus have significantly decreased across a number of wealthy countries.
The meta-analysis of 65 studies found that, depending on age and diagnosis, rates of HPV infection and genital warts had fallen by between 31% and 83%. The prevalence of precancerous lesions caused by HPV has also decreased since the introduction of the vaccine.
Use of the HPV vaccine is now becoming even more widespread in some countries, which will probably mean a significant drop in cervical cancer rates since this type of cancer is nearly always caused by HPV infection. More than 90% of anal cancers, 70% of oral, neck and throat cancers and more than 60% of penile cancers are all caused by HPV.
Cervical cancer can take as long as 20 years to develop, so the vaccine, which was first introduced in 2006, has not been available long enough for researchers to reliably tell whether HPV-related cancer incidence has fallen. However, the significant decline in infection rates is expected to result in similar falls in the associated cancer incidence.
A number of reviews have shown that the HPV vaccine is one of the safest vaccines available. Receiving the jab can be painful, but the only side effects that tend to be reported are soreness and redness at the injection site and sometimes fainting among adolescents.
The most effective way to combat cervical cancer has so far been screening, but this only flags up tissue that could become cancerous, whereas the vaccine stops the infections that cause this abnormal tissue to develop in the first place.
Since it is not currently possible to screen for HPV-related cancers, the vaccine remains the only way to prevent them from developing.
The vaccine is so effective that it even partially protects unvaccinated people on account of it reducing the prevalence of HPV among the wider population of sexually active people.
As reported in The Lancet, the current study found that rates of the two HPV strains that the vaccine protects against had fallen by 83% among teenage girls and by 66% among young women aged between 22 and 24 years, up to eight years after vaccination.
The incidence of anogenital warts also fell by nearly 70% among teenage girls and by 54% among women aged under 25. Among unvaccinated males, the authors also observed a 48% drop in teenagers and a 32% drop in men aged 20 to 24 years.
The fact that the incidence among unvaccinated men is also dropping shows just how effective the vaccination program is. The incidence of grade 2 cervical neoplasia also fell by half among girls aged between 15 and 19 years and by 31% among women aged 20 to 24 years.
The HPV vaccine needs to be made available across Africa
The vaccine is mainly only administered to women, but in countries where young men were also vaccinated, the protective effects were even greater. However, the vaccine is generally only available in high-income countries, with lower income countries not having yet adopted widespread use among men and women.
Study author Marc Brisson says: “Vaccinating girls in these countries would have the greatest impact on the worldwide burden of HPV-related cancers.”
In Africa, many women are dying from cervical cancer, even though doctors know what causes it and how to prevent it. At least 68,000 cases of cervical cancer arise every year and 46,000 women die as a result of the disease.
In a guest column for AllAfrica, director of Policy and Advocacy for Nigeria Health Watch, Ifeanyi Nsofor, writes that too many women on the African continent die from sexually transmitted diseases where we know the cause and how to prevent it: “This is unconscionable and should not continue.”
Nsofor says there are three approaches that could ensure the success of HPV vaccination in wealthy countries is replicated in Africa and that they must involve multiple stakeholders including health ministries, governments, schools and pharmaceutical companies.
Firstly, many people in Africa, particularly those in rural areas, do not have access to healthcare. A combination of poverty, lack of healthcare access and out-of-pocket payments mean women who need the vaccine are not given it.
If HPV vaccination is going to be made available in Africa, universal health coverage is needed so that people can access healthcare without suffering from financial hardship, writes Nsofor.
Secondly, the cost of a single vaccine is $39 in public facilities and $71 in private facilities, which is not affordable for people living in extreme poverty.
National health insurance schemes and Health Maintenance Organisations (HMOs) in Africa should add HPV vaccination and cervical cancer screening services as components of health plans that can be purchased by families. In the long run, it is cheaper to provide these preventative services than to treat cervical cancer.” Ifeanyi Nsofor
Thirdly, the age at which the vaccine is supposed to be given is an age where the majority of eligible girls are supposed to be in high school. Targeting them would require a combined effort from education ministries, school owners and principals, parents and the girls themselves.
