Podcast 2007 Show Notes

Episode #0042—October 5, 2007
Time: 00:24:49 | Size: 22.7 MB

Schmalfeldt: Welcome to episode 42 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health-the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, Researchers at the National Institutes of Health have found that more than 50 percent of the current asthma cases in the country can be attributed to allergies, with about 30 percent of those cases attributed to cat allergies. Wally Akinso has a report on how pregnant women who have very low cholesterol levels may face a greater risk of delivering their babies prematurely than women with regular cholesterol levels, according to a study by the National Human Genome Research Institute. And on the subject of preterm birth, extremely low birth weight premature babies who received breast milk shortly after birth had greater mental development scores at 30 months than did infants who were not fed breast milk, according to a study funded by the National Institute of Child Health and Human Development at the National Institutes of Health. And from the "In Case You Missed It" file, an interview from back in June with Dr. Julia Rowland, director of the Office of Cancer Survivorship at the National Cancer Institute. But first, Wally has a report about new online resources stressing the importance of calcium for bone health that are now available for middle school teachers through the Milk Matters calcium education campaign sponsored by the National Institute of Child Health and Human Development. That's next on NIH Research Radio.

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Schmalfeldt: Welcome back to NIH Research Radio. Wally Akinso has this report about some new resources available stressing the importance of calcium in a child's development.

Milk Matters Online Lesson Resources Available for Teachers

Akinso: New Online resources stressing the importance of calcium for bone health are now available for middle school teachers through the Milk Matters calcium education campaign sponsored by the National Institute of Child Health and Human Development. The campaign encourages 11-15 year olds in particular to consume sufficient calcium because these are the years of rapid bone growth, according to Dr. Karen Winer from the NICHD's Endocrinology, Nutrition, and Growth Branch.

Winer: The Milk Matters online lesson is really support to teachers. This can provide evidence base messages about the importance of calcium for bone health in adolescence and it just provides a lot of different ideas for teachers to incorporate in their lessons.

Akinso: Milk Matters' online lesson resources are designed to help students understand the importance of making smart food choices. Dr. Winer talks about some of the many features that the site has to offer.

Winer: They have take-home assignments. There's a cookbook which I thought was interesting. They teach concepts how to ready nutrition fact labels. You know, if they go to the supermarket they'll understand how to choose foods that are high in calcium. And then just to understand which foods are high in calcium and what is need for this age group which is approximately 1300 milligrams a day. So those are the basic resources that are provided there.

Akinso: In addition to teacher materials, the Milk Matters web site offers a variety of free materials for parents and health care providers that emphasize the importance of calcium in the diets of children and teens, including a booklet, poster, fact sheets, a coloring book, and sticker. So teachers and parents, if you would like to check out the website visit www.nichd.nih.gov/milk. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.

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New National Study Links Asthma to Allergies

Schmalfeldt: Researchers at the National Institutes of Health have found that more than 50 percent of the current asthma cases in the country can be attributed to allergies, with about 30 percent of those cases attributed to cat allergies. Researchers at the National Institute of Environmental Health Sciences and the National Institute of Allergy and Infectious Diseases determined that 56.3 percent of asthma cases are attributed to atopy-a condition that results from gene-environment interactions. Dr. Darryl C. Zeldin, a senior investigator at the NIEHS, said that sensitivity to cat allergens appears to be a strong risk factor for asthma in this study, but that some research shows that exposure to cats, particularly in early life, may be a protective factor.

ZELDIN: What we're looking at in our study is current exposure to allergens and current asthma symptoms. That said, there is certainly significant literature out there that suggests that early exposure to things like cats and dogs and farm animals is protective and it's thought that it leads to the development of a tolerance or to an immune system that's less likely to be allergic.

Schmalfeldt: A positive skin test reaction to cat allergens accounted for 29.3 percent of the asthma cases, followed by 21.1 percent for a fungus known as Alternaria and 20.9 percent for white oak. Dr. Zeldin said there are several implications to be drawn from the study.

