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Background Physical activity (PA) is associated with improved health-related quality of life (HRQoL) among women with breast cancer; however, uncertainty remains regarding PA types and dose (frequency, duration, intensity) and various HRQoL measures. A systematic review and meta-analysis of randomized controlled trials was conducted to clarify whether specific types and doses of physical activity was related to global and specific domains of HRQoL, as part of the Global Cancer Update Programme, formerly known as the World Cancer Research Fund–American Institute for Cancer Research Continuous Update Project. Methods PubMed and CENTRAL databases were searched up to August 31, 2019. Weighted mean differences (WMDs) in HRQoL scores were estimated using random effects models. An independent expert panel graded the evidence. Results A total of 79 randomized controlled trials (14 554 breast cancer patients) were included. PA interventions resulted in higher global HRQoL as measured by the Functional Assessment of Cancer Therapy–Breast (WMD = 5.94, 95% confidence intervals [CI] = 2.64 to 9.24; I2 = 59%, n = 12), Functional Assessment of Cancer Therapy–General (WMD = 4.53, 95% CI = 1.94 to 7.13; I2 = 72%, n = 18), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–C30 (WMD = 6.78, 95% CI = 2.61 to 10.95; I2 = 76.3%, n = 17). The likelihood of causality was considered probable that PA improves HRQoL in breast cancer survivors. Effects were weaker for physical function and mental and emotional health. Evidence regarding dose and type of PA remains insufficient for firm conclusions. Conclusion PA results in improved global HRQoL in breast cancer survivors with weaker effects observed for physical function and mental and emotional health. Additional research is needed to define the impact of types and doses of activity on various domains of HRQoL.

Dietary patterns, defined as the quantities, proportions, variety, or combination of different foods and drinks, as well as the frequency with which they are habitually consumed, are associated with an increased or decreased incidence of chronic diseases [...]

We used the Greek nationwide database to capture individuals on anti-osteoporotic treatment during 2019. From the estimated number of 683,679 osteoporotic individuals, only 42% were receiving treatment, with the total annual cost being almost one-tenth of the total cost of fractures. The treatment gap was significantly higher in males than in females.Based on the 2019 European scorecard (SCOPE), osteoporosis is diagnosed in an estimated 683,679 individuals in Greece, with the direct cost of incident fractures being €694.7 million, although further relevant real-world data are scarce.The e-Government Center for Social Security Services prescription database, which covers almost 100% of the Greek population, was used to capture all individuals on anti-osteoporotic treatment during 2019.A total of 288,983 among 8,641,341 people, corresponding to 3.3% of the total adult Greek population, had filled at least one anti-osteoporotic prescription (6.0% and 0.36% for females and males, respectively). Prevalence of anti-osteoporotic treatment increased with age, from 0.15% in those younger than 50 to 8.6% in those older than 70 years. Oral bisphosphonates were more frequently prescribed (58.8%), followed by denosumab (39.4%). Alendronate was more frequently prescribed in males and in people younger than 60 years. Denosumab was more frequently prescribed in females and in people older than 60 years. Selective estrogen-receptor modulators, teriparatide, and parenteral bisphosphonates accounted for 1.1%, 1.0%, and 0.02% of all prescriptions, respectively. Orthopedic surgeons (39.6%), endocrinologists (19.6%), general practitioners (19%), and rheumatologists (9.3%) prescribed the vast majority of anti-osteoporotic regimens, with significant differences in prescription patterns. The annual cost of treatment per patient increased significantly with age, being on average €323.33.Less than half of the estimated number of individuals with osteoporosis in 2019 in Greece received treatment, with the total annual cost being far less than the estimated cost of incident-fragility fractures. The impact of this undertreatment on related health care costs merits further investigation.

