In a new study, mice bioengineered to mimic the fading memory of Alzheimer's patients got their memories restored -- either by being placed in stimulating environments or by receiving a drug most commonly used to fight cancer.
While the research remains in an early stage, it "really provides hope for human patients, especially those with dementia," said study senior researcher Li-Huei Tsai, a professor of brain and cognitive sciences at the Massachusetts Institute of Technology's Picower Institute of Learning and Memory.
Her team published its findings April 29 in the online edition of the journal Nature.
Alzheimer's disease is becoming more widespread as the population ages, and five million Americans now suffer from the illness, according to the Alzheimer's Association. By 2050, unless new ways are found to prevent or treat the disease, that total could climb to 16 million.
A gradual but inexorable loss of memory is one of the tragic hallmarks of Alzheimer's disease, but neuroscientists have never been clear as to whether memories are truly lost or simply rendered inaccessible.
According to Tsai, experts have long known that a so-called "enriched" environment can boost learning. But can it also help restore fading powers of recall?
"I don't think anyone has studied this in depth, because there's only so much you can do with humans," Tsai said. "And in terms of animal models, it's been difficult, too."
However, a few years ago her team at MIT made a kind of breakthrough in that regard. They bioengineered a strain of mice that could be induced at any time in their lifespan to mimic the steady loss of brain cells -- called neurons -- that occurs with Alzheimer's and other neurodegenerative illnesses. This steady destruction of neurons can lead to serious memory deficits.
Working with this mouse model, Tsai's group first trained a number of the rodents to perform a number of tasks. They then induced an Alzheimer's-like neuronal loss that depletes memory.
However, mice that were kept in an "enriched" environment -- rooms full of shelves, perches, nesting material, tunnels and (especially) other mice -- were still able to use their memory to find their way through mazes they had learned to navigate weeks before.
In contrast, mice kept in unstimulating surroundings typically got lost and failed to complete tasks. These rodents were seemingly unable to remember tasks they had learned before, including navigating the mazes, the researchers said.
How might stimulating surroundings preserve or boost memory? "Environmental enrichment doesn't seem to be bringing back the lost neurons -- we don't think that's the case," Tsai said. "Rather, we think that environmental enrichment promotes new neurons to grow and synapses to form. We propose that it is actually rewiring the brain."
Similar results were seen when mice with induced memory loss received a new type of drug called a histone deacetylase (HDAC) inhibitor. These agents are already being used as cancer therapy and appear to work at the molecular level to "free up" genes that produce vital growth factors and proteins.
Mice given an HDAC inhibitor had much less trouble finding their way through mazes and performing other tasks that relied on memory, compared to mice that did not receive the drug, Tsai said.
Again, she believes that HDACs may have stimulated genes crucial to learning memory in the rodents' brains. This may have led to the formation of new neural networks that gave these brain-impaired mice renewed access to useful memories.
The HDAC inhibitor finding is "really intriguing," said Dr. Paul Sanberg, director of the Center of Excellence for Aging and Brain Repair at the University of South Florida College of Medicine in Tampa.
"Especially because these drugs are already being used in cancer patients, that means that they are already available clinically, so maybe they could be developed a little faster for Alzheimer's patients," he said.
Still, many questions remain. "Exactly which genes are being increased, and which are needed? I don't think that you can tell from this paper," Sanberg said.
Tsai agreed that more study is necessary before HDACs can be tested in Alzheimer's patients. "Right now, we only show the beneficial effects in animal models. Before proceeding to humans, we really have to know more," she said.
But enriched environments -- involving both mental stimulation and physical activity -- are available to help everyone's memory, right now.
"I think that's so important, and not just for Alzheimer's patients," Tsai said. "I think that all of us should keep busy and engaged. That's definitely very beneficial for everyone."
Sunday, April 29, 2007
Scientists Restore Lost Memory in Alzheimer's-Like Mice
Memory loss caused by brain damage is reversible
Degenerative brain diseases, including Alzheimers, could one day be treated with drugs that can reverse distressing loss of memory, according to a study released Sunday.
The very term "memory loss" could be a misnomer in such cases, suggests the study, published in British journal Nature: that cherished recollection of a first kiss, seemingly destroyed by disease, may have simply been rendered inaccessible by obstructed neural pathways.
In laboratory experiments, mice suffering the type of brain damage which in humans typically leads to dementia -- robbing victims of the ability to remember past events or even to recognize loved ones -- were able to recover memories acquired during earlier conditioning, according to the study carried out by researchers at the Massachusetts Institute of Technology.
Following a period of rehabilitation through mental stimulation, the genetically modified mice successfully performed tasks they had "forgotten" in the wake of damage inflicted on specific neural networks in the brain.
The same regenerative results were also later obtained through a drug treatment.
While there is no guarantee that the same techniques will work in humans, the study does raise "the possibility of recovering long-term memories in patients" ravaged by certain neurological disorders, according to lead author Li-Huei Tsai, who conducted the study with four colleagues.
Neurodegenerative diseases attack those parts of the brain and spinal cord that control bodily movement and process information stored in the form of memories.
When brain cells deteriorate or are destroyed, they are not replaced. Earlier studies have shown, however, that healthy neurons stimulated through mental activity or directly by chemicals can grow stronger and reconfigure themselves.
Tsai's breakthrough in a series of ingenious experiments was to demonstrate that this same process of remodeling can be reparative, unlocking memories rendered inaccessible by diseases causing "significant brain atrophy and neuronal loss."
The researchers began their experiment by selecting genetically modified mice in which a protein linked to neurodegenerative disease, called p25, could be switched "on" or "off" chemically.
Before this brain-damaging protein was activated, the mice demonstrated in two tests that they had learned how to avoid an electric shock, and how to navigate a maze quickly for a food reward.
After the animals were subjected to six-weeks of neurological degeneration, they could no longer perform these tasks. But an intensive, four-week regimen of "environmental enrichment" -- scientific jargon for access to lots of toys and play -- led to a sharp increase in learning ability and memory. Indeed, the mice passed the tests almost as well as control mice.
The researchers were careful to focus on long-term memories, thought to be stored in the cortical network, and not recently learned behavior, which is initially encoded in another part of the brain, the hippocampus.
Tsai and her colleagues had a hunch as to what was going on at a molecular level when the memories were retrieved and devised a further experiment to test it by chemically inhibiting an enzyme -- histone deacetylase (HDAC) -- known to interfere with gene transcription.
The results showed the same beneficial effect as the "environmental enhancement," suggesting that it could be the basis for a pharmaceutical treatment for memory loss.
"Using small molecules that target HDACs in patients with dementia could facilitate access to long-terms memories," the study concludes.
Health Tip: Precautions While Mowing the Lawn
Playing near lawn mowers is dangerous for children and adolescents, and adults can get hurt, too, if they don't take the proper precautions. To prevent lawn mower-related injuries, follow these safety suggestions from the American Academy of Pediatrics:
- Use a mower the comes with safety features, like a control that prevents the mower from moving forward if the handles are released.
- Never let children younger than 16 use a riding mower, and children younger than 12 use a push mower.
- Never allow children to ride on mowers, even with an adult.
- Always wear sturdy, closed-toe shoes while mowing, never sandals or flip flops that leave portions of the feet exposed.
- Clean the yard of things like rocks, sticks, and toys before mowing to prevent injuries from flying objects.
- Don't allow children to be in the yard while mowing.
- Always turn the mower off and let the blades stop completely before reaching around the blades.
- Avoid mowing in reverse.
Change of Season Brings Lawn Mower Warning
Each year in the United States, about 9,400 children are treated for lawn-mower related injuries such as lacerations, fractures and amputations of the fingers, hands, toes, feet and legs, say experts at Johns Hopkins Children's Center.
"The No. 1 advice to parents is: Treat the lawn mower as hazardous equipment, not a toy. You don't let a child play with an electric saw, and that's exactly what a lawn mower is," Carol Gentry, pediatric OR nurse manager, said in a prepared statement.
Of the lawn mower accident cases treated at the Johns Hopkins Children's Center between 2000 and 2005, 95 percent involved amputations that required reattachment or reconstructive surgery.
The Hopkins experts offer tips for preventing mower-related injuries:
Church urges Mexico MDs against abortion
The Roman Catholic Church on Sunday called on doctors in Mexico City not to perform abortions and lamented the city's decision to legalize the procedure in the first 12 weeks of pregnancy.
The church has vowed to continue its anti-abortion campaign even through it is under investigation for possibly violating Mexican laws forbidding the church's participation in politics.
Mexico City officials have said doctors at city-run hospitals cannot refuse to perform abortions based on personal moral objection, but in a letter read at Sunday Mass, Cardinal Norberto Rivera said they could.
"We call on all of those of good conscience not to be responsible for the abominable act," the letter stated. "We remind the doctors, nurses, health care workers and all those affected by this unjust law, that they can invoke their human right to conscientious objection."
Archdiocese spokesman Hugo Valdemar Romero has said doctors and nurses who performed abortions and lawmakers who supported the legalization will be excommunicated.
Mexico City Mayor Marcelo Ebrard, whose leftist Democratic Revolution Party backed the bill approved by city lawmakers last week, said he would not be deterred by the church's statements.
"We are in the 21st century, not the 16th," Ebrard said. "I have a lot of respect for issues of faith. ... But this is a case where the affairs of state reign."
Elsewhere in Mexico, abortion is only allowed in cases of rape, danger to the mother's life or severe fetal defects. The only countries in the region that allow abortion are Cuba and Guyana.
Friday, April 27, 2007
Canadian mice first to be grafted with human leukemia
Canadian scientists said Friday they have grown a human cancer from scratch in a lab mouse for the first time, allowing researchers to examine its progression from start to finish.
The animal model, which researchers have pursued for years, could "translate into more effective therapies," John Dick, the lead author of the study and a senior scientist at Princess Margaret Hospital, told AFP.
"By just studying the tumor at the end, we didn't know how the tumor was created," he said.
This crucial new tool could help scientists "better understand the whole process and more rationally target the critical pathways to eradicate these cells that lie at the heart of the cancer," he said.
The study was published Friday in the journal Science.
Previously, researchers would engineer mice to develop cancer, but it was the animal form of the disease. They could also implant human cancers into mice, but missed how the disease originated.
By inserting just one cancerous gene into human stem cells, Dick and his colleagues were able to seed leukemia in specially bred lab mice.
"We haven't proven it, but we believe this process could be used for other cancers too," Dick said.
The same team of scientists were the first to isolate cancer stem cells in acute myeloid leukemia in 1994.
Imaging Technique Could Help Fight Metastatic Cancers
A new imaging technique that measures diffusion of water through tumors may help guide the treatment of advanced prostate cancer that's spread to the bones, says a study by researchers at the University of Michigan Comprehensive Cancer Center.
This technique, called a functional diffusion map, uses an MRI scan and special software to monitor the movement of water through tumor cells over the course of treatment. As tumor cells die, this diffusion of water increases, the researchers explain.
In the study, the Michigan team tested the technique in mice with metastatic prostate cancer.
