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Find video protocols related to scientific articles indexed in Pubmed.
Survivorship: screening for cancer and treatment effects, version 2.2014.
J Natl Compr Canc Netw
PUBLISHED: 11-02-2014
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The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment. This portion of the guidelines describes recommendations regarding screening for the effects of cancer and its treatment. The panel created a sample screening tool, specifically for use in combination with the NCCN Guidelines for Survivorship, to guide providers to topics that require more in-depth assessment. Effective screening and assessment can help providers deliver necessary and comprehensive survivorship care.
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Survivorship: nutrition and weight management, version 2.2014.
J Natl Compr Canc Netw
PUBLISHED: 10-15-2014
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Healthy lifestyle habits have been associated with improved health outcomes and quality of life and, for some cancers, a reduced risk of recurrence and death. The NCCN Guidelines for Survivorship therefore recommend that cancer survivors be encouraged to achieve and maintain a healthy lifestyle, including attention to weight management, physical activity, and dietary habits. This section of the NCCN Guidelines focuses on recommendations regarding nutrition, weight management, and supplement use in survivors. Weight management recommendations are based on the survivor's body mass index and include discussions of nutritional, weight management, and physical activity principles, with referral to community resources, dietitians, and/or weight management programs as needed.
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Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study.
J. Clin. Oncol.
PUBLISHED: 10-13-2014
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Survivors of Hodgkin lymphoma (HL) are at increased risk of treatment-related cardiovascular (CV) events; whether exercise modifies this risk is unknown.
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Exercise barriers in korean colorectal cancer patients.
Asian Pac. J. Cancer Prev.
PUBLISHED: 10-09-2014
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To identify barriers to exercise in Korean colorectal cancer patients and survivors, and to analyze differences in exercise barriers by age, gender, treatment status, and physical activity level.
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American society of clinical oncology position statement on obesity and cancer.
J. Clin. Oncol.
PUBLISHED: 10-01-2014
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Rates of obesity have increased significantly over the last three decades in the United States and globally. In addition to contributing to heart disease and diabetes, obesity is a major unrecognized risk factor for cancer. Obesity is associated with worsened prognosis after cancer diagnosis and also negatively affects the delivery of systemic therapy, contributes to morbidity of cancer treatment, and may raise the risk of second malignancies and comorbidities. Research shows that the time after a cancer diagnosis can serve as a teachable moment to motivate individuals to adopt risk-reducing behaviors. For this reason, the oncology care team-the providers with whom a patient has the closest relationships in the critical period after a cancer diagnosis-is in a unique position to help patients lose weight and make other healthy lifestyle changes. The American Society of Clinical Oncology is committed to reducing the impact of obesity on cancer and has established a multipronged initiative to accomplish this goal by 1) increasing education and awareness of the evidence linking obesity and cancer; 2) providing tools and resources to help oncology providers address obesity with their patients; 3) building and fostering a robust research agenda to better understand the pathophysiology of energy balance alterations, evaluate the impact of behavior change on cancer outcomes, and determine the best methods to help cancer survivors make effective and useful changes in lifestyle behaviors; and 4) advocating for policy and systems change to address societal factors contributing to obesity and improve access to weight management services for patients with cancer.
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Comparison of performance status with peak oxygen consumption in operable patients with non-small-cell lung cancer.
Respirology
PUBLISHED: 09-17-2014
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In this era of increasing options for treatment of 'surgical' lung cancer patients, preoperative physiologic assessment of accurate patient selection is becoming more important. The variability in an objective measure of cardiorespiratory fitness (peak oxygen consumption (VO2peak )) across performance in operable non-small-cell lung cancer (NSCLC) patients enrolled in the Cancer and Leukemia Group B trial was compared.
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Survivorship: healthy lifestyles, version 2.2014.
J Natl Compr Canc Netw
PUBLISHED: 09-06-2014
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Healthy lifestyle habits have been associated with improved health outcomes and quality of life and, for some cancers, a reduced risk of recurrence and death. The NCCN Guidelines for Survivorship therefore recommend that cancer survivors be encouraged to achieve and maintain a healthy lifestyle, with attention to weight management, physical activity, and dietary habits. This section of the NCCN Guidelines focuses on recommendations regarding physical activity in survivors, including assessment for the risk of exercise-induced adverse events, exercise prescriptions, guidance for resistance training, and considerations for specific populations (eg, survivors with lymphedema, ostomies, peripheral neuropathy). In addition, strategies to encourage health behavioral change in survivors are discussed.
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Impact of health-related quality of life and fatigue on survival of recurrent high-grade glioma patients.
J. Neurooncol.
PUBLISHED: 08-13-2014
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Quality of life (QoL) impairment and fatigue are frequently experienced during treatment for recurrent high-grade glioma (HGG). Fatigue and QoL impairments can be due to primary neurological dysfunction, cytotoxic treatments, mood disturbances, and supportive medications. We now seek to understand how QoL and fatigue impacts survival in recurrent HGG. Using a prospective observational design, 237 patients with recurrent HGG and KPS ?70 completed a self-administered questionnaire that evaluated QoL and fatigue. QoL was assessed with Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-Brain (FACT-Br) scales while fatigue was assessed using Functional Assessment of Chronic Illness Therapy (FACIT-F) scale. Cox proportional hazard models were utilized to evaluate the association between QoL and fatigue and survival. Seventy-three (31 %) subjects had recurrent WHO grade III gliomas and 164 (69 %) had recurrent WHO grade IV gliomas. Median follow-up analysis was 27.60 months. In univariate Cox analyses, the FACT-Br specific subscale (HR 0.88; CI 95 %, 0.77-1; p = 0.048) and FACIT-F (HR 0.82; CI 95 %, 0.68-0.99; p = 0.045) were both significant predictors of survival. Fatigue added prognostic information beyond that provided by KPS, age, sex, tumor grade, and number of prior progressions (HR 0.80; CI 95 %, 0.68-0.9; p = 0.031). A greater degree of fatigue was associated with poorer survival in recurrent HGG patients. In multivariable analyses, FACT-G and FACT-Br are not independent predictors of prognosis. Fatigue is a strong independent predictor of survival that provides incremental prognostic value to the traditional markers of prognosis in recurrent HGG. Pharmacological or non-pharmacological strategies to treat fatigue warrant investigation.
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Thyrotoxic, hypokalemic periodic paralysis (THPP) in adolescents.
J. Pediatr. Endocrinol. Metab.
PUBLISHED: 08-12-2014
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Abstract Introduction: Periodic paralysis associated with hyperthyroidism and hypokalemia is an uncommon disorder reported primarily in Asian males and rarely in children. We report three Hispanic adolescent males who were seen with Graves' disease (GD) and THPP. Methods: The method used was chart review. Results: Two of these boys presented with episodes of paralysis and were diagnosed with GD. The third was initially seen with hyperthyroidism and developed weakness and paralysis when his disease progressed because of therapeutic noncompliance. Hypokalemia was documented in two of the three patients with the third not seen during paralysis. Intravenous K+ was required in only one case. All three boys were treated with antithyroid medications and ? blockers, and the musculoskeletal symptoms resolved in all three when hyperthyroidism was controlled after 2 weeks of treatment. The duration for each episode of weakness and paralysis varied in each case and resolved within 15 min to 2 h in case 1, 1-5 h in case 2, and 24 h in case 3. Conclusions: THPP is considered uncommon except in Asian males and rare in childhood and adolescence. Its occurrence in these three Hispanic boys suggests that it may occur more frequently in the young and in the USA than has been suspected, especially with the changing national demographics. We believe that our experience should raise the awareness of THPP among pediatric care providers.
