Mortality rates significantly higher if both mother and newborn admitted to ICU

ScienceDaily (Oct. 22, 2012) — When mothers and newborns are both admitted to intensive care units they are significantly more likely to die than when neither is admitted to an ICU, new research has found.

Researchers led by Dr. Joel Ray, a physician at St. Michael's Hospital, examined data on all 1.02 million single births in Ontario from 2002-10 and found that infants were 28 times more likely to die if they and their mother were both admitted to ICUs around the time of delivery. The maternal death rate was 330 times higher when both went to ICU, compared to when neither went to an ICU.

The research was published October 22 in the Canadian Medical Association Journal.

"A mother being admitted to an adult ICU as her infant is admitted to a neonatal ICU, a situation we call co-ICU, is a new and important marker of maternal and infant morbidity and mortality, above and beyond the situation in which just a mother or her baby is admitted to an ICU while the other is not," said Dr. Ray, who is also a research scientist with the Institute for Clinical Evaluative Sciences.

"We also found that when co-ICU arises, moms and babies are much more likely to be located in ICUs in different hospitals. This would compound the heavy stress already placed on parents and family and would negatively impact on mother-infant bonding."

Dr. Ray said that one likely explanation for the higher maternal and child death rates in co-ICU arise from diseases of the placenta. Placental dysfunction may result in pre-eclampsia (a form of hypertension arising in pregnancy), separation of the placenta from the wall of the uterus or an interruption of blood supply to the placenta. All of those can lead to premature delivery and a mother who is ill, while her infant has low infant birthweight and other serious complications.

When co-ICU is necessary, hospitals need to consider new methods to keep mothers and babies together and use trained social workers to minimize the burden of maternal-newborn separation on a mother and the family, Dr. Ray said.

He said regional obstetrical programs should be equipped to take care of both a sick mother and a sick infant. When that's not possible, attempts should be made to transfer both to another institution that can handle them both. He noted that webcams in neonatal intensive care units is another way in which a conscious mother in an ICU could view her newborn on a laptop computer or portable device.

"Co-ICU presents the highest probability of a maternal or infant death, such that bereavement counseling may also need to be modified to deal with the surviving mother and/or her family members during her illness," he said.

Mothers and newborns both needing ICU care occurs in about 1.2 of every 1,000 births. Nearly one-third of the mothers had pre-eclampsia. The higher risk of maternal and infant death was seen up to one year after delivery, which might mean that we need careful follow-of not only the babies, but mothers as well, after they leave hospital.

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The above story is reprinted from materials provided by St. Michael's Hospital. The original article was written by Leslie Shepherd.

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Journal Reference:

Joel G. Ray, Marcelo L. Urquia, Howard Berger, Marian J. Vermeulen. Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units. CMAJ, 2012 DOI: 10.1503/cmaj.121283

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Depression, shortened telomeres increase mortality in bladder cancer patients

ScienceDaily (Oct. 18, 2012) — Low depressive symptoms and a longer telomere length are compelling factors that contribute to a prolonged life for bladder cancer patients, according to researchers at The University of Texas MD Anderson Cancer Center.

In an observational study, a team of MD Anderson researchers analyzed clinical and behavioral data collected from 464 bladder cancer patients, according to research presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research.

"This is the first study of its kind that analyzes bladder cancer outcomes," said Meng Chen, Ph.D., an instructor in MD Anderson's Department of Epidemiology. "Psychological factors are not usually included in epidemiologic studies"

The patients observed were enrolled in an ongoing study of bladder cancer that provides extensive genetic, epidemiologic and psychological data. The collaboration of MD Anderson epidemiologists and psychologists is led by the study's principal investigator, Xifeng Wu, M.D., Ph.D., professor and chair of the epidemiology department.

Patients' information was analyzed according to four different groups. The first group involved patients with long telomeres and no depressive symptoms; the second identified patients who had long telomeres with depressive symptoms; the third had shortened telomeres and no depressive symptoms, while the fourth group had shortened telomeres and depressive symptoms.

Bladder cancer is the fourth most common cancer of men and is usually diagnosed in people over the age of 60. The American Cancer Society estimates 56,000 men and 18,000 women will have a bladder cancer diagnosis in 2012.

Research has identified shortened telomere length as an aging-associated biomarker in several diseases, including cancer. As people grow older, telomeres on the tips of chromosomes, which protect chromosomes from unraveling as cells replicate, shorten and eventually fail, leading to cell death. MD Anderson researchers analyzed blood samples to measure telomere length.

Depressive symptoms were analyzed using the Center for Epidemiologic Studies Depression Scale (CES-D). The self-report scale -- one of the most common screening tests used for finding levels of depression -- revealed patients who scored at high levels of depressive symptoms have a 1.89-fold risk of dying compared to those with lower levels of depression, who will live a little over three times longer -- 200 months vs. 58 months.

The study also revealed the combination of factors, longer telomeres and low levels of depressive symptoms, increased survival for bladder cancer patients by more than six-fold -- 31.3 months vs 199.8 months. Those with short telomeres and high levels of depression had a three-fold risk of mortality.