Mice that received chemotherapy showed progressive changes over the three weeks of treatment, while mice that did not receive chemotherapy had little or no change in water diffusion.
When the researchers removed the tumors from the mice, they found that the functional diffusion map had accurately measured tumor response to treatment. The study was published in the April 15 issue of Cancer Research.
The findings suggest that the functional diffusion map could provide an early assessment of tumor response to treatment, the scientists said. This could help patients avoid wasting time on a treatment that isn't working before they switch to an alternative therapy.
Currently, there is no way to detect bone tumor response to therapy, study author Brian D. Ross, a professor of radiology and biological chemistry at the U-M Medical School and co-director of the Molecular Imaging Program at the U-M Comprehensive Cancer Center, said in a prepared statement.
About 500,000 people in the United States develop metastatic prostate or breast cancers that spread to the bone, he said.
New diabetes genetic risk factors found
Scientists have found clusters of new gene variants that raise the risk of Type 2 diabetes — and how the researchers did it is as important as what they found.
In one of the largest studies yet of human genetic variability, the scientists tested the DNA of more than 32,000 people in five countries to pin down spots that harbor genetic risk factors for this complicated killer.
This type of research — called a "genome-wide association" study — promises to usher in a new era of genetics. Most breakthroughs so far have come from finding a mutation in a single gene that causes illness. But some of the world's most common killers, such as heart disease and diabetes, are caused by complex interactions among numerous genes and modern lifestyles — and teasing out the genetic culprits until now has been almost impossible.
"We have been for all of the last decade or more looking under the lamppost to try to find those genes ... and lots of times the lamplight was not actually where we wanted it," said Dr. Francis Collins, genetics chief at the
National Institutes of Health, a co-author of the research unveiled Thursday.
This new approach "allows us to light up the whole street, and look what we find."
What? Four previously unknown gene variants that can increase people's risk of Type 2 diabetes, and confirmation that six other genes play a role, too.
The work, by three international research teams that shared their findings, was published online Thursday by the journal Science.
Also Thursday in the journal Nature Genetics, another team led by Iceland researchers reported separately finding one of those same new genes — and that, interestingly, it seems to increase the diabetes risk most in people who aren't obese.
Next, the researchers will have to figure out just what those genes do, in hopes they'll point toward new ways to treat or prevent a disease that affects more than 170 million people worldwide, and rising.
With Type 2 diabetes, the body gradually loses its ability to use insulin, a hormone key for turning blood sugar into insulin. It is a major cause of heart disease, as high blood sugar damages blood vessels, and leads to kidney failure, blindness and amputations.
Obesity and lack of exercise are chief risk factors. But heredity is involved, too: People with an affected parent or sibling are at 3.5 times greater risk of developing diabetes than people from diabetes-free families.
The new work scanned DNA to find patterns of small gene variations known as SNPs (pronounced "snips") more common in diabetics. SNPs can serve as signposts for tracing disease-promoting genes. To be certain the implicated SNPs were involved, the researchers then checked for them in still more volunteers, ultimately testing DNA from 32,500 people in Britain, Finland, Poland, Sweden and the U.S.
The highest-risk variants can increase by 20 percent someone's odds of developing Type 2 diabetes, the teams reported.
Cervical abnormalities common in HIV-infected girls
Sexually active teenage girls infected around the time of birth with HIV, the virus that causes AIDS, are more likely to have cervical infections and abnormal Pap test results, new research shows.
Extensive research has examined the reproductive health outcomes among teenagers who acquire HIV infection through sex, senior investigator Dr. Susan B. Brogly of Harvard School of Public Health in Boston told Reuters.
In contrast, this is the largest cohort study, and the first to publish on rates of genital infections, cervical lesions, and pregnancy among girls who had been living with HIV since birth, she said.
Their results will be published in the June issue of the American Journal of Public Health.
The study involved a total of 638 girls infected with HIV during birth, and who were 13 to 21 years old when they entered a pediatric AIDS study between 2000 and 2005. Brogly and her co-investigators estimate that 174 of the girls were sexually active. More than three-quarters were receiving HIV medication.
Pelvic examinations revealed multiple cases of genital warts. Many of the HIV-infected teenage girls were found to have sexually transmitted diseases, including trichomoniasis, chlamydia, gonorrhea and syphilis.
Of the 101 sexually active girls who had Pap tests, 30 (29.7 percent) had abnormal results at the first examination including lesions that have the potential to become cancerous called squamous intraepithelial lesions or SIL.
"We were surprised at the high rates of SIL that were observed," Brogly said. "It is concerning to find such high rates in young adolescent girls."
She and her colleagues were also taken aback by the finding that "pap smears were so infrequent among these girls identified as sexually active."
Thirty-eight girls became pregnant for the first time while in the study. Seven were pregnant more than once, resulting in 32 pregnancies that ended with live births. Of these, only one newborn was known to be HIV-infected.
The rate of pregnancy is much lower in this cohort than among HIV-uninfected girls of similar ages in the US, the team reports. Brogly attributes the low pregnancy rates to the fact that "some of these girls have severely compromised health and serious illness, making it difficult to become pregnant."
SOURCE: American Journal of Public Health, June 2007.
Health Tip: Using Car Seats
Car seats can protect children in the event of an accident, but only if they are used properly.
Here are some tips on how to make sure you are using your child's car seat correctly, courtesy of the American Academy of Pediatrics:
- Always put your child in a car seat, starting with the baby's first ride home from the hospital.
- Install the car seat in the automobile's back seat, never in the front where there's an airbag.
- Always read the seat's instructions, including how to install it, and how to attach and detach the seat and base.
- Keep the instructions and owner's manual as long as you have the seat, in case you need them.
Health Tip: Precautions While Mowing the Lawn
Playing near lawn mowers is dangerous for children and adolescents, and adults can get hurt, too, if they don't take the proper precautions. To prevent lawn mower-related injuries, follow these safety suggestions from the American Academy of Pediatrics:
- Use a mower the comes with safety features, like a control that prevents the mower from moving forward if the handles are released.
- Never let children younger than 16 use a riding mower, and children younger than 12 use a push mower.
- Never allow children to ride on mowers, even with an adult.
- Always wear sturdy, closed-toe shoes while mowing, never sandals or flip flops that leave portions of the feet exposed.
- Clean the yard of things like rocks, sticks, and toys before mowing to prevent injuries from flying objects.
- Don't allow children to be in the yard while mowing.
- Always turn the mower off and let the blades stop completely before reaching around the blades.
- Avoid mowing in reverse.
Researchers Identify Genes for Childhood Seizures
French scientists studying four generations of a single family have honed in on two genes associated with fever-related seizures in infants and children.
These "febrile" seizures are the most common seizure disorder in children, affecting 2 percent to 5 percent of children by age 6 in the United States. Most children with the disorder experience seizures only once or a few times and suffer no permanent brain damage. Some children with febrile seizures do develop other seizure disorders, such as epilepsy, later in life.
Of the 51 people in the family, 13 had childhood febrile seizures. In all cases, the seizures stopped by age 7, but six of the 13 developed epilepsy later on. The researchers compared the 13 people affected by febrile seizures to 13 other family members who did not have the attacks.
The study found that those who had febrile seizures shared similarities on chromosome 3 and chromosome 18.
The findings are published in the April 24 issue of Neurology.
"Identifying the genes responsible for febrile seizures could improve the understanding, treatment and even prevention of this disorder," study author Dr. Rima Nabbout, of the French Institute for Medical Research in Paris, said in a prepared statement.
Previous studies have identified four other chromosome areas associated with febrile seizures.
Dozens sick after meal at Chinese school
More than 50 children were poisoned by a kindergarten breakfast in central China, state media said Thursday, in the latest case highlighting problems in the country's food supply chain.
Xinhua News Agency said the children were hospitalized after eating breakfast Wednesday at a private kindergarten in Zhengzhou city in Henan province. Thirty had been released and the others remained under observation.
Doctors believe soybean milk given to the children was not boiled properly, Xinhua said.
Mass poisonings are common in China, which has been struggling to improve a dismal food safety record. Manufacturers often mislabel food products or add illegal substances to them. Cooks routinely disregard hygiene rules.
Last week there were three cases in various parts of the country involving about 280 people.
In the latest incident, the person in charge of the private kindergarten and three cooks who prepared the breakfast have been detained by police, Xinhua said.
Vitamin A May Boost Vaccine Effectiveness in Kids
Giving vitamin A supplements to young children may boost their immune system response to tetanus and other types of vaccines, U.S. researchers say.
In regions of the world where vitamin A deficiency is common, preschool-aged children are often given vitamin A supplements along with vaccinations for tetanus and other pathogens, according to background information in the study.
However, whether vitamin A supplementation has an immediate effect on the immune system's response to the vaccine, or whether vitamin A helps immune response to vaccines only later in life, had not been tested, said a team from Pennsylvania State University.
In research with rats, they found that giving vitamin A supplementation to young rats helped improve immune response to tetanus vaccinations at a later age.
If the same is true in young children, the researchers said that "neonatal-age vitamin A supplementation may benefit the vaccine response of children whose post-weaning vitamin A intake is not adequate."
Omega-3 may fight Alzheimer brain changes
A fatty acid found in fish may help thwart the buildup of brain proteins linked to Alzheimer's disease, a study in mice suggests.
In Alzheimer's disease, lesions known as "plaques" and "tangles" form in the brain, due to the abnormal clumping of two proteins called beta-amyloid and tau. The mouse study found that a diet rich in the fatty acid DHA might interfere with this process.
DHA, short for docosahexaenoic acid, is a type of omega-3 fatty acid found mainly in fatty fish like salmon and mackerel, and to a lesser extent in seaweed, eggs, organ meats and DHA-fortified foods.
While the new findings come from studying mice, they complement studies in humans that have linked higher fish intake, as well as higher blood levels of DHA, to a lower risk of Alzheimer's disease.
Such research suggests that the animal findings might well translate to people, Dr. Frank LaFerla, the senior author on the new study, told Reuters Health.
He and his colleagues at the University of California at Irvine report their results in the Journal of Neuroscience. Several co-authors on the study are with Martek Biosciences Corp., a Maryland-based company that makes a DHA product used in a range of infant formulas, foods and supplements.
For their study, the researchers used mice genetically engineered to develop Alzheimer's-like plaques and tangles. At the age of 3 months, the animals were placed on one of four diets.
One diet mimicked the typical American diet, with low amounts of omega-3 fats and far higher levels of omega-6 fats, which are found in various vegetable oils, eggs and meat. The other three diets were rich in omega-3 fatty acids; one was supplemented with DHA only, while the other two had added DHA and omega-6 fats.
After 9 months, the study found, mice on the diet supplemented with DHA alone had lower levels of beta-amyloid and tau in their brain tissue than the animals in the other three groups.
The researchers also discovered that DHA may confer its benefit by lowering levels of an enzyme needed to generate beta-amyloid.
What's needed now, according to LaFerla, are clinical trials involving people with early-stage Alzheimer's to see whether DHA supplements can slow the progression of the disease. Martek has just launched such a study, he said.
