Multimorbidity and food insecurity in adults: A systematic review and meta-analysis

Food insecurity is one of the main factors affecting multimorbidity. Previous studies have shown that food insecurity may lead to multimorbidity due to person's inability to consume nutritious diet. However, considering that multimorbidity may cause work-related disabilities and an unstable income, others support the possible effect that multimorbidity has on food insecurity. The purpose of this systematic review and meta-analysis is to examine the relationship between food insecurity and multimorbidity in adults. A systematic literature review of studies was performed using the PubMed, EBSCO and SCOPUS for all articles including adults ≥ 18-year-old with multimorbidity living in developed countries published from August 5th until December 7th 2022. Meta-analysis was performed considering results from the fully adjusted model. The methodological quality was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies. This systematic review was not registered. This research received no specific grant from any funding agency. Four cross-sectional studies involving 45,404 participants were included in order to investigate the possible impact that food insecurity has on multimorbidity. The study findings showed an increased probability of multimorbidity 1.55 (95% CI:1.31-1.79, p<0.001, I2 = 44.1%) among people with food insecurity. Conversely, three of the included studies, involving 81,080 participants concluded that people with multimorbidity, have 2.58 (95% CI: 1.66-3.49, p<0.001, I2 = 89.7%) times higher odds to present food insecurity. This systematic review and meta-analysis provide evidence of a reverse association between food insecurity and multimorbidity. Further cross-sectional studies must be conducted in order to elucidate the association between multimorbidity and food insecurity across age groups and between the two genders.

Obesity and Chosen Non-Communicable Diseases in PURE Poland Cohort Study

INTRODUCTION

Obesity has been associated with a higher risk of morbidity, disability, and death. The objective of this study was to assess the prevalence of obesity and chosen non-communicable diseases (NCDs) in the PURE Poland cohort study.

MATERIAL AND METHODS

The study covers a group of 2035 people (1281 women and 754 men), who live in urban and rural areas of Lower Silesian voivodeship. The baseline study was conducted between 2007-2010. The data on demographic status and history of diseases were collected using questionnaires. The anthropometric parameters, blood pressure, blood lipids, and glucose level were measured.

RESULTS

Normal body weight was observed in 28.1% of participants, whereas overweight and obesity were observed in 40.1% and 31.1% of participants, respectively. Moreover, there was a significant difference in the body weight between genders. Prevalence of obesity was similar in men and women (31.0% and 31.1%, respectively). Obesity was more prevalent in rural vs. urban residents (38.5% and 26.0%, respectively). In a logistic regression analysis, the odds for obesity was two-fold higher in participants aged >64 years and rural inhabitants (OR 1.91; 95% CI 1.36-2.70; OR 1.79; 95% CI 1.48-2.16, respectively). Participants with obesity had 2.5-fold higher odds for diabetes and hypertension and two-fold higher odds for CHD in comparison with non-obese individuals (OR 2.74; 95% CI 2.01-3.73, OR 2.54; 95% CI 2.03-3.17, OR 1.88; 95% CI 1.26-2.80, respectively).

CONCLUSIONS

Taken together, the prevalence of obesity was associated with particular socio-demographic factors (age, place of residence, and level of education) as well as diabetes, hypertension, and coronary heart disease.

Mental Health and the SARS-COV-2 Epidemic-Polish Research Study

Background: The aim of this study was to assess the mental state of Poles in the first weeks of the SARS-COV-2 epidemic. Methods: In the study, the General Health Questionnaire-28 (GHQ-18), The Perceived Stress Scale (PSS-10), and Mini-Cope were used. Results: The study was conducted on a group of 443 individuals, including 348 women (78.6%) and 95 men (21.4%). There were more women (χ² = 6.42, p = 0.02) in the group of people with high results in the GHQ-28 questionnaire and the differentiating factors between those with sten scores above 7 (significantly deteriorated mental health) and those with average or low results (sten score below 7) turned out to be: treatment for mental disorders before the pandemic (χ² = 19.57, p < 0.001) and the use of psychotherapy during the pandemic (χ² = 4.21, p = 0.04) and psychiatric pharmacotherapy (χ² = 8.31, p = 0.01). The presence of suicidal thoughts since the appearance of the pandemic-related restraints and limitations significantly differentiates the compared groups (χ² = 38.48, p < 0.001). Conclusions: Every fourth person in the examined group (over 26% of the respondents) recorded results that indicate a high probability of mental functioning disorders. Approximately 10% of the respondents signalled the occurrence of suicidal thoughts since the beginning of the pandemic. The respondents complain mainly about problems in everyday life, lack of satisfaction from one’s own activities, tension, trouble sleeping, and feelings of exhaustion. Individuals with significantly reduced mental well-being use non-adaptive coping strategies, such as denying problems, emotional discharge, taking substances, discontinuation of action, and blaming themselves for the situation. The risk factors for the deterioration of the mental state of the respondents during the pandemic include psychiatric treatment before the beginning of the pandemic, the presence of suicidal thoughts during forced isolation, and the use of non-adaptive coping strategies (denial of the existence of problems, emotional discharge, use of psychoactive substances, discontinuation of action, and blaming oneself for the situation).

