No Safe Threshold for Sun or Indoor Tanning Exposure

The American Academy of Dermatology (Academy) recently issued an updated position statement on vitamin D after an updated review of the increasing body of scientific literature on this vitamin and its importance for optimal health.

The Academy continues to recommend that the public obtain vitamin D from nutritional sources and dietary supplements, and not from unprotected exposure to ultraviolet (UV) radiation from the sun or indoor tanning devices, as UV radiation is a known risk factor for the development of skin cancer.

The Academy’s position statement on vitamin D now also states that individuals who regularly and properly practice sun protection, such as the daily use of sunscreen on exposed skin or the wearing of sun protective clothing, may be at risk for vitamin D insufficiency. A higher dose of vitamin D may be necessary for these individuals and others with known risk factors for vitamin D insufficiency, such as those with dark skin, the elderly, photosensitive individuals, people with limited sun exposure, obese individuals or those with fat malabsorption. Therefore, the Academy encourages those with concerns about their levels of vitamin D to discuss options for obtaining sufficient dietary or supplementary sources of vitamin D with their physician.

“The vitamin D position statement supports the Academy’s long-held conviction on safe ways to get this important vitamin – through a healthy diet which incorporates foods naturally rich in vitamin D, vitamin D-fortified foods and beverages, and vitamin D supplements,” stated dermatologist David M. Pariser, MD, FAAD, president of the American Academy of Dermatology. “The updated recommendation for individuals who practice daily sun protection acknowledges that while protecting the skin from the damaging rays of the sun is important, so is maintaining adequate vitamin D levels. Concern about vitamin D should not lead people to forego sun protection, but rather prompt a conversation with their physician about how to ensure adequate and safe vitamin D intake while guarding against skin cancer .”

The Academy’s new position statement notes that the National Academy of Sciences Institute of Medicine guidelines for vitamin D are the standard reference for advising patients on proper minimum intake levels. The currently recommended adequate intake levels established by the Institute of Medicine may be revised upward due to evolving research on the increasing clinical benefit of vitamin D. The statement also notes that the U.S. Department of Agriculture (USDA) Dietary Guidelines discuss a daily total dose of 1,000 IU (International Units) of vitamin D for supplementation of those at-risk for vitamin D insufficiency.

The Academy’s new position statement also asserts that there is no scientifically proven, safe threshold of sun or indoor tanning device exposure that allows for maximum vitamin D synthesis in the skin without increasing the risk of skin cancer. Also, while numerous studies suggest an association between low levels of vitamin D and an increased risk of certain types of cancers and diseases, the Academy emphasizes that the causal relationship of vitamin D to these disease outcomes has yet to be demonstrated with clinical trials.

“It is well documented in the medical literature that unprotected exposure to UV radiation from natural sunlight or indoor tanning devices causes skin damage. There is no current research available that provides a safe limit for sun exposure to maximize vitamin D production that does not put the individuals health at risk for developing skin cancer,” stated Dr. Pariser. “In addition, contrary to some reported information about vitamin D and the prevention of certain cancers and diseases – other than for bone health, we simply need more clinical data to determine what role, if any, vitamin D plays in these conditions.”

The Academy continues to recommend that individuals protect themselves from UV exposure when outdoors, such as seeking shade whenever possible, wearing sunscreen and covering up with a wide-brimmed hat, long sleeves, pants and sunglasses. Also, the Academy urges the public to avoid tanning beds.

For more information about skin cancer, please visit the SkinCancerNet section on www.skincarephysicians.com, a Web site developed by dermatologists that provides the public with up-to-date information on the treatment and management of disorders of the skin, hair and nails.

Source: American Academy of Dermatology


E-petition Urges Congress, President to Create National Diabetes Coordinator Diabetes Efforts of 18 Federal Agencies Must Be Aligned

The National Changing Diabetes Program (NCDP) recently called for the creation of a National Diabetes Coordinator to develop and implement a nationwide strategy to reduce the incidence of diabetes and its devastating complications.

A study commissioned by NCDP showed that 18 of 21 federal agencies impact the disease of diabetes. The coordinator would be responsible for establishing priorities in the fight against diabetes and aligning efforts across all agencies to eliminate duplication and maximize impact.

“While mortality rates of major diseases such as cancer, heart disease and stroke are down, diabetes rates continue to rise,” said Dana Haza, Senior Director of the NCDP, an initiative created by Novo Nordisk to drive systems change at the national and local level. “It is impossible for 18 agencies to coordinate a response without designated oversight and leadership. That’s why we must take immediate action to align all diabetes efforts with a national strategy if we are going to succeed in the fight against this costly and debilitating illness.”

