Informal educational interventions for caregivers of adult cancer survivors

This review study explores the available data relating to the informal education aspects of effective interventions applied in caregivers of adult cancer survivors to maintain their own health and quality of life (QoL) and as such to provide the optimal care to the cancer patient. The implications of these interventions in oncology practice are also discussed. Available data show that, over the last years, a significant proportion of caregivers of cancer survivors are increasingly offered informal education interventions towards the reduction of their burden. More specifically, educational, skills training, and therapeutic counseling interventions seem to positively affect caregivers' well-being and overall QoL. However, based on available data, one cannot generalize these interventions on improving caregivers' outcomes of daily living activities and QoL. As such, available intervention strategies should be further tested and validated in larger samples, whereas novel health promotion educational approaches are expected to be designed to effectively address and comply with the appropriate needs of caregivers of cancer patients.     

beta-Glucans in promoting health: prevention against mutation and cancer

The polysaccharides beta-glucans occur as a principal component of the cellular walls. Some microorganisms, such as yeast and mushrooms, and also cereals such as oats and barley, are of economic interest because they contain large amounts of beta-glucans. These substances stimulate the immune system, modulating humoral and cellular immunity, and thereby have beneficial effect in fighting infections (bacterial, viral, fungal and parasitic). beta-Glucans also exhibit hypocholesterolemic and anticoagulant properties. Recently, they have been demonstrated to be anti-cytotoxic, antimutagenic and anti-tumorogenic, making them promising candidate as pharmacological promoters of health.     

Unravelling the biology of chromatin in health and cancer using proteomic approaches

Introduction: Chromatin remodeling complexes play important roles in the control of genome regulation in both normal and diseased states, and are therefore critical components for the regulation of epigenetic states in cells. Given the role epigenetics plays in cancer, for example, chromatin remodeling complexes are routinely targeted for therapeutic intervention.

Areas covered: Protein mass spectrometry and proteomics are powerful technologies used to study and understand chromatin remodeling. While impressive progress has been made in this area, there remain significant challenges in the application of proteomic technologies to the study of chromatin remodeling. As parts of large multi-subunit complexes that can be heavily modified with dynamic post-translational modifications, challenges in the study of chromatin remodeling complexes include defining the content, determining the regulation, and studying the dynamics of the complexes under different cellular states.

Expert commentary: Impwortant considerations in the study of chromatin remodeling complexes include the complexity of sample preparation, the choice of proteomic methods for the analysis of samples, and data analysis challenges. Continued research in these three areas promise to yield even greater insights into the biology of chromatin remodeling and epigenetics and the dynamics of these systems in human health and cancer.     

Health related quality of life in adult cancer survivors: Importance of social and emotional support

BackgroundAdult cancer survivors (ACS) are at increased risk for developing various comorbid conditions and having poor health-related quality of life (HRQOL) when compared to adults with no history of cancer. The effect of social and emotional support on HRQOL among ACS is not fully elucidated. The purpose of this study was to understand the role of social and emotional support on HRQOL in ACS and to examine if the association between social and emotional support and HRQOL is modified by gender, time since cancer diagnosis, or marital status.MethodsData for this study were obtained from the 2009 Behavioral Risk Factor Surveillance System. Statistical analysis was based on ACS with complete data (n = 23,939) on all variables considered. Multivariable logistic regression models were used to model the association between social and emotional support and indicators of HRQOL (i.e., general health, physical health, mental health, and activity limitation). To examine if gender, marital status, or the number of years since cancer diagnosis modify the association, separate stratified analyses were conducted.ResultsWhen compared to ACS who reported that they Rarely/Never received social and emotional support, those who reported that they Always received were 32 % less likely to report Fair/Poor General health, 23 % less likely to report frequent unhealthy days of Physical health, 73 % less likely to report frequent unhealthy days of Mental health and 38 % less likely to report frequent unhealthy days of Activity limitation. Social and emotional support was positively associated with all four domains of HRQOL among ACS who were female, unmarried, or greater than 5 years since cancer diagnosis, while this positive association was evident only with one or two domains of HRQOL among their corresponding counterparts (i.e., male, married, less than 5 years since diagnosis).ConclusionsSocial and emotional support is an important factor directly related to a better HRQOL, but it is modified by gender, marital status, and time since diagnosis. Findings from this study should inform health care providers about the importance of a support system for ACS in improving their overall quality of life.     