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Survivorship: immunizations and prevention of infections, version 2.2014.
J Natl Compr Canc Netw
PUBLISHED: 08-08-2014
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Cancer survivors are at an elevated risk for infection because of immune suppression associated with prior cancer treatments, and they are at increased risk of complications from vaccine-preventable diseases. This section of the NCCN Guidelines for Survivorship provides recommendations for the prevention of infections in survivors through education, antimicrobial prophylaxis, and the judicious use of vaccines. These guidelines provide information about travel and gardening precautions and safe pet care/avoidance of zoonosis, and include detailed recommendations regarding vaccinations that should be considered and encouraged in cancer and transplant survivors.
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Pre-exercise participation cardiovascular screening in a heterogeneous cohort of adult cancer patients.
Oncologist
PUBLISHED: 07-24-2014
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The purpose of this study was to investigate the extent of pre-exercise participation ("preparticipation") health screening in a heterogeneous cohort of adult cancer patients.
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Dehydration and Hyponatremia in Professional Rugby Union Players; A Cohort Study observing English Premiership Rugby Union Players during Match Play, Field and Gym Training in Cool Environmental Conditions.
J Strength Cond Res
PUBLISHED: 07-17-2014
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Fluid and sodium balance is important for performance and health; however limited data in rugby union players exists. The purpose of the study was to evaluate body mass (BM) change (dehydration) and blood[Na] change during exercise. Data was collected from 10 premiership rugby union players, over a 4-week period. Observations included match play (23 subject observations), field (45 subject observations) and gym (33 subject observations) training sessions. Arrival urine samples were analysed for osmolality and samples during exercise were analysed for [Na]. BM and blood[Na] were determined pre- and post-exercise. Sweat[Na] was analysed from sweat patches worn during exercise and fluid intake was measured during exercise. Calculations of fluid and Na loss were made. Mean arrival urine osmolality was 423±157 mOsm/kg, suggesting players were adequately hydrated. Following match play, field and gym training BM loss was; 1.0±0.7, 0.3±0.6 and 0.1±0.6%. Fluid loss was significantly greater during match play (1.404±0.977 kg) than field (1.008±0.447 kg, P=0.021) and gym training (0.639±0.536 kg, P<0.001). Fluid intake was 0.955±0.562, 1.224±0.601 and 0.987±0.503 kg during match play, field and gym training. On 43% of observations, players were hyponatremic when BM increased, 57% when BM was maintained and 35% when there was a BM loss of 0.1 to 0.9%. Blood[Na] was representative of normonatremia when BM loss was >1.0%. The findings demonstrate that RU players are adequately hydrated on arrival, fluid intake is excessive compared to fluid loss and some players are at risk of developing hyponatremia.
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Safety and efficacy of aerobic training in patients with cancer who have heart failure: an analysis of the HF-ACTION randomized trial.
J. Clin. Oncol.
PUBLISHED: 07-07-2014
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To investigate the efficacy and safety of aerobic training (AT) in patients with cancer with medically stable heart failure (HF).
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Survivorship: cognitive function, version 1.2014.
J Natl Compr Canc Netw
PUBLISHED: 07-05-2014
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Cognitive impairment is a common complaint among cancer survivors and may be a consequence of the tumors themselves or direct effects of cancer-related treatment (eg, chemotherapy, endocrine therapy, radiation). For some survivors, symptoms persist over the long term and, when more severe, can impact quality of life and function. This section of the NCCN Guidelines for Survivorship provides assessment, evaluation, and management recommendations for cognitive dysfunction in survivors. Nonpharmacologic interventions (eg, instruction in coping strategies; management of distress, pain, sleep disturbances, and fatigue; occupational therapy) are recommended, with pharmacologic interventions as a last line of therapy in survivors for whom other interventions have been insufficient.
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Sensitization of sexual behaviors in ovariectomized Long-Evans rats is induced by a subthreshold dose of estradiol benzoate and attenuated by repeated copulation.
Horm Behav
PUBLISHED: 06-19-2014
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Ovariectomy (OVX) abolishes the expression sexual behaviors in the rat, but they can be fully reinstated by sequential administration of estradiol benzoate (EB) followed by progesterone (P). When administered alone, 5 or 10?gEB (but not 2?g) acutely induce only low levels of lordosis, whereas repeated administration potentiates lordosis and induces sexually appetitive behaviors (e.g., hops, darts, solicitations, ear wiggles). The mechanisms mediating this behavioral sensitization are poorly understood, and it is not clear whether stimulation from the male during repeated copulation plays a role. OVX Long-Evans rats were given 4 sexual training sessions with EB (10?g) and P (500?g) 48 and 4h prior to testing, respectively, in a unilevel 4-hole pacing chamber followed by a 2-week hormone washout. Females were then treated with 2?g or 10?gEB 48h prior to copulation on Tests 1 and 8. On Tests 2-7, a group of females was treated with 10?gEB and allowed to copulate with a male (10?gEB/Male, n=16), or treated with 2?g or 10?gEB and placed in the chamber alone (2?gEB/Alone, n=6; 10?gEB/Alone, n=18). A negative control group was treated with the oil vehicle and placed in the chamber alone (Oil/Alone, n=6) on Tests 2-7, but treated with 2?gEB prior to copulatory Tests 1 and 8. All groups, except Oil, displayed behavioral sensitization to EB, suggesting that repeated administration EB is both necessary and sufficient to induce sensitization. Appetitive behaviors were attenuated in those that copulated on every session. Pacing was disrupted in all groups. Together these results suggest that EB activates excitatory mechanisms to promote the expression of sexual behaviors, which are potentiated across time under certain conditions. In contrast, copulatory stimulation attenuates behavioral sensitization to EB.
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Survivorship: fatigue, version 1.2014.
J Natl Compr Canc Netw
PUBLISHED: 06-14-2014
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Many cancer survivors report that fatigue is a disruptive symptom even after treatment ends. Persistent cancer-related fatigue affects quality of life, because individuals become too tired to fully participate in the roles and activities that make life meaningful. Identification and management of fatigue remains an unmet need for many cancer survivors. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and management recommendations for fatigue in survivors. Management includes education and counseling, physical activity, psychosocial interventions, and pharmacologic treatments.
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Relationship between exercise behavior, cardiorespiratory fitness, and cognitive function in early breast cancer patients treated with doxorubicin-containing chemotherapy: a pilot study.
