Cellulite answers: 10/01/2013

Friday, October 4, 2013

Eating more calories in the morning, rather than evening, assists in overcoming reproductive difficulties

A new study by researchers at the Hebrew University of Jerusalem and Tel Aviv University reveals that eating a good breakfast can have a positive impact on women with problems of infertility.

In recent years, nutritional research has found that our weight is affected not only by the level of calorie intake, but also by the question of when to consume large amounts of calories.

Now, research, conducted by Prof. Oren Froy, director of the Nutrigenomics and Functional Foods Research Center at the Robert H. Smith Faculty of Agriculture, Food and Environment of the Hebrew University, and Ma'ayan Barnea, plus Prof. Daniela Jocabovitz and Dr. Julio Weinstein from Tel Aviv University and Wolfson Medical Center, shows that a big breakfast increases fertility among woman who suffer from menstrual irregularities.

The study examined whether meal times have an impact on the health of woman with menstrual irregularities due to Polycystic Ovary Syndrome (PCOS). PCOS affects approximately 6-10% of woman of reproductive age, disrupting their reproductive abilities. This syndrome creates a resistance to insulin, leading to an increase in male sex hormones (androgens), and can also cause menstrual irregularities, hair loss on the scalp though increase in body hair, acne, fertility problems and future diabetes.

The experiment was carried out at Wolfson Medical Center on 60 women over a 12-week period. The women, from the ages of 25 to 39, were thin with a BMI (body mass index) of less than 23 and suffered from PCOS.

The women were divided into two groups and were allowed to consume about 1,800 calories a day. The difference between the groups was the timing of their largest meal. One group consumed their largest meal, approximately 980 calories, at breakfast, while the other at dinner. Researchers wanted to examine whether the schedule of calorie intake affects insulin resistance and the increase in androgens among woman suffering from PCOS. The women kept records of exactly what they ate.

The findings, recently published in the journal

Clinical Science,

showed improved results for the group that consumed a big breakfast. Glucose levels and insulin resistance decreased by 8%, while the second group ("dinner") showed no changes. Another finding showed that among the "breakfast" group, testosterone (one of the androgens) levels decreased by nearly 50%, while the "dinner" group level stayed neutral. In addition, there was a much higher rate of ovulating woman within the "breakfast group" compared to the "dinner" group, showing that eating a hearty breakfast leads to an increase in the level of fertility among woman with Polycystic Ovary Syndrome.

According to Prof. Froy, "The research clearly demonstrates that indeed the amount of calories we consume daily is very important, but the timing as to when we consume them is even more important."

Insertable ring could prevent HIV in women

Scientists from Northwestern University have developed a new intravaginal ring that they say could help prevent women from being infected with HIV.

The device is easily inserted and remains in place for 28 days, delivering a measured amount of the anti-retroviral tenofovir directly to the site of transmission.

HIV affects an estimated 34 million people around the world. In 2011, 2.5 million people were newly diagnosed, and in sub-Saharan Africa, women make up 60% of people living with HIV/AIDS.

Preventative drugs do exist, but many have proved ineffective, especially in developing countries where financial and cultural barriers interrupt their use.

Previous studies have shown that antiviral drugs can prevent HIV infection, but existing delivery methods often fall short: pills need to be taken daily and in high doses, while vaginal gels have to be applied before each sex act, making them inconvenient.

However, the researchers from Northwestern University believe they have found an answer with their new device.

Visiting associate professor Patrick Kiser, an expert in intravaginal drug delivery, claims the ring is easy to use, long-lasting and extremely effective. He says:

"After 10 years of work, we have created an intravaginal ring that can prevent against multiple HIV exposures over an extended period of time, with consistent prevention levels throughout the menstrual cycle."

Unique construction

The ring successfully prevented transmission of SIV in macaques, and human trials start soon.
Photo credit: Robert R. McCormick School of Engineering and Applied Science, Northwestern University

The ring has a unique polymer construction, which allows its elastomer to swell in the presence of fluid, delivering up to 1,000 times more of the drug than current intravaginal devices.

Based on its success in preventing transmission of simian immunodeficiency virus (SIV) in macaques, the ring - known as a TDF-IVR (tenofovir disoproxil fumarate intravaginal ring) - will be tested in a clinical trial at the Albert Einstein College of Medicine in New York in November.

Sixty women will be fitted with the ring, and the trial will assess its safety and measure how much of the drug is used.