A certain level of stress, which has also been associated with shortened telomere length, is a dominating factor with many cancer patients. "People are not treating the depression directly, but mainly focused on coping with cancer,"said Chen. "This leads to additional stress that increases mortality."

Enhanced stress management should be an integral part of cancer treatment, "Lifestyle behaviors including a healthy diet, regular exercise and smoking-cessation are factors for reducing stress and ultimately depression in cancer patients." " said co-author Jie Lin, Ph.D., assistant professor in the Department of Epidemiology.

Lin also said the new risk factors such as psychological risk factors identified by the team could be included in future risk prediction models. The team is optimistic that this study will encourage clinicians to incorporate behavioral factors into risk models so interventions can be developed to prolong survival for bladder cancer patients.

Contributing authors to the work include Jan Blalock, Ph.D., Paul Cinciripini, Ph.D. from the Department of Behavioral Science, and Lorenzo Cohen, Ph.D., from the Department of General Oncology.

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The above story is reprinted from materials provided by University of Texas M. D. Anderson Cancer Center, via Newswise.

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Depression and shortened telomeres increased bladder cancer mortality

ScienceDaily (Oct. 17, 2012) — The combination of shortened telomeres, a biological marker of aging associated with cancer development, and elevated depression significantly impacted bladder cancer mortality, according to data presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held in Anaheim, Calif. Oct. 16-19, 2012.

"We found that patients with bladder cancer with shorter telomeres and high levels of depression symptoms have a threefold increased risk for mortality," said Meng Chen, Ph.D., an epidemiologist at The University of Texas MD Anderson Cancer Center in Houston.

As part of an ongoing, large-scale epidemiologic study of bladder cancer, Chen and colleagues collected clinical and mental health information on 464 patients with bladder cancer. They assessed patients' depression levels with the Center for Epidemiologic Studies Depression Scale (CES-D).

Depression symptoms alone affected mortality: Patients with CES-D scores of 16 or greater had a median survival time of 58 months, while those with scores below 16 had a median survival time longer than 200 months. In addition, patients with CES-D scores of 16 or greater had a 1.89-fold increased risk for all-cause mortality compared with patients with CES-D scores less than 16.

Telomere length was measured from patient blood samples. Univariate analysis revealed that long telomeres were associated with improved survival, but this finding was not significant in a multivariate analysis.

When evaluating the combination of depression and telomere length, the researchers found that compared with patients without depression symptoms (i.e., CES-D scores less than 16) and long telomeres, patients with depression symptoms (i.e., CES-D scores of 16 or greater) and short telomeres demonstrated more than a threefold increased risk for mortality and significantly shorter disease-free survival (31.3 months versus 199.8 months).

Although the mechanisms behind these findings need to be furthered studied, "these results suggest the potential important role of psychological factors to improve survival in cancer patients," Chen said.

In addition, the researchers pointed to evidence that smoking cessation, weight loss and increased physical activity can slow telomere shortening and potentially improve survival.

"In terms of building a prediction model for bladder cancer mortality, current models only focus on clinical variables, such as treatment and tumor stage and grade," Chen said. "Our study suggests that psychological factors and perhaps lifestyle changes could be included in this prediction model."

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The above story is reprinted from materials provided by American Association for Cancer Research (AACR).

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Adhering to lifestyle guidelines reduced mortality in elderly female cancer survivors

ScienceDaily (Oct. 17, 2012) — Achieving and maintaining a healthy body weight, staying physically active and maintaining a healthy diet improved survival after cancer diagnosis in an elderly female cancer survivor population, according to data presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held in Anaheim, Calif. Oct. 16-19, 2012.

Researchers examined cancer survivors' adherence to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines for body weight, physical activity and diet.

"Elderly female cancer survivors who achieve and maintain an ideal body weight, stay physically active and eat a healthy diet have an almost 40 percent lower risk for death compared with women who do not follow these recommendations," said Maki Inoue-Choi, Ph.D., R.D., research associate in the Division of Epidemiology and Community Health in the School of Public Health at the University of Minnesota.

Study participants included 2,080 women from the Iowa Women's Health Study who had a confirmed cancer diagnosis between 1986 and 2002 and who completed a follow-up questionnaire in 2004. Women provided information on body weight, physical activity level, dietary intake and other demographic and lifestyle factors.

Through annual linkage with the State of Health Registry of Iowa and the National Death Index, researchers identified 495 deaths from 2004 to 2009, including 197 from cancer and 153 from cardiovascular disease. Researchers adjusted for age, number of comorbid conditions, general health, smoking, type and stage of cancer, current cancer treatment and subsequent cancer diagnosis. They found all-cause mortality was 37 percent lower for women with the highest (6 to 8) versus the lowest (0 to 4) adherence scores.

Reaching the WCRF/AICR physical activity recommendation was also associated with lower risk for death from any cause, from cardiovascular disease or from cancer after the researchers adjusted for dietary and body weight recommendation adherence scores and other covariates.

However, reaching the dietary recommendations was not associated with mortality following adjustment for body weight and physical activity recommendation adherence scores.

The study was funded by the National Cancer Institute.

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