Exercise Can Now Be Prescribed Like Medicine for Cancer Patients

It is well known that regular exercise can help prevent and treat many forms of heart disease, but less commonly known are the benefits of physical activity for cancer patients.

A new initiative called Moving Through Cancer — led by Dr. Kathryn Schmitz, professor of public health sciences at Penn State College of Medicine, and an international team of health practitioners and researchers — is hoping to change that.

According to the researchers, exercise is important for cancer prevention, as it can lower the risk of developing colon, breast, endometrial, kidney, bladder, esophagus and stomach cancers.

Exercise during and after cancer treatment can also help improve fatigue, anxiety, depression, physical function, and quality of life and can also help increase survival rates after a breast, colon or prostate cancer diagnosis.

In their new paper published in CA: A Cancer Journal for Clinicians, Schmitz and her team outline new exercise recommendations for people living with and beyond cancer.

“With more than 43 million cancer survivors worldwide, we have a growing need to address the unique health issues facing people living with and beyond cancer and better understand how exercise may help prevent and control cancer,” said Schmitz, who is also a member of the Penn State Cancer Institute.

“This esteemed, multidisciplinary group of leaders on the forefront of exercise oncology aimed to translate the latest scientific evidence into practical recommendations for clinicians and the public and to create global impact through a unified voice.”

Depending on each patient’s activity levels and abilities, the researchers generally recommend 30 minutes of moderately intense aerobic exercise three times a week and 20 to 30 minutes of resistance exercise twice a week.

But, Schmitz said health care professionals can also customize exercise prescriptions to individual patients.

“Through our research, we’ve reached a point where we can give specific FITT exercise prescriptions — which means frequency, intensity, time and type — for specific outcomes like quality of life, fatigue, pain and others,” Schmitz said.

“For example, if we’re seeing a head and neck cancer patient with a specific set of symptoms, we could give them an exercise prescription personalized to them.”

Schmitz said the recommendations will help with one of the premier goals of Moving Through Cancer: raising public awareness about the benefits of exercise for people living with and beyond cancer by 2029.

“Currently, an average person on the street will know that exercise is good for preventing and treating heart disease, but not for melanoma,” Schmitz said.  “We want to change that. When researchers in the 1950s built an evidence base for exercise and heart disease, there was a shift in public knowledge about that connection. It’s now time for the same thing to happen with exercise and cancer.”

Schmitz said the second piece of the initiative is resources and programs to help get cancer patients moving. The Moving Through Cancer website has an exercise program registry that can help patients, families, health care providers and others find programs near them.

The final piece is policy, Schmitz said, which could be used to increase the chances that health care professionals will talk to their patients about exercise and that patients will be adequately referred as they move through cancer.

“This is the center of my professional heart,” Schmitz said. “My mission for a decade now has been that I want exercise to be as ubiquitous in cancer care as it is in cardiac disease care, only better. The new recommendations and guidance are a tool that can help make that a reality.”

Source: Penn State

Solitary Confinement Tied to Greater Risk of Death After Prison Release

Prisoners who are held in restrictive housing (i.e., solitary confinement) face an increased risk of death after their release, according to a new study led by researchers from the University of North Carolina (UNC) at Chapel Hill.

The findings show that incarcerated individuals who were placed in restrictive housing in North Carolina from 2000 to 2015 were 24% more likely to die in the first year after their release, compared to those who were not held in restrictive housing.

In addition, those held in restrictive housing were 78% more likely to die from suicide, 54% more likely to die from homicide, and 127% more likely to die from an opioid overdose in the first two weeks after their release.

Further, the number of restrictive housing placements and spending more than 14 consecutive days in restrictive housing were associated with an even greater increase in the risk of death and reincarceration.

“For the first time ever, using data shared with us from our partners at the North Carolina Department of Public Safety, we’ve been able to demonstrate a connection between restrictive housing during incarceration and increased risk of death when people return to the community,” said lead author Lauren Brinkley-Rubinstein, PhD, an assistant professor of social medicine in the UNC School of Medicine.

“In addition, our study found that the more time people spent in restrictive housing the higher the risk of mortality after release. This study provides empirical evidence to support ongoing nationwide reforms that limit the use of restrictive housing.”