‘It is possible to prevent cervical cancer’ through vaccination
Nsofor says school outreach should begin with communicating the risks of cervical cancer to these stakeholders; they should be educated about its prevalence, causes, prevention, treatment, and prognosis: “Supplemental vaccination campaigns conducted in schools with the permission of school authorities and the consent of parents is a quick way of immunizing all who are eligible.”
Nsofor also thinks cervical cancer screening should be part of the overall approach to disease prevention and that since infected boys can develop cancers of the penis, anus, and pharynx, it is essential that they are also vaccinated to ensure that men who have sex with men are also protected.
The United Kingdom has shown that it is possible to prevent cervical cancer by deploying nationwide HPV vaccination. It is inexcusable to allow women (and men) to die from preventable diseases. African governments must show leadership by replicating the UK programme across the continent.”
Source: Sally Robertson, B.Sc.
Review: Kate Anderton, B.Sc. (Editor)
Picture: CNK02 | Shutterstoc
Journal reference:
Drolet, M., et al. (2019). Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. The Lancet. DOI: https://doi.org/10.1016/S0140-6736(19)30298-3.
Centers for Disease Control and Prevention (CDC) provides basic information and statistics about some of the most common cancers in the United States.
1. Bladder Cancer
Bladder cancer risk factors include smoking, genetic mutations, and exposure to certain chemicals.
2. Breast Cancer
Getting mammograms regularly can lower the risk of dying from breast cancer. Talk to your doctor about when to start and how often to get a screening mammogram.
3. Colorectal Cancer
If you are 50 years old or older, get screened. Screening tests can help prevent colorectal cancer or find it early, when treatment works best.
4. Head and Neck Cancers
Cancers of the head and neck include cancers that start in several places in the head and throat, not including brain cancers or cancers of the eye.
5. Kidney Cancer
Smoking is the most important risk factor for kidney and renal pelvis cancers. To lower your risk, don’t smoke, or quit if you do.
6. Liver Cancer
To lower your risk for liver cancer, get vaccinated against Hepatitis B, get tested for Hepatitis C, and avoid drinking too much alcohol.
7. Lung Cancer
Lung cancer is the leading cause of cancer death in the United States. The most important thing you can do to lower your lung cancer risk is to quit smoking and avoid secondhand smoke.
8. Lymphoma
Lymphoma is a general term for cancers that start in the lymph system. The two main kinds of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma.
9. Myeloma
Myeloma is a cancer of the plasma cells. In myeloma, the cells grow too much, forming a mass or tumor in the bone marrow.
10. Prostate Cancer
Most prostate cancers grow slowly and don’t cause any health problems in men who have them. Learn more and talk to your doctor before you decide to get tested or treated for prostate cancer.
11. Skin Cancer
Skin cancer is the most common cancer in the United States. To lower your skin cancer risk, protect your skin from the sun and avoid indoor tanning.
12. Thyroid Cancer
To lower the risk of thyroid cancer, avoid unnecessary exposure to radiation, including radiation from medical imaging procedures, especially in young children and around the head and neck.
*Gynecologic Cancers
Five main types of cancer affect a woman’s reproductive organs: cervical, ovarian, uterine, vaginal, and vulvar. As a group, they are referred to as gynecologic cancers.
13. Ovarian Cancer
Ovarian cancer causes more deaths than any other cancer of the female reproductive system. But when ovarian cancer is found early, treatment works best.
14. Cervical Cancer
Cervical cancer is highly preventable in most Western countries because screening tests and a vaccine to prevent human papillomavirus (HPV) infections are available.
15. Uterine Cancer
Uterine cancer is the most common cancer of the female reproductive system.
16.Vaginal and Vulvar Cancers
Vaginal and vulvar cancers are rare, but all women are at risk for these cancers.
Content source: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
* Get your kids vaccinated against Human papillomavirus (HPV)
You can lower your children’s risk of getting cancer later in life by getting them vaccinated against Human papillomavirus (HPV) and helping them make healthy choices.
