Survivors of childhood cancers 4 times more likely to develop post-traumatic stress disorder Young adult survivors of childhood cancers are four times more likely to develop Post-Traumatic Stress Disorder (PTSD) than their control group siblings, a Childhood Cancer Survivors Study has found.

The study focused on 6,542 childhood cancer survivors over 18 who were diagnosed with cancer between 1970 and 1986 and 368 of their siblings as a control group. The study found that 589 survivors, or 9 percent, reported significant functional impairment and clinical distress as well as symptoms consistent with a full diagnosis of PTSD. In comparison, eight siblings, or 2 percent, reported impairment, distress and PTSD symptoms.

The study is published in the May issue of the journal Pediatrics.

"Childhood cancer survivors, like others with PTSD, have been exposed to an event that made them feel very frightened or helpless or horrified," said Dr. Margaret Stuber, a professor of psychiatry and biobehavioral sciences, a Jonsson Cancer Center researcher and first author of the study. "This study demonstrates that some of these survivors are suffering many years after successful treatment. Development of PTSD can be quite disabling for cancer survivors. This is treatable and not something they have to just live with."

Affected survivors reported symptoms such as increased arousal, phobias, startling easily, being hyper vigilant, avoidance of reminders of their cancer diagnosis and treatment, being on edge and suffering extreme anxiety. They also reported that the symptoms kept them from functioning normally.

Other studies have looked for PTSD in childhood cancer survivors while they're still children or adolescents, but the percentage reporting symptoms is far less, about 3 percent, Stuber said.

There could be several reasons for the discrepancy. Today's treatment regimens employ less toxic treatments and rely far less on whole head radiation for brain tumors, causing far less trauma to the young patients. Additionally, the improved supportive care available today may result in fewer physical and cognitive late effects from treatment.

The survivors in Stuber's study often underwent far harsher treatment regimens commonly used in the 1970s and early 1980s, and within the group studied, those that underwent the more toxic and damaging therapies reported more cases of PTSD.

Another possible reason that more of the young adults reported PTSD symptoms is because they're facing the stressful situations typical for people at that age – finding a job, getting married, starting a family. That stress may exacerbate the PTSD, Stuber said.

"It may be that symptoms, clinical distress and functional impairment only emerge among the more vulnerable childhood cancer survivors as they contend with the developmental tasks of young adulthood and the added challenges of the late effects of treatment," the study states. "The relative protection of the parental home is diminished as young adult survivors face the challenges of completing their education, finding a job, getting health insurance, establishing long-lasting intimate relationships and starting a family."

And because many of the patients in the study underwent harsh therapies, they often suffer from significant late effects – infertility, cognitive impairment, stunted growth. This add to stress levels as well. Those that suffer from cognitive impairment may find it impossible to go to college or to land a good job that earns them an adequate income.

"These survivors may find that can't get health insurance. They may be reluctant to put themselves on the marriage market because they're sterile. Those that can have children may be afraid of passing their 'bad genes' onto their children. Some treatments affect growth, so some survivors may be shorter and heavier than their peers," Stuber said. "They may feel like they're damaged goods."

Treatment options such as therapy and medication are available to help the survivors manage their symptoms. But addressing the issue will not be simple, Stuber said.

"People who had more intense treatment are more likely to have these symptoms because their treatment was more traumatic," Stuber said. "And because more damage was done to their bodies, it makes it more difficult to have a good life later. It's all interdigitating." Despite tests, high blood pressure hard to recognize in children A Johns Hopkins Children's Center study of 2,500 patient records suggests that medical staff fails to check a child's blood pressure a fifth of the time, and is not recognizing what constitutes an abnormal reading in those whose blood pressure they do check.

Researchers at Hopkins Children's say the consequences are that pediatricians and nurses may be missing the development of hypertension and its serious consequences, even when they do take blood pressure measurements.

The American Academy of Pediatrics' (AAP) guidelines call for regular blood pressure checks in children 3 years and older to screen for elevated blood pressure, and say elevated blood pressure on three consecutive medical visits qualifies as hypertension. Even a single episode of high blood pressure can indicate hypertension and should trigger repeat measurements during the visit and subsequent doctor visits, the AAP says.

The problem is that measuring a child's blood pressure is far more complicated than it is in adults and requires interpreting each individual measure against a reference table for age, gender and height, says lead investigator Tammy Brady, M.D., M.H.S., a nephrologist at Hopkins Children's.

The researchers analyzed 2,500 records of visits to the pediatrician's office. Medical staff did not check blood pressure in 500 of the cases. Elevated blood pressure scores were recorded in 726 cases of the 2,000 measurements taken, but the implications went unrecognized and unremarked upon in 87 percent of them, the study found.