Zeldin: First is that if one can somehow prevent the development of allergy to cat, Alternaria and white oak, then a significant number of asthma cases could potentially be prevented. The other way to look at the coin is although 50-plus percent of individuals have asthma that can be attributable to this allergy or atopy, that means that just under half of asthma cases have a non-allergic etiology. In other words, their asthma is not related to development of allergy. And I think that we and other scientists are trying to figure out what other things may be causing or exacerbating asthma in the indoor environment and I think there needs to be further research in this area.

Schmalfeldt: The study is available online in the Journal of Allergy and Clinical Immunology.

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Schmalfeldt: When we return we'll discuss the challenges that face cancer survivors with Dr. Julia Rowland, director of the Office of Cancer Survivorship at the National Cancer Institute. That's next on NIH Research Radio.

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Schmalfeldt: Cancer survivorship - it's a topic that you really don't hear a whole lot about, and that's interesting in itself because more and more people are surviving cancer. It's not a death sentence any more, in many cases, it's a life sentence. You might be surprised to know that here at the National Institutes of Health we actually have an Office of Cancer Survivorship. And here with us right now on NIH Research Radio is the Director of the Office of Cancer Survivorship at the National Cancer Institute, Dr, Julia Rowland. Thank you for joining us today.

Rowland: Bill, it's lovely to be here today and I really welcome the opportunity. Schmalfeldt: Tell us a little, if you will, about the mission at the Office of Cancer Survivorship.

Rowland: Well, the ultimate goal at the office is really to enhance the length and quality of life of all those who carry a diagnosis of cancer.

Schmalfeldt: I know that when you hear about people who have survived some horrible event, you hear about the "guilt of survivorship." Does that enter into cancer survivorship at all?

Rowland: That's certainly an issue for many individuals who carry this history - "why me? Why did I do well? Why did I recover from this when there are so many like me who have succumbed to this disease?" So certainly there is an issue of that. And along with it, of course, there's the fear that many survivors tell us that they live with from day to day, and that's the fear that the disease will come back.

Schmalfeldt: Do you ever get over that?

Rowland: That's a really good question. In general, people will tell you it never really goes away. But people will find they can park it somewhere and get on with their lives and live rich, full, rewarding existences. For some, though, it's a real hurdle with daily reminders - and certainly we've seen a lot of stories in the press recently about public figures talking about their illness coming back. And when those events occur they raise a lot of anxiety in people who are survivors themselves.

Schmalfeldt: How did the National Cancer Institute come about this decision to start the Office of Cancer Survivorship?

Rowland: Well, the office was actually established back in 1996 in direct response to compelling and articulate response out of the advocacy community saying "it's wonderful you have all these advances, the earlier detection, the better treatments, more supportive care, and that people are living long term with this illness, but what we don't know is to what you are returning individuals, what are the kinds of problems that individuals face after treatment, and what are you doing about that?" Essentially, it was a challenge back to the NCI to say "congratulations on your success, but you need to be cognizant that cancer cures and care come with a cost."

Schmalfeldt: And what got you interested in this particular field?

Rowland: Well, I actually stumbled into this area in some ways in my graduate career. I was doing research in developmental psychology, so I was very interested in illnesses that occur across the life course, when in the time of an individual's life do they become ill. and one of my professors referred me to a physician who at that time was doing research up in the Bronx, looking at women who were breast cancer survivors and talking to them about their quality of life. And I was instantly hooked. I thought this was as fascinating area with lots of work to be done.

Schmalfeldt: What is on the horizon in the area of cancer survivorship? What research are you guys doing? What exciting things are we going to be hearing about in the future?

Rowland: I think some of the exciting things we're looking at, partly it goes back to the mission of the office, which is "tell us a little bit more about what happens to individuals post treatment". So, what has happened in the past 10 years since the office was created is that the medical community now recognizes that cancer survivorship - that post treatment period is an area of unique issues in and of itself. And that's very exciting because it has placed this solidly in the area of what we sometimes refer to as the "cancer control continuum." It has its own unique issues and there are researchers and clinicians who are addressing specifically that particular piece of recovery and wellness. What's been very exciting as we listen to the voice of survivors is recognizing we need to attend to their health behaviors after cancer. Interestingly, some relatively simple things - recommendations to stay physically active after your cancer diagnosis - may have important impact on disease recurrence and possibly long-term survival. So those kind of findings are very provocative, very exciting, because this is something everybody could do.

