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Walking and running, which one is better?

Wednesday, July 24, 2013 0 comments

Illustrations ran. © Shutterstock

Walking and running, which one is better? - Cardio exercise can be done by running or walking. Both physical activity are equally healthy, but which one is better? Find the answer by listening to a full explanation about running and walking, as reported by Health Me Up below.

Benefit

The benefits of running is to lower blood pressure, cholesterol, diabetes, heart disease risk, prevent osteoporosis, increase energy, and burn calories.

While the benefits of walking more. Such as maintaining a healthy heart, burn calories, improve physical fitness and mind, lowers blood pressure, cholesterol, and diabetes, healthy bones, making a deep sleep, and reduce stress.

Calories burned

If you are running with a speed of 8 km / h, it means you've burned 472 calories. While if it ran on the steps, calories burned was 885.

Then walk as far as 10 km the same as burning 116 calories and up and down stairs as much as 14,484 steps means burning 605 calories.

Both of these activities, either walking or running, depending on the speed and weight.

Negative effects

Error in running position could trigger a knee injury, muscle damage, and heel. Especially if running barefoot and do not start out with warming.

Almost the same as running, walking can also be negative effects on the body. However, in general, errors are often caused by walking barefoot in use.

That's the difference between walking and running. So, already know which one is better and fit you do regularly?

Bloomberg Continues Fight Against Obesity One Step (or Stairway) at a Time

Tuesday, July 23, 2013 0 comments

One thing is clear about New York City mayor Michael Bloomberg, he doesn't shy away from a good fight, especially if the health and well-being of citizens is at stake. Whether it's getting food establishments to post calorie counts, cut back on trans fats, or limit the size of sugary sodas, he and his administration charge full steam ahead, all the while providing a great example of one of the main tenets of public health: our surroundings - the people, the choices, the places around us - make a real difference in our health behaviors.

In his latest push, the mayor signed an executive order focused on improving physical activity by promoting easier access to stairs in new buildings or those under significant renovation. Good evidence shows that stairways can be an effective and practical venue for increasing activity levels - improving fitness and hopefully combatting weight gain and obesity. We've previously posted about an unscientific - but very entertaining - project showing how stairs can me made more engaging, likely increasing their use (see video).

Though building design has begun to slowly change as green design and smart design have started to take hold, most existing buildings built since the 70s seemingly hide stairways from regular use, and even when you can find them, they are often dark and uninviting and accessed by doors that may or may not let you return through. Not a recipe for daily use, to be sure.

Under Bloomberg's initiative - and in two proposed bills - stairways will be brought back into the fore - with the hope that being able to see and easily access stairs will increase their use.

There will be hiccups along the way as these initiatives are put into practice. Change is always difficult. This movement, though, may meet less resistance than some of the mayor's others, building as it does on the current design ethos to create healthy and energy-efficient structures.Time will tell. One thing is sure, however, Bloomberg will keep moving ahead one step at a time.

References

Meyer P, Kayser B, Kossovsky MP, et al. Stairs instead of elevators at workplace: cardioprotective effects of a pragmatic intervention. Eur J Cardiovasc Prev Rehabil. 2010;17:569-75.

Nicoll G, Zimring C. Effect of innovative building design on physical activity. J Public Health Policy. 2009;30 Suppl 1:S111-23.

Soler RE, Leeks KD, Buchanan LR, Brownson RC, Heath GW, Hopkins DH. Point-of-decision prompts to increase stair use. A systematic review update. Am J Prev Med. 2010;38:S292-300.

Photo: PracticalHacks

Obesity Cuts Life Short

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More than 15 yeas ago we showed conclusive evidence that obesity causes many chronic conditions in the US population1-3 -, that weight gain increases risk of diabetes 4-6, heart disease 7, breast cancer 8, and that this burden adds up quickly, even before we get to overweight, let alone obesity. In the New England Journal of Medicine (report) we summarized some of this evidence 9.

With a cut off of BMI at 25 defining overweight, we see that risk of diabetes, gall stones, and high blood pressure and heart disease are all elevated, and the risk continues to rise with higher levels of adiposity or BMI. This is true in the first figure – showing the relative risks for women, and in the second for men.

