Can a Low-Phosphate Diet for Chronic Kidney Disease Treat Cancer? An Interdisciplinary Literature Review.

Background: Cancer therapeutics have a low success rate in clinical trials. An interdisciplinary approach is needed to translate basic, clinical, and remote fields of research knowledge into novel cancer treatments. Recent research has identified high dietary phosphate intake as a risk factor associated with cancer incidence. A model of tumor dynamics predicted that reducing phosphate levels sequestered in the tumor microenvironment could substantially reduce tumor size. Coincidently, a low-phosphate diet is already in use to help patients with chronic kidney disease manage high serum phosphate levels. Methods: A grounded-theory literature-review method was used to synthesize interdisciplinary findings from the basic and clinical sciences, including oncology, nephrology, nutritional epidemiology, and dietetic research on cancer. Results: Findings of tumor remission associated with fasting and a ketogenic diet, which lower intake of dietary phosphate, support the hypothesis that a low-phosphate diet will reduce levels of phosphate sequestered in the tumor microenvironment and reduce tumor size. Additionally, long-term effects of a low-phosphate diet may reverse dysregulated phosphate metabolism associated with tumorigenesis and prevent cancer recurrence. Conclusions: Evidence in this article provides the rationale to test a low-phosphate diet as a dietary intervention to reduce tumor size and lower risk of cancer recurrence.

Health Comparisons Between Truck Drivers and the General Population Using the Canadian Community Health Survey.

BACKGROUND: This study examined and compared risk factors and health conditions of truck drivers compared with the general Canadian population. METHODS: This study used the Canadian Community Health Survey consisting of 991 male truck drivers and 29,958 male respondents of the general population. RESULTS: Compared with the general population, truck drivers were older, less educated, had lower incomes, worked more hours, and were more likely to be widowed/separated/divorced. In addition, truck drivers had significantly higher rates of cardiovascular disease and obesity and were more likely to be sedentary, smoke, drive when fatigued, and eat unhealthy compared with the general population. CONCLUSIONS: Multicomponent interventions are needed to address the poor lifestyle practices of truckers to reduce the high rates of morbidity.

Breast cancer, alcohol, and phosphate toxicity.

Alcohol consumption is associated with an increased risk of breast cancer, even at low alcohol intake levels, but public awareness of the breast cancer risk associated with alcohol intake is low. Furthermore, the causative mechanisms underlying alcohol's association with breast cancer are unknown. The present theoretical paper uses a modified grounded theory method to review the research literature and propose that alcohol's association with breast cancer is mediated by phosphate toxicity, the accumulation of excess inorganic phosphate in body tissue. Serum levels of inorganic phosphate are regulated through a network of hormones released from the bone, kidneys, parathyroid glands, and intestines. Alcohol burdens renal function, which may disturb the regulation of inorganic phosphate, impair phosphate excretion, and increase phosphate toxicity. In addition to causing cellular dehydration, alcohol is an etiologic factor in nontraumatic rhabdomyolysis, which ruptures cell membranes and releases inorganic phosphate into the serum, leading to hyperphosphatemia. Phosphate toxicity is also associated with tumorigenesis, as high levels of inorganic phosphate within the tumor microenvironment activate cell signaling pathways and promote cancer cell growth. Furthermore, phosphate toxicity potentially links cancer and kidney disease in onco-nephrology. Insights into the mediating role of phosphate toxicity may lead to future research and interventions that raise public health awareness of breast cancer risk and alcohol consumption.

Breast Cancer and Bone Mineral Density in a U.S. Cohort of Middle-Aged Women: Associations with Phosphate Toxicity.

Breast cancer is associated with phosphate toxicity, the toxic effect from dysregulated phosphate metabolism that can stimulate tumorigenesis. Phosphate toxicity and dysregulated phosphate metabolism are also associated with bone mineral abnormalities, including excessive bone mineral loss and deposition. Based on shared associations with dysregulated phosphate metabolism and phosphate toxicity, a hypothesis proposed in the present mixed methods-grounded theory study posits that middle-aged women with incidence of breast cancer had a greater magnitude of changes in bone mineral density over time compared with women who remained cancer-free. To test this hypothesis, a mixed-effects model was used to analyze the associations of breast cancer incidence with spinal bone mineral density changes in the U.S. Study of Women's Health Across the Nation. Compared with women in the cohort who remained cancer-free, women who self-reported breast cancer had higher bone mineral density at baseline, but had more rapid losses in bone mineral density during follow-up visits. These findings agree with the hypothesis that a greater magnitude of changes in bone mineral density over time is associated with breast cancer in a cohort of middle-aged women. The findings also have implications for studies investigating dysregulated phosphate metabolism and phosphate toxicity as causative factors of bone metastasis in metastatic breast cancer. Additionally, the authors previously found increased breast cancer risk associated with high dietary phosphate intake in the same cohort of middle-aged women, and more studies should investigate a low-phosphorus diet to reduce bone mineral abnormalities and tumorigenesis in breast cancer patients.