SOURCE: Journal of Neuroscience, April 18, 2007.
Depression May Be Early Sign of Parkinson's Disease
In some cases, depression can be an early manifestation of Parkinson's disease, new research suggests.
Researchers at the Harvard School of Public Health compared antidepressant use among more than 1,000 individuals with Parkinson's disease to more than 6,600 age- and gender-matched individuals without the degenerative neurological illness.
They found that people currently on antidepressants had an 80 percent higher risk of developing Parkinson's disease than those who had never taken antidepressants. This was true for both men and women, regardless of age or the class of antidepressant used.
"We think this is not actually the medication that is causing Parkinson's disease. Instead, we think people who are going to get Parkinson's disease get depression first," said study co-author Dr. Alvaro Alonso, a research associate at Harvard. "It's very important not to say that people taking antidepressants have a higher risk of developing Parkinson's disease," he said.
That's because the effect was only apparent in the year prior to disease diagnosis, and because it was true for two different types of medications, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), which work via wholly different mechanisms, Alonso explained.
He noted that additional data, not included in the published study, indicated that newer users of antidepressants -- those who had been on the drugs for less than one year -- had a threefold higher risk of developing Parkinson's than people who had never used antidepressants.
Alonso's interpretation: Depressive symptoms could be one of the first manifestations of Parkinson's disease.
The research is scheduled to be presented May 1 at the annual meeting of the American Academy of Neurology, in Boston.
Dr. Rajesh Pahwa, director of the Parkinson Disease and Movement Disorder Center at the University of Kansas Medical Center, in Kansas City, called the observation "interesting."
At the same time, he said, the depression-Parkinson's link is "common knowledge" among neurologists, who have long recognized that depression often occurs alongside Parkinson's disease.
However, primary care physicians and psychiatrists, who may not be aware of the link, "need to pay more attention to this issue," Pahwa said. At-risk individuals who suddenly develop depressive symptoms could in fact be showing the first signs of Parkinson's.
Neurologists could also benefit from these findings, Pahwa added.
"For us, the biggest issue is that we need to pay more attention to depression in Parkinson's disease," Pahwa said. Too often, physicians may view depression as a natural psychological reaction to a Parkinson's diagnosis. However, that may not sometimes be the case, "and we need to treat it more aggressively," he said.
According to Pahwa, Parkinson's disease is a progressive neurodegenerative disorder marked by the loss of dopamine-producing neurons in the brain. Though most commonly associated with motor deficits such as tremors and stiffness, there also are non-motor features, including urinary problems, constipation, insomnia, depression, anxiety, and dementia. There is no laboratory test for Parkinson's, so it must be diagnosed clinically. Nor is there yet any cure for this degenerative disease.
According to the National Parkinson Foundation, 1.5 million Americans currently have the illness, which strikes men and women in roughly equal numbers, usually after the age of 65.
Dr. Giselle Petzinger, a movement disorder specialist at the University of Southern California, said this study is the first to "really suggest" that non-motor features could be early indicators of Parkinson's disease.
"This is pretty convincing data," she said. "Mood probably could be an early manifestation. That's never been shown before."
Petzinger said such early symptoms could enable eventual earlier -- and thus, more effective -- use of neuroprotective medicines, though she noted that no such drug currently exists.
"You want to catch them before they develop motor symptoms," Petzinger said. "That might be a point of no return. Early recognition, that's when you want to capture people."
Program fails to curb falls in older folks
A community-based intervention designed to address multiple factors that put elderly people at increased risk for falling and injuring themselves has proven ineffective. There was no decrease in the number of falls in "at-risk" elderly individuals who completed the program.
Falls are a significant source of illness and death for older adults, Dr. Jane E. Mahoney, of the University of Wisconsin, Madison, and colleagues note in a report
They conducted a randomized, controlled trial to examine the efficacy of an intervention to reduce falls in 344 older adults living in the community. These people were at least 65 years old and had suffered two falls in the previous year, or one fall in the previous 2 years plus injury or balance problems.
In the intervention group, a trained nurse or physical therapist assessed the subjects' fall risk factors during two in-home visits, followed by 11 phone calls each month. The intervention group was also referred to physical therapy or other providers, along with a balanced exercise plan.
Individuals in the control group received the in-home assessment only and were advised to contact their physician about falls.
During follow up, which lasted at least 365 days for 274 participants, there was no significant difference in the risk of falls between the intervention group and the control group. However, the subjects in the intervention group spent fewer days in a nursing home than those in the control group.
SOURCE: Journal of the American Geriatrics Society April 2007.
Exercise May Help Ward Off Parkinson's Disease
New research suggests more evidence of yet another benefit of regular exercise: It could keep Parkinson's disease at bay.
The study doesn't conclusively link exercise to better brain health, but scientists think the connection could be more than a fluke.
"The people who seemed to have a lower risk of disease were engaging in moderate to vigorous activity for two to three hours a week," said study leader Evan Thacker, a research assistant at the Harvard School of Public Health.
Parkinson's disease is a movement disorder that worsens over time and causes a variety of symptoms, including disruptions in movement, as neurons in the brain deteriorate. The cause of the disease is not known, and there is no cure, but drug therapy and surgery can help manage symptoms, according to the Parkinson' Disease Foundation.
An estimated 1.5 million Americans have the disease, and 60,000 new cases are diagnosed each year, according to the foundation. Among famous people who have the condition are the actor Michael J. Fox and former U.S. Attorney General
Janet Reno.
In what Thacker called the largest research project of its kind, researchers looked at the results of a federal cancer study that followed 63,348 men and 79,977 women from 1992 to 2001. Of the participants -- with an average age of 63 -- 413 of them developed Parkinson's disease.
The researchers looked at exercise levels and tried to determine if they affected the rate of Parkinson's disease after adjusting the numbers to reflect the possible influence of factors such as age, gender and smoking.
People who exercised more than 75 percent of their fellow study participants were 20 percent less likely to develop Parkinson's, compared to those who didn't exercise. The risk of the disease was 40 percent lower in those who took part in the highest levels of moderate to vigorous activity, defined as exercise such as jogging, lap swimming, tennis and bicycling, the study found.
However, there's one caveat -- the researchers found no indication that physical activity at age 40 affected the risk of developing Parkinson's.
The results were expected to be reported Monday at the American Academy of Neurology annual meeting, in Boston. As is often the case with research presented at conferences, the study has not been published in a medical journal or gone through the review process that journals require.
A previous study suggested a link between exercise and Parkinson's in men, but not in women, Thacker said. The new findings show both genders may benefit.
Still, he cautioned that his study isn't "the final word."
"We can't prove there was some other factor that caused people to be different," he said. "We can just do the best we can.
Thacker said it's still not clear why exercise might influence the development of Parkinson's. One possibility could be that exercise might affect chemicals in the blood that play a role in the development of the disease, he said.
Researchers at the University of Southern California have found evidence suggesting that exercise changes the way neurons release dopamine -- a crucial brain booster -- in mice, said Michael Jakowec, an assistant professor of neurology at the school.
Disruptions in dopamine production have been linked to Parkinson's.
According to Jakowec, both animal studies and brain imaging in humans will help scientists understand the effects of exercise on the brain.
Does circumcision affect your sex life? Scientists are divided
Two studies have thrown up conflicting evidence as to whether circumcision could harm a man's sex life, New Scientist reports in its next issue.
The question is especially important, given the World Health Organisation's (WHO's) recent endorsement of circumcision in the panoply of weapons to tackle the spread of AIDS.
In a study led by Kimberley Payne of the Riverside Professional Center in Ottawa, 20 circumcised and 20 uncircumcised men watched erotic movies while their penises were measured for sensitivity at two points, using filaments that pressed down with predetermined amounts of pressure.
There was no difference in penile sensation between the two groups, according to their research.
However, a team led by Robert Van Howe of Michigan State University used a similar method, but measuring penile sensitivity at 19 points among 163 circumcised and uncircumcised men.
The five most sensitive points are all in portions of the penis removed by circumcision, especially those in folds exposed as the penis becomes erect, Van Howe believes.
"The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis," his paper says. "(...) Circumcision ablates the most sensitive parts of the penis."
The report appears in next Saturday's issue of the British weekly. Payne's research appears in The Journal of Sexual Medicine, while Van Howe's is published by the British Journal of Urology (BJU) International.
On March 28, the WHO and other agencies in the fight against AIDS gave the stamp of approval to promoting circumcision to help prevent the spread of the human immunodeficiency virus (HIV).
Three studies carried out in southern and eastern Africa found that circumcised men were more than half less likely to be infected by HIV compared to uncircumcised counterparts.
Weighing obesity surgery risks for teens
Seventeen-year-old Amanda Munson gained confidence and energy as she lost 40 of her 296 pounds after weight-loss surgery and her diabetes went into remission.
"People have told me I not only look thinner, but I seem to glow — maybe because I'm so much happier," she said. The 5-foot-5 high school senior from nearby Burlington, Ky., hopes to lose 75 to 100 more pounds.
Munson is the first of 200 teenagers who will be enrolled in a five-year, federally funded study on the benefits and risks of bariatric surgery on adolescents.
Surgery has been effective in treating extreme obesity in adults. Researchers want to find out if adults and adolescents who have the surgery have significantly different health problems and whether there is any benefit to having the operation earlier in life.
The researchers are responding to the growing problem of extreme obesity among the young.
"We know bariatric surgery is effective for weight-loss. We just need to carefully document how teenagers respond," said Dr. Thomas Inge, associate professor of pediatrics and surgery at Cincinnati Children's Hospital Medical Center, which is leading the study.
Recent data from the Centers for Disease Control and Prevention suggest that about 2 million U.S. adolescents may be severely obese and have complications of obesity previously seen only in adults.
While adult weight-loss surgery still is more common, an estimated 2,744 youngsters nationwide had the operations from 1996 through 2003, with the pace tripling between 2000 and 2003, according to an earlier study co-written by Inge.
The doctors expect their research will show that severe obesity in teens is associated with medical and psychosocial problems which may be more effectively treated during adolescence than waiting until adulthood.
"What's fascinating is that teenagers already can have a half-dozen complications of obesity that the surgery within months — if not weeks — can remedy," he said Inge, who has been performing the surgery on adolescents for five years.
The National Institute of Diabetes, Digestive and Kidney Disorders provided more than $5 million last year for the study. Texas Children's Hospital in Houston, Children's Hospital of Alabama in Birmingham and the University of Pittsburgh also are collecting data.
Researchers will compare data before and after surgery on health factors that include cholesterol levels, liver function, cardiosvascular risk and markers for diabetes. Those findings will be compared with data from a similar study on adults who have been obese since adolescence but are only now having the surgery.
Participants must already have been scheduled for the surgery and must have compelling obesity-related complications such as Type 2 diabetes, sleep apnea, high blood pressure or other cardiovascular risk factors.
Information also will be collected on psychological and social effects of the surgery on the teenagers. Severe obesity can lead to low self-esteem, less social interaction with peers and depression.