Relative Risk of Diabetes, and other chronic conditions by level of Body mass Index (BMI)

Women

Men

We recently completed and analysis of national data to predict life years lost associated with obesity-related diseases for U.S. non-smoking adults, and to examine the relationship between those obesity related diseases and mortality.10 We used data from the National Health Interview Survey, 1997-2000 (see report).

We analyzed these data to estimate the association between those obesity related diseases and mortality and used simulations to project life years lost associated with the diseases.

What did we find?

We found that obesity-attributable comorbidities are associated with early mortality that leads to large decreases in life years and increases in mortality rates. The life years lost associated with obesity related diseases is more marked for younger adults than older adults, for blacks than whites, for males than females. Furthermore, the magnitude of life years lost increases with increasing level of obesity.

Using U.S. non-smoking adults aged 40 to 49 years as an example to illustrate percentage of the life years lost associated with disease caused by obesity, we found that the mean life years lost for U.S. non-smoking black males aged 40 to 49 years with a body mass index above 40 kg/m2 was 5.43 years. This translates to a 7.5% reduction in total life years lived. White males of the same age range and same degree of obesity lost 5.23 life years on average - a 6.8% reduction in total life years. For black females the numbers are: 5.04 years, a 6.5% reduction in life years, and white females they are: 4.7 years, a 5.8% reduction in life years.

Overall, diseases caused by obesity increase the chances of dying and lessened life years by anywhere from 0.2 to 11.7 years depending on gender, race, BMI classification, and age. The effect of obesity related diseases on mortality is shown for each age group in the figure below.

The epidemic of obesity in the US continues to carry a heavy burden for society 11,12, on our health care system 13,14, our businesses 15, and on our families.

References

1. Willett W, Dietz W, Colditz G. Guidelines for healthy weight. N Engl J Med. 1999;341:427-434.

2. Colditz GA, Coakley E. Weight, weight gain, activity, and major illnesses: the Nurses' Health Study. Int J Sports Med. Jul 1997;18 Suppl 3:S162-170.

3. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. Oct 27 1999;282(16):1523-1529.

4. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes in women. Ann Intern Med. 1995;122:481-486.

5. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17:961-969.

6. Colditz GA, Willett WC, Stampfer MJ, et al. Relative weight and increased risk of diabetes in a cohort of US women (abstract). Am J Epidemiol. 1987;126:750-751.

7. Willett WC, Manson JE, Stampfer MJ, et al. Weight, weight change, and coronary heart disease in women: risk within the 'normal' weight range. J Am Med Assoc. 1995;273:461-465.

8. Huang Z, Hankinson SE, Colditz GA, et al. Dual effects of weight and weight gain on breast cancer risk. JAMA. 1997;278(17):1407-1411.

9. Willett WC, Dietz WH, Colditz GA. Guidelines for healthy weight. N Engl J Med. 1999;341:427-434.

10. Chang SH, Pollack LM, Colditz GA. Life Years Lost Associated with Obesity-Related Diseases for U.S. Non-Smoking Adults. PLoS One. 2013;8(6):e66550.

11. Oster G, Thompson D, Edelsberg J, Bird AP, Colditz GA. Lifetime health and economic benefits of weight loss among obese persons. Am J Public Health. Oct 1999;89(10):1536-1542.

12. Colditz G. Economic costs of obesity and inactivity. Med Sci Sports Exerc. 1999;31:S663-667.

13. Thompson D, Edelsberg J, Colditz G, Bird A, Oster G. Lifetime health and economic consequences of obesity. Arch Intern Med. 1999;159:2177-2183.

14. Thompson D, Brown JB, Nichols GA, Elmer PJ, Oster G. Body mass index and future healthcare costs: a retrospective cohort study. Obes Res. Mar 2001;9(3):210-218.

15. Thompson D, Edelsberg J, Kinsey K, Oster G. Estimated economic costs of obesity to U.S. business. Am J Health Promot. 1998;13:120-127.

Triglycerides and cholesterol, what's the difference?

