Global medical news in review: August 26-September 1, 2012
medwireNews: A roundup of select stories of interest to US physicians from the Merck Medicus Medical News wire.
Good for the body, bad for the mind?
Contrary to expectations, engagement in vigorous exercise is positively associated with the incidence and prevalence of psychiatric disorders, particularly bipolar II disorder and alcohol dependence, US researchers report.
In a study of data from the National Epidemiologic Survey on Alcohol and Related Conditions, the team found that individuals who engaged in vigorous physical exercise were significantly more likely to be diagnosed with a psychiatric disorder, less likely to achieve remission, and more likely to relapse than nonexercisers.
"This surprising finding may be due to reward-related factors that influence both exercise engagement and the expression of certain psychiatric disorders," suggest Elias Dakwar (Columbia University, New York) and team in the Journal of Clinical Psychiatry .
Model identifies lung-cancer screening candidates
The Liverpool Lung Project (LLP) Risk Model effectively identifies patients at the highest risk for lung cancer within 5 years, who are therefore suitable for computed tomography screening, report John Field (University of Liverpool, UK) and colleagues in the Annals of Internal Medicine.
The authors used two independent case-control studies and a population-based prospective cohort study to validate their model. The studies included questionnaire data from 12,397 participants, with and without lung cancer. From the questionnaires, the researchers extracted information on the five risk factors in the model - smoking duration, history of pneumonia, history of cancer, family history of cancer, and asbestos exposure.
In a decision utility analysis, the LLP Risk Model had a higher ability to discriminate risk across all three data sets than smoking duration or family history of cancer alone.
Galling news about obese children
The recent rise in childhood obesity has led to a dramatic increase in the number of older children and adolescents with gallstones, say Corinna Koebnick (Kaiser Permanente Southern California, Pasadena) and colleagues.
Koebnick and team evaluated the incidence of gallstone disease in 510,816 children aged 10-19 years who were enrolled in an integrated Kaiser Permanente health plan between 2007 and 2009.
In total, 766 children had a diagnosis of gallstones. Using boys in the underweight/normal weight category (below 85th body mass index [BMI]-for-age percentile) as a reference, boys who were overweight (85th-95th BMI-for-age percentile) had a 1.5-fold increased relative risk for gallstones, while those who were moderately obese (95th-1.2x95th BMI-for-age percentile) had a 1.8-fold increased risk, and extremely obese (>1.2x95th BMI-for-age percentile) boys had a three-fold greaterrisk for gallstones.
Similarly, girls who were overweight, moderately obese, and extremely obese had significant 2.7-, 5.8-, and 7.7-fold increased risks for gallstones compared with those in the underweight/normal weight category.
Dump the idealism to drop the pounds for good
To investigate factors associated with long- versus short-term weight loss, Bethany Barone-Gibbs (University of Pittsburgh, Pennsylvania) and colleagues analyzed information collected from 481 overweight or obese postmenopausal women enrolled in the Women on the Move through Activity and Nutrition (WOMAN) Study at baseline and at 6- and 48-month follow-ups.
At 6 months, factors significantly associated with weight loss included decreased intake of desserts, sugar-sweetened drinks, and fried foods, less eating out at restaurants, and increased fish consumption.
At 48 months, decreased dessert and sugar-sweetened drink consumption, but not reduced fried food consumption or eating out at restaurants, were associated with maintenance of weight or further weight loss. Decreased meat or cheese consumption and increased fruit and vegetable consumption were also associated with weight loss at 48, but not 6 months, Barone-Gibbs et al report in the Journal of Clinical Investigation.
With too much pot, kids' brains are shot
Persistent use of cannabis before the age of 18 years can lead to lowered intelligence, attention, and memory capacity in adulthood, show results published in Proceedings of the National Academy of Sciences.
Madeline Meier (Duke University, Durham, North Carolina, USA) and team used data from the Dunedin Study birth cohort in New Zealand to assess the effects of cannabis use. In total, 1037 individuals were followed up from birth to the age of 38 years. The team found that persistent cannabis use or dependence before the age of 18 years (at least once a week) resulted in broad neuropsychologic declines across different domains of function, even after controlling for years of education and use of alcohol or other drugs.
Dense breasts do not increase cancer mortality risk
Elevated breast density is not associated with an increased risk for death from breast cancer, despite being a risk factor for developing the disease, report Gretchen Gierach (National Cancer Institute, Rockville, Maryland) and colleagues.
The team examined data on 9232 women from the US Breast Cancer Surveillance Consortium diagnosed with primary invasive breast carcinoma between 1996 and 2005; 84% of the women were diagnosed with Breast Imaging Reporting and Data System (BI-RADS) density categories 2 or 3 (out of 4).
The team analyzed 60,759 person-years of follow up including 1795 deaths, of which 889 were from breast cancer.
On multivariate analysis, high-density breast tissue was not related to the risk for death from breast cancer or from all causes, at nonsignificant hazard ratios of 0.92 and 0.83, respectively. Results were adjusted for site, age at and year of diagnosis, American Joint Committee on Cancer stage, BMI, mode of detection, treatment, and income, the researchers report in Journal of the National Cancer Institute.
Go easy on the LABA withdrawals
Researchers have urged doctors to be cautious over withdrawal of long-acting beta-2 agonist (LABA) therapy in patients with asthma controlled by this type of bronchodilator in combination with an inhaled corticosteroid (ICS), after finding the approach often results in destabilization of their condition.
A meta-analysis of five available trials in patients aged 15 years or older found that a LABA step-off regimen led to increased asthma impairment, with worsening scores on asthma-related quality of life and asthma control questionnaires, and fewer symptom-free days, report researchers in The Archives of Internal Medicine.
The findings run counter to a recent US Food and Drug Administration labeling change for LABAs, which recommends stepping down LABA therapy once asthma control has been achieved and maintained because of concerns over a higher risk for catastrophic asthma events with LABA therapy.
By Neil Osterweil, medwireNews reporter