Human papillomavirus (HPV) is a common virus that is passed from one person to another during sex. It can cause cervical and other kinds of cancer. Some cancers of the vulva, vagina, penis, anus, and oropharynx (back of the throat, including the base of the tongue and tonsils) are caused by HPV.
The HPV vaccine protects against the types of HPV that most commonly cause cancer. Both boys and girls should be vaccinated when they are 11 or 12 years old. The vaccine can be given to teen girls and young women through 26 years and teen boys and young men through 21 years who weren’t vaccinated when they were younger.
*Talk to Your Kids About Smoking and Cancer
Nearly 9 out of 10 people who smoke cigarettes first try them by age 18, and 98% by age 26. In 2018, more than 1 in 4 high school students and about 1 in 14 middle school students had used a tobacco product in the past 30 days. Talk to your children about why you don’t want them to smoke.
Smoke from other people’s cigarettes (secondhand smoke) can cause serious health problems in children and adults, including lung cancer in adults who have never smoked. Don’t expose your children to secondhand smoke.
*Stay safe in the sun
Daily outdoor activities such as going to school, running, walking the dog, and going to the park could predispose your kid to skin cancer. Just a few serious sunburns can increase your child’s risk of skin cancer later in life.
SOURCE: Centres for Disease Control and Prevention
Since its approval in 1995, the opioid tramadol (marketed as ConZip and Ultram) has become a widely prescribed remedy for osteoarthritis and other painful indications, in part because it presents a lesser risk for some side effects and has a lower abuse potential when compared to other opioids. It is currently ranked among the top five prescribed opioids and top 60 prescribed medications in the country.
But as tramadol has grown in popularity so too have documented cases of adverse effects among its users. In a new paper, published August 28, 2019 by Scientific Reports, researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego show that patients who take tramadol are at greater risk for developing hypoglycemia, or abnormally low blood sugar.
The research team, led by senior author Ruben Abagyan, Ph.D., professor of pharmacy, analyzed more than 12 million reports from the FDA Adverse Effect Reporting System (FAERS) and Adverse Event Reporting System (AERS) databases, which chronicle voluntary reports of adverse effects while taking a medication. The period studied ranged from January 2004 to March 2019.
“The impetus was the recent dramatic surge in tramadol popularity and prescriptions,” said first author Tigran Makunts, PharmD, a researcher in Abagyan’s lab. “We wanted to have an objective data-driven look at its adverse effects and bumped into a dangerous, unlisted and unexpected hypoglycemia.”
Recognized adverse drug reactions associated with tramadol include dizziness, nausea, headaches and constipation—all common side effects of opioids. More serious but rarer adverse drug reactions include serotonin syndrome and increased seizure risk. The link to hypoglycemia is relatively new, though it had been previously suggested by case studies and animal model testing.
Hypoglycemia is often related to the treatment of diabetes, but can also occur in persons without diabetes. Untreated, hypoglycemia can lead to serious complications of its own, such as neurocognitive dysfunction, vision loss, greater risk of falls and loss of quality of life.
The researchers also looked at other widely prescribed opioids and similar acting, non-opioid medications, such serotonin and norepinephrine reuptake inhibitors (Cymbalta, Effexor XR) and NMDA receptors (ketamine and memantine). Only tramadol produced a significant risk of developing hypoglycemia in patients. In fact, there was a 10-fold greater risk of hypoglycemia using tramadol than virtually every other opioid. The only other drug identified with comparable effect was methadone, an opioid most commonly used to help persons reduce or quit addictions to heroin or other opiates.
While this study underscores an association between tramadol and hypoglycemia, a large, randomized, controlled clinical trial would be needed to definitively establish causality.
“The takeaway message is to warn physicians about the likelihood of low blood sugar (and/or high insulin content), in particular if the patient is predisposed to diabetes,” said Abagyan, “and to motivate research about the unique molecular mechanism leading to that side effect. It is particularly important for tramadol or methadone that are used widely and, often, chronically.”
More information: Scientific Reports (2019). www.nature.com/articles/s41598-019-48955-y
Journal information: Scientific Reports
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