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Illustration of cholesterol. © Shutterstock / JohnKwan

Triglycerides and cholesterol, what's the difference? - Heart health depends on cholesterol levels. While in addition to keeping cholesterol, you also need to control triglyceride levels. Then what is the difference between triglycerides and cholesterol? Check out more as reported by the Health Me Up below.

Definition

Triglycerides are compounds present in foods and blood plasma. Triglycerides are a source of energy and as triglycerides into the body through food, the shape can turn into fat cells if it is not transferred into energy. So basically, the body needs triglycerides to produce energy.

Difference

As already mentioned, triglycerides are a source for protein. While cholesterol is needed to form a cell. Both are equally important for the body, as long as the amount is not excessive. Someone had normal cholesterol levels should be no more than 150 mg / dL, especially for people with heart disease.

Excess

If excessive amount of triglycerides, the fat cells can clog blood vessels and increase the risk of cardiovascular disease (including heart disease and stroke). Excess triglycerides also affect the performance of the pancreas.

Control

So how to keep your triglyceride levels remain balanced? From now on, less fatty foods, stop consuming alcohol, lose weight, exercise diligently, and avoid sugary products that have high or purified.

Thus explanation of triglycerides. In addition to cholesterol, a compound that also need to be monitored to maintain overall body health.

Avoid food 6 cause of stress!

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Illustration of sugar. © Shutterstock.com / saurabhpbhoyar

Avoid food 6 cause of stress! - Some foods have properties increases levels of the hormone cortisol - stress. If you do not want to necessarily bad mood, you should avoid foods that cause stress as reported by the All Women Stalk following.

Saturated fat

Saturated fats not only improve cholesterol in the body, but also trigger the production of excess cortisol hormone that triggers stress.

Refined sugar

Sugar in any form, especially the refined, making blood sugar rise dramatically if consumed in excess. If used to eat, the body can be addictive and release the hormone cortisol until you satisfy it by eating more.

Caffeine

Coffee is actually healthy. However, the caffeine content in it to watch. Because caffeine can trigger stress and worsen mood.

Low fiber

Eating foods low in fiber makes easy stomach hungry, so you tend to be sensitive and grumpy. In addition, digestion also substandard due to too little fiber intake.

Alcohol

Alcohol is toxic to the liver because the body is unable to break down compounds in it. As a result, feel stressed organs and release the hormone cortisol as a form of protest.

Purified wheat

Almost the same as sugar, refined wheat should be shunned. Better to choose whole grains are much more healthy and not stressful.

That variety of foods that cause cortisol levels to rise and trigger stress. Should not consume excessive ya!

7 Things that damage eye health

Monday, July 22, 2013 0 comments

7 Things that damage eye health - Lifestyle, work culture, eating habits, polluted environment and attitude towards their health is a factor that can affect the overall health of the body. Lifestyle that we follow today put too much pressure on the body which in turn makes our risk of contracting various diseases. And eyes be one part of the body that is often affected by an unhealthy lifestyle that we live today. Here are some things that can damage the health of our eyes, as reported Boldsky.

1. Smoke

Smoking has adverse effects on overall body health. This bad habit can also damage the eyes. There are many chemicals in smoke that can damage sensitive parts of the retina, called the macula.

2. Tired eyes

Sometimes, without realizing we are putting too much pressure on our eyes. We often work at a computer, watching TV, playing video games, read or continue learning for hours. It causes eye fatigue which can lead to eye damage.

3. UV rays

You are always advised to wear sunglasses every time you go out. You know why? Because ultraviolet rays from the sun can be harmful to eye health. These rays can burn the cornea and cause damage to the eye lens and retina. In addition, UV rays also increases the risk of cataracts.

4. High blood pressure

High blood pressure can be very harmful for the eyes if not treated. It damages the blood vessels in the retina, the area at the back of the eye. This disease is known as hypertensive retinopathy.

5. Diabetes

If you have been diagnosed with diabetes, you are more likely to develop some eye diseases such as glaucoma, diabetic retinopathy, in which the retina can be damaged severely.