Other drugs could be integrated in the TDF-IVR, such as contraceptives and antiviral drugs, to prevent other sexually transmitted diseases, which Kiser believes could increase user rates.

"The flexibility to engineer this system to deliver multiple drugs and change release rates is extraordinary and could have a significant impact on women's health," he says.

Medical News Today recently reported that HIV in cells were eradicated with an antifungal drug.

Written by Belinda Weber

Thursday, October 3, 2013

Breast cancer: 'critical gaps' found in research

A new study published in the journal Breast Cancer Research has identified 10 "critical gaps" that exist in the research of the disease, which could see the loss of hundreds of thousands of lives if not addressed urgently.

Researchers from the Institute of Cancer Research in London and the University of Dundee have conducted what they say is the most "comprehensive review of breast cancer to have ever taken place," called the Gap Analysis 2013, which has been facilitated by leading UK breast cancer charity Breast Cancer Campaign.

They say the analysis provides information regarding the knowledge and activity needed in order to "prevent, cure and outlive" breast cancer by 2050.

The researchers have identified and prioritized gaps in key areas, including genetics, prevention, diagnosis, treatment and support, which they say if tackled, could have a significant impact on the lives of those affected.

The 10 gaps identified are:

Understanding how genetic changes lead to the development of breast cancer.

Identifying sustainable lifestyle changes, such as diet and exercise, which can reduce the risk of breast cancer, and improved chemoprevention for women at increased risk of the disease.

Targeting breast screening at those who will benefit most through finding accurate and practical ways to calculate a woman's individual risk for breast cancer.

Understanding the molecules and processes that encourage different types of breast cancer to grow, as well as those that allow breast cancer tumors to become resistant to treatments and spread to other areas.

Understanding how cancer cells with different characteristics form within a tumor, why cancer cells sometimes go into hibernation, and why some breast cancers are resistant to treatment from the beginning while others take time.

Developing tests to predict patients' response to chemotherapy or radiotherapy.

Understanding how to use combinations of drugs and other therapies to improve and tailor treatments for each individual.

Developing better ways of using imaging to diagnose breast cancer, track how the disease responds to treatments and monitor its spread throughout the body.

Providing practical and effective support to help people deal with the emotional impacts of breast cancer and the side effects of treatment.

Collecting tumor tissue and blood samples donated by breast cancer patients at different stages of their disease, as well as detailed information of each patient, to help study the disease and develop new treatments.

Solutions to breast cancer research gaps identified

The researchers then identified five "key strategic solutions," which they say will help close the 10 research gaps. These are:

Reverse the decline in resources targeted toward breast cancer research.

Develop a fully cohesive and collaborative infrastructure to support breast cancer research, including access to "appropriate, well annotated clinical material."

Improve the ways in which breast cancer is studied, and identify accurate methods to use in clinical practice to predict patients' response to treatments.

Encourage collaboration between researchers in different scientific fields.

Improve clinical trial design to "better meet the complexity of modern treatment options," and involve patients in this process.

Alastair Thompson, of the University of Dundee and study author, says he believes the impact of the Gap Analysis could be immediate:

"It gives us scientific rationale to change clinical practice. For example, currently, metastatic disease is not biopsied in order to tailor treatment, but this could change the way one in six women are treated and provide hope to women with secondary breast cancer, with limited treatment options."

Plans to overcome breast cancer by 2050

The research has led to a new action plan for Breast Cancer Campaign, called "Help us find the Cures." The action plan sets out a series of targets to help overcome breast cancer by the year 2050.

The charity is aiming for 25% fewer individuals to develop secondary breast cancer by 2020, and by 2030, they hope more than half of those who do develop this will live longer than 5 years.

By 2023, the charity plans to have a "fully cohesive and collaborative" global infrastructure in place to support breast cancer research. This includes the provision of tissue samples and bioinformatics - improving methods for storing, retrieving, organizing and analyzing biological data.

They plan to ensure breast cancer risk is more predictable by 2025, with up to 20% of all breast cancers prevented, and 60% will be diagnosed before they are symptomatic.

Furthermore, they plan that all women diagnosed with breast cancer and people close to them will receive individually tailored information and support to meet their needs.

The organization is aiming for all patients to benefit from individual care and treatment by 2030, and they plan to have identified what causes different tumors to grow and progress.