Obesity is underestimated using body mass index and waist-hip ratio in long-term adult survivors of childhood cancer

Objective

Obesity, represented by high body mass index (BMI), is a major complication after treatment for childhood cancer. However, it has been shown that high total fat percentage and low lean body mass are more reliable predictors of cardiovascular morbidity. In this study longitudinal changes of BMI and body composition, as well as the value of BMI and waist-hip ratio representing obesity, were evaluated in adult childhood cancer survivors.

Methods

Data from 410 survivors who had visited the late effects clinic twice were analyzed. Median follow-up time was 16 years (interquartile range 11–21) and time between visits was 3.2 years (2.9–3.6). BMI was measured and body composition was assessed by dual X-ray absorptiometry (DXA, Lunar Prodigy; available twice in 182 survivors). Data were compared with healthy Dutch references and calculated as standard deviation scores (SDS). BMI, waist-hip ratio and total fat percentage were evaluated cross-sectionally in 422 survivors, in who at least one DXA scan was assessed.

Results

BMI was significantly higher in women, without significant change over time. In men BMI changed significantly with time (ΔSDS = 0.19, P<0.001). Percentage fat was significantly higher than references in all survivors, with the highest SDS after cranial radiotherapy (CRT) (mean SDS 1.73 in men, 1.48 in women, P<0.001). Only in men, increase in total fat percentage was significantly higher than references (ΔSDS = 0.22, P<0.001). Using total fat percentage as the gold standard, 65% of female and 42% of male survivors were misclassified as non-obese using BMI. Misclassification of obesity using waist-hip ratio was 40% in women and 24% in men.

Conclusions

Sixteen years after treatment for childhood cancer, the increase in BMI and total fat percentage was significantly greater than expected, especially after CRT. This is important as we could show that obesity was grossly underestimated using BMI and waist-hip ratio.     

Microenterprise in health care and health education

Over the last decade, development aid has increasingly used a more collaborative model, with donors and recipients both contributing ideas, methods and goals. Though many examples of collateral aid projects exist in agriculture, business administration and banking, few have found their way into health care and health education, a typically donor-dominated model. The following case report describes a collateral project in health care education. This case report analyzes data-inducing project proposals, personal interviews and project reports obtained through standard archival research methods. The setting for this joint project was the collaboration between international nongovernmental (NGO) aid foundations and the faculty of a major sub-Saharan African Medical School's Department of Anesthesia. The initial goal of this project was to improve record keeping for all anesthetic records, both in the operating theatres and outside. Analysis of the data was performed using ethnographic methods of constant comparative analysis. The purpose of the analysis was to critically evaluate both the goals and their results in the Department of Anesthesiology. The findings of this analysis suggested that results included not only quality assurance and improvement programs in the department but also advances in the use of critical incidents as teaching tools, hospital-wide drug and equipment utilization information and the initiation of an outreach program to district hospitals throughout the country for similar projects.     

促进电活性微生物产电呼吸能力的方法研究进展

产电呼吸是指电活性微生物(electroactive microorganisms,EAMs)以胞外固体电极作为电子受体的一种呼吸形式,在可再生能源利用和环境修复方面具有广阔的应用前景。能否进一步提高EAMs的产电呼吸能力是相关技术能否从实验室走向实际应用的核心,而提高产电呼吸能力的关键是加强EAMs与胞外固体电极间的电子传递能力。目前总结如何促进EAMs产电呼吸能力的综述文献极少。因此,本文从投加化学试剂、施加物理作用及改造生物基因3个方面总结了现有的促进EAMs产电呼吸能力的方法,介绍了每种方法的优势与缺陷,重点阐述了每种手段的作用机理及促进效果,并从实际应用和机理研究的角度展望了今后的研究方向。     

Daily physical activities and sports in adult survivors of childhood cancer and healthy controls: a population-based questionnaire survey

Background

Healthy lifestyle including sufficient physical activity may mitigate or prevent adverse long-term effects of childhood cancer. We described daily physical activities and sports in childhood cancer survivors and controls, and assessed determinants of both activity patterns.