6. Alcohol

Excessive alcohol intake can be harmful to the body, including the eyes. Alcohol can cause problems with your vision and overall eye health. You may experience a decrease in visual performance, reaction pipil slow, frequent migraines, eye redness and decreased contrast sensitivity.

7. Unhealthy food

If you follow an unhealthy diet and the body does not get the nutrients needed for healthy eyes, you will be more susceptible to many diseases of the eye. Vitamin A deficiency causes blindness or difficulty seeing at night and dry eye terrace. Similarly, low intake of vitamin B-12 can cause blurred vision or double vision.

Here are seven things that can damage the health of your eyes. Remember, it is better to prevent than cure!

Pregnant over the age of 35 years? Consider this

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Pregnant over the age of 35 years? Consider this - There is a new woman can get pregnant at the age of 30 years. It is a happy and disturbing because that age are considered vulnerable to conceive. Consider the risk of containing reported by Fox News.

1. Lose weight

Most women who give birth after 35 would be fine. But many complications that could be prevented. So if you have heart disease, thyroid disease or are overweight, try to be more healthy with diet and if you drink alcohol or smoke, immediately was stopped.

2. Blood pressure checks

Because the drop in blood pressure in the second trimester, it is important to have a normal blood pressure in the first trimester to avoid the risk of pre-eclampsia.

3. Consumption of prenatal vitamins

Start is the consumption of prenatal vitamins which contain at least one milligram of folic acid three months before conception through pregnancy to prevent neural defects in the fetus.

4. The risk of gestational diabetes

Pregnant women in more than 35 years of age are more at risk of gestational diabetes. Immediately check your blood sugar when I discovered the pregnancy and attention levels up to the birth.

5. Disordered eating and exercise

Fulfill your nutrition as well as the fetus with nutritious food. Besides doing enough activity to improve fitness and prepare for birth.

6. Pre-birth testing

This test aims to check for abnormalities of chromosomes to facilitate diagnosis of the fetus and the possibility of obtaining good or bad that happens. Because the age-old pregnant woman at risk for fetal chromosomal abnormalities.

Take good care of pregnancy and your health so that you can give birth to healthy babies safely.

3 bad habits that make a fitness decreases

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3 bad habits that make a fitness decreases - A healthy body can not be obtained with it. You have to maintain fitness and health by doing healthy habits every day. Some habits such as smoking and drinking alcohol can damage the health of course.

But other than that there are some bad habits that are small, but can also affect your health. What is it? Here it is, as reported by the Huffington Post.

1. Only exercise when I want

Exercise should be done regularly, not just when you want it. If exercise only when they want to do it, you definitely will often make excuses like tired, lazy, and a lot of jobs. That way, you will reduce the fitness and health. However, research shows that 90 percent of people who exercise regularly have lower levels of fatigue and more focused. If you feel tired during the afternoon exercise, try to do it in the morning.

2. Weeks is necessary to exercise

If you feel you have to work hard, keep your diet and exercise every day, chances are you think that a few days lazing definitely not a problem. You are wrong if you think so. Although there are days when you do not exercise hard, you also can not really passive and laze around all day. This will affect your fitness. Although not go to the gym or exercising, you can take advantage of a day for a vacation or an outing. The important thing is to keep moving and active.

3. Have friends who do not like sports

One of the reasons you can be lazy sport is your friend group. Usually the group behavior can indeed affect someone. but this is not the reason. You should be able to define what you need, do not have to always follow what is done by the group. You are responsible for maintaining their health and fitness. If necessary, be a pioneer, and invite your friends who are lazy to exercise to exercise.

Those are some small habits and ordinary reasons a person. Although it seems trivial, but such practices can affect health if done too often. Even the unconscious habit has made you a fitness decreases.

Less vitamin D scaled physical abilities in old age

Sunday, July 21, 2013 0 comments

Illustration of vitamins and calcium supplements. © Shutterstock.com / Chezlov

Less vitamin D scaled physical abilities in old age - Not getting enough vitamin D can cause health problems in old age. A study showed that elderly people with vitamin D deficiency had physical function problems such as difficulty walking around the house than people who consume enough vitamin D.