Appl Physiol Nutr Metab
PUBLISHED: 05-30-2014
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The purpose of this study was to examine the relationship between self-reported exercise behavior, cardiorespiratory fitness (CRF), and cognitive function in early breast cancer patients. Thirty-seven breast cancer patients following completion of chemotherapy (median 16 months) and 14 controls were studied. Cognitive function was assessed using the Central Nervous System (CNS) Vital Signs software (CNS Vital Signs, LLC, Morrisville, N.C., USA), a computerized test battery consisting of 9 cognitive subtests. Exercise behavior was evaluated using the Godin Leisure Time Exercise Questionnaire, and CRF was assessed via a cardiopulmonary exercise test to assess peak oxygen consumption. Patients' mean total exercise was 184 ± 141 min·week(-1) compared with 442 ± 315 min·week(-1) in controls (p < 0.001). Significantly fewer patients (32%) were meeting exercise guidelines (i.e., ?150 min of moderate-intensity or vigorous exercise per week) compared with 57% of controls (p = 0.014). Patients' peak oxygen consumption averaged 23.5 ± 6.3 mL·kg(-1)·min(-1) compared with 30.6 ± 7.0 mL·kg(-1)·min(-1) in controls (p < 0.01). Scores on the cognitive subdomains were generally lower in patients compared with controls, although only the difference in verbal memory was significant (unadjusted p = 0.041). In patients, weak to moderate correlations were indicated between exercise, peak oxygen consumption, and the majority of cognitive subdomain scores; however, there was a significant positive correlation between exercise and visual memory (r = 0.47, p = 0.004). In conclusion, breast cancer patients following the completion of primary adjuvant chemotherapy exhibit, in general, worse cognitive performance than healthy women from the general population, and such performance may be related to their level of exercise behavior.
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Combining region-based and imprecise boundary-based cues for interactive medical image segmentation.
Int J Numer Method Biomed Eng
PUBLISHED: 05-29-2014
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In this paper, we present an approach combining both region selection and user point selection for user assisted segmentation, as either an enclosed object or an open curve, and investigate the method of image segmentation in specific medical applications (user assisted segmentation of the media adventitia border in IVUS images, and lumen border in OCT images), and then demonstrate the method with generic images to show how it could be utilised in other types of medical image, and is not limited to the applications described.. The proposed method combines point based soft constraint on object boundary and stroke based regional constraint. The user points act as attraction points and are treated as soft constraints, rather than hard constraints that the segmented boundary has to pass through. The user can also use strokes to specify region of interest. The probabilities of region of interest for each pixel are then calculated and their discontinuity is used to indicate object boundary. The combinations of different types of user constraints and image features allow flexible and robust segmentation, which is formulated as an energy minimization problem on a multilayered graph and is solved using a shortest path search algorithm. We show that this combinatorial approach allows efficient and effective interactive segmentation, which can be used with both open and closed curves to segment a variety of images in different ways. The proposed method is demonstrated in the two medical applications, that is intravascular ultrasound (IVUS), and Optical Coherence Tomography (OCT) images, where image artifacts such as acoustic shadow and calcification are commonplace and thus user guidance is desirable. The ultrasound images also allowed us to carry out not only qualitative but also quantitative analysis. The proposed method is compared against a number of interactive segmentation techniques. Copyright © 2014 John Wiley & Sons, Ltd.
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From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice.
Paediatr Child Health
PUBLISHED: 05-24-2014
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Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician's ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs.
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Poverty and pediatric palliative care: what can we do?
J Soc Work End Life Palliat Care
PUBLISHED: 05-20-2014
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It has been recognized that families of children with life-limiting health conditions struggle with significant financial demands, yet may not have awareness of resources available to them. Additionally, health care providers may not be aware of the socioeconomic needs of families they care for. This article describes a mixed-methods study examining the content validity and utility for health care providers of a poverty screening tool and companion resource guide for the pediatric palliative care population. The study found high relevance and validity of the tool. Significant barriers to implementing the screening tool in clinical practice were described by participants, including: concerns regarding time required, roles and responsibilities, and discomfort in asking about income. Implications for practice and suggestions for improving the tool are discussed. Screening and attention to the social determinants of health lie within the scope of practice of all health care providers. Social workers can play a leadership role in this work.
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Survivorship: sleep disorders, version 1.2014.
J Natl Compr Canc Netw
PUBLISHED: 05-10-2014
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Sleep disorders, including insomnia and excessive sleepiness, affect a significant proportion of patients with cancer and survivors, often in combination with fatigue, anxiety, and depression. Improvements in sleep lead to improvements in fatigue, mood, and quality of life. This section of the NCCN Guidelines for Survivorship provides screening, diagnosis, and management recommendations for sleep disorders in survivors. Management includes combinations of sleep hygiene education, physical activity, psychosocial interventions, and pharmacologic treatments.
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Reliability of Maximal Cardiopulmonary Exercise Testing in Men with Prostate Cancer.
Med Sci Sports Exerc
PUBLISHED: 05-01-2014
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In order to accurately assess exercise interventions and to evaluate acute and chronic cardiovascular effects in patients with early-stage cancer, consistently reliable functional outcome measures must be obtained. An incremental cardiopulmonary exercise test (CPET) with gas exchange measurement, to assess peak oxygen consumption (peak VO2), provides the gold standard outcome of cardiorespiratory fitness.
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Survivorship: pain version 1.2014.
J Natl Compr Canc Netw
PUBLISHED: 04-11-2014
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Many posttreatment cancer survivors experience chronic pain, often leading to psychological distress; decreased activity, motivation, and personal interactions; and an overall poor quality of life. This section of the NCCN Guidelines for Survivorship provides screening and management recommendations for pain in survivors. A multidisciplinary approach is recommended, with a combination of pharmacologic treatments, psychosocial and behavioral interventions, physical therapy and exercise, and interventional procedures.
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Speech and language support: How physicians can identify and treat speech and language delays in the office setting.
Paediatr Child Health
PUBLISHED: 03-15-2014
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Failure to recognize and intervene early in speech and language delays can lead to multifaceted and potentially severe consequences for early child development and later literacy skills. While routine evaluations of speech and language during well-child visits are recommended, there is no standardized (office) approach to facilitate this. Furthermore, extensive wait times for speech and language pathology consultation represent valuable lost time for the child and family. Using speech and language expertise, and paediatric collaboration, key content for an office-based tool was developed.
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Survivorship: sexual dysfunction (male), version 1.2013.
J Natl Compr Canc Netw
PUBLISHED: 03-12-2014
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Various anticancer treatments, especially those directed toward the pelvis, can damage blood vessels and reduce circulation of blood to the penis and/or damage the autonomic nervous system, resulting in higher rates of erectile dysfunction in survivors than in the general population. In addition, hormonal therapy can contribute to sexual problems, as can depression and anxiety, which are common in cancer survivors. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and treatment recommendations for male sexual problems, namely erectile dysfunction.
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Survivorship: sexual dysfunction (female), version 1.2013.
J Natl Compr Canc Netw
PUBLISHED: 03-04-2014
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Cancer treatment, especially hormonal therapy and therapy directed toward the pelvis, can contribute to sexual problems, as can depression and anxiety, which are common in cancer survivors. Thus, sexual dysfunction is common in survivors and can cause increased distress and have a significant negative impact on quality of life. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and treatment recommendations for female sexual problems, including those related to sexual desire, arousal, orgasm, and pain.