Methodology/Principal Findings

The Swiss Childhood Cancer Survivor Study is a questionnaire survey including all children diagnosed with cancer 1976–2003 at age 0–15 years, registered in the Swiss Childhood Cancer Registry, who survived ≥5years and reached adulthood (≥20years). Controls came from the population-based Swiss Health Survey. We compared the two populations and determined risk factors for both outcomes in separate multivariable logistic regression models. The sample included 1058 survivors and 5593 controls (response rates 78% and 66%). Sufficient daily physical activities were reported by 52% (n = 521) of survivors and 37% (n = 2069) of controls (p<0.001). In contrast, 62% (n = 640) of survivors and 65% (n = 3635) of controls reported engaging in sports (p = 0.067). Risk factors for insufficient daily activities in both populations were: older age (OR for ≥35years: 1.5, 95CI 1.2–2.0), female gender (OR 1.6, 95CI 1.3–1.9), French/Italian Speaking (OR 1.4, 95CI 1.1–1.7), and higher education (OR for university education: 2.0, 95CI 1.5–2.6). Risk factors for no sports were: being a survivor (OR 1.3, 95CI 1.1–1.6), older age (OR for ≥35years: 1.4, 95CI 1.1–1.8), migration background (OR 1.5, 95CI 1.3–1.8), French/Italian speaking (OR 1.4, 95CI 1.2–1.7), lower education (OR for compulsory schooling only: 1.6, 95CI 1.2–2.2), being married (OR 1.7, 95CI 1.5–2.0), having children (OR 1.3, 95CI 1.4–1.9), obesity (OR 2.4, 95CI 1.7–3.3), and smoking (OR 1.7, 95CI 1.5–2.1). Type of diagnosis was only associated with sports.

Conclusions/Significance

Physical activity levels in survivors were lower than recommended, but comparable to controls and mainly determined by socio-demographic and cultural factors. Strategies to improve physical activity levels could be similar as for the general population.     

Long-term effects of radiation exposure among adult survivors of childhood cancer: results from the childhood cancer survivor study

In the last four decades, advances in therapies for primary cancers have improved overall survival for childhood cancer. Currently, almost 80% of children will survive beyond 5 years from diagnosis of their primary malignancy. These improved outcomes have resulted in a growing population of childhood cancer survivors. Radiation therapy, while an essential component of primary treatment for many childhood malignancies, has been associated with risk of long-term adverse outcomes. The Childhood Cancer Survivor Study (CCSS), a retrospective cohort of over 14,000 survivors of childhood cancer diagnosed between 1970 and 1986, has been an important resource to quantify associations between radiation therapy and risk of long-term adverse health and quality of life outcomes. Radiation therapy has been associated with increased risk for late mortality, development of second neoplasms, obesity, and pulmonary, cardiac and thyroid dysfunction as well as an increased overall risk for chronic health conditions. Importantly, the CCSS has provided more precise estimates for a number of dose-response relationships, including those for radiation therapy and development of subsequent malignant neoplasms of the central nervous system, thyroid and breast. Ongoing study of childhood cancer survivors is needed to establish long-term risks and to evaluate the impact of newer techniques such as conformal radiation therapy or proton-beam therapy.     

