Endometriosis increases ovarian cancer risk

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Adapted from BMJ 27 July 24

Some types of endometriosis can increase the risk of ovarian cancer by almost ten fold.

Endometriosis affects 11% of the female population and causes half of all cases of pelvic pain and female infertility.

A large cohort study from Utah found that women who were diagnosed with endometriosis were 4.2 times more likely to get ovarian cancer over their lifetime than those who had never been diagnosed.

Deep infiltrating endometriosis was associated with a 9.66 fold increased risk compared to superficial peritoneal endometriosis which gave a 2.82 increased risk.

In a separate Dutch study in 2021, Adenomyosis (related to Endometriosis) was also shown to increase cancer risk, the relative risk being 1.5.

My comment: The background risk of a woman developing ovarian cancer is 2%. Many women diagnosed with endometriosis will need surgery to remove it, to divide adhesions and in severe cases may opt for a hysterectomy. If they are having extensive surgery anyway removal of the ovaries seems a very good idea. Screening women for ovarian cancer has been tried and unfortunately has not been found to be successful. I wonder if studies in the subgroup of women with endometriosis is something that will happen in future. Adenomyosis is when the endometrial deposits are located in the uterine muscle and are found at hysterectomy.

Difficult pregnancies can foretell lower maternal life expectancy

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Adapted from BMJ 27 April 2024

A national Swedish cohort study of more than two million women has found that women who have experienced difficult pregnancies can be at higher risk of early death up to 46 years later.

Preterm delivery, small for gestational age, pre-eclampsia, hypertension and gestational diabetes, all were associated with increased mortality risks. The main causes of death were cardiovascular diseases, respiratory disorders and diabetes.

These factors were independent risks for premature mortality. Siblings of the women who had normal pregnancies were not at increased risk of earlier death.

Researchers suggest that women who have experienced these problems consider enhanced health checks, put effort into prevention and get treatment for chronic disease if diagnosed.

JAMA Internal Medicine 2024

EchoSOS: get help fast!

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The EchoSOS phone app is an alert app that you load onto your phone PRIOR to a holiday abroad or before undertaking any sort of adventure activity particularly away from a city.

I found out about this from several readers of the Times who had responded in the comments section about the disappearance of a man in his sixties in a mountainous area of southern France. This follows on from the loss of several other tourists in Mediterranean countries over the summer.

One said that it had saved her life more than once.

It is a free app. You put in your personal details, contact numbers of relatives or friends, your blood group, medical history, allergies and medication. You then allow the app tracking and response permissions.

Should you have a medical or other emergency in your home, city, or outside location, you can press the emergency button. Obviously, you still have to have some sort of signal for this to work.

The app takes note of your details, your location and transfers this to the nearest emergency response number to your current location. This means that you should be able to speak to a relevant dispatcher without the palaver of finding emergency numbers.

Several tourists have died because they have not been able to contact emergency services or have not been able to give their locations if they did. For readers of this blog, many of whom have diabetes, the ability to contact emergency services fast and being able to be located precisely is of even more relevance.

Please pass this information on to anyone that you think will benefit.

Poor sleep duration and poverty worsen outcomes in diabetes

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Adapted from BMJ 23 March 2024

Compared to people who sleep 7 to 8 hours each night, people who slept for five hours or less were more likely to develop type two diabetes. The risk increased in those getting 3-4 hours a night. This risk was present even when people eating a “healthy” diet were compared. This study was done in the UK Biobank participants.

It is already known that night shift workers have an increased rate of metabolic syndrome and cancer. They also have lower life expectancy rates.

If you are sleep deprived, you will also be aware that you tend to eat more, particularly carbohydrate containing foods.

For many people they don’t have a choice over whether they even get the chance to sleep. They may have long commutes, work shifts, work night shifts and have high noise levels when they are trying to sleep either by night or day. A new baby is a particular difficulty especially in the first year of life.