Kerri Green, director of education for the Weller Health Education Center in Easton, Pa., believes studies are needed to find out if young people can understand the physical, psychological and emotional consequences of bariatric surgery, which she said should be done only for compelling medical reasons.
"We see a lot of what we call the 'Extreme Makeover' phenomenon, where kids see surgery as a quick fix that will make up for poor eating habits and a lack of exercise," she said.
Munson's mother, Barbara Farnsworth, said they exhausted all other options before resorting to surgery.
"It breaks your heart to see your child struggling and becoming so depressed and to hear doctors say she won't see 30 if she doesn't lose weight," Farnsworth said. "This is only a tool, but I now see a future for Amanda that just wasn't there before."
Obesity surgery in teens studied
THE ISSUE: A growing number of teenagers are fighting severe obesity and seeking ways to loss weight, including surgery.
THE QUESTION: Researchers want to know if there are benefits to having weight-loss surgery earlier in life.
THE METHOD: A federally funded study will compare health data from teens having the surgery with data from adults having the surgery.
Wednesday, April 25, 2007
Gentlemen, rate yourselves: cucumber or banana?
Gentlemen please, rate yourselves: are you a cucumber or a banana in bed?
Singapore's Society for Men's Health and a pharmaceutical firm are proposing a four-point scale for erectile dysfunction, allowing men to rate their own hardness with four categories: cucumber, unpeeled banana, peeled banana and tofu (bean curd).
"Men should aim for this," UK sex therapist Victoria Lehmann told a news conference, holding a cucumber.
The scale does not involve any scientific measurement -- patients would merely be asked to assess their own levels of hardness -- and has not been accepted by any medical authorities.
Fish oil may preserve thinking ability in elderly
High blood levels of omega-3 highly unsaturated fatty acids, found in fish oil, may help preserve thinking ability in the elderly, according to the findings of two studies published in the American Journal of Clinical Nutrition.
The results were particularly striking among subjects with high blood pressure or high cholesterol levels.
Accumulating evidence suggests that diets that include omega-3 fatty acids, specifically, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), protect against the development of dementia and Alzheimer's disease, according to a Dutch research team. However, the effect of EPA+DHA consumption on thinking ability, or "cognitive function," has received less scrutiny.
So Dr. Boukje Maria van Gelder, from the National Institute for Public Health and the Environment in Bilthoven, and associates evaluated data for 210 healthy men in the "Zutphen Study," who were 79 to 89 years old in 1990 and had normal mental capacity. Their diets were assessed in 1990, and cognitive function was tested in 1990 and again in 1995.
Subjects who ate fish had a slower decline in cognitive function than subjects who did not eat fish.
The investigators conclude that "fish consumption and EPA+DHA intake are not significantly related to cognitive impairment but are significantly related to cognitive decline."
Van Gelder's team recommends the daily consumption of roughly 400 mg of EPA and DHA, found in fish, meat, eggs, leeks, and cereal products.
In the second study, which involved 2,251 older individuals, Dr. May A. Beydoun, at the University of North Carolina at Chapel Hill, and colleagues showed that high blood levels of EPA and DHA are associated with less decline in verbal ability.
In an accompanying editorial, Dr. William E. Connor and Dr. Sonja L. Connor suggest that EPA has anti-clotting and anti-inflammatory properties that work together to help preserve cognitive function.
SOURCE: American Journal of Clinical Nutrition, April 2007.
Genes May Predict Elderly Blindness Risk
Two genes could determine an older person's vulnerability to an advanced form of age-related macular degeneration (AMD), researchers report.
People who smoked or were overweight faced an even greater risk for the potentially blinding eye condition, the study found.
"The two genetic variants are related and predict to a certain extent which individuals who have earlier-intermediate forms of macular degeneration progress to the advanced form and visual loss," explained the study's lead author, Dr. Johanna M. Seddon, director of the Ophthalmic, Epidemiology and Genetics Service in the department of ophthalmology at Tufts-New England Medical Center and New England Eye Center.
"Genetic variants are part of the way we can differentiate who gets worse, coupled with environmental factors like a high body mass index and smoking," said Seddon, whose team published its results in the April 25 issue of the
Journal of the American Medical Association.
The findings have implications for the prevention of AMD, one expert said.
"They've actually identified specific genes and specific abnormalities in specific genes that prove that macular degeneration has a strong genetic component," said Dr. Robert Cykiert, clinical associate professor of ophthalmology at New York University School of Medicine in New York City. "What this says is if you have someone in your immediate family such as parents or siblings with AMD, then you need to see an ophthalmologist and be carefully followed, because there are things that can be done to prevent progression."
Down the line, there may even be a blood test to detect these genes, further brightening the picture for prevention and early treatment, Cykiert said.
But it's too early to recommend widespread screening, the authors stated.
"Some individuals who progress do not have these genetic variants or have never smoked," Seddon said. "We need to refine this predictive measure, add more genetic variants and maybe even more environmental factors."
Age-related macular degeneration (AMD) involves damage to the inner lining of the eye and can lead to visual impairment and even legal blindness.
"There are several million people who have the earlier-intermediate stages of AMD once they reach the age of 75 or older, but [only] 6 to 8 percent of individuals have advanced disease, so the question is, how do we predict or identify those people who are at higher risk?" Seddon said.
AMD has previously been associated with variations in two genes: CFH and LOC387715. But previous studies exploring this relationship had been cross-sectional in nature, not prospective as the current one is.
For this study, Seddon and her colleagues looked at almost 1,500 white adults aged 55 to 80 with the earlier intermediate signs of macular degeneration. During an average of more than six years of follow-up, 281 individuals progressed to advanced AMD in one or both eyes.
Genotypic analysis revealed that two specific genetic polymorphisms -- CFH Y402H and LOC387715 A69S -- were linked with progression to more advanced AMD.
The risk of progression was 2.6 times higher for those with the CFH variant and 4.1 times higher for those with the LOC387715 variant, after controlling for other factors.
For people who had one of the genotypes, smoking and being overweight increased the risk 19-fold, making a strong argument for lifestyle changes in people who are identified as having the genetic risk factors.
States lag in hospice oversight
A significant number of Medicare hospice programs were not checked by state inspectors for nine years and were long overdue for certification, according to a federal report released Tuesday.
Three states — California, Illinois and Michigan — were furthest behind, accounting for 41 percent of the past-due certifications, according to the report by the inspector general's office of the U.S. Department of Health and Human Services.
Of the hospices surveyed, 46 percent were cited for at least one health deficiency, such as missing or inadequate patient-care plans.
Visits by state surveyors are the main way the federal government tracks the quality of care in hospices that get Medicare funding.
Medicare payments to hospices overdue for inspection averaged $2.7 million each in 2004, the report said.
Hospices give care, including pain management, to people with terminal illnesses. Most care takes place in a dying patient's home, with hospice staff members making regular home visits and being on call to families.
"We've been calling for more frequent surveys for some time," said Judi Lund Person of the National Hospice and Palliative Care Organization, which has 3,100 member hospices.
State surveys give "a chance to make sure providers and staff know what regulators are looking for," Person said. Currently, a hospice staff can turn over completely without a certification survey, she said.
The federal government, which contracts with states to do the hospice surveys, sets the priorities, said Bill Bell, who heads the Illinois Department of Public Health division responsible for the surveys. Hospital surveys and complaints have top priority in that system, Bell said. Even complaints from citizens about hospices go through the federal government, Bell said.
"If the federal government feels the complaint significant enough to investigate, they'll say, 'Go do this investigation,'" Bell said.
During a survey, a state can cite a hospice for problems with patient care. If problems are severe, a hospice can be eliminated from the Medicare program, but that is the only enforcement tool available to the federal government.
In contrast, the government can fine or deny Medicare payments to a nursing home with problems. The report recommends changes in the law to allow other enforcement tools for hospices. The report also recommends more frequent surveys.
The report was based on data from 2,537 active hospice providers in 2005.
"Hospice facilities should be surveyed timely so that problems can be detected and addressed," said Daniel Levinson, inspector general of the Health and Human Services Department, in a prepared statement.
The Centers for Medicare and Medicaid Services sets the frequency of hospice certification as part of its budget process. In fiscal year 2005, the centers required hospice certification surveys every six years, a standard in effect since 2000.
In 2006, the agency changed the frequency requirement to every eight years.
As of July 2005, according to the report, 14 percent of Medicare hospices were past due for certification, the report said. On average, they had not been surveyed for nine years, which was three years longer than the centers' standard at the time.
Study urges new system for elderly care
The aging baby boom generation is likely to increase the nation's disabled population, and a study says the United States needs a better system to provide care for them. More than 40 million Americans currently have some sort of disability, the Institute of Medicine reported Tuesday.
And a decline in physical activity and increase in obesity and diabetes in younger generations raises concerns that, as the nation ages, an increasing share of the population will experience disability, the Institute said.
"The number of Americans who have disabilities will grow significantly in the next 30 years as the baby boom generation enters late life," said Alan M. Jette, director of the Health and Disability Research Institute at the Boston University School of Public Health.
"If one considers people who now are disabled, those likely to develop a future disability and people who are or will be affected by the disabilities of family members or others close to them, it becomes clear that disability will eventually affect the lives of most Americans," said Jette, chairman of the committee that prepared the report.
He added: "The sobering reality, however, is that over the past two decades, far too little progress has been made in adopting major public policy and practice advances to reduce disability in America."
The Institute of Medicine is a branch of the National Academy of Sciences, which is an independent organization chartered by Congress to advise the government on scientific matters.
In a previous report in 1997, IOM said the federal research into disability was inadequate and called for more.
Nonetheless, the new report says, federal spending on this research remains "minuscule in relation to current and future needs."
The study concluded that action "taken sooner rather than later — is essential for the nation to avoid a future of harm and inequity and, instead, to improve the lives of people with disabilities."
Among the recommendations, the report called on the Congress and federal agencies to:
_Increase funding for research into clinical health services, social, behavioral and other disability problems.
_Strengthen provisions of the Americans with Disabilities Act to ensure that health care facilities are accessible to the disabled.
_Eliminate the two-year waiting period for Medicare eligibility for those who are receiving Social Security Disability Insurance.
_Modify the "in-home-use" requirement for Medicare coverage of durable medical equipment. That requirement now prevents payment for equipment that can be used both in and outside the home, the report said.
_Increase educational programs for health professionals caring for the disabled.
_Develop a system for monitoring the number and types of disabled people through the National Center for Health Statistics, Census Bureau and Bureau of Labor Statistics.
TV Food Ads Lead to Weight Gain in Kids
Television food ads prompted a 134 percent increase in the amount of food eaten by obese children, says a study by British researchers.
The study of 60 children, ages 9 to 11, also found that overweight children ate 101 percent more, and normal weight children ate 84 percent more, after they were shown a series of TV food and toy ads, followed by a cartoon.
A child's weight seemed to influence what they ate. The children in the study were provided with different kinds of foods, and the obese children consistently chose the highest fat item -- chocolate. Overweight children preferred jelly sweets, as well as chocolate.