Challenges in Facing the Lung Cancer Epidemic and Treating Advanced Disease in Latin America

Lung cancer, the deadliest cancer worldwide, is of particular concern in Latin America. The rising incidence poses a myriad of challenges for the region, which struggles with limited resources to meet the health care needs of its low- and middle-income populations. In this environment, we are concerned that governments are relatively unaware of the pressing need to implement effective strategies for screening, diagnosis, and treatment of lung cancer. The region has also been slow in adopting molecularly-based therapies in the treatment of advanced disease: testing for epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements are not routine, and access to targeted agents such as monoclonal antibodies and tyrosine kinase inhibitors is problematic. In this paper, we review the current situation in the management of lung cancer in Latin America, hoping that this initiative will help physicians, patient associations, industry, governments, and other stakeholders better face this epidemic in the near future.

An Estimate of the Incidence of Prostate Cancer in Africa: A Systematic Review and Meta-Analysis

BACKGROUND

Prostate cancer (PCa) is rated the second most common cancer and sixth leading cause of cancer deaths among men globally. Reports show that African men suffer disproportionately from PCa compared to men from other parts of the world. It is still quite difficult to accurately describe the burden of PCa in Africa due to poor cancer registration systems. We systematically reviewed the literature on prostate cancer in Africa and provided a continent-wide incidence rate of PCa based on available data in the region.

METHODS

A systematic literature search of Medline, EMBASE and Global Health from January 1980 to June 2015 was conducted, with additional search of Google Scholar, International Association of Cancer Registries (IACR), International Agency for Research on Cancer (IARC), and WHO African region websites, for studies that estimated incidence rate of PCa in any African location. Having assessed quality and consistency across selected studies, we extracted incidence rates of PCa and conducted a random effects meta-analysis.

RESULTS

Our search returned 9766 records, with 40 studies spreading across 16 African countries meeting our selection criteria. We estimated a pooled PCa incidence rate of 22.0 (95% CI: 19.93-23.97) per 100,000 population, and also reported a median incidence rate of 19.5 per 100,000 population. We observed an increasing trend in PCa incidence with advancing age, and over the main years covered.

CONCLUSION

Effective cancer registration and extensive research are vital to appropriately quantifying PCa burden in Africa. We hope our findings may further assist at identifying relevant gaps, and contribute to improving knowledge, research, and interventions targeted at prostate cancer in Africa.

Diabetes mellitus increases the risk of colorectal neoplasia: An updated meta-analysis

OBJECTIVE

Recent studies proved that patients with diabetes were at significantly higher risk of developing colorectal cancer. However, the association between diabetes mellitus and the risk of colorectal adenoma remains undefined. Thus we conducted an updated meta-analysis to identify the association between diabetes mellitus and the risk of colorectal neoplasia including adenoma and cancer.

METHODS

We conducted a search in databases including Pubmed, Web of Science, EMBASE Databases, Cochrane CENTRAL, Wanfang Data, and CNKI database. Case-control and cohort studies were included. All articles were published before January 2015 and the quality of each study was evaluated by the Newcastle-Ottawa Scale. Odds ratios (ORs) or relative risks (RRs) and its corresponding 95% confidence intervals (CIs) for each study were calculated and summary relative risk estimates with corresponding 95% CIs were generated using the random-effects model. Heterogeneity and publication bias were assessed.

RESULTS

Twenty-nine articles including ten case-control studies and nineteen cohort studies were included in this meta-analysis. In a pooled analysis of all studies, diabetes mellitus was associated with increased risk of colorectal neoplasia (RR=1.35, 95% CI=1.28-1.42). The risk increased significantly for both colorectal cancer (RR=1.37, 95% CI=1.30-1.45) and adenoma (RR=1.26, 95% CI=1.11-1.44). Subgroup analyses on study design, gender, geographical region, and type of diabetes mellitus further evidenced these findings.

CONCLUSIONS

Diabetes mellitus was associated with an increased risk of colorectal neoplasia. Not only the increased risk of colorectal cancer but also the higher risk of adenoma was identified in patients with diabetes mellitus.