High Dietary Phosphorus Is Associated with Increased Breast Cancer Risk in a U.S. Cohort of Middle-Aged Women.

Research has shown that high amounts of dietary phosphorus that are twice the amount of the U.S. dietary reference intake of 700 mg for adults are associated with all-cause mortality, phosphate toxicity, and tumorigenesis. The present nested case-control study measured the relative risk of self-reported breast cancer associated with dietary phosphate intake over 10 annual visits in a cohort of middle-aged U.S. women from the Study of Women's Health Across the Nation. Analyzing data from food frequency questionnaires, the highest level of daily dietary phosphorus intake, >1800 mg of phosphorus, was approximately equivalent to the dietary phosphorus levels in menus promoted by the United States Department of Agriculture. After adjusting for participants' energy intake, this level of dietary phosphorus was associated with a 2.3-fold increased risk of breast cancer incidence compared to the reference dietary phosphorus level of 800 to 1000 mg, which is based on recommendations from the U.S. National Kidney Foundation, (RR: 2.30, 95% CI: 0.94-5.61, p = 0.07). Despite the lack of statistical significance, likely due to the small sample size of the cohort, the present nested case-control study's clinically significant effect size, dose-response, temporality, specificity, biological plausibility, consistency, coherence, and analogy with other research findings meet the criteria for inferred causality in observational studies, warranting further investigations. Furthermore, these findings suggest that a low-phosphate diet should be tested on patients with breast cancer.

Evolving pipe joining methods and their association to musculoskeletal symptoms for residential plumbers.

BACKGROUND: Recently the plumbing trade has transitioned from traditional copper piping to flexible plastic piping (PEX) for residential water distribution systems. However, there has been very limited research into the ergonomic implications of the modernized processes. OBJECTIVE: This research documents the physical workload and risks of musculoskeletal disorders (MSDs) with the use of new tools and processes for joining piping. The research also identifies the factors which can facilitate or limit the use of new ergonomically beneficial tools. METHODS: This mixed methods research included workplace observations, interviews, an experiment, a survey of plumbers in residential construction and focus groups with both plumbers and plumbing contractors. RESULTS: Advantages and disadvantages of the various techniques for joining pipes showed that manual crimping has advantages (i.e., productivity and lower cost) that make it desirable for plumbing contractors. Power devices, which were not widely used, have great potential to reduce MSD risks especially if the size and weight of the tools decreases with newer technologies. A continuing barrier is the cost of power equipment. CONCLUSION: The move to provide ergonomically beneficial tools was not as rapid as the willingness to change piping materials. Productivity and costs of tools are barriers to ergonomic interventions.

Synthesis of Evidence to Support EMS Personnel's Mental Health During Disease Outbreaks: A Scoping Review.

Emergency medical services (EMS) personnel are at high risk for adverse mental health outcomes during disease outbreaks. To support the development of evidence-informed mitigation strategies, we conducted a scoping review to identify the extent of research pertaining to EMS personnel's mental health during disease outbreaks and summarized key factors associated with mental health outcomes. We systematically searched three databases for articles containing keywords within three concepts: EMS personnel, disease outbreaks, and mental health. We screened and retained original peer-reviewed articles that discussed, in English, EMS personnel's mental health during disease outbreaks. Where inferential statistics were reported, the associations between individual and work-related factors and mental health outcomes were synthesized. Twenty-five articles were eligible for data extraction. Our findings suggest that many of the contributing factors for adverse mental health outcomes are related to inadequacies in fulfilling EMS personnel's basic safety and informational needs. In preparation for future disease outbreaks, resources should be prioritized toward ensuring adequate provisions of personal protective equipment and infection prevention and control training. This scoping review serves as a launching pad for further research and intervention development.

Biological Embedding of Psychosocial Stressors Within a Sample of Canadian Firefighters: An Exploratory Analysis.