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Nutrition outcomes following implementation of validated swallowing and nutrition guidelines for patients with head and neck cancer.
Support Care Cancer
PUBLISHED: 02-25-2014
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Head and neck cancer patients have a high risk of malnutrition and swallowing dysfunction. This study reports on adherence and nutrition outcomes with the use of local evidence-based guidelines for the nutrition management of patients with head and neck cancer, including placement of proactive gastrostomy tubes for high risk patients.
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Bacterial comparison of preoperative rinsing and swabbing for oral surgery using 0.2% chlorhexidine.
J Investig Clin Dent
PUBLISHED: 02-15-2014
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The aim of the present study was to compare bacterial load using preoperative rinsing and swabbing techniques for oral surgery with 0.2% chlorhexidine (CHX).
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Daughters and Mothers Against Breast Cancer (DAMES): main outcomes of a randomized controlled trial of weight loss in overweight mothers with breast cancer and their overweight daughters.
Cancer
PUBLISHED: 02-10-2014
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Few studies to date have used the cancer diagnosis as a teachable moment to promote healthy behavior changes in survivors of cancer and their family members. Given the role of obesity in the primary and tertiary prevention of breast cancer, the authors explored the feasibility of a mother-daughter weight loss intervention.
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Home-based exercise: promising rehabilitation for symptom relief, improved functional status and quality of life for post-surgical lung cancer patients.
J Thorac Dis
PUBLISHED: 02-04-2014
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Post-thoracotomy non-small cell lung cancer (NSCLC) patients report cancer-related fatigue (CRF) as a severe symptom that may increase the occurrence and severity of other symptoms while decreasing functional status and quality of life (QOL). The aim of this pilot study was to describe the effects of a home-based rehabilitative exercise intervention on CRF, other symptoms, functional status, and QOL for post-surgical NSCLC patients starting within days after hospital discharge.
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Does preoperative oral carbohydrate reduce hospital stay? A randomized trial.
AORN J
PUBLISHED: 01-30-2014
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Oral carbohydrate-rich fluids are used preoperatively to improve postoperative recovery, but their effectiveness for reducing length of hospital stay is uncertain. We assessed the effectiveness of preoperative loading with carbohydrates on the postoperative outcomes of 44 patients scheduled for elective colorectal surgery who were randomly allocated to a carbohydrate-rich fluid group or a usual care group during their preadmission clinic visit. Our primary outcome was the time patients required to be ready for discharge. Patients in the control group spent an average of 4.3 days (95% confidence interval [CI], 3.2-5.7) in the hospital and patients in the carbohydrate-rich fluid group spent 4.1 days (95% CI, 3.2-5.4) in the hospital until they met discharge criteria (P = .824). We found that the safety of administering preoperative oral carbohydrate-rich fluids is supported, but we were unable to confirm or refute the benefit of this treatment regimen for contributing to shorter hospital stays after elective colorectal surgery.
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Physical activity and prostate gene expression in men with low-risk prostate cancer.
Cancer Causes Control
PUBLISHED: 01-28-2014
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Vigorous physical activity after diagnosis of localized prostate cancer may reduce the risk of disease progression and prostate cancer-specific mortality. The molecular mechanisms by which physical activity may exert protective effects in the prostate remain unknown.
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Survivorship: introduction and definition. Clinical practice guidelines in oncology.
J Natl Compr Canc Netw
PUBLISHED: 01-24-2014
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Many cancer survivors experience physical and/or psychosocial side effects, which can be severe, debilitating, and sometimes permanent. These NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common consequences of cancer and cancer treatment for health care professionals who work with survivors of adult-onset cancer in the posttreatment period. These introductory sections of the guidelines include the panel's definition of cancer survivors, a discussion of the effects of cancer and its treatment, general principles and standards for survivorship care, and guidance regarding screening for problems that require further assessment.
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Cardiorespiratory fitness in breast cancer patients: a call for normative values.
J Am Heart Assoc
PUBLISHED: 01-15-2014
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There is emerging evidence that adjuvant treatments for breast cancer negatively impact cardiorespiratory fitness (CRF) or Vo2max, a key predictor of cardiovascular risk. Although a number of studies have measured CRF in breast cancer patients, there is currently limited data regarding expected CRF values in this patient population. Given that CRF is a poor prognostic sign and recently highlighted as a key measure to standardize by the American Heart Association, we sought to review the available literature on CRF among breast cancer patients.
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Utility of 3-dimensional echocardiography, global longitudinal strain, and exercise stress echocardiography to detect cardiac dysfunction in breast cancer patients treated with doxorubicin-containing adjuvant therapy.
Breast Cancer Res. Treat.
PUBLISHED: 01-04-2014
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Conventional resting left ventricular ejection fraction (LVEF) assessments have limitations for detecting doxorubicin (DOX)-related cardiac dysfunction. Novel resting echocardiographic parameters, including 3-dimensional echocardiography (3DE) and global longitudinal strain (GLS), have potential for early identification of chemotherapy-related myocardial injury. Exercise "stress" is an established method to uncover impairments in cardiac function but has received limited attention in the adult oncology setting. We evaluated the utility of an integrated approach using 3DE, GLS, and exercise stress echocardiography for detecting subclinical cardiac dysfunction in early breast cancer patients treated with DOX-containing chemotherapy. Fifty-seven asymptomatic women with early breast cancer (mean 26 ± 22 months post-chemotherapy) and 20 sex-matched controls were studied. Resting left ventricular (LV) function was assessed by LVEF using 2-dimensional echocardiography (2DE) and 3DE and by GLS using 2-dimensional speckle-tracking echocardiography (2D-STE). After resting assessments, subjects completed cardiopulmonary exercise testing with stress 2DE. Resting LVEF was lower in patients than controls by 3DE (55 ± 4 vs. 59 ± 5 %; p = 0.005) but not 2DE (56 ± 4 vs. 58 ± 3 %; p = 0.169). 10 of 51 (20 %) patients had GLS greater than or equal to -17 %, which was below the calculated lower limit of normal (control mean 2SD); this patient subgroup had a mean 20 % impairment in GLS (-16.1 ± 0.9 vs. -20.1 ± 1.5 %; p < 0.001), despite similar LVEF by 2DE and 3DE compared to controls (p > 0.05). Cardiopulmonary function (VO2peak) was 20 % lower in patients than controls (p < 0.001). Exercise stress 2DE assessments of stroke volume (61 ± 11 vs. 69 ± 15 ml; p = 0.018) and cardiac index (2.3 ± 0.9 vs. 3.1 ± 0.8 l min(-1) m(-2) mean increase; p = 0.003) were lower in patients than controls. Post-exercise increase in cardiac index predicted VO2peak (r = 0.429, p = 0.001). Resting 3DE, GLS, and exercise stress 2DE detect subclinical cardiac dysfunction not apparent with resting 2DE in post-DOX breast cancer patients.
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A rehabilitation program for lung cancer patients during postthoracotomy chemotherapy.
Onco Targets Ther
PUBLISHED: 01-01-2014
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The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue (CRF), other symptoms, functional status, and quality of life (QOL) for patients with non-small cell lung cancer (NSCLC) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy.