Baroness Delyth Morgan, chief executive of Breast Cancer Campaign, stresses the importance of acting on the findings of the Gap Analysis:

"We want future mothers, daughters and wives to have their breast cancer prevented, cured or for them to outlive the disease, and hope that together we can achieve this by 2050."

Medical News Today recently reported on a study that suggested the majority of deaths from breast cancer occur in younger women who do not have regular mammograms.

Written by Honor Whiteman

Mothers with prematurely born infants benefited from personal listening sessions with NICU nurses

For most women, childbirth is an intense experience, culminating in the joy of delivering a newborn, swaddled and sweet, resting in the mother's arms within hours. Yet for those who deliver their babies prematurely, the experience is bereft of such bonding, laden with anxiety, confusion, and doubt.

"Having a prematurely born baby is like a nightmare for the mother," explains Lisa Segre, assistant professor in the University of Iowa College of Nursing. "You're expecting to have a healthy baby, and suddenly you're left wondering whether he or she is going to live."

These new moms have a tremendous need for help while they're in the hospital's neonatal intensive care unit (NICU). So, Segre and a longtime NICU nurse, Rebecca Siewert, decided to find out whether women who delivered babies prematurely would benefit from having a nurse sit with them and listen to what they had to say. In a new study, published in the Journal of Perinatology, Segre's research team writes that pre-term baby mothers who participated in a series of personal sessions with a NICU nurse reported lower anxiety and depression symptoms, while their self-esteem improved.

Segre says it's the first proof-of-concept study conducted that enlisted NICU nurses in "listening visits" with mothers of pre-term infants. The research shows that "listening matters," says Segre, who is a psychologist. "These mothers are stressed out, and they need someone to listen to them," she adds.

Some 15 million babies are born prematurely worldwide, of which one million die, according to the World Health Organization (WHO). In the U.S., more than half a million babies are pre-term each year, WHO reports.

The listening visits concept comes from the United Kingdom, where post-partum mothers are screened in the home for depression. In 2007, the British National Institute for Clinical Excellence recommended the visits as an evidence-based treatment for mild to moderate postnatal depression. Segre found similar, positive results in home visits stateside for full-term infants' mothers in a study published in 2010.

But no one had taken the idea into the NICU, much less had the sessions led by hospital nurses. The closest parallel was a study, published in the journal Pediatrics in 2006, which examined whether intervention in the NICU would reduce premature infants' length of stay and better prepare moms and dads to care for the preemies when they took them home. That study did not address mothers' mental and emotional states, and nurses were not involved, Segre says.

Yet the need seems to be there: Last year, a different research team found that when leaving the hospital, 1 in 5 mothers still had elevated depression levels and more than 4 in 10 reported at least moderate anxiety.

The trial at University of Iowa Children's Hospital involved 23 mothers with pre-term infants and ran from 2010 through the first half of last year. The women received an average of five one-on-one sessions lasting about 45 minutes each with Rebecca Siewert, an advanced registered nurse practitioner who has worked in NICUs for three decades and is a co-author on the paper. The mothers chose the setting - their room, an outdoor patio, or the cafeteria. The first sessions generally focused on the birth, in which the women described the emotional roller coaster of giving birth to a baby they hardly saw afterward and whose health was compromised.

"The mothers wanted to tell their birth stories," Siewert recalls. "They wanted someone to understand what it felt like for their babies to be whisked away from them. They were very emotional."

Subsequent sessions allowed the mothers to focus on themselves and their needs, which many tend to consider subsidiary or perhaps even trivial when compared to their newborns' plight, Siewert maintains.

"A lot of times they suffer in silence because they don't want to sound as if they're weak and not doing well, and because all the focus is on the baby, they become secondary," says Siewert, an associate clinical professor in the College of Nursing.

"But the mother needs to be healthy to be able to take that baby home and for that baby to do well."

The mothers' depression level dropped from a mean of 14.26, considered elevated as measured by the Edinburgh Postnatal Depression Scale, before the listening visits to a mean of 9.00, below the standard for professional help, after the sessions ended. Anxiety levels also fell, from a mean of 16.57 as measured by the Beck Anxiety Inventory to a mean of 9.13, according to the study. Both drops are considered statistically significant, the authors write.

The participants also felt better about themselves and their situation, according to the Quality of Life, Enjoyment and Satisfaction Questionnaire they filled out before and after the listening sessions. A follow-up assessment one month after the last listening visit showed further declines in depression and anxiety on average, and higher quality of life feelings.

