Vitamin D supplementation and breast cancer prevention : a systematic review and meta-analysis of randomized clinical trials

In recent years, the scientific evidence linking vitamin D status or supplementation to breast cancer has grown notably. To investigate the role of vitamin D supplementation on breast cancer incidence, we conducted a systematic review and meta-analysis of randomized controlled trials comparing vitamin D with placebo or no treatment. We used OVID to search MEDLINE (R), EMBASE and CENTRAL until April 2012. We screened the reference lists of included studies and used the “Related Article” feature in PubMed to identify additional articles. No language restrictions were applied. Two reviewers independently extracted data on methodological quality, participants, intervention, comparison and outcomes. Risk Ratios and 95% Confident Intervals for breast cancer were pooled using a random-effects model. Heterogeneity was assessed using the I2 test. In sensitivity analysis, we assessed the impact of vitamin D dosage and mode of administration on treatment effects. Only two randomized controlled trials fulfilled the pre-set inclusion criteria. The pooled analysis included 5372 postmenopausal women. Overall, Risk Ratios and 95% Confident Intervals were 1.11 and 0.74–1.68. We found no evidence of heterogeneity. Neither vitamin D dosage nor mode of administration significantly affected breast cancer risk. However, treatment efficacy was somewhat greater when vitamin D was administered at the highest dosage and in combination with calcium (Risk Ratio 0.58, 95% Confident Interval 0.23–1.47 and Risk Ratio 0.93, 95% Confident Interval 0.54–1.60, respectively). In conclusions, vitamin D use seems not to be associated with a reduced risk of breast cancer development in postmenopausal women. However, the available evidence is still limited and inadequate to draw firm conclusions. Study protocol code: FARM8L2B5L

The Palliative Radiotherapy and Inflammation Study (PRAIS) - protocol for a longitudinal observational multicenter study on patients with cancer induced bone pain

Background: Radiation therapy (RT) results in pain relief for about 6 of 10 patients with cancer induced bone pain (CIBP) caused by bone metastases. The high number of non-responders, the long median time from RT to pain response and the risk of adverse effects, makes it important to determine predictors of treatment response. Clinical features such as cancer type, performance status and pain intensity, and biomarkers for osteoclast activity are proposed as predictors of response to RT. However, results are inconsistent and there is a need for better predictors of RT response. A similar argument can be stated for the development of cachexia; there are currently no predictors that can identify patients who will develop cachexia later in the cancer disease trajectory. Experimental and preclinical studies show that pain, depression and cachexia are related to inflammation. However, it is not known if inflammatory biomarkers can predict CIBP, depression or development of cachexia. Methods: This multicenter, multinational longitudinal observational study will include 600 adult patients receiving RT for CIBP. Demographic data, clinical variables, osteoclast and inflammatory biomarkers will be assessed before start of RT, and 3, 8, 16, 24 and 52 weeks after last course of RT. The primary aim of the study is to identify potential predictors for pain relief from RT. Secondary aims are to explore potential predictors for development of cachexia, the longitudinal relationship between pain intensity and depression, and if inflammatory biomarkers are associated with changes in pain intensity, cachexia and depression during one-year follow up. Discussion: The immediate clinical implication of the PRAIS study is to identify potential predictive factors for a RT response on CIBP, and thereby reduce non-efficacious RT. Patient benefits are fewer hospital visits, reduced risk of adverse effects and more individualized pain treatment. The long-term clinical implication of the PRAIS study is to improve the knowledge about inflammation in relation to CIBP, cachexia and depression and potentially identify associations and mechanisms that can be targeted for treatment. Trial registration: ClinicalTrials.gov NCT02107664 , date of registration April 8, 2014 (retrospectively registered). Trial sponsor: The European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, NTNU, Faculty of medicine and Health Sciences, Trondheim, N-7491, Norway

A gerência da Unidade Básica de Saúde no controle da tuberculose: um campo de desafios