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Energy balance and metabolism after cancer treatment.
Semin. Oncol.
PUBLISHED: 12-17-2013
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Unfavorable physiological, biological, and behavioral alterations during and following treatment for cancer may lead to chronic energy imbalance predisposing to a myriad of deleterious health conditions including obesity, dyslipidemia, and the metabolic syndrome. In addition to the cardiovascular and musculoskeletal effects of these conditions, energy imbalance and metabolic changes after cancer treatment can also affect cancer-related morbidity and mortality. To this end, lifestyle interventions such as diet and physical activity are especially relevant to mitigate the deleterious impact of chronic energy imbalance in cancer survivors.
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Immunological and hormonal effects of exercise: implications for cancer cachexia.
Curr Opin Support Palliat Care
PUBLISHED: 10-26-2013
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There is increasing interest in the use of therapeutic exercise for cancer cachexia. Apart from the directly beneficial effects on muscle, exercise has the potential to attenuate some of the immunological and hormonal abnormalities found in cachexia. This review summarizes the findings of recent studies, which have explored such effects in patients with cancer, and discusses their relevance to patients with cancer cachexia.
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Order statistics inference for describing topological coupling and mechanical symmetry breaking in multidomain proteins.
J Chem Phys
PUBLISHED: 10-05-2013
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Cooperativity is a hallmark of proteins, many of which show a modular architecture comprising discrete structural domains. Detecting and describing dynamic couplings between structural regions is difficult in view of the many-body nature of protein-protein interactions. By utilizing the GPU-based computational acceleration, we carried out simulations of the protein forced unfolding for the dimer WW - WW of the all-?-sheet WW domains used as a model multidomain protein. We found that while the physically non-interacting identical protein domains (WW) show nearly symmetric mechanical properties at low tension, reflected, e.g., in the similarity of their distributions of unfolding times, these properties become distinctly different when tension is increased. Moreover, the uncorrelated unfolding transitions at a low pulling force become increasingly more correlated (dependent) at higher forces. Hence, the applied force not only breaks "the mechanical symmetry" but also couples the physically non-interacting protein domains forming a multi-domain protein. We call this effect "the topological coupling." We developed a new theory, inspired by order statistics, to characterize protein-protein interactions in multi-domain proteins. The method utilizes the squared-Gaussian model, but it can also be used in conjunction with other parametric models for the distribution of unfolding times. The formalism can be taken to the single-molecule experimental lab to probe mechanical cooperativity and domain communication in multi-domain proteins.
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Too sick not to exercise: using a 6-week, home-based exercise intervention for cancer-related fatigue self-management for postsurgical non-small cell lung cancer patients.
Cancer Nurs
PUBLISHED: 09-26-2013
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Two prevalent unmet supportive care needs reported by the non-small cell lung cancer (NSCLC) population include the need to manage fatigue and attain adequate exercise to meet the physical demands of daily living. Yet, there are no guidelines for routine rehabilitative support to address fatigue and exercise for persons with NSCLC during the critical transition from hospital to home after thoracotomy.
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Effects of Nonlinear Aerobic Training on Erectile Dysfunction and Cardiovascular Function Following Radical Prostatectomy for Clinically Localized Prostate Cancer.
Eur. Urol.
PUBLISHED: 08-27-2013
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Erectile dysfunction (ED) is a major adverse effect of radical prostatectomy (RP). We conducted a randomized controlled trial to examine the efficacy of aerobic training (AT) compared with usual care (UC) on ED prevalence in 50 men (n=25 per group) after RP. AT consisted of five walking sessions per week at 55-100% of peak oxygen uptake (VO2peak) for 30-60min per session following a nonlinear prescription. The primary outcome was change in the prevalence of ED, as measured by the International Index of Erectile Function (IIEF), from baseline to 6 mo. Secondary outcomes were brachial artery flow-mediated dilation (FMD), VO2peak, cardiovascular (CV) risk profile (eg, lipid profile, body composition), and patient-reported outcomes (PROs). The prevalence of ED (IIEF score ?21) decreased by 20% in the AT group and by 24% in the UC group (difference: p=0.406). There were no significant between-group differences in any erectile function subscale (p>0.05). Significant between-group differences were observed for changes in FMD and VO2peak, favoring AT. There were no group differences in other markers of CV risk profile or PROs. In summary, nonlinear AT does not improve ED in men with localized prostate cancer in the acute period following RP.
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Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: A phase II randomized trial.
Acta Oncol
PUBLISHED: 08-19-2013
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Abstract Background. To evaluate the safety and efficacy of moderate-to-high intensity aerobic training in breast cancer patients receiving neoadjuvant chemotherapy. Methods. Twenty patients with stage IIB-IIIC operable breast cancer were randomly assigned to receive doxorubicin plus cyclophosphamide (AC) or AC in combination with aerobic training (AC + AET) (n = 10/group) for 12 weeks. The AC+ AET group performed three supervised aerobic cycle ergometry sessions per week at 60%-100% of exercise capacity (VO2peak). Safety outcomes included exercise testing as well as treatment- and exercise training-related adverse events (AEs), whereas efficacy outcomes included cardiopulmonary function and patient-reported outcomes (PROs) as measured by a cardiopulmonary exercise test (CPET) and Functional Assessment of Cancer Therapy-Breast (FACT-B) scale. Results. Twelve non-significant ECG abnormalities and three non-life threatening events occurred during CPET procedures. One AE was reported during aerobic training. There were no significant between group differences for clinician-documented events (e.g. pain, nausea) or hematological parameters (ps > 0.05). Attendance and adherence rates to aerobic training were 82% and 66%, respectively. Intention-to-treat analysis indicated that VO2peak increased by 2.6 ± 3.5 ml/kg/min (+ 13.3%) in the AC + AET group and decreased by 1.5 ± 2.2 ml/kg/min (-8.6%) in the AC group (between group difference, p = 0.001). FACT-B increased 11.1 points in the AC + AET group compared to a 1.5 point decrease in the AC group (between group difference, p = 0.685). Conclusion. Moderate-to-high intensity aerobic training when conducted with one-on-one supervision is a safe adjunct therapy associated with improvements in cardiopulmonary function and select PROs during neoadjuvant chemotherapy.
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Producer survey of herd-level risk factors for nursing beef calf respiratory disease.
J. Am. Vet. Med. Assoc.
PUBLISHED: 08-02-2013
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To identify herd-level risk factors for bovine respiratory disease (BRD) in nursing beef calves.
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A comparative analysis of early child health and development services and outcomes in countries with different redistributive policies.
BMC Public Health
PUBLISHED: 07-12-2013
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The social environment is a fundamental determinant of early child development and, in turn, early child development is a determinant of health, well-being, and learning skills across the life course. Redistributive policies aimed at reducing social inequalities, such as a welfare state and labour market policies, have shown a positive association with selected health indicators. In this study, we investigated the influence of redistributive policies specifically on the social environment of early child development in five countries with different political traditions. The objective of this analysis was to highlight similarities and differences in social and health services between the countries and their associations with other health outcomes that can inform better global early child development policies and improve early child health and development.
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Modulation of circulating angiogenic factors and tumor biology by aerobic training in breast cancer patients receiving neoadjuvant chemotherapy.