OBJECTIVE: We wanted to determine whether the biological embedding of perceived psychosocial stress could be observed within a sample of Canadian firefighters. METHODS: We collected sociodemographic and general health-related information from 58 firefighters. In addition, measures of work-related and general life psychosocial stress, perceived social support, and physiological parameters thought to reflect the embedding of stress were gathered and analyzed using analysis of variance and linear regression models. RESULTS: Despite observing a positive relationship between psychosocial stress and allostatic load, the association was not significant; however, age did significantly predict allostatic load ( B = 0.09, P = 0.04). Notably, our participants reported abundant social support that was inversely associated with perceived stress. CONCLUSIONS: Although perceived stress did not significantly affect allostatic load in our sample, high levels of social support may have provided an important countervailing force.

The Path from Survey Development to Knowledge Activism: A Case Study of the Use of a Physical Loads Survey in a Retail Workplace.

Workers at a multi-site retailer were concerned that they were experiencing higher than anticipated work-related musculoskeletal disabilities (MSDs). They approached union leadership and academic researchers and a Participatory Action Research (PAR) project was developed which culminated in a targeted online Physical Loads Survey (PLS). The goal was to initiate discussions to design a preventative collaborative ergonomic program. Survey results confirmed that during a shift, workers had significant exposure to standing, carrying loads of more than 25 lbs, pushing and pulling loads greater than 225 lbs, and repetitive arm and hand movements. The successful survey was the first step in the development of a proactive health and safety program. The union proceeded without management participation and was able to move beyond knowledge creation to knowledge activism and change.

Long-Haul Truck Driver Training Does Not Meet Driver Needs in Canada.

INTRODUCTION: Training standards for long-haul truck drivers (LHTD) are rapidly evolving in Canada, yet the opinions of the drivers themselves have not been adequately considered. The purpose was to survey LHTD on their work training history and to examine LHTD perceptions of driver training and licensing protocols. METHODS: LHTD were recruited across two Western Canadian provinces from seven different truck stops. The sample completed 207 surveys and 67 semi-structured interviews. RESULTS: The average age of the participants was 52.5 ± 11.5 years (range 24-79); 96% were men. Approximately 33% of the LHTD had at least one crash. Those who did not receive formal driver training were significantly more likely to crash than those who had received training. Participants stated that current training standards are inadequate for the industry, particularly for new drivers. According to participants, entry-level curriculums should consist of both classroom and practical training, as well as on-road observation with a senior mentor. LHTD reported that many new drivers are not equipped to drive in various contexts and settings (e.g., mountains, slippery roads). CONCLUSIONS: LHTD are not confident in the current training guidelines for novice truck drivers. Revisions to the training curriculum and standardization across Canada should be considered. PRACTICAL APPLICATION: A federal mandatory entry-level training program is needed in Canada to ensure that all new LHTD ascertain the necessary skills to drive safely. Such a program requires government involvement and input from LHTD to facilitate appropriate licensure and consistent training for all drivers.

Health outcomes of psychosocial stress within firefighters: A systematic review of the research landscape.

BACKGROUND AND OBJECTIVES: Much of the research surrounding firefighter health has concerned the hazards intuitively associated with the occupation, such as physical, thermal, and chemical risks. However, an additional aspect of their work environment, psychosocial stressors, has begun to attract a growing level of attention. Work-related psychosocial stress may best be described as mental and emotional strain caused by a combination of workplace events and characteristics, and the objective of our review was to identify the health outcomes associated with these stressors in firefighters. METHODS: A systematic review was performed of studies reporting on the psychosocial stressors and the associated health outcomes experienced by firefighters. Data sources included the MEDLINE, PsychInfo, and CINAHL databases. RESULTS: Twenty-nine studies met the inclusion criteria. Upon analysis, we found that firefighters experienced a range of psychosocial stressors (including interpersonal conflict and concerns over organizational fairness) and observed that these stressors were associated with a number of health-related outcomes that could be arranged into six areas: depression-suicidality, non-depressive mental health problems, burnout, alcohol use disorders, sleep quality, and physiological parameters and somatic disorders. CONCLUSION: Our findings strongly suggest that work-related psychosocial stressors can affect the health and well-being of those in the fire service, and highlight that interventions meant to address these psychosocial risk factors should focus upon promoting self-esteem, enhancing self-efficacy, and strengthening social support.

Examining the Association Between Alcohol Consumption and Health Conditions in Community Dwelling Older Adults.