"Our research confirms food TV advertising has a profound effect on all children's eating habits -- doubling their consumption rate. The study was also particularly interesting in suggesting a strong connection between weight and susceptibility to over-eating when exposed to food adverts on television," Dr. Jason Halford, director of the Kissileff Human Ingestive Behaviour Laboratory at the University of Liverpool, said in a prepared statement.
The study was presented this week at the European Congress on Obesity in Budapest.
The researchers plan further studies to investigate whether increased responsiveness to TV food ads or large amounts of TV viewing can predict childhood obesity.
Pneumococcal Strains Not Covered by Vaccine on the Rise
While the pneumococcal vaccine for children is highly effective, strains of the bacteria not covered by the vaccine are emerging as potential threats in certain populations.
A new U.S. government investigation has found that in Alaskan Native children who are already protected against seven strains of pneumococcal disease due to vaccination, the rate of serious infection by other strains is increasing by as much as 140 percent.
"The vaccine has been very effective and has done exactly what we hoped it would do. It's decreased the incidence of invasive pneumococcal disease (covered by the vaccine strains) by 95 percent in Alaskan Native children," said the study's lead author, Dr. Rosalyn Singelton, a visiting researcher for the U.S. Centers for Disease Control and Prevention in Anchorage, Alaska. "But, we've recently seen a significant increase in emerging non-vaccine serotypes."
The bacterium Streptococcus pneumoniae causes a variety of pneumococcal diseases, according to the CDC. Some are relatively mild, such as ear infections, while others are potentially life-threatening, such as pneumonia, meningitis and blood infections.
In 2000, the PCV7 pneumococcal conjugate vaccine first became available for infants and children. The vaccine includes the seven strains or serotypes of the bacteria that commonly cause pneumococcal disease in the United States.
Alaskan Natives have traditionally had higher rates of pneumococcal disease, according to the study. Before the introduction of the PCV7 vaccine, Alaskan Native children had three times the rate of invasive pneumococcal disease compared to the overall U.S. population. Possible reasons for this, according to Singleton, were overcrowding in small households, spending large amounts of time indoors and a lack of running water in many communities.
The new study, published in the April 25 issue of the Journal of the American Medical Association, included surveillance data from the beginning of 1995 through 2006.
The researchers found that within three years of the introduction of the vaccine, the overall rates of invasive pneumococcal disease in Alaskan Native children under age 2 was down by 67 percent.
However, when the researchers compared the two-year periods of 2001-2003 to 2004-2006, they saw an 82 percent increase in the rate of overall invasive pneumococcal disease in Alaskan Native children under 2. For strains not covered by the vaccine, the rate jumped by 140 percent compared to the pre-vaccine period.
One strain in particular, serotype 19A, was responsible for almost one-third of the non-vaccine covered disease, according to the study.
"This is a warning sign that this may occur in other populations," said Singleton, who pointed out that researchers have already been anticipating this shift and are working on second-generation pneumococcal vaccines.
Dr. Katherine Poehling, a pediatrician at Brenner Children's Hospital at Wake Forest University School of Medicine in Winston-Salem, N.C., said, "The serotype replacement is occurring to a greater extent in this (Alaskan Native) population, but it will happen in others."
Poehling, who wrote an accompanying editorial in the same issue of the journal, said, "This study is helping us to make sure that we maintain the magnificent gains we've seen over the last seven years."
Along with receiving the pneumococcal vaccine, Singleton said that other potential ways to reduce the incidence of disease are good hand-washing, breast-feeding your baby if you can, and delaying putting children into day care if possible.
Fear affects emergency care for child with asthma
Parents' psychological responses to asthma attacks are among the strongest motivators of seeking accident and emergency (A&E) services for their child, according to a study conducted in London.
In contrast, characteristics of the home environment, such as dampness, overcrowding, or living with a smoker, have little effect on use of emergency departments.
Children with asthma often use A&E services, Dr. Lindsay Forbes, from Springfield University Hospital, and associates note in their paper, published in the journal Thorax. To find out what triggers a visit to A&E, they studied children with asthma residing in south-east inner London, which has a high poverty rate.
The team identified 209 children ages 3 to 14 years old who were treated at an A&E for asthma over a 1-year period. Another 712 randomly chosen subjects who also had asthma but had not attended an A&E during the year prior to their enrollment. The data came from patients' records and questionnaires they were asked to completed.
The authors found that patients who had attended an outpatient clinic with a family doctor during the previous year were 13 times more likely to visit A&E.
Parents who reported feeling alone or experiencing panic or fear when their child's asthma got worse, or who believed they would get quicker service in an A&E, were 2- to 3-fold more likely to bring their child to the emergency department.
To reduce A&E use for asthma in children, Forbes and associates recommend that "health service planners should take a broader approach, considering what is the most appropriate setting for treating asthma attacks for children of different levels of attack severity, ensuring that services are accessible and address parents' concerns, and that the different parts of the health service communicate appropriate care pathways effectively and consistently to parents."
In wake of vaccine, new pneumonia strains emerge
While a new vaccine has all but eradicated common causes of pneumonia, meningitis and ear infections in children, new strains of bacteria not covered by the vaccine have emerged, U.S. researchers said on Tuesday.
Since the introduction of Wyeth's wildly successful vaccine Prevnar in 2000, doctors have been waiting and watching for the arrival of replacement bacteria that could undo its progress.
Now they may have found it.
Researchers from the U.S. Centers for Disease Control and Prevention have noted an increase in the rates of bacterial infections not covered by the current pneumococcal vaccine among native children in Alaska.
"People are on top of it. It is not unexpected, but it is important," Dr. Katherine Poehling of Brenner Children's Hospital at Wake Forest University in Winston-Salem, North Carolina, said in a telephone interview.
The vaccine, also called heptavalent pneumococcal conjugate vaccine or PCV7, is marketed as Prevnar in the United States and Canada and as Prevenar elsewhere in the world.
Given initially at 2, 4 and 6 months of age, it protects children from bacteria that often cause ear infections and drug-resistant pneumonia.
"Because of the surveillance, we are seeing it and we can act in a timely manner and maintain the benefits that we've seen," said Poehling, who wrote a commentary on the study, published in the
Journal of the American Medical Association.
The CDC's Dr. Rosalyn Singleton and colleagues studied pneumococcal infections such as pneumonia, meningitis or blood infections known as bacteremia that occurred from 1995 through 2006.
They found that in the three years after introduction of Prevnar, from 2001 through 2003, these diseases fell by 67 percent among native Alaskan children younger than age 2 and 61 percent in non-native children in the same age group.
Between 2001-2003 and 2004-2006, these infection rates remained stable in non-native Alaskan children younger than 2, but jumped 82 percent among Alaska Native children, who are more prone to the infections.
Since 2004, diseases caused by strains of bacteria not covered by the vaccine have risen by 140 percent compared with the pre-vaccine period.
During the same period, diseases caused by the vaccine-covered strains fell by 96 percent.
"The big news is the vaccine is highly successful. It has prevented a tremendous amount of disease, and it is still preventing a lot of disease in these children," Poehling said.
She said a new vaccine by Wyeth is in late-stage clinical trials that could help protect against these new strains.
The current vaccine, one of Wyeth's biggest-selling products with annual sales of more than $2 billion, targets seven strains of pneumococcal bacterial.
The new vaccine would target 13 strains of the bacterial. Wyeth has said it plans to seek regulatory approvals for the new vaccine in early 2009. GlaxoSmithKline is working on a rival to Prevnar.
Breast-feeding won't deter obesity
While breast-feeding has many benefits, it won't prevent a child from becoming fat as an adult, says a new study that challenges dogma from U.S. health officials.
The research is the largest study to date on breast-feeding and its effect on adult obesity.
"I'm the first to say breast-feeding is good. But I don't think it's the solution to reducing childhood or adult obesity," said the study's lead author, Karin Michels of Harvard Medical School.
The U.S. Centers for Disease Control and Prevention promotes breast-feeding as a way to reduce children's excess weight, and the guidelines for federal chronic disease prevention grants to states call for breast-feeding promotion. Some health officials say 15 to 20 percent of obesity could be prevented through breast-feeding.
A
CDC official said he couldn't comment on the new research because he hadn't fully reviewed it. But many previous studies have linked breast-feeding and lower rates of childhood obesity, he noted.
Perhaps the obesity-preventing benefits of breast-feeding are strong for children but wane by adulthood, said the official, Larry Grummer-Strawn.
"It would be remarkable to find a behavior that you engage in for one year of life and see detectable effects from it 40 years later," said Grummer-Strawn, chief of the CDC's maternal and child nutrition branch.
Good or bad eating and exercise habits, developed later in life, may sustain or erase initial weight-related benefits from breast-feeding, he and other experts said. Of course, that doesn't take away the other benefits of breast-feeding, such as building a child's immunity to disease.
The Harvard study, published online this week in the International Journal of Obesity, involved nearly 14,500 women who were breast-fed as infants and more than 21,000 who were not.
In 1989, the women were asked their height and weight and what those measurements were when they were children and at age 18. Then every two years, through 2001, they were asked to update their weight information. The surveyed women were all between 25 and 42 at the time of the 1989 questionnaires, Michels said.
In 2001, the mothers of these women were sent a questionnaire asking if their daughters had been breast-fed and for how long.
When possible, researchers checked medical records to confirm what the mothers and daughters recalled, but breast-feeding is not routinely documented. Still, the researchers believe the women's recollections of breast-feeding are reliable.
"A mother knows whether she breast-fed her child," said Michels, an associate professor of epidemiology.
Women who were breast-fed for at least a week had a risk of being overweight or obese that was nearly identical to that of women who were bottle-fed, the study found. And duration of breast-feeding didn't seem to make a difference. The women who had been breast-fed for more than nine months had a risk of becoming overweight or obese similar to that of women breast-fed less than one week.
The study involved only women, but the researchers believe the results are equally true for men, Michels said.
Michels believes that one reason previous studies might have been misleading about breast-feeding's effects on weight gain is that many of those studies failed to properly account for socioeconomic factors that also may have had an influence.
An Emory University pediatrics expert said he is not surprised by the study's findings about adults. But he said breast-feeding is beneficial for children, and the government's health message should not change.
"The first step is preventing childhood obesity. We know obese children have to work harder to not become obese adults," said Dr. Robert Geller, an associate professor who also is chief of pediatrics for Atlanta's Grady Health System.
Fat workers cost employers more
Overweight workers cost their bosses more in injury claims than their lean colleagues, suggests a study that found the heaviest employees had twice the rate of workers' compensation claims as their fit co-workers.
Obesity experts said they hope the study will convince employers to invest in programs to help fight obesity. One employment attorney warned companies that treating fat workers differently could lead to discrimination complaints.
Duke University researchers also found that the fattest workers had 13 times more lost workdays due to work-related injuries, and their medical claims for those injuries were seven times higher than their fit co-workers.
Overweight workers were more likely to have claims involving injuries to the back, wrist, arm, neck, shoulder, hip, knee and foot than other employees.
The findings were based on eight years of data from 11,728 people employed by Duke and its health system. Researchers found that workers with higher body mass indexes, or BMIs, had higher rates of workers' compensation claims.