Socioeconomic deprivation is associated with poorer outcomes for many medical conditions. The scale of the problem for those with type one diabetes is stark. A UK study has shown that type ones are diagnosed with sight threatening diabetic retinopathy three times as commonly as those in the least deprived areas.

This could be due to many reasons. Food intake, attendance at clinics, care over injections, education, stress, leisure activities and support. It does point to the fact that changing what you do can make a substantial difference to health outcomes. 80% of the money spent on diabetes is for treating the complications of diabetes rather than on prevention.

What matters most to people in different countries of the world

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Adapted from BMJ 25 May 2024

The World Values Survey Wave 6 2010-14 asked people from many different world countries what mattered the most to them. The topics that they said were grouped into six categories and these were ranked for the countries.

These were ranked in the world overall as being in order: Family, Work, Friends, Leisure Time, Religion and then Politics. How would you have answered?

There were some interesting differences. Almost all countries said that Family was the most important thing to them. Those in the Netherlands said Friends. People from Ghana said Work. Quatar, Egypt and Algeria all said Religion. All of these countries put Family in second place, so Family is still extremely close to people’s hearts all over the world.

Work and Friends seemed to be the most popular second choices.

Work was the next highest priority in Brasil, Ecuador, Peru, Romania, Azerberjan, India, Kyrgystan, Armenia, Thailand, Zimbabwe, Columbia, Mexico, and Uruguay.

Friends were the second highest priority in Argentina, Belarus, Cyprus, Kazakhstan, Poland, Rwanda, Slovenia, Taiwan, Australia, Estonia, Germany, Hong Kong, Japan, New Zealand, Sweden, Russia, Singapore, Spain, Ukraine, USA, China, South Korea, Lebanon, Uzbekistan, Turkey, and Georgia.

When it came to lowest priorities almost all countries agreed that Politics was what they cared about least. The Netherlands, Australia, Estonia, Germany, Hong Kong, Japan, New Zealand, Sweden, China and South Korea all put Religion last.

Leisure Time tended to be on the low end of priority too, but never the lowest.

If you are looking for the most fun, I think that the Netherlands is the place. They ranked Friends, Family and Leisure Time way above Work, Politics and Religion. I don’t know that they would be keen on overtime though!

Other fun prioritising countries are Australia, Estonia, Germany, Hong Kong, Japan, New Zealand, Sweden, Russia, Singapore, Spain, Ukraine, and the USA.

The least fun countries from this survey seem to be Algeria and Ghana. They both rank Work, Religion, and Family ahead of either Friends or Leisure Time.

When comparing my priorities with those in other countries it would seem that the clear winner for me is Uruguay.

What using the Zoe app can do for your health

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Adapted from BMJ 18 May 24

Nature Medicine has published the results of the use of the Zoe METHOD study on 347 people.

They were allocated either general advice on cardiometabolic health or were trained and supported to use the Zoe app for 18 weeks. The Zoe users are trained to individualise their diet with feedback on their gut microbiome and post meal blood glucose and triglyceride levels.

What improved: Triglycerides reduced, weight lowered, waist circumference reduced, energy levels improved, and sleep improved.

What didn’t change: LDL-C concentration, hip circumference, blood pressure and glucose levels.

My comment: I only know one woman who used the Zoe app. She said that as a result she increased the variety and amount of fruit and vegetables she was eating and reduced sugar and starch intake. She had lost weight and felt more energetic. When I answered the Zoe questions myself I was advised that it wasn’t a suitable programme for me due to my irritable bowel syndrome and wheat intolerance as these foods are encouraged as a major part of the diet. It seemed reasonably priced to me and could be a good help for people to understand the effect food has on their metabolism.

Cancer treatment delays double in the past year

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Adapted from BMJ 22 June 24

The risk of death from delays in cancer treatment is rising in the UK. Treatment has been delayed twice as often in 2023 compared to 2022. Workforce shortages are the main reason.