The Canadian low-risk drinking guidelines were developed for adults, however, the applicability to older adults was not considered in the development of the guidelines. The objectives of this study were to: (1) to examine alcohol use in community dwelling older males and females using the current Canadian guidelines; (2) to test lower limits of alcohol use on various health factors; and (3) to determine health factors associated with high-risk drinking in older males and females. Data on community dwelling older adults (aged 65 +) was used from the Canadian Injury Prevention Survey (n = 2274). Descriptive statistics and comparative analysis were used to compare alcohol consumption categories. Logistic regressions were performed to examine the relationships between health factors and alcohol consumption categories. 70% of the sample reported having at least one drink per week; 4.5% of males and 6.8% of females were high-risk drinkers according to the current guidelines. There were no significant associations between the current alcohol categories with demographics, behavioral risk factors or health conditions. Using the new guidelines, 21% of males and females were classified as high-risk drinkers, respectively. Diabetes and having an illness or disability before retirement was protective of high-risk drinking in males while having diabetes and poorer physical health was protective of high-risk drinking in females. The prevalence of high-risk drinkers is dependent on what alcohol classifications are used. Further studies are needed to determine the causal relationships between health-related factors and alcohol using standardized definitions of alcohol consumption.

Flexible Work Arrangements and Health in White-Collar Urban Professionals.

Although some research has examined health implications of flexible work arrangements, little is known about job flexibility and health in the context of modern working life, characterized by intensification. Grounded on the Job Demand-Resource model, this article explores access to flexible work arrangements and organizational climate on the health and well-being of white-collar, urban professionals in downtown Toronto. A qualitative content analysis of eight semistructured interviews with white-collar, urban professionals between the ages of twenty-five and thirty-two revealed three domains-intensity of work life and demands, coworker and managerial relations, and the boundaries between work and home-where demands outweighed resources to limit workers' ability to practice flexibility. Thus, an emerging trend where workers need to be flexible within flexible work arrangements emerged. Findings point to the need for organizational commitment and activities to address unhealthy behaviors in the context of modern working life.

Gender differences in the longitudinal association between multilevel latent classes of chronic disease risk behaviours and body mass index in adolescents. / Différences entre les sexes quant à l'association longitudinale entre classes latentes multiniveaux de comportements à risque associés aux maladies chroniques et indice de masse corporelle chez les adolescents.

INTRODUCTION: Few studies have assessed the relationship between chronic disease risk behaviours and body mass index (BMI) in a longitudinal, sex/gender-specific context. This study used gender-specific analyses to assess the extent to which chronic disease risk behaviour latent classes are associated with BMI and weight status at follow-up. METHODS: Longitudinal data from 4510 students in Grades 9 to 12, tracked from 2013- 2015, who participated in the COMPASS study were used to assess gender differences in the lagged association between previously determined latent classes (of physical activity and substance use) with BMI using multilevel mixed-effects models. Our multilevel regression models assessed the association between two latent classes, active experimenters and inactive non-using youth, with BMI when stratified by gender. RESULTS: Male inactive non-substance-using youth were associated with a 0.29 higher continuous BMI (95% CI: 0.057, 0.53) and odds of overweight/obesity increased by 72% (OR = 1.72, 95% CI: 1.2, 2.4) for binary BMI at follow-up relative to active youth who experiment with substance use. No significant associations were detected in females. CONCLUSION: Over time, physical activity has a protective role on BMI in male youth. Both substance use and physical inactivity should be addressed in obesity prevention efforts. Gender stratification in analyses is also important since females and males have different contributing factors to increases in BMI.

Exploring gender differences in the longitudinal association between bullying and risk behaviours with Body Mass Index among COMPASS youth in Canada.

The purpose of this study was to identify gender differences in the association between bullying and Body Mass Index (BMI) longitudinally. Longitudinal data (2013-2015) from 4510 youth (Ontario, Canada) were used to model BMI with consecutive bullying status prospectively, adjusting for previously identified gender-specific health risk behaviour latent classes. To assess for gender differences, these mixed-effects models were stratified by gender. Youth who were victims of bullying (VoB) were more active, engaged in more substance use and reported higher BMI than their non-victim of bullying (NVoB) peers. The gender-specific mixed-models showed that there are gender differences in the association between bullying and BMI. Among females, repeated bullying was associated with higher odds of having overweight/obesity [by 51% (95% C.I. = 1.03, 2.23)] at follow-up. Among male youth, being a VoB at the previous wave only, was associated with higher odds of having overweight/obesity [by 60% (95% C.I. = 1.11, 2.29)] at follow-up. In contrast with previous literature that measured BMI during adulthood (i.e., years after school victimization), our study adds a unique contribution to the literature that across one year (while youth are still in secondary school), bullying is associated with higher odds of weight status and BMI among female and male youth. Since this increase occurs during secondary school, school-based programs aimed at decreasing youth bullying behaviours and addressing increases in BMI before youth leave school are of paramount importance.