The findings, to be published in June's Pediatrics and appearing online May 3, underscore the need for better recognition and aggressive monitoring of all children to prevent both the short-term and long-term complications of hypertension, the investigators say.

The study found that medical staff was more likely to miss elevated blood pressures in children of normal weight and in those without a family history of cardiovascular disease. The same was true for those children whose blood pressure was at or below 120/80, a score considered ideal in adults, but one that may portend trouble in a child, depending on height, gender and age.

Blood pressure parameters in adults are clearly defined, but the complicated arithmetic involved in children's blood pressure may be one of the greatest barriers to recognizing a child's elevated pressure, the investigators say.

Brady says more education and automated systems that alert the medical staff if a child's blood pressure is out of range can help. Hopkins Children's is currently testing one such alert system and will soon publish data on its effectiveness.

Hypertension, defined as persistently elevated blood pressure, can cause kidney, eye and heart damage, but while some complications take years and decades to develop, certain ones evolve quickly, the researchers say. A dangerous thickening of the heart muscle called left-ventricular hypertrophy can develop in a matter of months in children with untreated hypertension, but is reversible with early treatment.

Because high blood pressure rarely causes symptoms, medical staff may overlook a child who has no traditional risk factors, such as obesity or family history, the researchers say. Half of the children in the study with elevated blood pressure were normal weight.

"Nurses and doctors may be so falsely reassured by a child's lack of symptoms and risk factors that they either miss milder elevations or may chalk them up to measurement error and never follow up on them," Brady says.

In the study, covering children ages 3 to 20 visiting a primary care pediatric clinic at Johns Hopkins, high blood pressure was discovered in six percent of healthy-weight children and in 20 percent of overweight and obese children. Even though medical staff was more attentive to elevated blood pressure among overweight and obese children, high blood pressure was still missed in four out five of them. Children with scores below 120/80 were nearly eight times more likely to have their high blood pressure missed than children with blood pressure above 120/80. Children without a family history of cardiovascular disease were twice as likely to have their high blood pressure unrecognized as those with family history. Quality-of-life testing may predict malignancy and survival in patients with pancreatic disease Quality-of-life measures used routinely to assess treatment outcomes for patients with pancreatic disease may be used to predict both malignancy and survival for those patients, according to a study by Henry Ford Hospital.

Researchers found that pre-treatment quality-of-life scores could predict malignancy in patients with pancreatic lesions and survival in those who are found to have malignancies.

"Our findings suggest that pretreatment quality-of-life scores may show which patients will have a poor survival and therefore could avoid aggressive, but futile, treatment," says Vic Velanovich, M.D., chief of General Surgery at Henry Ford Hospital and lead author of the study.

Study results were presented May 3 at the Digestive Diseases Week conference in New Orleans.

The study assessed 323 surgical patients with pancreatic lesions who completed the SF-36, a short-form health survey which contains eight domains measuring quality of life including physical functioning, role-physical, role-emotional, bodily pain, vitality, mental health, social functioning, and general health.

Patients with pain related to known chronic pancreatitis were excluded, however, patients with undiagnosed solid or cystic lesions were included. Of those patients, 210 were found to have malignancies.

"Patients with pancreatic malignancies had lower scores than patients with benign pancreatic disease," says Dr. Velanovich. "Patients with non-cancerous lesions were found to have better overall functioning than those with malignancies."

Patients with malignancies surviving less than one year had lower scores, even after controlling for the stage of their disease.

Dr. Velanovich explains that the lower scores may reflect more advanced disease or frailties which identify patients with poor prognoses.

"We were even able to predict from which patients we would be able to surgically remove the cancer entirely and from which patients we would not," says Dr. Velanovich. "Additional studies are needed to confirm whether quality-of-life measures are a reliable way to determine if patients should seek alternative treatment and when to abandon aggressive treatments."

The pancreas is a gland behind the stomach and in front of the spine that produces juices that help break down food and hormones that help control blood sugar levels. Problems with the pancreas can lead to many health problems including pancreatitis, an inflammation of the pancreas and pancreatic cancer. In 2009, an estimated 42,000 new cases of pancreatic cancer and 35,000 deaths were reported, according to the National Institutes of Health. Antibiotic prescriptions in the first year of life increases the risk of pediatric inflammatory bowel disease: a population-based analysis By comparing cases of pediatric IBD and antibiotic use, researchers from the University of Manitoba have discovered that infants who are prescribed antibiotics in the first year of life may be three times more likely to develop lifelong IBD than children not exposed to antibiotics.