The trial has sparked debate whether nurses, rather than mental-health professionals, should be the first line of help for post-natal mothers. Segre acknowledges the study is preliminary and would like to test the results in a larger randomized controlled trial.

Still, she and Siewert think nurses are well suited for the job.

"Listening is what nurses have done their whole career," Siewert says. "We've always been the ones to listen and try to problem solve. So, I just think it was a wonderful offshoot of what nursing can do. We just need the time to do it."

Extended follow-up of hormone therapy trials does not support use for chronic disease prevention

Extended follow-up of the two Women's Health Initiative hormone therapy trials does not support use of hormones for chronic disease prevention, although the treatment may be appropriate for menopausal symptom management in some women, according to a study in the October 2 issue of JAMA.

The hormone therapy trials of the Women's Health Initiative (WHI) were stopped after investigators found that the health risks outweighed the benefits. Menopausal hormone therapy continues in clinical use, but questions remain regarding its risks and benefits over the long-term for chronic disease prevention, according to background information in the article.

JoAnn E. Manson, M.D., Dr.P.H., of Brigham and Women's Hospital, Boston, and colleagues provide a comprehensive, integrated overview of findings from the two WHI hormone therapy trials with extended post-intervention follow-up and stratification by age and other important variables. The study included 27,347 postmenopausal women, ages 50 through 79 years, who were enrolled at 40 U.S. centers in 1993. Women with an intact uterus received conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) (n = 8,506) or placebo (n = 8,102). Women with prior hysterectomy received CEE alone (n = 5,310) or placebo (n = 5,429). The intervention lasted a median [midpoint] of 5.6 years in the CEE plus MPA trial, and 7.2 years in the CEE alone trial, with 6-8 additional years of follow-up until September 30, 2010.

The researchers found that overall, the risks of CEE+MPA during intervention outweighed the benefits. Risks were increased for coronary heart disease, breast cancer, stroke, pulmonary embolism, dementia (in women 65 years of age and older), gallbladder disease, and urinary incontinence. Benefits included decreased hip fractures, diabetes, and vasomotor symptoms. Most risks and benefits dissipated postintervention, although some elevation in breast cancer risk persisted during follow-up.

For CEE in women with prior hysterectomy, the benefits and risks during the intervention phase were more balanced, with increased risks of stroke and venous thrombosis, reduced risk of hip and total fractures, and a nonsignificant reduction in breast cancer. Post-intervention with CEE, a significant decrease in breast cancer emerged and most other outcomes were neutral. For CEE alone, younger women (age 50-59 years) had more favorable results for all-cause death and heart attack.

Neither regimen affected all-cause mortality.

"In summary, current WHI findings based on results from the intervention, postintervention, and cumulative posttrial stopping phases do not support the use of either estrogen-progestin or estrogen alone for chronic disease prevention," the authors write.

"Even though hormone therapy may be a reasonable option for management of moderate to severe menopausal symptoms among generally healthy women during early menopause, the risks associated with hormone therapy, in conjunction with the multiple testing limitations attending subgroup analyses, preclude a recommendation in support of CEE use for disease prevention even among younger women. Current findings also suggest caution when considering hormone therapy treatment in older age groups, even in the presence of persistent vasomotor symptoms, given the high risk of coronary heart disease and other outcomes associated with hormone therapy use in this setting."

Editorial: The Women's Health Initiative - A Victory for Women and Their Health

"Twenty-two years following its inception, the WHI is a model for publicly funded rigorous, thorough, and objective clinical trials that have broadly affected human health. More than 160,000 women participated (many with great pride), more than 900 peer-reviewed reports from the WHI Publications and Presentations Committee have been published, the WHI data set is publically available, and scores of trainees have been mentored in fields from human biology to public health by participating in its analysis. The WHI has overturned medical dogma regarding the use of menopausal hormone therapy," writes Elizabeth G. Nabel, M.D., of Brigham and Women's Hospital, Boston, in an accompanying editorial.

"The WHI underscores the decisive importance of taxpayer-funded research conducted by the National Institutes of Health (NIH). Further reductions in the NIH budget virtually ensure that vitally important studies like the WHI will not be conducted, and hence, U.S. society will be poorly served. The fact that the public sector undertook this historic project (and that the researchers whose work is now reported have taken it to its next stage) has moved medical science forward by the most effective means of doing so - shattering prior dogma. For that, women and all patients whose health depends on sound science are grateful."