"Seniors who have low levels of vitamin D have problems such as difficulty moving body functions. They will experience a decline in function of the body with age," said lead researcher Evelien Sohl of the VU University Medical Center in Amsterdam, as reported by NBC News.

Researchers revealed that about 90 percent of seniors lack of vitamin D. Though vitamin D helps maintain muscle and bone health and prevent bone loss such as osteoporosis. Vitamin D can be obtained from sunlight or foods such as oily fish, mushrooms, eggs, milk.

These results were found after researchers observed 762 people aged 65 to 88 years and 597 men aged 55 to 65 years. They were observed for six years and questioned about the activity and the level of vitamin D in the blood.

Researchers found that the first group of seniors, low levels of vitamin D lead to an increased risk of physical problems as much as 1.7 times more while in the younger group doubled. Researchers also found that problems began to emerge after three years in the oldest group and six years in the younger group.

Frequent exercise can lower the risk of stroke

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Frequent exercise can lower the risk of stroke - Frequent exercise to sweat is known to lower the risk of stroke in middle-aged to elderly, according to recent research. Compared to people who never exercise, people who work up a sweat at lower risk.

"A healthy diet, a healthy weight, exercising regularly and avoiding bad habits like smoking and drinking alcohol can reduce the risk of stroke by 80 percent. Meanwhile, the most important aspect of the exercise is to be done," said study author Michelle McDonnell, as reported by U.S. News.

According to McDonnell, exercise can reduce the risk of stroke by boosting blood vessel health. Indirectly it also lowers the risk of high blood pressure and obesity.

This study was conducted with 27,000 people following the Americans starting in 2003 to 2007. Participants were aged 45 years or older at the start of the study and had no history of stroke never experienced before. During this study several cases of stroke occurred in participants.

Approximately 3.1 percent of those who diligently exercise group experienced a stroke, compared with 3.3 percent of people who only exercise one to three times a week, and 3.6 percent in the group that did not exercise.

After making observations and statistics by eliminating other factors, researchers found that a group of people who exercise often have a 20 percent lower risk of stroke than those who never exercise.

5 bad habits in the morning

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Illustration of waking. © Shutterstock / Vicente Barcelo Varona

5 bad habits in the morning - It has often been mentioned that skipping breakfast is a bad habit that should be stopped. But other than that, there are many other bad routines that are often done in the morning. What is it? Check out more as reported by the Huffington Post following.

Difficult to wake up in the morning

Many people are having trouble up early fault of their own, which was late in the day before. Though keeping the ration was still trying to wake up early and important to do in order to maintain the body's biological clock.

Delaying alarm

Alarm delay will not make feel more refreshed because you've got a chance to sleep longer, but it can damage the sleep system and make the body feel weak. Instead of delaying alarm, better install an alarm and put it in a place away from the reach of the hand.

Sleep and wake up at will

As mentioned previously, keeping the body's biological clock needs to be done in a way to sleep and wake up at the same time. If you accustom yourself to sleep and wake up at will, the body will feel weak and lethargic.

Exercise on an empty stomach

Exercise after waking up is a good habit. But what makes it worse is exercising on an empty stomach. Better wake up 15 or 20 minutes early, enjoy fruit and hurried exercise.

Skipping breakfast

Research shows that skipping breakfast can increase the risk of diabetes. Not only that, no breakfast also affect mood and memory of the men. So stop this bad habit as soon as possible.

That's bad habits in the morning. Hopefully you are not one of those people who always do.

5 How to control your weight without dieting

Saturday, July 20, 2013 0 comments

5 How to control your weight without dieting - Diet is not the only way to control weight. There are more effective ways, namely by adjusting your mindset about food itself. However, you will encounter many challenges when you have to be in a banquet serving a variety of dishes. Here's how to manage your diet to keep it controlled, as reported Boldsky.

1. Do not eat until you are full

Avoid eating to satiety. Stop when you feel full up to 80 percent. If not, you will eat to excess and make a disturbed metabolism.