Researchers believe that antibiotic use in infants can cause irrevocable impact to developing bowel flora, or bacteria, in the human bowel. Changes or irregularities in bowel flora are thought to be a potential cause of IBD. Bowel flora is established and remains relatively unchanged after one year of age. Taking antibiotics can temporarily change bowel flora, but after, use flora revert back.

Using the University of Manitoba IBD Epidemiological Database (UMIBDED), a database of all Manitobans diagnosed with IBD, researchers identified all children (age 11 and younger) diagnosed with IBD between 1996 and 2008 and cross referenced these records with the Drug Program Information Network, a database of all prescriptions. They compared the prescription records of the children with IBD to a matched cohort database of children without IBD. The control cohort of 360 children was matched to the 36 children diagnosed with IBD on the basis of age, gender and region of residence during diagnosis. Sixty percent of the children with IBD had received one or more prescription antibiotic in the first year of life compared with 39 percent of the control group.

"Our findings suggest that antibiotic use in the first year of life is associated with developing IBD in childhood. It is also possible that children who require antibiotics may for other reasons be predisposed to developing IBD. However, if the use of antibiotics is associated with triggering IBD, it may be by impacting upon bowel flora at a vulnerable point in development," said Charles Bernstein, MD, professor of medicine, head of the section of gastroenterology and director of the University of Manitoba IBD Clinical and Research Center.

He added, "This association may give us cause to think about the overuse of antibiotics in young children, especially those who may be at risk for developing IBD, such as children with siblings who have IBD." Bernstein noted that antibiotic use should not be eliminated in newborns, but should be prescribed more vigilantly.

To confirm this study's findings, more research with another population and larger sample sizes is necessary.

Souradet Y. Shaw, MD, will present these data on Sunday, May 2 at 10:30 a.m. CT in 295-296, Ernest N. Morial Convention Center.

(Abstract #95)

Digestive Disease Week® 2010 (DDW®) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the AGA Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 1 – May 5, 2010 in New Orleans, LA. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. Maternal use of proton pump inhibitors (PPI) during pregnancy is associated with an increased risk for cardiac birth defects The use of common anti-reflux medications during pregnancy may be associated with cardiac birth defects, according to a new study from the University of Pennsylvania School of Medicine.

More than half of all women who become pregnant suffer from gastroesophageal reflux (GERD), better known as heartburn, which can be hard to control during pregnancy. Often symptoms start early in pregnancy when the fetus is most vulnerable to the effects of medications, which can lead to birth defects. Because of the prevalence of GERD during pregnancy, investigators sought to determine the safety of a popular class of anti-reflux medications, proton pump inhibitors (PPIs), on the developing fetus.

Usually, physicians treat pregnancy-related GERD with conservative measures such as advising patients to eat smaller meals, but frequently, these methods are ineffective, which is why physicians are increasingly prescribing PPIs. Since PPIs are relatively new to the market, not much is known about their safety during pregnancy. For example, omeprazole, the most commonly used PPI, is designated as a class C by FDA, which means that animal studies show adverse effects to the fetus, yet there are no adequate studies in humans since those that have been conducted had too small a sample to draw any definitive conclusions.

Researchers performed a nested case-control study within The Health Improvement Network database and looked at medical records from pregnant women in the U.K. from 2000 to 2008. They identified which pregnancies resulted in birth defects and compared the maternal PPI use of these cases with matched pregnancies that did not result in a birth defect.

"We found that PPI use during pregnancy was associated with a doubling in the risk of cardiac birth defects in the newborn," said lead researcher Andrew D. Rhim, MD, the Sir William Osler MD Fellow in Gastroenterology at the University of Pennsylvania School of Medicine. "The lack of association between maternal PPI use and other types of birth defects makes it less likely that our findings are due to confounding."

Dr. Rhim cautioned that cardiac birth defects associated with PPI use, such as ventricular septal defect and Tetralogy of Fallot, are relatively rare. Thus, a pregnant woman taking PPIs should not necessarily assume this will automatically cause birth defects in her baby. He added that patients and physicians need to weigh the possible risks and benefits of anti-reflux treatment on a case-by-case basis, since many women will develop heartburn in pregnancy that can be severe and result in poor quality of life. Of all of the PPIs that researchers looked at, omeprazole was associated with the greatest increase in the risk for having a baby with a cardiac birth defect.

He said the data from the study suggest that H2 receptor antagonists (H2RA), another anti-reflux medication that has been proven to be effective and are considered safe in pregnancy, could be tried before PPIs to minimize potential risks. Then, if symptoms are not controlled by H2RAs, PPIs could be considered next.

Dr. Rhim will present these data on Monday, May 3 at 4:15 p.m. CT in 291, Ernest N. Morial Convention Center.