A gender-stratified, multilevel latent class assessment of chronic disease risk behaviours' association with Body Mass Index among youth in the COMPASS study.

This paper sought to examine chronic disease risk behaviour latent classes and their association with Body Mass Index (BMI), assessing for gender differences. Participants were youth (n = 116,086; grades 9-12) enrolled in the COMPASS study (Ontario, Canada) during 2013, 2014, 2015. Multilevel latent class analysis was used to identify underlying, homogenous classes of youths' engagement in physical activity, smoking, binge drinking and marijuana use. Adjusted multilevel models regressed BMI on the latent classes controlling for ethnicity and grade. Three latent classes were identified: active experimenters (ACE), inactive clean youth (INC) and inactive substance users (INSU). This study found that gender differences are apparent in chronic disease risk behaviour latent classes and their association with BMI. INC males (OR = 0.85, 95% CI = 0.78, 0.93) were associated with a lower odds of overweight/obesity relative to active males who experimented with substance use. As for females, the class with the highest proportion of youth using substances were associated with higher odds (Females: OR = 1.2, 95% CI = 1.1, 1.4) of overweight/obesity relative to their active experimenting peers. As such, youth in latent classes with substance use are associated with higher BMI and weight status. Successful interventions may include school policies/programs that limit screen time use, as they were seen to have a positive effect on PA engagement and including social-influences approaches for substance use. Future research and interventions should be gender-specific as our results show that different latent classes are associated with obesity across genders.

The impact of different seats and whole-body vibration exposures on truck driver vigilance and discomfort.

Laboratory studies have shown that exposure to whole-body vibration (WBV) increases physical and mental fatigue, which are common issues professional drivers face. The objective of this study was to determine whether altering WBV exposures had any effect on driver vigilance and discomfort. A repeated measures crossover design of five truck drivers with regular 10-h routes was used. Active and passive suspension truck seats were evaluated. For each seat, WBV exposures were measured. Participants completed a discomfort questionnaire and a reaction time task before and after their shift for two weeks, one week per seat. Compared with the passive seat, the active seat significantly reduced WBV exposures, decrements in the optimal and mean reaction times (p = 0.02, 0.047, respectively), and discomfort in the lower back and wrist(s)/forearm(s) (p < 0.01, 0.01, respectively). Study results indicated that reducing WBV helps reduce discomfort and maintain vigilance, which may improve drivers' health and reduce the risk of truck collisions. Practitioner Summary: The active suspension seat used in this study reduced truck drivers' exposure to whole-body vibration (WBV) by over 33% in relation to their current industry standard passive suspension seat. This study demonstrated that reducing truck drivers' exposure to WBV reduced fatigue and discomfort development over a workday.

Using standard clinical assessments for home care to identify vulnerable populations before, during, and after disasters.

OBJECTIVES: Several studies have shown the increased vulnerability of and disproportionate mortality rate among frail community-dwelling older adults as a result of emergencies and disasters. This article will discuss the applicability of the Vulnerable Persons at Risk (VPR) and VPR Plus decision support algorithms designed based on the Resident Assessment Instrument-Home Care (RAI-HC) to identify the most vulnerable community-dwelling (older) adults. DESIGN: A sample was taken from the Ontario RAI-HC database by selecting unique home care clients with assessments closest to December 31, 2014 (N = 275,797). Statistical methods used include cross tabulation, bivariate logistic regression as well as Kaplan-Meier survival plotting and Cox proportional hazards ratios calculations. RESULTS: The VPR and VPR Plus algorithms, were highly predictive of mortality, long-term care admission and hospitalization in ordinary circumstances. This provides a good indication of the strength of the algorithms in identifying vulnerable persons at times of emergencies. CONCLUSIONS: Access to real-time person-level information of persons with functional care needs is a vital enabler for emergency responders in prioritizing and allocating resources during a disaster, and has great utility for emergency planning and recovery efforts. The development of valid and reliable algorithms supports the rapid identification and response to vulnerable community-dwelling persons for all phases of emergency management.