Toddler naps can impact on night sleep
AUSTRALIAN researchers have found that napping beyond the age of 2 years can affect night sleep, and could impact on behaviour, cognition and physical health in children. The systematic review, published in Archives of Disease in Childhood, included 26 studies examining the effect of napping on children aged 0‒5 years. It found a low volume of evidence on the associations between napping and development and health, with the literature covering a range of outcomes and few using standard, comparable measures. The most consistent finding was an association between napping and night sleep, with sleep onset, duration and quality associated with napping, particularly beyond the age of 2 years as sleep consolidated into the night time. The researchers said the relationship between napping and other child development and health outcomes was less clear. “There is an imperative for increased understanding about individual differences in napping trajectories and, indeed, sleep needs within this age group”, they wrote. “For clinicians treating sleep problems, particularly among preschool aged children, the investigation of napping patterns is indicated.”
Big improvement in cancer survival in younger patients
A 20-year follow-up of more than a million US cancer patients has found significant improvements in survival that were more pronounced for younger patients. The longitudinal analysis of follow-up data from 1990 to 2010, published in JAMA Oncology, included patients diagnosed with cancer of the colon or rectum, breast, prostate, lung, liver, pancreas or ovary. For patients aged 50‒64 years diagnosed from 2005 to 2009, adjusted hazard ratios (HRs) were 0.57, 0.48, 0.61 and 0.32 for cancer of the colon or rectum, breast, liver and prostate, respectively, compared with the same age groups of patients diagnosed in 1990‒1994. Corresponding HRs for elderly patients aged 75‒85 years were 0.88, 0.88, 0.76 and 0.65 for the same four cancer sites, respectively. The researchers wrote that similar, but weaker, age-related improvements in survival were observed for lung and pancreatic cancers. The researchers wrote that the slower improvement in cancer survival among older cancer patients resulted in a widening gap in cancer survival for six of the seven cancers evaluated in the study. “We observed that the age-related gap was most pronounced for cancers with the largest diagnosis and treatment advances during the study period, including colorectal, breast, and prostate cancers”, they wrote. “Our findings are a call to action; future studies should strive to include diverse populations … in order to establish an evidence base for treatment of all patients.”

Practice nurses increase physical activity in older patients
PRIMARY care nurses can safely deliver an intervention that increases objectively measured physical activity levels in older people, which can have appreciable effects on risks of chronic diseases, research has found. The randomised control study, published in PLOS Medicine, included 298 adults aged 60‒75 years who received either standard care or the PACE (pedometer accelerometer consultation evaluation)-Lift intervention aimed at increasing physical activity (PA). A nurse delivered the intervention in four consultations over 3 months, and participants were provided with an individualised PA plan, a PA diary and a pedometer. At each consultation, the nurse used behaviour change techniques, such as goal setting, to encourage participants to walk regularly. PA intensity and duration of both groups were objectively measured at 3 and 12 months using an accelerometer. After 3 months, participants in the intervention group had an average daily step count that was 1037 steps higher than the control group. The intervention group also spent 63 minutes more per week in moderate to vigorous PA bouts lasting 10 minutes or longer. At 12 months, the corresponding differences were 609 steps per day and 40 minutes per week. The authors said this increased physical activity could reduce the risk of heart disease and type 2 diabetes by 5.5% and 9.1% respectively. Adverse effects, including falls or injuries, were similar between groups, and participants found the intervention to be enjoyable. The authors said their results demonstrated that primary care provided “the ideal setting for delivering PA interventions in this age group and the opportunity to integrate this into routine care”. However, future trials needed to distinguish between the different aspects of PA interventions and to test the intervention in socioeconomically diverse populations, the authors wrote.