2. Eating healthy foods

Healthy foods can give you energy and protein. Therefore, multiply eat healthy foods to keep your body fit.

3. changing perspective

To run a healthy lifestyle such as this, the first thing you have to change is your perspective. Which is healthy and what is unhealthy. Which one should eat or not eat.

4. Overeat when sad

Stop eating certain foods to excess when you're sad. It's a bad habit that many women often do when they are feeling emotionally. Remember, stop doing it if you want to control your weight.

5. Know your actual hunger

Remember, hunger coming from your stomach and not of eyes and your head. With a hunger to know the truth, you can eat wisely and not just by mere lust.

Here's five ways to control weight without dieting. By controlling the mind, you can easily control what goes into your mouth.

How Cervical Cancer After the verdict ?

Friday, July 19, 2013 0 comments

Illustration of Cervical Cancer verdict

How Cervical Cancer After the verdict ? What is meant by pre-cervical cancer (Cervical Dysplasia) is when Pap test results indicate the presence of abnormal cells on the surface of the cervix (cervical) under the microscope. Although it took more than 10 years before they turn into cervical cancer, it needs to watch out. Because when the cervical dysplasia treated early, can prevent the occurrence of cervical cancer in later life.

Pre-cancerous conditions of the cervix (cervical dysplasia) is described using the term squamous intraepithelial lesion (SIL), which is usually assessed as follows :

Low-grade (LSIL)
High-grade (HSIL)
Maybe cancerous (malignant)

When a Pap smear test result is not good, the doctor will usually recommend that HPV DNA testing done or biopsy to see signs of cervical cancer. Dysplasia seen in cervical biopsies using the term neoplacia cervical intraepithelial (CIN), and grouped into three categories:

CIN I - mild dysplasia
CIN II - moderate to marked dysplasia (marked displacia)
CIN III - severe dysplasia to cervical pre-cancer

Cause of Cervical Pre-Cancer

Most cases of cervical dysplasia occur in women aged 25-35, although it can develop at any age. Almost all cases of cervical dysplasia or cervical cancer caused by HPV is transmitted through sexual contact. Things that can increase the risk of cervical dysplasia :

Women who are sexually active before the age of 18 years
Give birth before the age of 16 years
Has a lot of sexual partners
Using drugs that suppress the immune system (immunosuppressant)
Smoke

Pre-Treatment of Cervical Cancer

Without treatment, 30-50% of cases of severe cervical dysplasia can become invasive cervical cancer. Risk of cervical cancer is lower for mild dysplasia. Treatment depends on the degree of dysplasia. Mild cervical dysplasia (LSIL or CIN I) may disappear by itself. You only need to repeat the Pap smear test every 3-6 months. If repeated for 2 years, treatment is usually recommended. Treatment for moderate to severe cervical dysplasia or cervical dysplasia recurring minor may include :

Cryosurgery
Electrocauterization
Evaporation laser to destroy abnormal tissue
Use electrocauter LEEP procedure to remove abnormal tissue
Surgery to remove the abnormal tissue (cone biopsy)

Very rarely, hysterectomy (surgical removal of the uterus) is done. Women with cervical dysplasia should consistently follow-up, usually every 3 to 6 months as recommended by your doctor.

Pre-Cervical Cancer Prevention

HPV vaccination may be considered to prevent the occurrence of cervical pre-cancer. Girls who receive HPV vaccine before they become sexually active can reduce their risk of cervical cancer by 70%. In addition, to prevent cervical cancer, you should :

Do not smoke
Do a practice monogamy
Use a condom during sexual intercourse
Do not have sex, until at least the age of 18 years or more

Cervical cancer and your sexual life

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Cervical cancer and your sexual life

Cervical cancer and your sexual life. You may feel nervous about your sexual life after a diagnosis of cervical cancer, or when you're in a phase of treatment. If you are having chemotherapy, good partner to use a condom. It's just a precaution only, so far there is not enough information about the side effects of chemo are channeled through the vaginal mucus.

It is good when you give pause for a few weeks of recovery. After that sex is safe. Sex can not make you more severe cervical cancer or increase the risk of cancer recurrence. Cervical cancer is not a contagious disease so that your partner does not need to worry.