The NCDP launched an e-petition so that the diabetes community can voice its support for new government leadership dedicated to fighting diabetes and pre-diabetes, which cost the nation more than $218 billion each year in medical expenses and lost productivity. The e-petition, which is targeted to Congress and the Obama Administration and is designed to show a groundswell of support for a National Diabetes Coordinator, is available at www.ncdp.com/coordinator.

“There is no doubt that diabetes is an epidemic that needs to be addressed at the highest levels of government,” Haza said. “Today there are 24 million Americans diagnosed with diabetes and another 57 million with pre-diabetes.”

The coordinator would be responsible for developing and implementing a national strategy to reduce the incidence, progression and impact of diabetes by linking government agencies with public and private sector efforts. This coordination would extend across federal and state levels to community public health agencies.

“By harnessing all these government resources, we will be able to increase detection of diabetes and improve the care of those who have the disease, maximize treatment and research into new medicines, and work aggressively to prevent the disease in populations at greatest risk,” said Lana Vukovljak, Chief Executive Officer at the American Association of Diabetes Educators. “All this will be done with an eye toward saving taxpayers money through better alignment of government resources.

Among the NCDP member associations in support of the National Diabetes Coordinator position are The American Diabetes Association (ADA), American Association of Diabetes Educators (AADE), American Association of Clinical Endocrinologists (AACE), American Academy of Family Physicians (AAFP) and American Optometric Association (AOA).

“The social and economic costs of diabetes are staggering to American patients, families, and humanity as a whole. A National Diabetes Coordinator will help ensure coordination of diabetes research, education and outreach efforts across the spectrum of federal agencies.”  – Ted Epperly, MD President, AAFP

“Our hope is that the creation of a National Diabetes Coordinator will provide the leadership necessary to promote and encourage early diagnosis and treatment, and efficiently and effectively reduce the incidence, progression and impact of diabetes – ultimately saving lives, America’s vision and taxpayer resources.” – Peter H. Kehoe, O.D. President, AOA

About Diabetes

Known as the “silent killer,” diabetes is the fifth-deadliest disease in the U.S. In addition to its effects on the nation’s health, diabetes also takes a toll on the economy. The direct and indirect economic costs for diagnosed diabetes, undiagnosed diabetes, pre-diabetes and gestational diabetes in 2007 were an estimated $218 billion, according to a recent Lewin Group study commissioned by NCDP. In 2005, the federal government spent nearly $80 billion on diabetes treatment, with only $4 billion of this amount invested in prevention and health promotion.

Nearly 24 million Americans have diabetes and another 57 million have pre-diabetes. Research shows that a child born after the year 2000 has a one in three chance of developing diabetes, and minority children have a one in two chance of developing diabetes.

Source: National Changing Diabetes Program


New Research Shows that the Proportion of People with Alzheimer’s and Dementia also Rises in the Oldest Age Groups

The number of people with Alzheimer’s and dementia – both new cases and total numbers with the disease -continues to rise among the very oldest segments of the population in contradiction of the conventional wisdom, according to research reported today at the Alzheimer’s Association 2009 International Conference on Alzheimer’s Disease (ICAD 2009) in Vienna.

Previous epidemiological studies have suggested that the number of people with Alzheimer’s and dementia begins to level off and perhaps even go down a bit in people age 90 and above, known as the “oldest old.” This is the fastest growing segment of the population in western countries.

“The number of people affected by Alzheimer’s and dementia is growing at an epidemic pace, and the skyrocketing financial and personal costs will devastate the world’s economies and healthcare systems, and far too many families,” said William Thies, Ph.D., Chief Medical & Scientific Officer at the Alzheimer’s Association. “We must make the fight against Alzheimer’s a priority before it’s too late.”

“However there is hope. There are many drugs in late stage clinical trials for Alzheimer’s that show promise to slow or stop the progression of the disease. This, combined with advancements in early detection, has the potential to change the landscape of Alzheimer’s in our lifetimes. But we need more funding for research to see these possibilities through to completion,” Thies said.

The research reported at ICAD 2009 includes a study of more than 2,100 individuals age 80 years or older in eight municipalities of Varese province, Italy, and a systematic review and collaborative analysis of studies reporting the prevalence of dementia in Europe.

The Monzino 80-plus Study – Dementia Risk Continues to Rise in the “Oldest Old”

Ugo Lucca, head of the Laboratory of Geriatric Neuropsychiatry at the Mario Negri Institute for Pharmacological Research in Milano, Italy, and colleagues conducted a prospective, door-to-door, population-based study of all people age 80 years or older in eight municipalities of Varese province, Italy, roughly 30 kilometers (20 miles) north of Milan (known as the Monzino 80-plus Study). Their goal was to estimate the prevalence (total number with the disease) and incidence (new cases of the disease) of dementia in this population.

The researchers were able to gather information and an initial dementia evaluation for 2,138 individuals. The mean age of the population at that first evaluation was 87.5 years; 74.1% were women. Mean education was 5.1 years, and mean MMSE score was 21.4. After an average follow-up period of three years, of the 1,085 survivors non-demented at baseline, 995 were re-evaluated for dementia.