BackgroundNationwide data at a country level on Covid-19 in unvaccinated patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are scarce.MethodsBy interlinking data from national electronic registries, covering nearly 99% of the Greek population (approximately 11,000,000), between March 2020 and February 2021, when vaccination became available, we recorded confirmed infections and Covid-19-associated hospitalizations and deaths in essentially all adult patients with RA, AS, PsA, SLE, and SSc under treatment (n=74,970, median age of 67.5, 51.2, 58.1, 56.2, 62.2 years, respectively) and in individually matched (1:5) on age, sex, and region of domicile random comparators from the general population.ResultsBinary logistic regression analysis after adjusting for age, sex and biologic agents, revealed that RA, PsA, SLE and SSc, but not AS patients, had significantly higher risk of infection (by 43%, 25%, 20% and 49%, respectively), and hospitalization for Covid-19 (by 81%, 56%, 94%, and 111%, respectively), possibly due, at least in part, to increased testing and lower threshold for admission. Patients with RA and SSc had indeed higher Covid-19 associated mortality rates [OR:1.86 (95% CI 1.37 to 2.52) and OR:2.90 (95% CI 0.97 to 8.67), respectively] compared to the general population. Each additional year of age increased the risk of hospitalization for Covid-19 by 3% (OR 1.030, 95% CI: 1.028 to 1.034) and the risk of Covid-19 related death by 8% (OR 1.08, 95% CI: 1.07 to 1.09), independently of gender, systemic rheumatic disease, and biologic agents. A further analysis using AS patients as the reference category, adjusting again for age, sex and use of biologic agents showed that patients with SSc had increased mortality (OR: 6.90, 95% CI: 1.41 to 33.72), followed by SLE (OR: 4.05 95% CI: 0.96 to 17.12) and RA patients (OR: 3.65, 95% CI: 1.06 to 12.54), whereas PsA patients had comparable mortality risk with AS patients.ConclusionComparing to the general population, Covid-19 may have a more severe impact in real-world patients with systemic rheumatic disease. Covid-19 related mortality is increased in subgroups of patients with specific rheumatic diseases, especially in older ones, underscoring the need for priority vaccination policies and access to targeted treatments.

Background: We examined associations between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations using the standardized 2018 WCRF/AICR Score and cancer risk among older U.S. adults. Methods: Participants included 215,102 adults in the NIH-AARP Diet and Health Study followed between 2004 and 2011 (mean 7.0 person-years). Scores (range: 0–7 points) were calculated from self-reported weight, physical activity, and diet and alcohol intake measures. Outcomes included 17 cancers reviewed by WCRF/AICR (cases: male n = 11,066; female n = 8,865) and top three U.S. cancers in males (total n = 4,658; lung n = 2,211; prostate n = 920; colorectal n = 1,527) and females (total n = 5,957; lung n = 1,475; post-menopausal breast n = 3,546; colorectal n = 936). Cox proportional hazard ratios (HRs) were estimated for score and cancer risk associations, stratifying by sex and smoking status. Results: Each one-point score increase was associated with 6% to 13% reduced cancer risk across combined outcomes, except for male never smokers’ risk for top three cancers and male current smokers’ risk for both combined cancer outcomes. Higher scores were associated with decreased lung cancer risk only among male former smokers (HR, 0.84; 95% CI, 0.79–0.89) and female current smokers (HR, 0.89; 95% CI, 0.82–0.96). Higher scores were associated with 7% to 19% decreased breast cancer risk across smoking strata and 10% to 14% decreased colorectal cancer risk among male and female never and former smokers. Conclusions: Greater recommendations adherence was associated with reduced cancer risk. Impact: Findings emphasize the importance of considering combined contributions of multiple lifestyle factors for cancer prevention among older adults and the potential modifying role of smoking history.