You may just need a little time to adapt to your current condition. Anxiety will only lower the mood for sex. When this happens, talk openly with your partner and find a way out together. If you both do not find an agreement, it is worth visiting sex therapist or psychologist to consult. If the diagnosis of cervical cancer shows that you are infected with the HPV virus, then your partner should also undergo HPV testing and treatment. So, be carefully with this one of deathly virus in the world.

New Study Shows HPV Vaccine Also Likely Protects Against Throat Cancers

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Adding to the growing benefits linked to the human papillomavirus (HPV) vaccine that protects against cervical cancer, is a new study providing solid evidence that the vaccine will also likely help protect youth and young adults from developing throat cancers later in life. The study appeared in the journal PLoS One and was also written up in today's New York Times.

The study followed approximately 7,500 women ages 18 - 25 years old - half of whom received the HPV vaccine and half of whom did not - getting the hepatitis A vaccine instead. After four years, both groups were tested for oral HPV infection, and the group that had received the HPV vaccine experienced a single case of HPV while the unvaccinated group experienced 15 cases, making the vaccine 93 percent effective.

Just as cervical infection with HPV is strongly linked with cervical cancer, oral infection with HPV - which occurs largely through oral sex - is linked with oropharyngeal cancer (related post, here). Cutting down or eliminating oral infection with HPV can significantly lower the risk of developing certain types of throat cancer later in life.

With a little over half of all sexually active heterosexual youth and young adults ages 15 - 24 in the United States reporting oral sex as their first major sexual experience, these findings can have major implication for future rates of throat cancer - if vaccination programs continue to take hold.

Yet, the use of the HPV vaccine in girls - which requires three shots over a number of months - hovers around 14 percent, leaving much room for improvement. And in boys - who are also recommended to have the vaccine - rates are much lower, around one percent in targeted ages.

For a vaccine that is demonstrated to be safe and effective, and that is a major highlight in the fight against important cancers in the United States - and the world - it is meeting slow uptake, and at times, outright resistance by some parents and politicians. That it is a newer vaccine - and one that targets a sexually transmitted infection - makes it understandable that some parents have some questions about it. Yet, as new data and better information come out, the reasons parents may have for not getting the vaccine strip away quickly.

As we do a better job breaking down barriers to getting the vaccine - whether it's through improving health care access or knowledge of the vaccine's safety and benefits - it's hard to imagine that high rates of parents will continue to avoid a vaccine that will lower their children's risk not only of cervical and oropharyngeal cancer but also vaginal, penile, and anal cancers.

Photo: Melissa P

Reducing cancer disparities through participating in clinical research

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Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet National Institutes of Health-mandated goals, strategies to increase participation are required. We recently reported our work from Siteman Cancer Center and the Program for the Elimination of CancerDisparities to increase trial participation.

Clinical trials are crucial to advancing science across the cancer continuum. Comprehensive inclusion of diverse participants in clinical trials is essential to assuring generalizability of prevention, diagnostic and treatment recommendations and ultimately the identification of effective treatments for all sectors of society. Although federal mandates require investigators to demonstrate sufficient representation of minorities in study samples 1-4, there continues to be disparity in the representation of racial and ethnic minorities in clinical trials 5-10.

Data available from 2000 show that accrual to National Cancer Institute-sponsored clinical trials for African Americans, Hispanics or Latinos, Asian/Pacific Islanders and American Indians was 8.2%, 4.5%, 1.8% and 0.3%, respectively 5. An update for the period 2003 to 2005 indicates that NCI and publically funded phase 1, 2, and 3 trials showed a national average of 8% African American participants among the total enrollment. Addition of Asian Pacific Islander (2.8%) and Native American Alaska Native (0.5%) and multiple (.1%) brought the total minority participation by race to 11.4% 11.

For all aforementioned groups except American Indians, clinical trial accrual percentages are considerably lower than each group’s respective make-up of the United States population (12.3%, 12.5%, 3.7% and 0.9%, respectively) 12. Additionally, other groups have been under-represented in clinical trials, including uninsured and underinsured adults, adults with lower socioeconomic status, and those living in underserved or rural areas 8,13-15.