Cancer Prev Res (Phila)
PUBLISHED: 07-10-2013
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Aerobic exercise training (AET) is an effective adjunct therapy to attenuate the adverse side-effects of adjuvant chemotherapy in women with early breast cancer. Whether AET interacts with the antitumor efficacy of chemotherapy has received scant attention. We carried out a pilot study to explore the effects of AET in combination with neoadjuvant doxorubicin-cyclophosphamide (AC+AET), relative to AC alone, on: (i) host physiology [exercise capacity (VO2 peak), brachial artery flow-mediated dilation (BA-FMD)], (ii) host-related circulating factors [circulating endothelial progenitor cells (CEP) cytokines and angiogenic factors (CAF)], and (iii) tumor phenotype [tumor blood flow ((15)O-water PET), tissue markers (hypoxia and proliferation), and gene expression] in 20 women with operable breast cancer. AET consisted of three supervised cycle ergometry sessions/week at 60% to 100% of VO2 peak, 30 to 45 min/session, for 12 weeks. There was significant time × group interactions for VO2 peak and BA-FMD, favoring the AC+AET group (P < 0.001 and P = 0.07, respectively). These changes were accompanied by significant time × group interactions in CEPs and select CAFs [placenta growth factor, interleukin (IL)-1?, and IL-2], also favoring the AC+AET group (P < 0.05). (15)O-water positron emission tomography (PET) imaging revealed a 38% decrease in tumor blood flow in the AC+AET group. There were no differences in any tumor tissue markers (P > 0.05). Whole-genome microarray tumor analysis revealed significant differential modulation of 57 pathways (P < 0.01), including many that converge on NF-?B. Data from this exploratory study provide initial evidence that AET can modulate several host- and tumor-related pathways during standard chemotherapy. The biologic and clinical implications remain to be determined.
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Both aerobic exercise and resveratrol supplementation attenuate doxorubicin-induced cardiac injury in mice.
Am. J. Physiol. Endocrinol. Metab.
PUBLISHED: 05-21-2013
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Because doxorubicin (DOX)-containing chemotherapy causes left ventricular (LV) dysfunction and remodeling that can progress to heart failure, strategies to alleviate DOX cardiotoxicity are necessary to improve health outcomes of patients surviving cancer. Although clinical evidence suggests that aerobic exercise training (ET) can prevent cardiotoxicity in patients undergoing DOX chemotherapy, the physiological mechanisms involved have not been extensively studied, nor is it known whether compounds [such as resveratrol (RESV)] have similar beneficial effects. With the use of a murine model of chronic DOX exposure, this study compared the efficacy of modest ET to RESV treatment on exercise performance, LV remodeling, and oxidative stress resistance. Mice were divided into four groups that received saline, DOX (8 mg/kg ip, one time per week), DOX + RESV (4 g/kg diet, ad libitum), and DOX + ET (45 min of treadmill exercise, 5 days/wk) for 8 wk. LV function and morphology were evaluated by in vivo echocardiography. DOX caused adverse LV remodeling that was partially attenuated by modest ET and completely prevented by RESV. These effects were paralleled by improvements in exercise performance. The cardioprotective properties of ET and RESV were associated with reduced levels of atrial natriuretic peptide and the lipid peroxidation by-product, 4-hydroxy-2-nonenal. In addition, ET and RESV increased the expression of cardiac sarcoplasmic/endoplasmic reticulum calcium-ATPase 2a, superoxide dismutase, mitochondrial electron transport chain complexes, and mitofusin-1 and -2 in mice administered DOX. Compared with modest ET, RESV more effectively prevented DOX-induced LV remodeling and was associated with the reduction of DOX-induced oxidative stress. Our findings have important implications for protecting patients against DOX-associated cardiac injury.
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Complementary therapies and integrative medicine in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.
Chest
PUBLISHED: 05-08-2013
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Physicians are often asked about complementary therapies by patients with cancer, and data show that the interest in and use of these therapies among patients with cancer is common. Therefore, it is important to assess the current evidence base on the benefits and risks of complementary therapies (modalities not historically used in modern Western medicine).
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Exercise therapy as treatment for cardiovascular and oncologic disease after a diagnosis of early-stage cancer.
Semin. Oncol.
PUBLISHED: 04-02-2013
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Advances in early detection and adjuvant therapy have led to dramatic improvements in longevity after a cancer diagnosis. As a result, there are ~13.7 million cancer survivors alive in the United States, with this figure projected to increase to 18 million in 2022. Despite improvements in the 5-year relative survival rates, cancer patients with early-stage disease not only remain at high risk of cancer recurrence but also have sufficient longevity to now be at risk for late effects of adjuvant therapy, particularly cardiovascular disease (CVD). Against this background, we review here the risk factors common to cancer and CVD as well as the extant evidence supporting the potential efficacy of exercise therapy to modify the risk of cancer-specific and CVD-specific mortality in persons with cancer. We also evaluate evidence from clinical studies investigating the effects of structured exercise therapy to modify risk factors common to cancer and CVD. Findings of this review indicate that several major biomarkers/risk factors are predictive of both recurrence as well as non-cancer mortality in persons diagnosed with cancer. Such information is important to health professionals providing disease-risk screening as well as informing effective management strategies in long-term cancer survivors. In terms of the latter, there is growing but preliminary evidence that exercise may be efficacious in lowering both recurrence and CVD risk in cancer patients.
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Sensitization of sexual behavior in ovariectomized rats by chronic estradiol treatment.
Horm Behav
PUBLISHED: 03-05-2013
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The ovariectomized (OVX) rat treated with estradiol benzoate (EB) is used to elucidate neuroendocrine mechanisms of sexual behavior. Chronic behavioral and pharmacological manipulations can be confounded by rising baselines, since females are behaviorally more sensitive to repeated EB injections. The literature lacks a systematic examination of chronic effects of EB administered alone to the sexually experienced OVX rat. Long-Evans rats were repeatedly treated (8 tests) with s.c. injections of 2, 5, or 10 ?g EB at different time intervals (4 or 8 days). Female sexual behaviors as well as receipt of mounts, intromissions and ejaculations from the male were observed in the unilevel 4-hole pacing chamber. The effects of adrenalectomy (ADX) and strain (Long-Evans vs. Wistar) were also assessed. Long-Evans OVX rats treated with 5 ?g EB every 8 days showed persistently low levels of sexual behavior. Sensitization was most robust following 10 ?g EB at 4-day intervals. Very few sexual behaviors were ever induced by 2 ?g EB. ADX did not affect the development of behavioral sensitization by 10?g EB. Therefore, to achieve a low steady state of sexual behaviors in sexually experienced Long-Evans OVX rats 5?g of EB administered every 8days is optimal, whereas a persistently high level of sexual behaviors is induced with 10 ?g EB administered every 4 days. OVX Wistar rats are behaviorally more sensitive to EB. Behavioral sensitization to EB may serve as a mechanism to optimize reproductive success.
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Association between exercise and primary incidence of prostate cancer: does race matter?
