不曬太陽的風險和抽菸一樣


  【24drs.com】根據針對近30,000名瑞典女性進行超過20年的研究指出,不曬太陽之非抽菸者的預期壽命,和曬最多太陽的抽菸者相似。
  
  研究作者於3月21日內科醫學期刊中指出,這意謂著,避免曬太陽是和抽菸相當的死亡風險因素,相較於曬太陽時間最多者,避免日曬者的預期壽命減少達0.6至2.1年。
  
  瑞典Huddinge Karolinska大學醫院Pelle Lindqvist醫師等人發現,相較於避免日曬的婦女,尋求日曬者的心血管疾病(CVD)、非癌症/非心血管疾病,如糖尿病、多發性硬化症、肺部疾病風險都比較低。
  
  本篇研究的強度之一在於,研究結果具有劑量特定性 —陽光的好處隨曝曬量增加。
  
  研究人員承認,日光浴者的預期壽命比較長,和一般認知的曬太陽會增加皮膚癌風險之間互相矛盾。
  
  Lindqvist醫師表示,我們並未發現皮膚癌風險增加,不過,有曬太陽的皮膚癌患者預後比較好。
  
  根據這些發現,他表示,婦女不要過度日曬,而日曬不足造成的危險可能比人們認知的更嚴重。
  
  我們知道,在我們的人口中,有三大[危害健康]的生活方式因素:抽菸、過重、不運動,現在,我們發現第四個因素:避免日曬。
  
  這篇研究發現,瑞典這個國家,一年中、最強UV指數屬於低(< 3)的時間長達9個月,過去40年來避免日曬的限制性指引可能是相當不明智的。
  
  Lindqvist醫師表示,在全國和其他地區,防曬霜的使用也被廣泛誤解。
  
  如果你在太陽下的時間久,你的使用方法可能錯誤,但是,如果你是待在船上且要走到船艙外,有使用防曬霜會比沒有使用還要好。
  
  他表示,膚色較深的婦女停止避免日曬的效果特別好,例如也依循著像瑞典一樣終年避免日曬指引的大部份印度婦女。Lindqvist醫師表示,因為黑色素瘤在膚色較深的婦女比較罕見,衡量日曬的風險與利益時,對這些人的好處是增加的。
  
  研究者針對「Melanoma in Southern Sweden」世代、沒有惡性腫瘤病史的29,518名婦女,以前瞻方式追蹤20年,研究將日曬做為所有原因死亡的一個風險因素。
  
  這些婦女在1990-1992年間、25-64歲時被納入研究,研究開始時獲得的詳細資料包括日曬習慣與可能的干擾因素,如婚姻狀態、教育程度、抽菸、飲酒、生育數。
  
  研究者指出,在這篇研究的研究期間,當納入抽菸因素時,相較於避免日曬的抽菸者,即使是將近60歲、有積極日曬習慣的抽菸者,預期壽命多2年。
  
  不過,作者們也承認,有一些主要的研究限制。其中,無法區分積極日曬習慣和健康生活型態,他們也沒有運動相關的資料。
  
  研究結果為維他命D對於健康的影響與人們的需要量之論辯增添證據,但是,這篇研究還是沒有解決問題。
  
  作者們寫道,這篇觀察型研究發現的日曬產生的正面效果,無法確定是否是因為維他命D、其他與紫外線有關的機轉、或者是未發現的偏見因素。
  
  Lindqvist醫師表示,從愛爾蘭的研究,我們知道,維他命D缺乏症使黑色素瘤更惡性化。這與我們的結果一致;[未曝曬於]太陽者之黑色素瘤的預後比較糟。
  
  資料來源:http://www.24drs.com/
  
  Native link:Avoiding Sun as Dangerous as Smoking

Avoiding Sun as Dangerous as Smoking

By Marcia Frellick
Medscape Medical News

The natural history of rheumatoid arthritis (RA) has changed dramatically since 1990, apparently as a result of advances in RA treatment, such as the use of biologicals and more aggressive "treat to target" clinical approaches. The annual progression rates in studies of long-term progression reported after 1990 were less than half those reported in the prior 25 years, researchers report in an article published online March 8 in Rheumatology.

Adam Young, MD, consultant rheumatologist, University of Hertfordshire, Hatfield, United Kingdom, and colleagues examined annual progression rates reported in long-term studies of RA published between 1965 and 2014. Their systematic review and meta-analysis of long-term cohorts included 28 studies of long-term radiographic progression and 41 studies of predictors of progression.

Baseline radiographic scores were similar in cohorts of patients recruited pre- and post-1990. At baseline, for all trials, the median baseline radiographic score was 2.02% of maximal damage. The baseline score for patients recruited before 1990 was 2.01% and for patients recruited after 1990 it was 2.03%.

Overall, the researchers estimated an annual rate of progression of 1.08% of maximum damage. However, the annual rate for progression of radiographic joint damage scores was 0.68% in the post-1990 cohorts vs 1.50% in the pre-1990 cohorts (P < .05).

According to the authors, differences between the two recruitment periods coincide with changes in clinical management, particularly more intensive use of methotrexate as an anchor disease-modifying antirheumatic drug.

The authors acknowledge not being able to assess the direct effect of treatment. "Nevertheless, it is likely patients received standard contemporary care based on published guidelines about treatment regimens from the time they were being studied," they write.

The main predictive factors identified in the review were acute phase markers, rheumatoid factor positivity, and anti–cyclic citrullinated peptide antibody positivity. The authors write, "Currently, genetic markers do not provide much additional prognostic information that can be applied clinically."

The researchers conclude that the progression of radiographic damage has halved since 1990, probably as a result of improved treatment, and that rheumatoid factor/anti–cyclic citrullinated peptide antibody positivity, along with increased markers of acute phase reactants, are the strongest predictors of radiographic progression, possibly useful for early identification of patients with RA who are at higher risk for progression and who might benefit from early, aggressive treatment.

The study was supported by the UK National Institute for Health Research. The authors have disclosed no relevant financial relationships.

Rheumatology. Published online March 8, 2016.

    
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