“North Carolina is a leader in this thinking as the Department of Public Safety has preemptively implemented multiple reforms that have resulted in the limited use of restrictive housing.”

“We appreciate this research collaboration and recognize the importance of these results in shaping policy and practice,” said Gary Junker, PhD, Director of Behavioral Health for the N.C. Department of Public Safety Adult Correction and Juvenile Justice.

“Since 2015, the department has initiated several programs to divert people from restrictive housing, including Therapeutic Diversion Units for those with mental illness. While safety and security must remain our top priority, we recognize that reduced use of restrictive housing will likely improve post-release outcome.”

These findings, published in the journal JAMA Network Open, are from a retrospective cohort study conducted by Brinkley-Rubinstein and co-authors from UNC, Emory University, the N.C. Department of Public Safety and the N.C. Department of Public Health.

Incarceration data for people who were confined in North Carolina between 2000 and 2015 were matched with death records from 2000 to 2016.

“We also found that non-white individuals were disproportionately more likely to be assigned to restrictive housing than their white counterparts,” said co-author Shabbar Ranapurwala, PhD, MPH, an assistant professor of epidemiology in the UNC Gillings School of Global Public Health and a core faculty member of the UNC Injury Prevention Research Center.

“In fact, the mortality and reincarceration outcomes after release were also quite different between these racial groups. The post-release opioid overdose and suicide death outcomes among those receiving restrictive housing were more pronounced among white individuals compared to non-whites, while the all-cause and homicide death and reincarceration outcomes were higher among non-white Americans compared to whites.”

Given the observational nature of the study, establishing cause and effect may be difficult, yet, the strength and consistency of the findings points to the fact that restrictive housing is an important marker of increased mortality risk among formerly incarcerated individuals.

Source: University of North Carolina Health Care

Two-Year-Olds From Poor Neighborhoods More Likely to Have Language Difficulties

Two-year-olds from disadvantaged backgrounds are three times more likely to develop difficulties with language than those from more affluent areas, according to a new Scottish study published in the journal JAMA Network Open.

Researchers say the findings highlight the need for policy makers to address the social factors that can hinder speech, language and communication (SLC) development.

Failing to do so means children might not fully develop the language skills necessary for emotional development, wellbeing and educational and employment opportunities.

“Growing up in a disadvantaged neighbourhood where there is poverty and reduced access to services is closely associated with problems with preschool language development,” said Professor James Boardman of Neonatal Medicine at the University of Edinburgh’s MRC Centre for Reproductive Health.

“These results suggest that policies designed to lessen deprivation could reduce language and communication difficulties among pre-school children.”

For the study, a research team from the University of Edinburgh and NHS Lothian in Scotland looked at more than 26,000 records of children who had received a routine health review between 27 and 30 months between April 2013 and April 2016.

The findings show that two-year-olds living in the most economically deprived neighborhoods were three times more likely to have SLC concerns compared to those brought up in better-off areas.

It is believed that growing up in neighborhoods with low income and unemployment — which is related to problems with education, health, access to services, crime and housing — can increase the risk of setbacks.

The researchers also discovered that being born prematurely had an impact on language issues. The findings show that each week a child spent in the womb from 23 to 36 weeks was associated with an 8.8% reduction in the likelihood of the children having an SLC concern reported at 27 months.

A pregnancy is considered full term between 39 weeks and 40 weeks, 6 days, while preterm birth is defined as delivery before 37 weeks of gestation. Socioeconomic disadvantage has also been associated with a greater risk for preterm birth.

Although the research team looked at birth data from children born in the Lothians, experts say similar results might be expected across the United Kingdom.

Source: University of Edinburgh

How Partisan Hate Leads People to Believe Lies

A recent study sheds new light on why people who frequently watch partisan news outlets are more likely to believe falsehoods about political opponents.

And contrary to popular opinion, it isn’t because these individuals live in media “bubbles” where they aren’t exposed to the truth. Rather, it is tied to the way in which partisan media outlets promote hostility against their “rivals.”

For the study, researchers from Ohio State University analyzed data from the 2012 and 2016 presidential elections and discovered that Americans who consumed more partisan media had stronger negative feelings than others toward political opponents.

This dislike was linked to greater belief in misperceptions about those from the “other side.”