Cancer
PUBLISHED: 02-11-2013
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Exercise is a modifiable lifestyle risk factor associated with prostate cancer risk reduction. However, whether this association is different as a function of race is unclear. In the current study, the authors attempted to characterize the link between exercise and prostate cancer (CaP) in white and black American men.
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Facial cues to depressive symptoms and their associated personality attributions.
Psychiatry Res
PUBLISHED: 02-08-2013
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Depression is a common mental health disorder, with 12% of the UK population diagnosed at any one time. We assessed whether there are cues to depressive symptoms within the static, non-expressive face, and if other socially relevant impressions might be made by these cues. Composite "average" face images were created from students scoring high and low on self-report measures of depressive symptoms, capturing potential correlations between facial appearance and symptoms of depression. These were then used in a warping procedure, creating two versions of individual faces, one warped towards the high symptom composite, and the other towards the low. In Experiment 1, we first found observers were able to identify images representing high and low symptom occurrence at levels significantly greater than chance. Secondly, we collected observer impressions of the two versions of each face. The faces reflecting high levels of depressive symptoms were picked as less socially desirable over a broad range of personality trait estimates compared to low symptom images. In Experiment 2, we replicated the key finding that the static face contains cues to levels of depression symptoms, using composites created from a new database of student photos and depression inventory scores.
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Determinants of maternal triglycerides in women with gestational diabetes mellitus in the Metformin in Gestational Diabetes (MiG) study.
Diabetes Care
PUBLISHED: 02-07-2013
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Factors associated with increasing maternal triglyceride concentrations in late pregnancy include gestational age, obesity, preeclampsia, and altered glucose metabolism. In a subgroup of women in the Metformin in Gestational Diabetes (MiG) trial, maternal plasma triglycerides increased more between enrollment (30 weeks) and 36 weeks in those treated with metformin compared with insulin. The aim of this study was to explain this finding by examining factors potentially related to triglycerides in these women.
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The effects of inpatient exercise therapy on the length of hospital stay in stages I-III colon cancer patients: randomized controlled trial.
Int J Colorectal Dis
PUBLISHED: 02-02-2013
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This study aimed to examine the effects of a postsurgical, inpatient exercise program on postoperative recovery in operable colon cancer patients
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Effects of a 12-week home-based exercise program on the level of physical activity, insulin, and cytokines in colorectal cancer survivors: a pilot study.
Support Care Cancer
PUBLISHED: 01-18-2013
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The purposes of this study are to examine (1) the feasibility and efficacy of two different home-based exercise protocols on the level of physical activity (PA), and (2) the effect of increased PA via home-based exercise program on biomarkers of colorectal cancer.
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The potential role of aerobic exercise to modulate cardiotoxicity of molecularly targeted cancer therapeutics.
Oncologist
PUBLISHED: 01-18-2013
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Molecularly targeted therapeutics (MTT) are the future of cancer systemic therapy. They have already moved from palliative therapy for advanced solid malignancies into the setting of curative-intent treatment for early-stage disease. Cardiotoxicity is a frequent and potentially serious adverse complication of some targeted therapies, leading to a broad range of potentially life-threatening complications, therapy discontinuation, and poor quality of life. Low-cost pleiotropic interventions are therefore urgently required to effectively prevent and/or treat MTT-induced cardiotoxicity. Aerobic exercise therapy has the unique capacity to modulate, without toxicity, multiple gene expression pathways in several organ systems, including a plethora of cardiac-specific molecular and cell-signaling pathways implicated in MTT-induced cardiac toxicity. In this review, we examine the molecular signaling of antiangiogenic and HER2-directed therapies that may underpin cardiac toxicity and the hypothesized molecular mechanisms underlying the cardioprotective properties of aerobic exercise. It is hoped that this knowledge can be used to maximize the benefits of small molecule inhibitors, while minimizing cardiac damage in patients with solid malignancies.
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The influence of adjuvant therapy on cardiorespiratory fitness in early-stage breast cancer seven years after diagnosis: the Cooper Center Longitudinal Study.
Breast Cancer Res. Treat.
PUBLISHED: 01-16-2013
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We examined cardiorespiratory fitness (CRF) levels in early stage breast cancer patients and determined whether CRF differs as a function of adjuvant therapy regimen. A total of 180 early breast cancer patients representing three treatment groups (surgery only, single-, and multi-modality adjuvant therapy) in the Cooper Center Longitudinal Study (CCLS) were studied. A non-cancer control group (n = 180) matched by sex, age, and date of the CCLS visit was included. All subjects underwent an incremental exercise tolerance test to symptom limitation to assess CRF (i.e., peak metabolic equivalents [METs] and time to exhaustion). The mean time from breast cancer diagnosis to exercise tolerance testing was 7.4 ± 6.2 years. In adjusted analyses, time to exhaustion and peak METs were incrementally impaired with the addition of surgery, single-, and multi-modality adjuvant therapy compared to those of matched controls (p = 0.006 and 0.028, respectively). CRF was lowest in the multi-modality group compared to all other groups (all ps < 0.05). Despite being 7 years post-diagnosis, asymptomatic early breast cancer survivors have marked reductions in CRF. Patients treated with multi-modal adjuvant therapy have the greatest impairment in CRF.
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Availability of long-acting and permanent family-planning methods leads to increase in use in conflict-affected northern Uganda: evidence from cross-sectional baseline and endline cluster surveys.
Glob Public Health
PUBLISHED: 01-11-2013
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Humanitarian assistance standards require specific attention to address the reproductive health (RH) needs of conflict-affected populations. Despite these internationally recognised standards, access to RH services is still often compromised in war. We assessed the effectiveness of our programme in northern Uganda to provide family planning (FP) services through mobile outreach and public health centre strengthening. Baseline (n=905) and endline (n=873) cross-sectional surveys using a multistage cluster sampling design were conducted in the catchment areas of four public health centres in 2007 and 2010. Current use of any modern FP method increased from 7.1% to 22.6% (adjusted odds ratio [OR] 3.34 [95% confidence interval (CI) 2.27-4.92]); current use of long-acting and permanent methods increased from 1.2% to 9.8% (adjusted OR 9.45 [95%CI 3.99-22.39]). The proportion of women with unmet need for FP decreased from 52.1% to 35.7%. This study demonstrates that when comprehensive FP services are provided among conflict-affected populations, women will choose to use them. The combination of mobile teams and health systems strengthening can make a full range of methods quickly available while supporting the health system to continue to provide those services in challenging and resource-constrained settings.
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Patterns of physical activity participation across the cancer trajectory in colorectal cancer survivors.
Support Care Cancer
PUBLISHED: 01-06-2013
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The purpose of the present study was to explore the participation in physical activity (PA) by colorectal cancer survivors across cancer trajectories and based on selected demographic and medical variables.
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Searchers vs surveyors in estimating the monetary value of a QALY: resolving a nasty dilemma for NICE.