Schmalfeldt: Now this goes beyond the cancer patient him or herself. This is everyone who knows and loves the cancer patient. Rowland: Absolutely. Back in 1986 a group of about 24 individuals gathered and created what is now known as the National Coalition for Cancer Survivorship. And when they did that at the time and looked at how a survivor was labeled, essentially, in that early period, the medical definition for "survivor" was someone who remained five years disease free. And in their wisdom, they said this is no longer acceptable, because you can't not be thinking about the quality of life issues for five years. You can't decide five years later, "Gee, I would have liked to have had kids."

Schmalfeldt: You're thinking about those every day.

Rowland: Absolutely. And they need to be part of the decision making in your care. And when they decided they needed to change that definition, it was the coalition that gave us the language that we use for survivors now, that anybody who is diagnosed with cancer may refer to him or herself as a cancer survivor from the moment of diagnosis.

Schmalfeldt: From day one.

Rowland: From day one through the balance of their lives, whether they want to call themselves a survivor or not, but they're entitled to that. And there were two important messages they wanted to convey. Hope. You have a life, you have the opportunity to think about a life after cancer. As you said, we're turning these more and more into curable diseases, or more often, chronic illnesses that you can live long term with. Included under that larger umbrella were family members and caregivers because they recognize that they are part of this journey - often, an integral part of it.

Schmalfeldt: Well, I know that as a person with a chronic condition myself, and the listeners to this podcast know that I have Parkinson's Disease and have been going through some clinical trial surgery for that, if you're not careful, you tend to think of everything that happens in your life in terms of the disease. How do you convey to a cancer survivor that there's more to you than just the fact that you had cancer?

Rowland: That's a really important point, Bill, and you know as you talk about your own experience with Parkinson's Disease, cancer survivors will tell you that after this diagnosis and treatment a headache is no longer a headache - it's a metastatic brain tumor. This is what you worry about, and it's part of the territory. We talked earlier about fear of recurrence. It's trying to find some place to park that worry but get on with your life. And that's one of the challenges that individuals must deal with and find some comfortable resolution around if they're going to move forward.

Schmalfeldt: We hear so much about the fight to research the causes of cancer, the research for new treatments, preventions, We don't really hear enough, I think, about what to do when you've had cancer and what to do afterwards. And that's why I think this is a very valuable discussion we're having today. What are some of the web resources available - your own web site, for instance?

Rowland: Absolutely. The URL is www.survivorship.cancer.gov. You can come and find out what kind of research we're supporting with public dollars here in the United States, very cutting edge research here. We also have on that site links to major reports that have come out. There have been in the last five years five major reports addressing the issue of cancer survivorship. So this is an issue that has really garnered public attention. People are excited about it. And these major reports we're hoping are not only going to stimulate more attention to, more funding for this kind of research and answers to those very questions you've posed.

Schmalfeldt: Anything else you want to add before we wrap it up?

Rowland: Well, we were talking earlier about language. Many people don't like to label themselves as a survivor.

Schmalfeldt: Some people don't even like to say the word "cancer" as if saying the word will get the tumor to start growing again.

Rowland: Absolutely. And I think that when the coalition adopted that language it was not their intent to "label" people, but rather to change the culture of care, to take away the stigma of having the disease, but also to say there's a lot of hope here and to say that people can live very satisfying and productive lives after cancer. An important take home message here is that after you've had a cancer diagnosis, it is important to ask what you can be doing to promote and maintain your health after these treatments.

Schmalfeldt: A patient is his or her own best advocate in this case.

Rowland: Absolutely! And needs to be actively engaged in it, knowledgeable about it, asking those questions about it, "What can I do, what do I need to know, how do I promote and ensure my health going forward?"