“Partisan news outlets promote a feeling of animosity toward the other side and that animosity can help explain inaccurate beliefs,” said Dr. R. Kelly Garrett, lead author of the study and professor of communication at Ohio State.

“As people grow increasingly hostile towards those with whom they disagree, our study found they are more likely to believe false information about them.”

The results suggest that the link between partisan media use, hostility and belief in falsehoods was more pronounced among Republicans than among Democrats. Garrett said this finding was “provocative,” but that this data alone isn’t enough to prove that association.

But the findings, published online in the Journal of Communication, do offer a grim warning.

“If this (partisan) hostility translates into a willingness to believe anything that members of your party tell you, regardless of empirical evidence or claims made by those not belonging to the ingroup, then the U.S. political situation is dire,” the study authors wrote.

Two surveys were designed and carried out by Garrett and his team.

During the 2012 presidential election campaign, 652 Americans were interviewed online three times: near the beginning and middle of the campaign and right after the election.

During each wave of the study, the participants were asked about how often they used partisan news outlets to get information about the presidential candidates, Democrat Barack Obama and Republican Mitt Romney. They also rated how favorably they felt about each candidate on a scale of 0 to 10.

In addition, the respondents rated on a scale of 1 (definitely false) to 5 (definitely true) whether they believed four statements about Obama and four statements about Romney that were false but had been reported in partisan media outlets.

One of the statements about Obama was that he is a socialist and one about Romney was that he believes Mormon Church leaders (Romney is Mormon) should play a defining role in national affairs.

The findings show that the more any individual Republican in the study consumed conservative media outlets, the more that he or she disliked Obama and the more that he or she believed untruths about Obama.

There was no similar finding among Democrats who used liberal media, but Garrett warns against making too much of that finding. For example, it is possible that the differences found between Republicans and Democrats could be connected to the falsehoods chosen for this study.

The study of the 2016 election involved 625 participants who were also interviewed three times during the course of the election season. But in this case, the team focused on just one issue in which partisans on both sides had closely matched misperceptions: Russian interference in the election.

Investigations at that time showed evidence of Russian hacking into email accounts of the Democratic Party, but there was no conclusive evidence one way or the other about any coordination with the Trump campaign.

The interviewers asked respondents if the investigation had confirmed coordination between Russian intelligence and the Trump campaign (a liberal falsehood) or confirmed no coordination (a conservative falsehood). The participants could also choose that there was no conclusive evidence at the time, which was the true statement.

The findings were similar to the first study. Those who consumed more conservative media showed greater dislike than others of Democratic candidate Hillary Clinton and were more likely to believe the misperception that investigators had cleared Trump of coordination.

Again, there was no similar finding among those who consumed more news from liberal media outlets.

“The fact that we found the same difference between liberal media use and conservative media use in 2016 as we did in 2012 is provocative,” Garrett said. “It merits more careful scrutiny. We think these results provide a useful step forward. But it would be a mistake to treat this issue as settled.”

Garrett said the study helps fill the void left behind after research showed that most people aren’t viewing only news that supports their side.

“We used to think that if we could just expose people to all the information out there, the truth would emerge. The problem is that we now have a lot of evidence that people don’t live in bubbles — they may consume more media from one side, but they aren’t avoiding everything else,” he said.

“Our results suggest an alternative reason why partisan media viewers believe misperceptions.”

The findings also suggest that partisan media can help promote belief in falsehoods about political opponents without even mentioning the misperceptions themselves.

“Encouraging hostility toward political opponents has the same effect,” Garrett said.

Source: Ohio State University

 

Many Food-Insecure Families Also Lack Access to Medications

Research has established a link between food insecurity and higher rates of disease, but there is little evidence showing exactly why this occurs. A new study of more than 10,000 Canadian households shows this association may be at least partially attributed to lack of access to prescription medication.

“We knew that negative health outcomes are associated with food insecurity. But we didn’t really understand the mechanism,” said study co-author Dr. Craig Gundersen, distinguished professor of agricultural and consumer economics in the College of Agricultural, Consumer and Environmental Sciences at the University of Illinois in Champaign-Urbana.