Neste estudo analisamos a gerência das Unidades Básicas de Saúde no controle da Tuberculose em um município do interior de São Paulo. Participaram do estudo 14 gerentes; a coleta dos dados foi realizada por meio de um questionário fechado e uma questão aberta, e também por meio de entrevista com consentimento livre e esclarecido. Para o tratamento dos dados, utilizamos o Programa Statística 8.0 da Statsoft, e para os dados qualitativos, utilizamos a técnica de análise de conteúdo, modalidade temática. Fica explícita uma gerência técnico-burocrática, com debilidades nas dimensões do planejamento e organização das atividades dos serviços de saúde. Assim, os gerentes desta investigação necessitam incorporar aspectos do planejamento e organização como forma de viabilizar a política de controle da TB.En este estudio analizamos el gerenciamiento de las Unidades Básicas de Salud en el control de la Tuberculosis en un municipio del interior de San Pablo, Brasil. Participaron del estudio 14 gerentes. La recolección de datos fue realizada a través de un cuestionario cerrado y una pregunta abierta, más entrevista con consentimiento libre y esclarecido. Para el tratamiento de los datos, utilizamos el programa Statistica 8.0 de la compañía Starsoft; y para los datos cualitativos, se usó la técnica de análisis de contenidos, modalidad temática. Quedó evidenciada una gerencia técnico-burocrática, con debilidad en las dimensiones de planeamiento y organización de las actividades de los servicios de salud. De tal modo, los gerentes que participaron de esta investigación necesitan incorporar aspectos de planeamiento y organización como modo de viabilizar la política de control de la TB.In this study we analyzed the management of Basic Health Units in terms of Tuberculosis (TB) control in a city in the interior of São Paulo state. Fourteen managers participated in the study. A closed questionnaire was administered and an open question was also applied. The interview was carried out after obtaining free and informed consent. Data analysis was performed using the Statsoft software Statística 8.0 and thematic content analysis was used for the qualitative data. It was found there is a clear technical-bureaucratic management, deficient in the activity planning and organization dimensions at the BHU. Hence, health care managers in this study should include management aspects of planning and organization as ways to make TB control feasible

Intraspecific variation in leaf traits facilitates the occurrence of trees at the Amazonia–Cerrado transition

The ability of plant species to adjust key functional traits through intraspecific variation may determine their success in persisting on our planet in the future, especially in unstable habitats, such as the Amazonia–Cerrado transition zone. We assessed intraspecific variation in 12 leaf morphological and anatomical traits for four tree species along a savanna–forest gradient, including rocky cerrado, typical cerrado and woodland savanna. Generally, all evaluated species showed great intraspecific variation. Our findings demonstrate that trees occurring in the woodland savanna are potentially more vulnerable to climate change, while in the cerrado the individuals presented higher tolerance to water deficit and high temperatures. Trees occurring in open-canopy habitats showed smaller stomata, higher stomata and trichome densities, compared to the same species growing in the woodland savanna. In contrast, the individuals in the woodland savanna shift leaf traits to increase resource acquisition (e.g. light), showing higher specific leaf area and larger stomata, compared to cerrado individuals. We have shown that vegetation-induced shifts in leaf morphological and anatomical traits are a major effect in within-species variability, with consequences for persistence and tolerance of species under future climatic conditions

Postnatal depression across countries and cultures : a qualitative study

Background: Postnatal depression seems to be a universal condition with similar rates in different countries. However, anthropologists question the cross-cultural equivalence of depression, particularly at a life stage so influenced by cultural factors. Aims: To develop a qualitative method to explore whether postnatal depression is universally recognised, attributed and described and to enquire into people’s perceptions of remedies and services for morbid states of unhappiness within the context of local services. Method: The study took place in 15 centres in 11 countries and drew on three groups of informants: focus groups with new mothers, interviews with fathers and grandmothers, and interviews with health professionals.Textual analysis of these three groups was conducted separately in each centre and emergent themes compared across centres. Results: All centres described morbid unhappiness after childbirth comparable to postnatal depression but not all saw this as an illness remediable by health interventions. Conclusions: Although the findings of this study support the universality of a morbid state of unhappiness following childbirth, they also support concerns about the cross-cultural equivalence of postnatal depression as an illness requiring the intervention of health professionals; this has implications for future research