Current depression among adult cancer survivors: Findings from the 2010 Behavioral Risk Factor Surveillance System

BackgroundA cancer diagnosis and subsequent treatments constitute a significantly increased psychological burden among cancer patients. This study examined the prevalence of current depression and the risk factors associated with a high burden of depression among cancer survivors in the US.MethodsWe analyzed data from 3550 cancer survivors (aged ≥18 years) and 26,917 adults without cancer who participated in the 2010 Behavioral Risk Factor Surveillance System. Depressive symptoms were assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Participants with a total depression severity score of ≥10 were defined as having current depression. Prevalence and prevalence ratios were estimated by conducting log-linear regression analysis while controlling for potential confounders.ResultsOverall, 13.7% of cancer survivors (vs. 8.9% of adults without cancer, P < 0.001) reported having current depression; the prevalence varied significantly by cancer category. Among cancer survivors, after multivariate adjustment for covariates, cancer diagnosis within a year, being in ‘other’ racial/ethnic group, divorced, separated, widowed, or never married, current or former smoker, or having histories of diabetes, disability, or depression were associated with significantly higher prevalence ratios for current depression; whereas being at an advanced age (≥60 years old), attaining educational levels of >high school graduate, or engaging in leisure-time physical activity were associated with significantly lower prevalence ratios for current depression.ConclusionOur results indicate that cancer survivors are at increased risk of current depression. Targeting cancer survivors at high risk of depressive issues may be especially important for clinical support and interventions aimed at improving mental well-being.     

Sequencing approaches in cancer treatment

Use of sequencing approaches is an important aspect in the field of cancer genomics, where next‐generation sequencing has already been utilized for targeting oncogenes or tumour‐suppressor genes, that can be sequenced in a short time period. Alterations such as point mutations, insertions/deletions, copy number alterations, chromosomal rearrangements and epigenetic changes are encountered in cancer cell genomes, and application of various NGS technologies in cancer research will encounter such modifications. Rapid advancement in technology has led to exponential growth in the field of genomic analysis. The $1000 Genome Project (in which the goal is to sequence an entire human genome for $1000), and deep sequencing techniques (which have greater accuracy and provide a more complete analysis of the genome), are examples of rapid advancements in the field of cancer genomics. In this mini review, we explore sequencing techniques, correlating their importance in cancer therapy and treatment.     

益生菌促进胃肠道健康的机制及应用

人体胃肠道内生活着大量微生物,它们影响着宿主的健康.益生菌是一种活的微生物,对维持肠黏膜屏障功能、调节免疫功能和促进营养物质的代谢吸收等具有重要作用;对肠道菌群紊乱、功能性消化不良、肠胃炎、腹泻、便秘、肠绞痛、肠易激综合征、炎症性肠病以及幽门螺杆菌感染等胃肠道疾病具有良好的应用.本文对益生菌与胃肠道健康的影响作简要概述...     

Risk of prostate cancer among cancer survivors in the Netherlands

BackgroundIn parallel with increasing numbers of cancer patients and improving cancer survival, the occurrence of second primary cancers becomes a relevant issue. The aim of our study was to evaluate risk of prostate cancer as second primary cancer in a population-based setting.MethodsData from the Netherlands Cancer Registry were used to estimate standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for prostate cancer as second primary cancer. The effect of time since first cancer diagnosis, specific first cancer sites, age, and pelvic radiotherapy was taken into account.ResultsOut of 551,553 male patients diagnosed with a first primary cancer between 1989 and 2008, 9243 patients were subsequently diagnosed with prostate cancer. Overall, cancer survivors showed an increased risk (SIR 1.3, 95% CI 1.2–1.3) of prostate cancer. The increased prostate cancer risk was limited to the first year of follow-up for the majority of the specific first cancer sites. More than 10 years after the first cancer diagnosis, only melanoma patients were at increased risk (SIR 1.5, 95% CI 1.2–1.9), while patients with head or neck cancers were at decreased risk (SIR 0.7, 95% CI 0.5–0.9) of being diagnosed with prostate cancer. Patients who underwent primary pelvic radiotherapy for their first cancer had a decreased risk of prostate cancer in the long term (SIR 0.5, 95% CI 0.4–0.6).ConclusionsOur data showed that cancer survivors have an increased prostate cancer risk in the first year following a first cancer diagnosis, which is most likely the result of active screening or incidental detection.