The findings, published in the journal CMAJ Open, suggest that people may become ill or get worse because they can’t afford their medications. “For example, we know that there is a close connection between food insecurity and diabetes; it could be the case that part of the reason is medication nonadherence,” he said.

The study draws on data from the Canadian Community Health Survey, conducted annually by the Canadian national statistics office.The researchers evaluated data from 11,172 respondents, combining information on food insecurity with prescription drug use.

Overall, they found that food insecurity affects 12.6% of Canadian households, and 8.5% of respondents reported some form of nonadherence to prescription drugs. Nonadherence includes skipping or reducing doses of medication, as well as delaying or not filling prescriptions because of cost.

The researchers found a strong link between food insecurity and prescription drug nonadherence. Almost half (47.9%) of those who did not adhere to their prescription drug usage also reported some level of food insecurity. Of those who did adhere to their medications, only 10.5% were food insecure.

The findings indicate that nonadherence increases as food insecurity status gets worse. While just 4.9% of food secure households reported nonadherence to prescription drugs, cost-related nonadherence was reported by 13.2% of marginally, 29.4% of moderately, and by 47.1% of severely food insecure households.

Gundersen says that even though the health care system in Canada differs from the United States, there are lessons to learn for Americans in the study. All Canadians have access to health care; however, prescription drugs are covered by a combination of private and public insurance. Over four million Canadians are not enrolled in any drug insurance program.

“The study helps separate the effects of access to medical care from access to prescription drugs,” Gundersen said.

“Even if health insurance is covered, people still face struggles if prescription drugs are not covered. This amplifies the conclusion that illness associated with food insecurity is related to lack of access to medication.”

Source: University of Illinois College of Agricultural, Consumer and Environmental Sciences

 

Study: Suicide Prevention in Less Well-Off Countries Needs Wider Approach

A new study suggests that the treatment and prevention of suicidal behavior in low- and middle-income countries (LMIC) should involve a wider range of approaches beyond just the treatment of psychiatric illness.

There are 800,000 suicide deaths annually, and the vast majority (76 percent) are from LMIC. However, current evidence into suicide prevention is largely based on high-income countries (HIC) and suggests more than 80 percent of suicidal behavior is linked to psychiatric disorders. Prevention initiatives in LMIC have been relatively neglected to date.

The study, published in the journal PLOS Medicine, is the first systematic review of the link between psychiatric disorders, such as depression, anxiety and schizophrenia, and suicidal behavior in LMIC.

“This is the first time we’ve really been able to take an overall look at what we already know about the association between psychiatric morbidity and suicidal behaviour in LMIC,” said Dr. Duleeka Knipe, Elizabeth Blackwell Institute (EBI) Vice Chancellor’s Research Fellow at the University of Bristol Medical School.

“Our analyses show there is a lot of variability between studies and countries, and this suggests there is no one answer, but does support our thinking that psychiatric disorder is perhaps not as important in these settings as in higher income countries.”

“Of course, the treatment of underlying psychiatric illness is important but prevention efforts should also incorporate a wider range of activities which aim to reduce access to lethal means, poverty, domestic violence and alcohol misuse. For example, population level solutions, such as banning highly toxic pesticides, have been shown to be effective in reducing the number of suicide deaths.”

An international research team, comprising experts from the universities of Manchester, Birmingham, Sheffield Hallam, Nottingham, Western Sydney and National Taiwan University, looked at data from 112 studies on 30,030 episodes of non-fatal suicidal behavior and 4,996 suicide deaths in 26 LMIC.

The study, which aimed to address the issue of suicide prevention in LMIC, found 58 percent of suicide deaths and 45 percent of non-fatal suicidal behaviors were linked to psychiatric disorders.

The researchers also found that the proportion of psychiatric disorders in suicidal behavior was highly variable, possibly reflecting between-country differences.

In HIC the treatment of psychiatric disorder is a key focus for suicide prevention, but this study suggests that a wider approach might be needed in LMIC.

“Despite the huge toll of deaths, suicide prevention in LMIC has been relatively neglected to date,” said Dr. Nav Kapur, professor of psychiatry and population health at the University of Manchester and the senior author on the paper. “Of course, we need more research — that much is clear. But we also need to get on and implement solutions based on what we already know.”

Source: University of Bristol