Factors that contribute to this disproportional representation are well-documented and are influenced by multiple levels of interaction in the clinical trial recruitment process. In a recent paper, our team at Siteman published a report of our initiative through the Program for the Elimination of Cancer Disparities (see report). We present a framework for institutional enhancement of minority clinical trial accrual.

Four interrelated levels interact to influence enrollment of minorities to clinical trials. They range from individual level influences on patient trial participation (e.g. mistrust of research, faith beliefs, or fear of side effects) to interpersonal level factors (e.g. physician-patient relationships/communication or communication about trials between patients and friends or other patients) to institutional and clinical practice level influences (e.g. organizational infrastructure to reinforce minority recruitment, lack of physician awareness of available clinical trials, systemic lack of time for recruiting, or small minority patient pools), and finally, community and public policy level influences (e.g. federal mandates or inhibitive inclusion criteria that restrict participation due to a range of factors including co-morbidities) 16-31.

These discrete, but interrelated obstacles clearly indicate opportunities for intervention including careful consideration of required inclusion and exclusion criteria 19,32-35; structured evaluation of cancer trial results on strata such as age (or ethnicity) to understand tumor biology, treatment tolerability and the effects of comorbid conditions to help refine mandatory eligibility criteria for future studies 36,37; targeted patient communication via patient trusted communication vectors 38; use of peer coaches 39; and increased trust building between patient/provider and with communities 40,41.

Such interventions are essential in the path to achieve federal mandates for minorities in clinical trials. Emphasis is usually placed on individual and interpersonal levels of influence respective to both patients and providers. While this approach has merit and is part of the solution 42, closer linkage across levels of influence from individual to policy will speed attainment of minority clinical trial recruitment benchmarks over time. Sorensen et al. 43 illustrate this approach for cancer health behavior interventions across social contexts, and for achieving population-wide health advances in the United States 44. Without this linkage, interventions focused on individual and interpersonal levels of influence to increase minority participation are disconnected from parallel interventions at the community and public policy level of influence.

Consequently, an implementation gap results, which diffuses both progress toward and accountability for reaching national recruitment benchmarks, and makes way for slower progression of science discovery reinforcing poorer health status and quality of life for the population.

Fundamental to making the link across the continuum from individual to policy levels of influence is a focus on institutional level influences. Usually, there is an absence of any formal structure for ongoing monitoring of organizational/institutional progress in minority recruitment, beyond cancer center wide reporting at competitive peer review. To bridge this disconnect and underscore centralized accountability, tracking and monitoring across an organization, systematic adjustments to improve organizational infrastructure for minority clinical trial enrollment are required. Here, we describe a framework for centralized organizational accountability through systematic benchmark development, continuous progress monitoring and responsive adjustments at provider and organizational levels to enhance organizational infrastructure to induce and sustain increased minority participation in clinical trials.

Just how did we do this?

We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: (1) leadership support; (2) center-wide policy change; (3) infrastructural process control, data analysis, and reporting; and (4) follow-up with clinical investigators. A Protocol Review and Monitoring Committee reviews studies with 15 or more patients accruals as the target, and monitors accrual, and the Program for the Elimination Cancer Disparities leads efforts for proportional accrual, supporting the system through data tracking, web tools that allow investigators to see the average distribution of cancer by stage and race over the preceding 3 years, and provides feedback to investigators.

What did we find?

Following implementation in 2005, minority accrual to therapeutic trials increased from 12.0 % in 2005 to 14.0 % in 2010. The "rolling average" minority cancer incidence at the institution during this timeframe was 17.5 %. In addition to therapeutic trial accrual rates, we note significant increase in the number of minorities participating in all trials (therapeutic and nontherapeutic) from 2005 to 2010 (346-552, 60 % increase, p < 0.05) compared to a 52 % increase for Caucasians.

What dies this mean?

Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring of accrual, offers a successful strategy. We believe this approach can be replicated in other cancer centers, and may also extend to other clinical and translational research centers.

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