The most obese workers — those with BMIs of 40 or higher — had the highest rates of claims and lost workdays. BMI is a measure of height and weight. A 6-foot, 300-pound person, for example, has a BMI of just over 40.
Study co-author Dr. Truls Ostbye said the findings should encourage employers to sponsor fitness programs.
"There are many promising programs," Ostbye said. "We'd like to see more research about what is truly effective."
James Hill, who heads the Center for Human Nutrition at the University of Colorado, said managers will pay attention to the findings because injuries mean more immediate financial losses than the future health-care costs of diabetes and heart disease.
"When you see that claims rates double, I think that's going to get people's attention," Hill said.
But there isn't enough good information about employer-sponsored programs that work, said John Cawley, an expert in the economics of obesity at Cornell University. Employers don't know whether paying for nutrition counseling, obesity surgery or anti-obesity drugs through health insurance makes economic sense, he said.
"It's now apparent to everybody that obesity is a big problem," Cawley said. "But the research isn't there to know where to get biggest bang for the buck."
Cawley noted that BMI does not distinguish muscle from fat and can equate a buff body builder to a couch potato. Although BMI, a measure of height and weight, is used in most obesity research, Cawley's research has found that blacks are particularly likely to be misclassified as obese by BMI.
New York employment attorney Richard Corenthal cautioned employers not to overreact with discriminatory policies.
"Employers need to be careful not to view this study as a green light to treat obese or overweight workers differently," Corenthal said.
The study, appearing in Monday's Archives of Internal Medicine, got funding from the National Institute for Occupational Safety and Health.
Breast-feeding no help in preventing adult obesity
Being breast-fed as a baby provides no protection against adult obesity, according to a U.S. study published on Tuesday.
Health agencies including the U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics encourage women to breast-feed their babies for at least six months, mostly because many studies show it leads to healthier babies.
It also reduces the risk of childhood obesity.
But the effects do not appear to extend into adulthood, according to a study in the International Journal of Obesity.
Karin Michels and colleagues at Harvard's Brigham and Women's Hospital studied 35,000 nurses working in the United States over a 12-year period.
Their mothers were asked to report on their breast-feeding habits.
When adjusted for socioeconomic factors, the researchers found breast-feeding had no significant effect on the body mass index or BMI of the nurses in adulthood. BMI is calculated as weight in kilograms divided by height in meters squared.
Breast-feeding for more than 6 months does appear to have a benefit in children. The study found these kids a had a leaner body shape at age 5, but this benefit did not extend into adolescence or adulthood.
The authors said that while breast-feeding promotes the health of mother and child, it is not likely to play an important role in controlling the obesity epidemic.
Tuesday, April 24, 2007
Health Tip: When Your Child Outgrows a Car Seat
If your child has already moved from a car seat to a booster seat and is outgrowing that as well, it's time to make sure she can safely ride in a car strapped in with a safety belt.
For the child to be safely restrained, it's important that the seat belt fits properly and can protect her in the event of an accident.
Here are some guidelines for the proper fitting of a child's safety belt from the American Academy of Pediatrics:
Melanoma in kids differs from the adult cancer
The demographics, site of appearance, and outcome of children and teenagers with melanoma differ from the features seen in young adults, according to study findings published in the Journal of Clinical Oncology.
The results suggest melanoma may be biologically different in children and adolescents.
"Melanoma is uncommon in teenagers and rare in younger children," Dr. Julie R. Lange, of Johns Hopkins Medicine, Baltimore, Maryland, and colleagues write. However, differences in this cancer between children and adults are not well understood.
Using the National Cancer Data Base, the researchers compared melanoma cases of children and teenagers who were between 1 and 19 years old with those for patients between 20 and 24 years.
Among the 3,158 children and teenagers, 96.3 percent had melanoma of the skin, the most common site; 3.0 percent had melanoma of the eye; and 0.7 percent had an unknown primary site. Skin melanoma was more common in girls (55 percent) than in boys, and in subjects older than 10 years (90.5 percent).
The authors detected a relationship between the demographics, the site of skin melanomas and age. Younger patients were significantly more likely to be male and nonwhite, to have primary tumors of the head and neck, and to have regional or distant cancer spread.
The patients were followed-up for an average of 59 months. An association was observed between poorer survival and more extensive disease progression and younger age. "Females had significantly better overall survival than males, except in patients aged 1 to 9 years," the investigators found.
Patients between 20 and 24 years with thinner melanomas had significantly better survival rates (96.8 percent) than patients with thicker tumors (82.4 percent)," Lange's team reports. However, within the younger group, survival rates were not significantly different between the thinner and thicker tumors.
The lack of prognostic value of tumor thickness in the young group suggests biologic differences, even more than does the demographic differences compared to the older patients, Dr. Lange and colleagues point out. "More research in the molecular genetics of pediatric melanoma is needed," they conclude.
SOURCE: Journal of Clinical Oncology, April 2007.
Potential rabies treatment fails two children
An experimental rabies treatment that saved the life of a teenager in 2004 has failed to help two other children infected with the deadly virus, U.S. experts said on Friday.
A 10-year-old Indiana girl and an 11-year-old boy in California both died despite getting the treatment that involves putting patients into a drug-induced coma and giving them antiviral drugs.
This means it is critical for parents and doctors to recognize quickly if a child may have been exposed to rabies and get treatment as quickly as possible, the team at the U.S. Centers for Disease Control and Prevention said.
Quick vaccination after exposure -- usually via a bite or some other contact with the saliva of an infected animal -- can save lives. But if a person begins showing symptoms, which are vague enough to be confusing, it is usually too late.
Rabies kills 55,000 people a year globally and affected 24 people in the United States in the years 2000 to 2006.
In 2004 a 15-year-old Wisconsin girl was successfully treated for rabies infection a month after she was bitten by a bat. It took doctors six days to figure out why she was ill but they quickly used drugs to put her into a coma, used a ventilator to keep her breathing and gave her the antiviral drug ribavirin.
She survived -- the first time anyone with documented rabies illness has lived without a rabies vaccination.
But the so-called Wisconsin protocol failed on the two U.S. children who became ill in September and November of last year, the CDC team said.
"To consider use of the Wisconsin rabies treatment protocol, the disease must be diagnosed as early in the course as possible, which requires enhanced clinical awareness of the disease among health-care providers," the CDC said in its report.
The 10-year-old Indiana girl's symptoms started with pain in her arm. It was days before her mother remembered that the girl had reported having been bitten by a bat that flew into her window the previous June.
The child died after 26 days in the hospital.
In the second fatal case, the 11-year-old boy had apparently been bitten by a rabid dog in the Philippines, perhaps two years before.
"Typical rabies incubation periods vary from 1 to 3 months after exposure," the CDC said. But longer time lags have been documented.
Obesity rising in Europe, especially in children
The number of overweight people in Europe is rising and there is an especially worrying trend of increasing childhood obesity and in the number of people who are grossly obese, according to recent studies.
Europe is facing major health and social burdens and the rise in obesity is reaching "epidemic" proportions, the 15th European Congress on Obesity in Budapest was told on Sunday.
Estimates show there are around 1.1 billion overweight people in the world, of whom 312 million are obese, and that in Europe 10-20 percent of men are obese and almost half the population is overweight.
Some 30 percent of children in Britain are obese or overweight, and percentages are rising in southern Europe, while in new
European Union states in eastern Europe, rates of obesity are surging at a time when health spending is being curtailed.
"More than 80 percent of children who are already obese will stay obese as adults," said Martin Fried of Prague's Charles University, who authored a major study on the effect of surgery on obese patients.
Fried estimates that there are around 11 million Europeans who are grossly obese, with a body mass index of 40 or more.
Body mass index (BMI) is a measure of body fat based on height and weight in which normal weight is in a BMI range of 18.5-24.9.
Obese people are far more likely to suffer early deaths, have health problems like type-2 diabetes, and have a lower quality of life, as well as being unable to participate in work, Fried told journalists on the sidelines of the conference.
Fried said surgery was increasingly a workable solution for obese adults and that far from competing for health resources, it was better than for example continuing to treat type-2 diabetes with drugs, as surgery offered a once-and-for-all solution for 80 percent of cases after six months to a year.
In Britain, which has one of the highest levels of childhood obesity in Europe, a study showed that community-based programs had a major impact on overweight and obese children.
Results of a 9-week trial program conducted by University College London (UCL) and Great Ormond Street Hospital for Children involving 107 families showed significant improvements in BMI, waistlines, lifestyle and self-esteem.
These results were sustained over 12 months, the study said.
"Obesity costs the nation 7 billion pounds a year. This popular community-based program has the potential to underpin effective national strategies for obesity treatment and preservation," said Professor Alan Lucas of UCL's child health department.
Childhood obesity: Breast is not necessarily best
Long-term research into obesity suggests that being breastfed as a child does not help prevent obesity later in life, a finding that contradicts guidelines in the United States and elsewhere.
Investigators in the United States looked at the health of 35,000 nurses working in the US between 1989 and 2001.
They asked the nurses' mothers to report on their breastfeeding habits when their child was a newborn, while the nurses themselves were asked to report their height, their current weight and their weight at 18.
The nurses were also asked to recall their body shape at ages five and 10 using a nine-level figure drawing.
Duration of breastfeeding did not affect the body mass index (BMI) -- a key indicator of fat -- in adulthood, according to their paper, which appears in the International Journal of Obesity.
Women who had been breastfed for more than nine months had a risk of becoming overweight or obese that was similar to that of women who had been breastfed for less than a week or exclusively bottle-fed.
"Breastfeeding, as good as it is, is not a solution to the obesity epidemic," Karin Michels, associate professor at Harvard Medical School and lead author of the study, told AFP.
"It's important to realize that there are much more important causes and reasons for the obesity epidemic."
The researchers found that women who had been breastfed for several months were indeed slightly slimmer in early childhood compared with those who had been bottle-fed.
But this difference is of "borderline statistical significance," according to Michels.
The mooted reason: breast-fed infants start off skinnier, but this is probably due to the natural limitations of available food in their first year of life -- and the difference does not extend to later years.
Breastfeeding does provide plenty of other benefits to mother and child, Michels pointed out.
Its vital nutrients help the child to build up its immune system and, as has been recently discovered, lessens a mother's risk for diabetes and heart disease, Michels said.
The paper contradicts the recommendations of the US Centers for Disease Control (
CDC) and the European Union's Childhood Obesity Programme, which promote breastfeeding as a method for controlling childhood obesity, with the eventual aim of curbing adolescent and adult obesity.
In another study released on Tuesday, the British journal Archives of Disease in Childhood concluded that primary schoolchildren should not be routinely screened for obesity and weight problems if there are no means to treat them.
The British government has introduced population weight monitoring in primary schools.
But the authors, led by Marie Westwood of the University of York, northern England, found no evidence to say the screening strategy worked and suggested it may even be potentially harmful if counselling and other help were not available.
