U.S. service members are at high risk of early disability from osteoarthritis due to the job’s extreme physical demands, according to a study in Arthritis and Rheumatism. An estimated 26.9 million American adults have osteoarthritis, the most common form of arthritis in older individuals. The condition is also associated with traumatic joint injuries. From 1999 to 2008, first-time diagnoses of osteoarthritis were recorded in active-duty service members from the Army, Navy, Air Force and Marine Corps. On average, 10,827 cases were diagnosed annually among about 1.4 million service members.
Osteoarthritis rates were 26% higher in members age 20 to 24 than in the general population, and twice as high in those over 40, the study found. Women had 20% higher rates of osteoarthritis than men; blacks had 15% to 26% higher rates than non-blacks.
The Army had the highest rate of osteoarthritis, followed by the Air Force, Marine Corps and Navy. Regular knee and hip bending plus strenuous physical activity likely contribute to higher osteoarthritis rates in service members, the study concludes. More research on risk factors in military populations is recommended.
Caveat: It isn’t known how many cases of osteoarthritis in the study were caused by trauma. Service members may have unique risk and protective factors that limit drawing wider conclusions from the findings, researchers said.
• Allergy and cancer: People who are affected by contact allergies appear to have a reduced risk for certain cancers. However, the risk for developing one type of cancer—of the bladder—was higher among those with the allergies, according to a study in BMJ Open.
About 20% of Europeans are affected by contact, or Type IV, allergies, a delayed response to certain chemicals, such as ones found in cosmetics and poison ivy, and to some metals, such as nickel. Previous studies have looked at possible associations between the more common Type I allergic disorders and the unrestrained cell growth in cancer. But there has been little research into any link between cancer and contact allergies, which involves a different immune-system response than in Type I allergies, the researchers said.
Data from 16,922 Danish patients who underwent patch-testing from 1984 to 2008 showed that 6,065 had at least one positive skin reaction to a contact allergen. Benign tumors or malignant cancers were diagnosed in 3,200, or 19% of patients, and 1,207 or 38% of these individuals had a positive patch test reaction. Contact allergy was associated with a 20% reduced risk for breast cancer and 17% for nonmelanoma skin cancer. But contact allergy was associated with a 44% increased risk of bladder cancer, the analysis showed.
The inverse association between contact allergy and some cancers may be due to an allergy-related hyperimmunity that counters tumor growth, the researchers suggested. Accumulated chemical molecules may explain the increased bladder-cancer risk, they said.
Caveat: The study didn’t account for smoking, although smoking may increase the risk of nickel allergy and some cancers, including bladder cancer, researchers said. The association between specific allergens and cancer types wasn’t considered.
• Masculinity and health: The average American man has a life expectancy of 75.4 years, five years less than a woman, yet men are generally better educated and wealthier than women, advantages associated with longer life. Research published in the Journal of Social Behavior suggests this paradox in men’s health and socioeconomic status is due to traditional beliefs about gender that cause some men to avoid doctors to preserve their sense of manhood and invincibility.
Using a recognized masculinity scale, researchers assessed attitudes toward success, toughness, independence and concealing emotions in 1,045 U.S. men age 65 in 2004. Strong masculine beliefs were found in 304 subjects, termed idealists, while 741 were classed as moderates. In the previous 12 months, 57% of idealists and 64% of moderates received voluntary flu shots, 69% of idealists and 76% of moderates had preventive prostate exams and 71% of idealists and 77% of moderates had general-health checkups, the study found. Overall, 35% of idealists and 50% of moderates obtained all three services.
Surprisingly, the rate of preventive-health-care seeking decreased with increased socioeconomic status. Researchers said higher-status men might feel emasculated by placing themselves in a subordinate position of patient or avoid health care as a means of exerting their independence. Such men may also feel they have the resources to remedy any problems that might arise from not seeking preventive care, they said.
Caveat: The subjects grew up in the 1950s and may have stronger opinions about masculinity than more recent generations, researchers said. As the subjects were almost all white and high-school educated, the results may not apply to other populations.
• Nicotine for obesity: Nicotine-based drugs may be useful in controlling obesity and other metabolic disorders, and also help people stop smoking, according to a study in Science.
