American Cancer Society nutrition and physical activity guideline for cancer survivors

The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.     

Exercise as an Adjunct Treatment for Opiate Agonist Treatment: Review of the Current Research and Implementation Strategies

ABSTRACT

Opiate dependence is a significant public health concern linked to poor quality of life, comorbid psychiatric disorders, and high costs to society. Current opiate agonist treatments are an effective but limited intervention. Adjunctive interventions could improve and augment opiate agonist treatment outcomes, including drug abstinence, quality of life, and physical health. This article reviews exercise as an adjunctive intervention for opiate agonist treatment, especially in regards to improving mood and overall quality of life, while reducing other substance use. Poor adherence and dropout frequently prevent many individuals from garnering the many physical and mental health benefits of exercise. Strategies for implementing an exercise intervention, including safety considerations, are discussed.     

Common Acute Upper Extremity Injuries In Sports

Familiarity with anatomical differences in the pediatric patient is necessary to properly identify and treat the variety of upper extremity musculoskeletal injuries encountered in the ED. The many unique characteristics of pediatric bone, the presence of physes, and degree of skeletal maturity all pose a challenge for the emergency physician's ability to diagnose and treat pediatric orthopedic injuries. The somewhat subtle findings both on physical and radiographic examination of many serious pediatric orthopedic injuries further complicate the evaluation process. The treatment of upper extremity injuries in children and young athletes requires heightened vigilance for classic mechanisms of injury, a thorough systematic approach to the orthopedic examination, and a broad knowledge of various injury patterns and treatments. With experience, the emergency or primary care physician will enjoy the challenge of caring for acute traumatic sports-related upper extremity injuries in children.     

THE INFLUENCE OF THE PERCEIVED QUALITY OF COMMUNITY ENVIRONMENTS ON LOW-INCOME WOMEN’S EFFORTS TO WALK MORE

There is increasing interest in how the quality of community environments influences health. We present the results of a pilot study designed to encourage overweight and obese low-income women to increase their level of physical activity, and explore the factors that either support or constrain their walking. The findings suggest that even relatively small increases in lifestyle physical activity among overweight or obese low-income women (an increase in 2,000 steps per day) can lead to significant weight loss. The interviews we carried out with study participants suggest there are several ways in which the perceived quality of community environments affects low-income women’s efforts to increase their steps. Having friends and family living within walking distance was supportive of participant’s efforts, in some cases because their homes represented places to walk to, and in others because in addition, friends and family were walking companions. The perceived lack of safety participants reported as a constraint to walking reflected in some cases the fear of being assaulted or harassed, and in others the fear that passers-by would not stop to help if needed. Our findings point to the importance of including community-level interventions that address residents’ safety and security concerns, along with future efforts to increase physical activity and decrease obesity among low-socioeconomic status groups.Rebecca Miles, PhD is Associate Professor, Florida State University; Lynn Panton, PhD, FACSM is Assistant Professor, Florida State University     

Injection-Related Venous Disease and Walking Mobility

ABSTRACT

Injection users are at risk for vascular injuries resulting in chronic venous disease (CVD). The authors examined walking mobility in relation to CVD for 713 individuals in methadone treatment. The authors used a cross-sectional, comparative design that was stratified on age, sex, ethnicity, and drug use. CVD was present in 92.3% of participants. The structural equation model supported the causal link between leg injection and CVD (.40, P<.001). The worse the mobility, the greater was the CVD classification (?.21, P<.001). CVD had an indirect effect on mobility through pain. CVD and pain need to be considered when assessing mobility in illicit drug users.