BP overtreatment deadly in frail elderly patients
NEW research shows low systolic blood pressure (SBP) and combination antihypertensive treatment in frail, elderly nursing home residents are both associated with higher mortality rates. The research, published in JAMA Internal Medicine, found that institutionalised individuals aged more than 80 years with SBP of less than 130 mm Hg and taking combination antihypertensive treatment of two or more drugs had a greater than twofold risk of mortality compared with other nursing home residents. The mortality rates were much lower in residents with low SBP who were receiving no or single agent antihypertensive therapy, and in residents who did not have low SBP taking combination therapy. The researchers wrote that the results were unchanged after adjusting for age, sex and several covariables, including history of heart failure, cancer and other major cardiovascular disease. They wrote that there were no clear recommendations on target BP level to treat hypertension in very old, frail individuals, although recent European guidelines recommended reducing SBP to 140‒150 mm HG in patients older than 80 years with baseline SBP of 160 mm HG or higher. “Our findings point to the potentially crucial issue of overtreatment in frail elderly individuals”, they wrote, saying the study highlighted the limited understanding of the benefits and harms of BP treatment in frail, older nursing home patients. “Since the evidence in these patients is scarce, physicians should be more cautious when implementing international guidelines, which propose to reduce the SBP to a level between 140 mm Hg and 150 mm Hg.”

Mouldy home associated with asthma development
MOISTURE damage and mould in a child’s bedroom, living room or kitchen during early infancy is associated with asthma development, according to research published in Pediatrics. The study included 398 children drawn from a birth cohort in Finland, whose homes were inspected at an average age of 5 months and who were followed up until they were 6 years old. The authors found that exposure to moisture damage and mould in their home’s main living areas (but not in bathrooms or other interior spaces) from an early age was associated with the risk of ever developing physician-diagnosed asthma, persistent asthma, and respiratory symptoms during their first 6 years. Associations with developing asthma ever were strongest for moisture damage with visible mould in the child’s bedroom and in the living room. The authors said the observed associations with asthma were also greater among atopic children and during the first 2 years of follow-up. No consistent links were found between moisture damage (with or without mould) and atopic sensitisation, the authors wrote. They said their estimates were unstable due to the low number of children included in the research and that “the true associations are likely to be smaller than estimates presented in this study”. “Larger prospective studies are needed, with objective and detailed assessment of moisture damage and mold, to obtain new and more accurate methods of assessing asthma risk in moisture-damaged buildings”, the authors wrote.

Modern radiation therapy effective for prostate cancer
EXTERNAL beam radiotherapy (EBRT) should be considered an equivalent treatment option to surgical and brachytherapy techniques for men with localised prostate cancer, according to Australian researchers. The study, published in the Journal of Medical Imaging and Radiation Oncology, aimed to evaluate the long-term efficacy of modern EBRT in treating immediate-risk (IR) and high-risk (HR) disease using a combination of androgen deprivation therapy (ADT) and dose-escalated intensity modulated radiotherapy with magnetic resonance imaging and computed tomography fusion and daily image guidance with fiducial markers (image-guided intensity-modulated radiotherapy, DE-IG-IMRT). The authors calculated a 5-year actuarial biochemical disease-free survival (bDFS), metastasis-free survival (MFS) and prostate cancer-specific survival (PCaSS) for 675 patients treated with DE-IG-IMRT and ADT from 2006 to 2010. The results were compared with eight Australian studies of patients treated with surgery or brachytherapy, which recorded actuarial outcomes at 3 years or later. The authors said that among patients treated with DE-IG-IMRT, bDFS at 5 years was 93.3% overall, and 95.5% and 91.3% respectively for IR and HR patients. MFS was 96.9% overall, and PCaSS was 98.8% overall. They wrote that DE-IG-IMRT treatment was also associated with very low toxicity at 5 years. In comparison, the median 5-year bDFS, MFS and PCaSS in studies which reported the outcomes of high-dose rate brachytherapy was 82.5%, 90.0% and 96.5% respectively. One surgical series reported 5-year bDFS of 65.5% for HR patients. The authors said their results highlighted that modern EBRT was at least as effective as modern Australian surgical and brachytherapy techniques. They wrote that “due to the rapid engineering and technological advances underpinning EBRT, the physician best able to discuss modern EBRT is a radiation oncologist”, a view which was consistent with the recommendations of the Cancer Council Australia.

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