Smokers often cite depressed appetite and weight control as reasons for not quitting, but the anorexic effects of nicotine aren’t well understood. Researchers at Yale University found that low doses of nicotine or cytisine, a drug that binds to nicotine receptors, reduced body fat in mice by 15% to 20% and food intake by up to 50% but had no effect on water consumption. Research showed the nicotine drugs acted on a brain pathway involved in the regulation of appetite called the hypothalamic melanocortin system. The drugs activated receptors located on pro-opiomelanocortin or POMC cells, a subset of neurons in the hypothalamus.
When mice with the POMC pathway were given nicotine or cytisine, they lost weight whereas mice without the pathway were unchanged. The study found that POMC receptors aren’t the same as those that trigger tobacco cravings. Drugs that target the POMC pathway could limit the weight gain that follows smoking cessation, researchers noted.
Caveat: Nicotine’s effects on the POMC pathway have only been demonstrated in mice
• Circadian hypertension: Taking anti-hypertension medications at bedtime instead of first thing in the morning gives patients with Type 2 diabetes better overall blood-pressure control, especially at night while sleeping, and reduces the risk of cardiovascular complications, according to a study in Diabetes Care.
Nocturnal hypertension, common in diabetes, is considered a better predictor of cardiovascular-disease risk than daytime or 24-hour blood-pressure readings. In a study of 448 residents of Spain with Type 2 diabetes and hypertension, 216 were assigned to take their blood-pressure medications at bedtime and 232 upon awakening. Subjects were recruited from 2000 to 2007 and followed for 5.4 years.
Blood pressure was measured annually or more frequently. Nocturnal blood-pressure control was achieved in 55% of the morning group and 71% of the bedtime group. The morning group had 76 adverse health events compared with 26 in the bedtime group. Of the seven cardiovascular deaths reported, six were in the morning group. Synchronizing treatment to the biology of hypertension is a cost-effective health-prevention strategy, researchers said.
Caveat: The study didn’t specify a specific hypertension medication, limiting the scope of the conclusions to different classes of drugs, researchers said.
• NSAIDs and melanoma: Regular use of aspirin and non-aspirin NSAIDs for five or more years reduced the risk of malignant melanoma by 43% in users compared with non-users, irrespective of previous sunburns. Research, published in the Journal of Investigative Dermatology, also showed that use of aspirin alone reduced melanoma risk by 25%.
But statin use, also assessed in the study, had a neutral effect. Previous studies have suggested that NSAIDs (non-steroidal anti-inflammatory drugs) and cholesterol-lowering statins may reduce melanoma risk but the results were inconsistent.
The association between melanoma and long-term use of statins, NSAIDs and aspirin was assessed in 400 U.S. individuals with melanoma aged 40 and over and 600 healthy controls. Data from patient interviews showed that 4.2% of controls and 1.8% of patients used NSAIDs four to five times weekly, and 43% of controls and 36% of patients had used aspirin in the previous year. The cancer-fighting benefits of NSAIDs were highest after five years, the study found. Ibuprofen was the most commonly used NSAID. The anti-cancer properties of aspirin and NSAIDs may extend to malignant skin cancers, researchers said.
Caveat: Drug doses and the health condition they were prescribed to treat weren’t verified by researchers. As the control group was recruited from the community, it’s possible that preference was given to individuals with greater awareness of health issues, researchers said.
• Appendectomy in kids: Children older than 12 who had their appendix removed by the minimally invasive laparoscopic technique had fewer complications and shorter hospital stays than those who underwent traditional open appendectomy, according to a study in Archives of Surgery comparing the two methods.
About 70% of appendices in the U.S. are removed by laparoscopy, but the procedure only recently became standard surgery in children. Laparoscopic appendectomy (LA) involves three or four small incisions in the abdomen. Open appendectomy (OA) involves a larger incision and longer recovery.
An analysis of appendectomies performed on 7,650 children from Southern California from 1998 to 2007 found that 3,551 had LA and 4,099 had OA. Infection rates were 2.4% for LA and 5.2% for OA. Readmission rates were 3.2% for LA and 4.5% for OA. Perforated, or ruptured, appendices were more likely to be treated with OA (34%) than LA (24%) but hospital stays for patients with perforations averaged five days for LA and 5.7 days for OA. The average age of LA patients was 12.8 years and 10.4 years for OA. The benefits of LA were mainly seen in older children, researchers said.
Caveat: The medical diagnoses and surgical procedures weren’t independently validated. Information about different surgeons’ preferences or experiences with the techniques was not available.
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