Sinapine as an active compound for inhibiting the proliferation of Caco-2 cells via downregulation of P-glycoprotein

Sinapine, an alkaloid from seeds of the cruciferous species, shows favorable biological activities such as antioxidant and radio-protective activities. However, the inhibitory effect of sinapine on tumors, and the molecular mechanisms have not been completely understood thus far. In this study, we determined anti-proliferative effects of sinapine. We examined the anti-tumor effects of the combination of sinapine and doxorubicin. The results of the MTT assay and apoptosis showed that sinapine increased the sensitivity of Caco-2 cells to doxorubicin in a dose-dependent manner, whereas no or less effect was observed in the cells treated with doxorubicin alone. The combination of sinapine and doxorubicin had a synergistic effect and increased the cytotoxicity of doxorubicin against Caco-2 cells. Doxorubicin accumulation assay showed that sinapine increased the intracellular accumulation of doxorubicin in dose-dependent manner. Immunoblotting and QT-PCR analysis showed that sinapine suppressed P-glycoprotein (P-gp) expression via ubiquitination. A significant correlation was observed between the expression of p-ERK1/2 and P-gp. These results indicated that sinapine played an important role in the down-regulation of P-gp expression through suppression of FGFR4-FRS2α-ERK1/2 signaling pathway. To our knowledge, this is the first study to show that sinapine can be used as an effective natural compound for chemo-resistance.

Cancer registries in four provinces in Turkey: a case study

Background

The burden of cancer affects all countries; while high-income countries have the capacity and resources to establish comprehensive cancer control programs, low and middle-income countries have limited resources to develop such programs. This paper examines factors associated with the development of cancer registries in four provinces in Turkey. It looks at the progress made by these registries, the challenges they faced, and the lessons learned. Other countries with similar resources can benefit from the lessons identified in this case study.

Methods

A mix of qualitative case study methods including key informant interviews, document review and questionnaires was used.

Results

This case study showed that surveillance systems that accurately report current cancer-related data are essential components of a country’s comprehensive cancer control program. At the initial stages, Turkey established one cancer registry with international support, which was used as a model for other registries. The Ministry of Health recognized the value of the registry data and its contribution to the country’s cancer control program and is supporting sustainability of these registries as a result.

Conclusions

This study demonstrates how Turkey was able to use resources from multiple sources to enhance its population based cancer registry system in four provinces. With renewed international interest in non-communicable diseases and cancer following the 2011 UN high-level meeting on NCDs, low- and middle- income countries can benefit from Turkey’s experience. Other countries can utilize lessons learned from Turkey as they address cancer burden and establish their own registries.

The state of research and development in global cancer surgery

OBJECTIVE

The objective of this study was to perform an analysis of global cancer surgery research and development trends over the last 10 years across 21 countries.

BACKGROUND

Surgery is the main modality for cancer cure and control globally. Yet, in comparison to other areas such as cancer drugs, we know little about ongoing research activities to inform policymakers.

METHODS

Two subfield filters, surgery research and oncology, were developed and applied to Web of Science. The intersection of these 2 filters identified papers in surgical oncology, and their bibliographic details were downloaded for analysis. This included matching of 5-year citation counts to the papers, impact factor, geographical analysis by country, translational collaboration, involvement in clinical trials, citation on clinical guidelines, and percentage of reviews.

RESULT

Surgical oncology represents about 9% of all cancer research-low in comparison with surgery's contribution to cancer treatment. The US published the most, followed by Japan which had a high relative commitment to surgery within cancer research, followed by the large West European countries. Although Sweden's papers were relatively basic, it participated the most in clinical trials. Its papers were also the most cited on clinical guidelines, but contained relatively few reviews, where the UK, Greece, and Belgium scored best. Surgical oncology papers are generally not well cited compared with cancer research overall, but on this measure the Netherlands, the US, and Sweden scored best. International collaboration was measured relative to what might have been expected, on this indicator Canada, Switzerland, and the US were the best performers.

CONCLUSIONS

Globally, low activity-low funding cycle needs to be addressed by new national and supranational policies to support surgical oncology research.

Delivering affordable cancer care in high-income countries

The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies.

Global patterns of cancer incidence and mortality rates and trends

While incidence and mortality rates for most cancers (including lung, colorectum, female breast, and prostate) are decreasing in the United States and many other western countries, they are increasing in several less developed and economically transitioning countries because of adoption of unhealthy western lifestyles such as smoking and physical inactivity and consumption of calorie-dense food. Indeed, the rates for lung and colon cancers in a few of these countries have already surpassed those in the United States and other western countries. Most developing countries also continue to be disproportionately affected by cancers related to infectious agents, such as cervix, liver, and stomach cancers. The proportion of new cancer cases diagnosed in less developed countries is projected to increase from about 56% of the world total in 2008 to more than 60% in 2030 because of the increasing trends in cancer rates and expected increases in life expectancy and growth of the population. In this review, we describe these changing global incidence and mortality patterns for select common cancers and the opportunities for cancer prevention in developing countries.