Prevalence of dementia standardized on the 2008 Italian population was 22.9% and was higher in women (25.8%) than in men (17.1%). Prevalence increased with advancing age:

  • 13.5% at 80-84 years
  • 30.8% at 85-89
  • 39.5% at 90-94
  • 52.8% over 94

The estimated annual incidence of dementia standardized on the 2008 Italian population was 8.6% and was higher in women (9.2%) than in men (7.2%). Incidence also rose with increasing age:

  • 6.0% at 80-84 years
  • 12.4% at 85-89
  • 13.1% at 90-94
  • 20.7% over 94

“Gathering reliable information on such a large number of the ‘oldest old’ makes this one of the largest studies investigating dementia in this age segment of the population,” Lucca said. “This study’s results confirm that Alzheimer’s and dementia are very common among the oldest people in society. We believe this strengthens the need to shift more of the focus of clinical research to this segment of the elderly population.”

According to the researchers, though the rate of women who developed dementia during the follow-up period was higher than in men in this study, no definite conclusion can be drawn about this difference because the number of men in the oldest ages became very small.

Systematic Review of Dementia in Europe – Higher Prevalence in Female “Oldest Old”

The goal of Dr. Emma Reynish, a consultant geriatrician and coordinator of the European Alzheimer’s Disease Consortium from the VictoriaHospital, Kirkcaldy, Scotland, UK, and colleagues at the EuroCoDe (European Collaboration on Dementia) project, was to determine the prevalence of dementia in Europe based on up to date research findings and including data from Eastern Europe. They conducted an extensive literature search using Cochrane review methodologies and compiled a database of all European epidemiological studies in the field up to the present date. 194 articles were identified by the review and 26 studies met inclusion criteria to participate with raw data in the collaborative analysis.

According to the researchers, while dementia prevalence rates for all men and for women up to age 85 confirmed previous findings, age-specific prevalence rates were higher than previously documented in the female “oldest old” age groups, rising to over 50% in those over 95 years.

“Our key findings confirmed that age remains as the single most important risk factor for dementia,” Reynish said. “Nevertheless, due to the lack of data in the oldest old in previous prevalence studies, the prevalence of dementia of women over the age of 85 had been underreported.”

Source: Alzheimer’s Association


More and more children are participating and getting hurt playing sports each year. A new study presented at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting in Keystone, Colorado, (July 9-12) details the benefits and risks of repairing a torn anterior cruciate ligament (ACL) in young athletes under the age of 14.

“The risk of inducing a growth disturbance with early reconstruction of a torn ACL must be balanced against the risk of further knee damage by delaying treatment until closer to skeletal maturity. Our study measured the independent risk factors for and relative risk of meniscal and chondral injuries in pediatric ACL patients,” said author, Theodore J. Ganley, MD, Director of the Sports Medicine and Performance Center for The Children’s Hospital of Pennsylvania and the University of Pennsylvania School of Medicine.

Researchers analyzed the records of 69 patients, 14 years of age and younger who had undergone ACL reconstruction between 1991 and 2005. Data collected included demographics, relevant history (mechanism and side of injury, time from injury to surgery, one or more episodes of instability with activity, use of brace and return to sports), earliest MRI findings and physical exam findings. Operative reports and intra-operative images were also used to classify meniscal and articular cartilage pathology.

All of the patients were counseled as to the benefits and risks of delaying ACL reconstruction and advised to avoid any at-risk activities along with participating in physical therapy prior to their reconstruction. If the decision was made to delay treatment, patients were instructed to wear a custom ACL brace. All patients who underwent the surgery utilized a soft tissue graft with anatomically placed tunnels and fixation devices that did not cross the growth plate. Patients were also followed for a minimum of one-year post-operatively with no growth disturbances being noted.

“In our study, the largest of skeletally immature patients to evaluate independent risk factors, a delay in treatment of more than 12 weeks had about a four-fold increase in irreparable medial meniscus tears, an

11-fold increase in lateral compartment chondral injuries and a three-fold increase in patellotrochlear injuries. Issues with instability in the knee were also increased significantly. Our results highlight and help quantify the risk associated with delaying ACL reconstruction in young athletes and the need for continued injury prevention efforts,” said Ganley.

The American Orthopaedic Society for Sports Medicine (AOSSM) is a world leader in sports medicine education, research, communication and fellowship, and includes national and international orthopaedic sports medicine leaders. The Society works closely with many other sports medicine specialists, including athletic trainers, physical therapists, family physicians, and others to improve the identification, prevention, treatment, and rehabilitation of sports injuries.

Source: American Orthopaedic Society for Sports Medicine


Categories

Archives

Blogroll

Meta