Obesity is gaining pandemic proportions in many developed countries but also in emerging economies. Experts point the finger at sedentary lifestyle, persistent snacking and food that is rich in calories. Genetic factors, too, may be significant.
Monday, April 23, 2007
Elderly Need to Watch Vitamin D Levels
A lack of vitamin D may encourage disability in older adults, a new study finds.
Vitamin D, which can be obtained from food and is produced naturally by the body through exposure to the sun, plays an important role in bone health and muscle function and may help protect against diabetes, cancer, colds and tuberculosis.
About 25 percent of people over age 60 have low levels of vitamin D, say researchers reporting in the April issue of the Journal of Gerontology: Medical Sciences.
Older adults are prone to low vitamin D levels, because they tend to get less exposure to sunlight, and their skin is less efficient in producing vitamin D from sun exposure, said the study's lead author, Denise Houston, an instructor in internal medicine-gerontology at Wake Forest University School of Medicine. Older adults also may not get enough vitamin D from dietary sources such as fortified milk, juice and cereals.
She and her colleagues analyzed data from a study of 976 Italians age 65 and older and found that those with low levels of vitamin D scored five percent to 10 percent lower in tests of physical performance and grip strength.
While the researchers didn't look at whether low vitamin D levels actually cause poor physical performance, they said the findings suggest the need for additional research in this area.
Current recommendations say that people ages 50 to 69 should get 400 international units (IUs) of vitamin D per day, and people over age 70 should get 600 IUs per day. However, many experts believe that may not be enough.
"Higher amounts of vitamin D may be needed for the preservation of muscle strength and physical function as well as other conditions such as cancer prevention. The current recommendations are based primarily on vitamin D's effects on bone health," Houston said.
Study sees major depression connection to diabetes
Elderly people who are depressed are more likely to become diabetic than those who are not, according to a study that suggests depression may play a role in causing the most common form of diabetes.
Writing on Monday in the Archives of Internal Medicine, the researchers said people with a high number of symptoms of depression were about 60 percent more likely to develop type 2 diabetes, formerly called adult-onset diabetes, than people not considered depressed.
Unlike some other studies examining a link between depression and diabetes, this one looked at the effects not only of single bouts of depression but also of chronic depression and depression that worsened over time. It found an increased risk for diabetes in each of those scenarios.
Researchers tracked 4,681 men and women in North Carolina, California, Maryland and Pennsylvania ages 65 and older, with an average age of 73, who did not have diabetes when the study began in 1989.
For 10 years, they were screened annually for 10 symptoms of depression, including those related to mood, irritability, calorie intake, concentration and sleep.
"People who report higher depressive symptoms may not take as good a care of themselves as they should," lead researcher Mercedes Carnethon of the Northwestern University's Feinberg School of Medicine said in an interview.
"For example, they may be less physically active, and thus more likely to gain weight, which is the primary risk factor for diabetes," Carnethon said.
But the study statistically accounted for known lifestyle risk factors for diabetes like being overweight and sedentary, and still found that depression increased the risk of diabetes.
Carnethon said the findings suggest depression may play a role in causing diabetes. While the study did not explore possible biological mechanisms, Carnethon said a high level of the stress hormone cortisol in depressed people may be the reason.
Diabetes is marked by high levels of blood glucose resulting from defects in the production or action of insulin, which allows glucose to enter the body's cells for use as fuel. High cortisol levels, the researchers said, may cut insulin sensitivity and raise fat deposits around the waist.
"Diabetes not only causes heart disease, but is strongly related to strokes, blindness, kidney failure, amputations. Diabetes is a very serious condition that's highly prevalent in older adults," Carnethon said.
Diabetes is a growing worldwide problem, closely tied to obesity. Type 2 diabetes accounts for about 95 percent of all cases.
The findings point to the importance of doctors screening older adults for depression and, if it's present, for diabetes risk, Carnethon said.
Medicare fund exhausted in 2019
The U.S. Medicare Hospital Insurance trust fund will exhaust its assets in 2019 instead of the 2018 date forecast last year due to bigger payroll tax collections, a report from the fund's trustees said on Monday.
The Social Security trust fund also extended its exhaustion date by a year to 2041. Despite the slight improvement reported by the trustees, the Bush administration said the two popular programs for the elderly needed urgent reform.
"Without change, rising costs will drive government spending to unprecedented levels, consume nearly all projected federal revenues and threaten America's future prosperity," Treasury Secretary Henry Paulson said in a statement.
The Medicare report raised a "funding warning" that is meant to trigger congressional debate over trimming costs of the health care program, which faces huge strains from rapidly rising costs and the aging baby boom generation.
Also, the trustees projected Social Security outlays to outstrip tax income in 2017, the same date as forecast last year.
President George W. Bush said the new Medicare prescription drug program, which relies mostly on private insurers to deliver the benefits to seniors, should serve as an example during the Medicare reform debate, adding, "competition works, competition can lower price, and improve the quality" for beneficiaries.
Bush said the cost of delivering the Medicare Part D drug benefit turned out to be substantially less than originally estimated, but the report warned that financing for the drug program and other parts of Medicare will have to increase rapidly to match expected cost increases.
Paulson said time was of the essence for lawmakers to address the projected funding shortfall for the two programs. "The longer we delay, the larger the required adjustments will be -- and the burden of making those adjustments will fall more heavily on future generations," he said.
Vitamin D affects physical function in elderly
Older men and women who fail to get enough vitamin D -- either from their diets or exposure to the sun -- are at heightened risk for muscle weakness and poor physical performance, a study shows. This is troubling, researchers say, given the high numbers of older folks who are deficient in vitamin D.
In a sample of 976 adults who were 65 or older at the outset, nearly 29 percent of women and 14 percent of men had vitamin D deficiency, determined by measuring blood levels of 25-hydroxy-vitamin D, a frequently used and accurate measure of a person's vitamin D status.
Moreover, 75 percent of women and 51 percent of men had insufficient vitamin D levels.
The researchers tested the participants' physical performance by timing their walking speed, as well as their ability to get up from a sitting position and keep their balance while standing in increasingly more challenging positions. They also measured handgrip strength, a predictor of future disability.
Dr. Denise K. Houston of the Wake Forest University of Medicine in Winston-Salem, North Carolina, and colleagues found that physical performance and grip strength were 5 to 10 percent lower in people with low blood levels of vitamin D levels, compared with those with normal levels.
The finding held up after they took into account factors that could potentially influence the results such as a person's weight, level of physical activity, the season of the year, mental abilities, overall health condition and anemia (a deficiency of oxygen-carrying red blood cells that frequently causes fatigue).
Vitamin D plays an important role not only in bone health -- research suggests it may also help protect against diabetes, cancer, colds, and tuberculosis.
People get vitamin D from the sun's ultraviolet rays and from certain foods such as fortified milk, juice and cereals. However, it is hard to get sufficient amounts of the vitamin through diet alone. Older adults are prone to low vitamin D levels because of reduced exposure to the sun and because their skin is less able to produce vitamin D from sun exposure compared with younger adults.
It's estimated that 1 in 4 people over age 60 have low vitamin D levels.
Current guidelines recommend that people between the ages of 50 and 69 get 400 international units (IUs) of vitamin D per day and for those over age 70 to get 600 IUs.
Houston contends that "higher amounts of vitamin D may be needed for the preservation of muscle strength and physical function as well as other conditions such as cancer prevention."
"The current recommendations," she added, "are based primarily on vitamin D's effects on bone health."
Low blood pressure in elderly linked to
Aggressive treatment of high blood pressure (hypertension) in patients who are 80 years or older is associated with lower five-year survival rates than their counterparts with blood pressure levels at or higher than treatment target levels, researchers report.
Physicians should therefore "use caution in their approach to blood pressure-lowering in this age group," they advise in the Journal of the American Geriatric Society.
Dr. Daniel J. Oates of the Boston Medical Center and his co-workers evaluated five years of data from 10 Veterans Affairs sites and
Social Security files. The study group involved 4,071 ambulatory patients 80 years or older with hypertension.
The researchers found that patients with normal or higher blood pressures were less likely to die during follow-up than those with lower blood pressures. Specifically, for each 10-point decrease in blood pressure, the researchers estimated that the mortality risk increased by about 17 percent.
This effect was seen up to a systolic blood pressure of 139 mmHg (the top number) and a diastolic blood pressure of 89 mmHg (the bottom number).
However, in patients with uncontrolled hypertension, defined as systolic pressure of 140 mmHg or higher and diastolic pressure of 90 mmHg or higher, there was "no significant association between survival and blood pressure levels."
These findings "suggest that overly aggressive control of blood pressure might be harmful in this age group," the investigators conclude. They cite other studies that also show higher blood pressures are protective in older patients.
Older patients with low blood pressure need to be monitored for fainting, which would put them at risk of falls, the team notes. This group should also be watched for nonspecific symptoms, such as weakness, weight loss and memory loss.
SOURCE: Journal of the American Geriatric Society, March 2007.
Studies line up on Parkinson's and pesticides link
Evidence that pesticides can cause Parkinson's disease is stronger than it has ever been after a meeting of experts who have put together links in animals and people, scientists say.
One study shows that farm workers who used the common weedkiller paraquat had two to three times the normal risk of Parkinson's, a degenerative brain disease that eventually paralyzes patients.
A second study shows that animals exposed to paraquat have a build-up of a protein called alpha-synuclein in their brains. This protein has been linked to Parkinson's in the past.
A third piece of the puzzle shows that this buildup of protein kills the same brain cells affected in Parkinson's.
"All of these pieces really look like they are coming together now," Dr. William Langston, founder of the non-profit Parkinson's Institute, told Reuters.
Langston and colleagues said they were energized by research presented at the Parkinson's Disease Environmental Research meeting in Monterey, California, earlier this month.
Parkinson's disease, which affects more than 1 million patients in the United States, is marked by the death of brain cells that produce dopamine.
Dopamine is a neurotransmitter, or message-carrying chemical, associated with movement. Drugs can delay symptoms for a while but there is no good treatment and no cure.
Farm workers are at especially high risk but links to pesticides have been difficult to document because years usually pass between a person's exposure to pesticides and the development of the disease.
Dr. Beate Ritz of the University of California at Los Angeles and Dr. Caroline Tanner of the Parkinson's Institute looked at 80,000 people in Iowa and North Carolina and found farm workers exposed to paraquat had twice the expected risk of Parkinson's over their lifetimes.
Exposure to another pesticide called dieldrin also raised the risk, the study, funded by the National Institute of Environmental Health Sciences, found.
A second study found similar effects in farm workers in central California.
BETTER DOCUMENTATION
What made the studies especially important was that pesticide exposure could be carefully documented through records of pesticide purchase, Langston said. Details will be published in a scientific journal later.
Dr. Donato Di Monte of the Parkinson's Institute gave paraquat to laboratory animals and found it caused a buildup of alpha-synuclein in the brain that killed the same neurons affected by people with Parkinson's disease.
"This increase in alpha-synuclein in the brain could be the missing link between the exposure to this agent and how this agent causes the disease," Di Monte said in a telephone interview.