Health Econ Policy Law
PUBLISHED: 08-22-2011
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Recently, for many health economics researchers, empirical estimation of the monetary valuation of a quality-adjusted life year (QALY) has become an important endeavour. Different philosophical and practical approaches to this have emerged. On the one hand, there is a view that, with health-care budgets set centrally, decision-making bodies within the system can iterate, from observation of a series of previous decisions, towards the value of a QALY, thus searching for such a value. Alternatively, and more consistent with the approach taken in other public sectors, individual members of the public are surveyed with the aim of directly eliciting a preference-based - also known as a willingness-to-pay-based (WTP-based) - value of a QALY. While the former is based on supply-side factors and the latter on demand, both in fact suffer from informational deficiencies. Sole reliance on either would necessitate an acceptance or accommodation of chronic inefficiencies in health-care resource allocation. On the basis of this observation, this paper makes the case that in order to approach optimal decision making in health-care provision, a framework incorporating and thus, to a degree, reconciling these two approaches is to be preferred.
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Evidence-based risk assessment and recommendations for physical activity clearance: cancer.
Appl Physiol Nutr Metab
PUBLISHED: 08-02-2011
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Physical activity is becoming increasingly acknowledged as an integral component of in the multidisciplinary management of cancer patients. Intensive inquiry in this area is likely to increase further over the next decade; however, cancer-specific, evidence-based risk assessment and recommendations for physical activity are not available. A systematic literature review was performed of all studies conducting an exercise training intervention and (or) any form of objective exercise test among adults diagnosed with cancer. Studies were assessed according to evaluation criteria developed by a panel of experts. A total of 118 studies involving 5529 patients were deemed eligible. Overall, the results suggest that exercise training and maximal and submaximal exercise testing are relatively safe procedures with a total nonlife-threatening adverse event rate of <2%. There was only 1 exercise training-related death. However, the quality of exercise testing methodology and data reporting is less than optimal. Thus, whether the low incidence of events reflects the true safety of exercise training and exercise testing in cancer patients or less than optimal methodology and (or) data reporting remains to be determined. Evidence-based absolute and relative contraindications to physical activity and exercise training and testing are provided as well as probing decision-trees to optimize the adoption and safety of physical activity in persons diagnosed with cancer.
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Homeless youths overwhelming health burden: A review of the literature.
Paediatr Child Health
PUBLISHED: 07-05-2011
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Homelessness has reached epidemic proportions in Canada. Canadian children and adolescents are the most vulnerable because youth comprise the fastest growing segment of the homeless population. A systematic literature review was undertaken using MEDLINE, Web of Science and the Homeless Hub (www.homelesshub.ca) to encompass the time frame from January 1990 to June 2009. The following terms were used as key words: homelessness, homeless youth, poverty, street youth and runaway. The present review identified an intersection among education deficits, social service insufficiencies, and poor mental and physical health in homeless youth. Health care delivery to homeless youth was often nonanticipatory, inconsistent and perceived as discriminatory. However, street youth were identified as requiring health care for pregnancy, mental health concerns, sexually transmitted illnesses, respiratory conditions, substance abuse and a myriad of other illnesses. Plenty of work is still required to reduce health inequalities and improve the daily living conditions of Canadian youth living in poverty.
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Prognostic significance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer.
Lung Cancer
PUBLISHED: 06-23-2011
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To investigate the prognostic importance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer (NSCLC).
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Exercise behavior, functional capacity, and survival in adults with malignant recurrent glioma.
J. Clin. Oncol.
PUBLISHED: 06-20-2011
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Identifying strong markers of prognosis are critical to optimize treatment and survival outcomes in patients with malignant recurrent glioma. We investigated the prognostic significance of exercise behavior and functional capacity in this population.
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Conducting cancer control and survivorship research via cooperative groups: a report from the American Society of Preventive Oncology.
Cancer Epidemiol. Biomarkers Prev.
PUBLISHED: 04-18-2011
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As the number of cancer survivors expands, the need for cancer control and survivorship research becomes increasingly important. The National Cancer Institute (NCI) Cooperative Groups may offer a viable platform to perform such research. Observational, preventive, and behavioral research can often be performed within the cooperative group setting, especially if resources needed for evaluation are fairly simple, if protocols are easily implemented within the typical clinical setting, and if interventions are well standardized. Some protocols are better suited to cooperative groups than are others, and there are advantages and disadvantages to conducting survivorship research within the cooperative group setting. Behavioral researchers currently involved in cooperative groups, as well as program staff within the NCI, can serve as sources of information for those wishing to pursue symptom management and survivorship studies within the clinical trial setting. The structure of the cooperative groups is currently changing, but going forward, survivorship is bound to be a topic of interest and one that perhaps may be more easily addressed using the proposed more centralized structure.
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Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: a pilot study.
Lung Cancer
PUBLISHED: 04-11-2011
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To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption, muscle strength and health related quality of life (HRHRQOL) in patients with inoperable lung cancer, undergoing chemotherapy.
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A review of VEGF/VEGFR-targeted therapeutics for recurrent glioblastoma.
J Natl Compr Canc Netw
PUBLISHED: 04-06-2011
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Glioblastoma, the most common primary malignant brain tumor among adults, is a highly angiogenic and deadly tumor. Angiogenesis in glioblastoma, driven by hypoxia-dependent and independent mechanisms, is primarily mediated by vascular endothelial growth factor (VEGF), and generates blood vessels with distinctive features. The outcome for patients with recurrent glioblastoma is poor because of ineffective therapies. However, recent encouraging rates of radiographic response and progression-free survival, and adequate safety, led the FDA to grant accelerated approval of bevacizumab, a humanized monoclonal antibody against VEGF, for the treatment of recurrent glioblastoma in May 2009. These results have triggered significant interest in additional antiangiogenic agents and therapeutic strategies for patients with both recurrent and newly diagnosed glioblastoma. Given the potent antipermeability effect of VEGF inhibitors, the Radiologic Assessment in Neuro-Oncology (RANO) criteria were recently implemented to better assess response among patients with glioblastoma. Although bevacizumab improves survival and quality of life, eventual tumor progression is the norm. Better understanding of resistance mechanisms to VEGF inhibitors and identification of effective therapy after bevacizumab progression are currently a critical need for patients with glioblastoma.
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Recreational physical activity and ovarian cancer risk and survival.
Ann Epidemiol
PUBLISHED: 02-08-2011
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Physical activity may influence ovarian cancer risk and outcomes through effects on ovulation, inflammatory markers, and other processes. We examined associations between self-reported physical activity and ovarian cancer risk and survival in a population-based, case-control study in North Carolina.
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Physical activity and lung cancer survivorship.
Recent Results Cancer Res.
PUBLISHED: 01-28-2011
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A lung cancer diagnosis and associated therapeutic management is associated with unique and varying degrees of adverse physical/functional impairments that dramatically reduce a patients ability to tolerate exercise. Poor exercise tolerance predisposes to increased susceptibility to other common age-related diseases, poor quality of life (QOL), and likely premature death. Here we review the putative literature investigating the role of exercise as an adjunct therapy across the lung cancer continuum (i.e., diagnosis to palliation). The current evidence suggests that exercise training is a safe and feasible adjunct therapy for operable lung cancer patients both before and after pulmonary resection. Among patients with inoperable disease, feasibility and safety studies of carefully prescribed exercise training are warranted. Preliminary evidence in this area supports that exercise therapy may be an important consideration in multidisciplinary management of patients diagnosed with lung cancer.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.