BACKGROUND: The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) published Cancer Prevention Recommendations in 2018 focused on modifiable lifestyle factors. OBJECTIVES: The aim was to examine how adherence to WCRF/AICR recommendations via the 2018 WCRF/AICR score is associated with risk for all-cause, cancer, and cardiovascular disease (CVD) mortality outcomes among older US adults. METHODS: Baseline and follow-up questionnaire data (n = 177,410) were used to calculate weight, physical activity, and diet components of the 2018 WCRF/AICR score (0–7 total points). Adjusted HRs and 95% CIs were estimated, stratified by sex and smoking status. RESULTS: There were 16,055 deaths during a mean of 14.2 person-years. Each 1-point score increase was associated with a 9–26% reduced mortality risk for all outcomes, except for current male smokers’ cancer mortality risk. When the score was categorized comparing highest (5–7 points) with lowest (0–2 points) scores, associations with reduced all-cause mortality risk were strongest in former smokers (HR(males): 0.51; 95% CI: 0.43, 0.61; HR(females): 0.38; 95% CI: 0.31, 0.46), followed by current smokers (HR(males): 0.55; 95% CI: 0.34, 0.89; HR(females): 0.44; 95% CI: 0.32, 0.59) and never smokers (HR(males): 0.57; 95% CI: 0.47, 0.70; HR(females): 0.50; 95% CI: 0.41, 0.60). An association with cancer mortality risk was also seen in former smokers (HR(males): 0.59; 95% CI: 0.43, 0.81; HR(females): 0.52; 95% CI: 0.37, 0.73) and female current (HR(females): 0.55; 95% CI: 0.32, 0.96) and never (HR(females): 0.57; 95% CI: 0.40, 0.80) smokers; findings were not statistically significant in other strata. For CVD mortality, highest compared with lowest scores were associated with a 49–73% risk reduction, except in male never and current smokers. In exploratory analysis, physical activity, body weight, alcohol, and plant-based foods were found to be predominant components in the score. CONCLUSIONS: Greater 2018 WCRF/AICR scores were associated with lower mortality risk among older adults. Future research can explore how smoking modifies these relations, and further examine different populations and other cancer-relevant outcomes.

Objectives This cross-sectional study aimed: 1) to compare the saliva characteristics and the occurrence of caries in patients with type 2 diabetes mellitus (T2DM) and patients without T2DM, 2) to study the impact of inadequate glycemic control on saliva and caries prevalence. Methods 23 adults with T2DM and 18 controls participated. Patients with T2DM were divided depending on their metabolic control: a) well-controlled (W.C.): HbA1c≤7 %, and b) poorly-controlled (P.C.): HbA1c> 7 %). The examined clinical parameters were: 1) number of natural teeth, 2) DMFT index of coronal caries, 3) saliva pH, 4) saliva flow and buffering capacity, and 5) subjective feeling of dry mouth. Results The groups W.C and P.C showed significant differences in the number of teeth, the saliva flow, and DMFT. The C and P.C groups presented differences in pH, saliva flow, buffer capacity, and DMFT. Finally, the W.C and C groups indicated differences in the buffer capacity, saliva flow, and DMFT. The subjective feeling of dry mouth is related to the duration of the disease. The DMFT value correlated negatively with the status of metabolic regulation. Multiple linear regression revealed that the DMFT value was positively associated with serum HbA1c levels. Conclusions 1) Adults with T2DM present a lower saliva flow rate and buffering capacity, as well as higher caries prevalence than controls; 2) The metabolic control of T2DM is essential for the maintenance of saliva flow rate and buffering capacity, and caries prevalence; 3) The duration of T2DM is of importance for the subjective sense of dry mouth. Clinical significance The duration and metabolic control of T2DM are important clinical parameters for oral complications. Awareness and co-operation of diabetologists and dentists are needed to detect oral lesions in patients with diabetes and be treated timely and effectively.