The Royal College of Radiologists say that almost half of cancer treatment centres are experiencing weekly delays. Figures for delay in radiotherapy treatments were 22% in 2022 compared to 43% in 2023.

Cancer Research UK says that 382,000 patients in England missed target treatment rates of 85% within 62 days of an urgent referral since 2015.

97% of Clinical Directors said that workforce shortages were the problem. A delay of a month in treatment raises mortality rate by 10%.

The NHS is short of 1,962 Consultant Radiologists meaning that the workforce is only two thirds of what it need to be. There is a shortage of 185 Clinical Oncologists. There are 15 out of a hundred posts unfilled. It is predicted that the shortages will be 40% and 21% by 2028 if nothing is done to address the problem.

Demand for chemotherapy increased by 6-8%, but the consultant workforce only increased 3.5%. Some regions of the country are much more affected than others.

Cancer Research UK said that health boards had finally caught up with the COVID backlog. Shortages of staff and equipment remain and in April 24 only two thirds of cancer patients began treatment within 62 days of referral.

The NHS is treating a record number of cancer patients. 30% more people with cancer are being treated compared to 2015 figures.

Effective self care for adult ADHD

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Adapted from Human Givens Vol 30 No 2.

Attention Deficit Hyperactivity Disorder now affects 2-5% of people across western populations.

Becker P et al focussed their research on things that people affected could do to lessen the impact of the problem on their lives. Inattention, lack of concentration and impulsivity are the main features of the diagnosis. Rather than use medication, these things can be effective.

Gain self awareness.

Be responsible and learn from the effects of your actions.

Stay active during the day.

Have a schedule to follow.

Remove distractions or move yourself away from them.

Schedule activities for the time of day that suits you best.

To stay organised and on time set alarms and reminders on your phone.

Have supportive relationships with your family and friends.

Consider medication if you are not managing.

Becker P. Self care strategies shown to be useful in daily life for adults diagnosed with ADHD. A systematic review. Issues in Mental Health Nursing. 2023.

Giving babies peanut products between 4 and 6 months of age reduces allergy

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Adapted from BMJ 25 March 23

The incidence of peanut allergy has tripled in recent decades and now affects 2% of the population. Researchers from Southampton University and King’s College London found that peanut allergy could be cut by 77% if peanut products are added to baby’s diets.

They suggest that babies with eczema are started at 4 months and other babies at 6 months. The effectiveness of allergy prevention reduced with every month that peanut introduction was delayed.

Most peanut allergies had developed by the age of one. Professor Gideon Lack said, “there is a narrow window of opportunity to prevent allergy developing.

Mary Feeney, paediatric dietician at King’s College London says, “Breast feeding should still continue. The baby should be developmentally able to take solids. Small amounts of pureed vegetable, fruit or cereals such as baby rice should be introduced first. Once this is established then add peanut butter which has been loosened with a little baby milk. Whole or chopped peanuts should not be used. A heaped teaspoon of peanut butter three times a week is good.”

Unhappy babies make unhappy adults

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Adapted from Human Givens Volume 30 No 2 2023

Frequent or persistent crying in babies after three months of age, and sleeping and feeding problems after six months of age, are associated with an increase in mood disorders in young adulthood.

The affected adults also report less likelihood of social support from friends and contemporaries.

This association was found in data from Finnish and German longitudinal studies. (BMC Psychiatry 2023).

My comment: Looking after a new baby is spectacularly boring, demanding, and relentless. Time seems to slow down to a snail’s pace. Night after night you hope for a better night than the last one, only to face a long day ahead and another long, long night. We don’t know why some babies are easier or worse than others.

Is it personality differences due to genetics? Parenting problems? The wrong milk? Breastfeeding problems? Colic? Heartburn? Why do such miserable babies have a higher chance of becoming miserable adults? Does the fractured sleep of the parents affect how they react to the baby? Does this affect future childhood interactions? Are miserable people just born miserable?