Schmalfeldt: A lot of reason to be optimistic, it sounds like.

Rowland: Absolutely. 10-point-8 million survivors in the United States alone today, a very promising figure.

Schmalfeldt: Well thank you for being with us and sharing some of that optimism with us today. Dr. Julia Rowland, Director of the Office of Cancer Survivorship at the National Cancer Institute, thanks for spending a few minutes with us on NIH Research Radio.

Rowland: My pleasure, Bill.

Schmalfeldt: When we come back, Wally Akinso has a story about a surprising study concerning preterm birth. That's next on NIH Research Radio.

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Schmalfeldt: Who has a higher risk of preterm delivery, women with high cholesterol levels, or women with low cholesterol? Wally Akinso has the story.

Low Maternal Cholesterol Tied to Premature Birth

Akinso: Pregnant women who have very low cholesterol levels may face a greater risk of delivering their babies prematurely than women with regular cholesterol levels, according to a study by the National Human Genome Research Institute. The study was published in the October issue of the journal Pediatrics, and although it confirms previous findings that very high levels of maternal cholesterol can increase the risk of premature birth, a surprising twist in the current study shows that low maternal cholesterol levels also may lead to adverse outcomes according to Dr. Max Muenke, the study's senior author.

Muenke: The interesting finding was-and we were very surprised about this-that women who had very low cholesterol had babies that were born too early. The most interesting finding in this was that we found the significant 4-fold increase in premature birth only in white women and not in African American women. What we could confirm in our study was that women who have high cholesterol that they also have babies born prematurely but this was already known before we started our study.

Akinso: In the study of 1,058 South Carolina women and their newborns, researchers found about 5 percent of the women with cholesterol levels in the moderate range of 159-261 milligrams per deciliter gave birth prematurely. But between white and African American women, there was a difference in the rate of premature births which Dr. Muenke discusses.

Muenke: What we found was in healthy white and healthy African American women at ages between 21 and 34, we found that in both groups women who had low cholesterol had babies born who were with a lower birth rate. What was different in both groups was that among white women babies were born earlier; that is born before 37 weeks, where as African American women we did not find this. At this point we do not know where this difference comes from and this is something we would like to explore in future studies.

Akinso: Premature birth is a major cause of infant death and raises the risk of many potentially disabling conditions, including cerebral palsy, cognitive impairment, blindness, deafness and respiratory illness. Dr. Muenke said in light of these findings researchers have a renewed drive to establish the genetic and environmental causes of low cholesterol levels because of its relevance to pregnancy. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.

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Breast Milk Associated with Greater Mental Development in Preterm Infants, Fewer Re-hospitalizations

Schmalfeldt: Extremely low birth weight premature babies who received breast milk shortly after birth had greater mental development scores at 30 months than did infants who were not fed breast milk, according to a study funded by the National Institute of Child Health and Human Development at the National Institutes of Health. What's more, babies fed breast milk were less likely to be re-hospitalized after their initial discharge than the babies who were not fed breast milk. This study is a follow-up to a previous study, according to Dr. Rosemary Higgins, program officer with the Pregnancy and Perinatology Branch at the NICHD.

Higgins: We had one study in this population looking at these children at 18 months showing that the breast-fed babies had developmental gains at that point in time. However, some of the information gained at 18 months is not always translatable to older children. So we then got these children back at age 30 months, and the gain persisted in their mean developmental index.

Schmalfeldt: Researchers have long known the benefits of breast milk for full term infants, but the potential effects in preterm babies had not been well-studied, according to Dr. Higgins.

Higgins: There's natural substances in breast milk that are very beneficial. There are several that are known, however, key factors that contribute overall are still not clear and no one has been able to reproduce this in formula.

Schmalfeldt:Researchers speculated that nutrients present in breast milk might foster brain development. The study appeared in the October 1 issue of Pediatrics.

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Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, October 19th when episode 43 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail address ws159h@nih.gov -once again, our e-mail address is ws159h@nih.gov. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.

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