Purpose: Variation of plasma thyroid hormone levels influences insulin sensitivity and peripheral glucose disposal. High thyroxin dose administration to healthy humans induces insulin resistance, whereas moderate doses increase peripheral glucose disposal. An open-labeled, randomized and placebo-controlled intervention was performed in euthyroid type 2-diabetic patients, to examine the effect of a small thyroxin dose within the euthyroid range on postprandial forearm muscle glucose uptake, insulin sensitivity, in vitro glucose uptake and GLUT4 recruitment in the plasma membrane of monocytes. Methods: A meal was given to eleven euthyroid, treatment-naive, type-2 diabetic patients (aged 43 ± 3.8 yrs, BMI 27.48 ± 1.39 kg/m2, T3 119 ± 5.7 ng/dl, T4 8,13 ± 0.46 μg/dl, TSH 1.51 ± 0.14 μU/ml, FT4 1.272 ± 0.047 ng/dl) before and after administration of 50 μg of thyroxin once daily for 2 months. Similarly, a placebo was given to eleven age, sex and BMI-matched euthyroid, type-2 diabetic patients. Blood was drawn for 300 min from a forearm deep vein and the radial artery for measurements of glucose, insulin, and GLUT4 abundance in peripheral monocytes. Forearm blood flow (BF) was measured with strain-gauge-plethysmography. Forearm glucose-uptake, and insulin sensitivity were assessed. After the first meal-tolerance-test, daily treatment with 50 μg of thyroxin or placebo was initiated for a 2-month period. Then a second identical test was repeated. Results: TSH, glucose, insulin levels and HbA1c reduced significantly in the treatment group. Peak-baseline BF and Glucose-uptake (AUC0-300 min) increased significantly (1.685 ± 0.3 vs. 3.07 ± 0.15 ml/min per 100 cc tissue, p=0.0018) and (587 ± 68 vs. 1015 ± 131 μmol per 100 cc tissue, p=0.0051), respectively. All insulin-sensitivity indices improved post-treatment. Glucose uptake and GLUT4 abundance in monocytes also improved. The placebo group exhibited no change in all variables. Conclusion: Administration of small, subthyrotoxic doses of thyroxin to euthyroid diabetic patients improves peripheral glucose disposal, blood flow responses and overall insulin sensitivity. This could be of therapeutic importance by reducing the burden of hyperglycaemia and possibly the long term complications of diabetes.

Objective A prospective phase II study was conducted to evaluate the efficacy and toxicity of oxaliplatin plus 5-fluoruracil (5-FU) and high-dose leucovorin (LV) (FOLFOX-4) in patients with platinum-resistant, taxane-pretreated recurrent ovarian cancer. Patients and methods Thirty-eight patients, with a median age of 58 years (range 33–77), were treated with oxaliplatin 85 mg m −2 as a 2-h infusion on day 1, LV 200 mg m −2 day −1 as a 2-h infusion followed by bolus 5-FU 400 mg m −2 day −1 and a 22-h infusion of 5-FU 600 mg m −2 day −1 for 2 consecutive days. Treatment was repeated every 3 weeks. Patients were evaluated for response every two cycles. Results The vast majority of patients had performance status 0 or 1 and 76.3% had ≥ 2 metastatic sites. A median number of four cycles per patient (range, 1–8) were administered. Based on an intention-to-treat analysis, 3 patients (7.9%) achieved a complete response (CR) and 8 (21.1%) achieved a partial response (PR), for an overall response rate of 29%. Another 29% of patients had stable disease (SD). The median relapse-free survival was 5.2 months (range 2.5–17), the median time to tumor progression was 4.8 months (range 0.6–19), and the median overall survival was 10.1 months (range 0.2–36). Toxicity was mild to moderate. Grade 3/4 neutropenia and thrombocytopenia occurred in 29% and 21.1% of patients, respectively. Febrile neutropenia was encountered in 3 patients (7.9%), who were successfully treated. Grade 3/4 neurotoxicity developed in 15.8% of patients; neurotoxicity gradually declined after treatment discontinuation. Alopecia, nausea–vomiting, diarrhea, mucositis, and asthenia were not a serious problem. There were no treatment-related deaths. Conclusion The combination of oxaliplatin and 5-FU/LV (FOLFOX-4) appears to be an effective regimen with a good toxicity profile for the treatment of platinum-resistant, taxane-pretreated ovarian cancer.