(Abstract #475b)

Digestive Disease Week® 2010 (DDW®) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the AGA Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 1 – May 5, 2010 in New Orleans, LA. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. Patients with IBS commonly use narcotics Doctors often unnecessarily treat irritable bowel syndrome (IBS) with narcotics. A course of treatment is generally inadvisable because it does not improve functional status and may have adverse long term effects, according to a new study. Women are about twice as likely as men to suffer from IBS.

Researchers, led by Spencer D. Dorn, MD, assistant professor of medicine, University of North Carolina (UNC), surveyed nearly 1,800 patients who had seen a physician for Rome III criteria defined IBS. They looked at demographic characteristics, clinical features including subtype, duration, severity, most troublesome symptom, quality of life, psychological factors such as anxiety and depression, overall satisfaction with care, and medications currently used.

The study, conducted by researchers at the UNC Center for Functional GI disorders and the International Foundation for Functional GI Disorders, found that 325 patients, or 18 percent, reported currently using narcotics. These patients reported more abdominal pain, poorer health quality, more IBS-related limitations, more hospitalizations and surgeries, and that they were more likely to use antidepressants and antacid medications.

"Although narcotics are commonly used, they may have deleterious long term effects, including narcotic bowel syndrome and sometimes drug dependency," said Dr. Dorn. Instead, Dr. Dorn and his UNC colleagues recommend an integrative approach that emphasizes patient education, self management over time, non-narcotic symptom-based therapies, and sometimes antidepressants and/or psychotherapy.

"In the current U.S. health-care system, clinicians often lack the time, infrastructure and incentives needed to provide integrative care to patients with chronic conditions, including IBS," said Dr. Dorn. "Instead, very often physicians take the path of least resistance. Narcotic prescriptions are a quick and easy way to get patients out of their office, even though the long term effects can be harmful." He added that physicians have to resolve to finding better training and incentives to treat patients who would otherwise benefit from more integrative treatments.

Dr. Dorn said the findings are especially important since the U.S. accounts for just 4 percent of the world's population and more than 80 percent of the narcotics prescribed worldwide.

Dr. Dorn will present these data on Monday, May 5 at 8 a.m. CT in Hall F, Ernest N. Morial Convention Center.

(Abstract #W1378)

Digestive Disease Week® 2010 (DDW®) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the AGA Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 1 – May 5, 2010 in New Orleans, LA. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. Inbreeding may have caused Darwin family ills Charles Darwin's worries about possible adverse effects of inbreeding in his family seem to have been justified, according to a study described in the May 2010 issue of BioScience. Darwin married his first cousin, Emma Wedgwood, and his mother, Susannah Wedgwood, was the daughter of third cousins. The study, which extended to 25 families including 176 children, found a statistical association between child mortality and the inbreeding coefficient of individuals in the Darwin/Wedgwood dynasty.

Charles Darwin demonstrated the phenomenon of inbreeding depression in many plants, and was aware of research into the effects of marriage between relatives on the health of resulting children. He feared that his marriage might have been responsible for some of his children's health problems and asked a member of Parliament to add a question about marriages to relatives to the British 1871 census form.

Three of Charles Darwin's 10 children died before reaching adulthood, one from childhood tuberculosis at age 10 and one from unknown causes as an infant. A third child, who died in infancy of scarlet fever, appears in a photograph to have developmental abnormalities. Inbreeding is an important risk factor in a number of human diseases, including infectious diseases. The authors of the study, Tim M. Berra, Gonzalo Alvarez, and Francisco C. Ceballos, suggest that the expression of deleterious genes "produced by consanguineous marriages could be involved in the high childhood mortality experienced by Darwin progeny." Furthermore, three of Darwin's six children with long-term marriages left no offspring. Unexplained infertility may also be a consequence of a consanguineous marriage. On the other hand, three of Darwin's sons were fellows of the Royal Society and were knighted by Queen Victoria.

The complete list of peer-reviewed articles in the May 2010 issue of BioScience is as follows:

Applications of Microarrays for Crop Improvement: Here, There, and Everywhere by David W. Galbraith and Jeremy Edwards

Pest Risk Maps for Invasive Alien Species: A Roadmap for Improvement by Robert C. Venette and colleagues

Why Are Daphnia in Some Lakes Sicker? Disease Ecology, Habitat Structure, and the Plankton by Spencer R. Hall, Robyn Smyth, Claes R. Becker, Meghan A. Duffy, Christine J. Knight, Sally MacIntyre, Alan J. Tessier, and Carla E. Cáceres

Was the Darwin/Wedgwood Dynasty Adversely Affected by Consanguinity? by Tim M. Berra, Gonzalo Alvarez, and Francisco C. Ceballos

Got Hybridization? A Multidisciplinary Approach for Informing Science Policy by Norman C. Ellstrand and colleagues