"Maybe being exposed to paraquat may not be enough to cause the disease but increases the probability the disease may develop," Di Monte said.
Langston and Di Monte said inflammation also could be a factor.
"Give an animal a compound that creates a marked inflammation response in the body ... and months later the animal loses cells in same area of the brain that is associated with Parkinson's," Langston said.
"This suggests that systemic inflammation may somehow sensitize the brain."
Multiple concussions, which can cause inflammation in the brain, raise the risk of Parkinson's, Langston said.
Two other groups of people that have a higher-than-average risk of Parkinson's are health workers and teachers.
"At first glance that doesn't make sense," Langston said.
But both do have something in common -- frequent exposure to viruses.
It could be, Langston and Di Monte said, that if a person is exposed to a pesticide while his or her brain has inflammation, this greatly raises the risk of Parkinson's many years later.
Obese File Twice as Many Workers' Comp Claims
A new study of almost 12,000 Duke University employees found that obese workers filed twice the number of workers' compensation claims, had seven times higher medical costs from those claims, and had 13 times more lost work days due to work injury/illness than non-obese employees.
The study, by researchers at Duke University Medical Center in Durham, N.C., also found that obese workers in high-risk jobs incurred the highest medical and economic costs of all employees.
The study is published in the April 23 issue of the Archives of Internal Medicine.
"We all know obesity is bad for the individual, but it isn't solely a personal medical problem -- it spills over into the workplace and has concrete economic costs," study author Dr. Truls Ostbye, a professor of community and family medicine, said in a prepared statement.
"Given the strong link between obesity and worker's compensations costs, maintaining healthy weight is not only important to workers but should also be a high priority for employers," Ostbye said. "Work-based programs designed to target healthful eating and physical activity should be developed and then evaluated as part of a strategy to make all workplaces healthier and safer."
People with a body mass index (BMI) of 30 or above are considered obese. This study found that workers with a BMI of 40 had close to 12 workers' compensation claims per 100 workers, compared with about 6 claims per 100 in workers with a normal BMI (18.5 to 24.9).
Obese workers lost an average of almost 184 work days per 100 employees, compared with just over 14 per 100 for those with a normal BMI. Obese workers had average medical claim costs of $51,019 per 100 workers, compared with $7,503 for non-obese employees.
The lower extremities, wrists, hands, and back were the areas of the body most prone to injury among obese workers. Falls, slips and lifting were the causes of most of these injuries.
Fat workers cost employers more
Overweight workers cost their bosses more in injury claims than their lean colleagues, suggests a study that found the heaviest employees had twice the rate of workers' compensation claims as their fit co-workers.
Obesity experts said they hope the study will convince employers to invest in programs to help fight obesity. One employment attorney warned companies that treating fat workers differently could lead to discrimination complaints.
Duke University researchers also found that the fattest workers had 13 times more lost workdays due to work-related injuries, and their medical claims for those injuries were seven times higher than their fit co-workers.
Overweight workers were more likely to have claims involving injuries to the back, wrist, arm, neck, shoulder, hip, knee and foot than other employees.
The findings were based on eight years of data from 11,728 people employed by Duke and its health system. Researchers found that workers with higher body mass indexes, or BMIs, had higher rates of workers' compensation claims.
The most obese workers — those with BMIs of 40 or higher — had the highest rates of claims and lost workdays. BMI is a measure of height and weight. A 6-foot, 300-pound person, for example, has a BMI of just over 40.
Study co-author Dr. Truls Ostbye said the findings should encourage employers to sponsor fitness programs.
"There are many promising programs," Ostbye said. "We'd like to see more research about what is truly effective."
James Hill, who heads the Center for Human Nutrition at the University of Colorado, said managers will pay attention to the findings because injuries mean more immediate financial losses than the future health-care costs of diabetes and heart disease.
"When you see that claims rates double, I think that's going to get people's attention," Hill said.
But there isn't enough good information about employer-sponsored programs that work, said John Cawley, an expert in the economics of obesity at Cornell University. Employers don't know whether paying for nutrition counseling, obesity surgery or anti-obesity drugs through health insurance makes economic sense, he said.
"It's now apparent to everybody that obesity is a big problem," Cawley said. "But the research isn't there to know where to get biggest bang for the buck."
Cawley noted that BMI does not distinguish muscle from fat and can equate a buff body builder to a couch potato. Although BMI, a measure of height and weight, is used in most obesity research, Cawley's research has found that blacks are particularly likely to be misclassified as obese by BMI.
New York employment attorney Richard Corenthal cautioned employers not to overreact with discriminatory policies.
"Employers need to be careful not to view this study as a green light to treat obese or overweight workers differently," Corenthal said.
The study, appearing in Monday's Archives of Internal Medicine, got funding from the National Institute for Occupational Safety and Health.
Obesity down in sugar-free schools
Stockholm schools that banned sweets, buns and soft drinks saw the number of overweight children drop by six percentage points in four years, a Karolinska Institute study published on Monday showed.
The number of overweight or obese six-to-10-year-olds dropped from 22 to 16 percent in the 10 Stockholm schools that participated in the study by banning sweets and introducing healthier lunches, the Swedish research institute said in a statement.
A control group of schools that did not introduce specific food regulations saw the number of overweight or obese children rise from 18 to 21 percent.
The results of the project were to be presented on Monday in Budapest at an international conference on obesity.
"Our results show that programmes to reduce the increasing rate of obesity can be carried out within the schools' existing budgets," the head of the project, Professor Claude Marcus, said in the statement.
"We also interpret the results to mean that clear regulations in schools can help parents to set standards for their children and improve dietary habits at home," it said.
Sunday, April 22, 2007
New virus found in Australia deaths
Australian doctors revealed Sunday that three people who died shortly after receiving organ transplants from the same donor were all infected with a previously unknown virus.
The virus was found in three Melbourne patients who died just weeks after they received organs from a 57-year-old man who suffered a fatal brain haemorrhage one week after returning from Europe.
Australian officials said the infection was similar to lymphocytic choreomeningitis virus (LCMV), which was linked to the deaths of several transplant patients in the United States last year.
"I'm very pleased that out of a sad episode we've been able to draw some conclusions and find something new in a world first," Dr Mike Catton from the Victorian Infectious Disease Laboratory said.
"It's a new virus and it's a new way of finding the virus."
Catton said tests carried out with the assistance of the Greene Infectious Disease Laboratory at Columbia University in New York looked at tissue samples taken from the dead tranplant patients using new gene sequencing techniques.
The new virus was found in all samples taken from the transplant recipients but not in tissue taken from the donor.
"The fact that we haven't yet discovered it in the donor doesn't rule out the fact that this was transmitted from donor to recipient," he said.
"There's much work that needs to be done characterising this virus in both laboratories and that will be continuing as we speak."
Catton said doctors did not know yet how many people could be infected with the virus or whether it has killed anyone in the past.
But Australian officials insisted that the new virus did not pose a threat to the community and was not thought to be an infectious disease.
"Organ transplant recipients are hit with a variety of drugs to suppress their immune system so that they don't reject the organ that's transplanted," Victoria state's acting chief health officer Dr John Carnie said.
"So if you're immuno-depressed, any kind of infection can have devastating consequences, whether it's the common cold or influenza or anything like that."
Australian doctors began investigating in January when three women who received organs from the same donor died within days of each other and no common cause could be established between the deaths.
Two women, aged 63 and 44, each received a kidney while the donor's liver went to a 64-year-old woman.
Carnie said he hoped the discovery did not lead to calls to stop the transplant programme.
"This may be an extremely rare one-off event and we don't want to deprive people of the benefits of a liver or kidney or something else that would be life-saving for some event that may be extremely rare," he said.
Tamiflu key to treat bird flu, avoid steroids
Bird flu patients who get early treatment with the antiviral drug Tamiflu have the best chances of surviving while using steroids can do more harm than good, the World Health Organization (WHO) said on Friday.
The United Nations agency was reporting on the preliminary conclusions of international experts who met last month in Turkey to compare notes on treatments, including the attempt by doctors in some countries to use steroids as well.
"Corticosteroid therapy has failed so far to show effectiveness," the WHO warned in a statement. "Prolonged or high dose corticosteroids can result in serious adverse events."
Frederick Hayden of WHO's global influenza program said some doctors, notably in Vietnam and Indonesia, had administered steroids to try to save quickly deteriorating bird flu patients. Eight of nine had died, he said, citing published research.
"A concern is some treatment is of unsubstantiated value and in some instances may be doing more harm than good," he told Reuters.
The WHO reaffirmed that early treatment with Tamiflu, made by Swiss-based Roche and known generically as oseltamivir, was useful in reducing death from the H5N1 virus. Giving it to people with advanced symptoms was also "warranted."
"Data presented gave strong support that early treatment makes a difference," Hayden said, citing data from Egypt where 20 of 34 bird flu patients have survived to date.
"Unfortunately the problem is many patients are coming in late with shortness of breath and progressive symptoms that would indicate advanced viral pneumonia," he said.
While bird flu is mainly a disease in animals, experts fear it could mutate into a form that can be spread easily among people, triggering a possible pandemic.
Some 291 people have been infected with the disease, including 172 who have died, according to the agency.
Tamiflu, a flu drug, may also be used at a two-fold higher dosage and possibly in so-called "dual antiviral therapy" with an older class of drugs known as amantadine, the WHO said, in line with previous recommendations.
But such decisions should be made on a case-by-case basis, especially in patients with pneumonia or progressive disease.
Combining Tamiflu with amantadine may be especially useful in countries where the virus is susceptible to amantadine.
These countries include China and parts of Europe and Africa where a particular H5N1 subvirus or "clade" has spread, causing human cases since January 2006, according to Hayden. He cited Turkey, Egypt and Azerbaijan.
Antibiotics should only be given if there is good reason to suspect the patient has a bacterial complication to pneumonia -- according to the WHO. Antibiotics should not be given preventively, due to possible resistance and side-effects.
Health Tip: When the Elderly Should Stop Driving
When you begin to notice the inevitable signs that an elderly loved one should no longer drive, Helpguide.org from Rotary International offers these suggestions on how to discuss this sensitive issue:
- Tell the person that you are concerned for his or her safety, as well as the safety of others.
- Mention other transportation options, so the person doesn't feel trapped at home.
- Talk about how much money can be saved in gas and maintenance by no longer driving.
- Offer to take the person to regular appointments, the grocery store, and other errands.
Brain Structure Changes Before Memory Loss
Brain structure changes occur years before a person shows signs of memory loss caused by Alzheimer's disease or other forms of dementia, a new U.S. study suggests.
The study, published in the April 17 issue of the journal Neurology, included 136 healthy people over the age of 65 who underwent brain scans and cognitive tests at the start of the study and were all found to be cognitively normal. They were then assessed once a year for five years.
By the end of the five years, 23 participants had developed mild cognitive impairment (MCI), and nine of those 23 people were later diagnosed with Alzheimer's disease.
The brain scans revealed that the 23 who developed MCI or Alzheimer's had less gray matter in key memory processing areas of their brains at the beginning of the study. Those 23 people also scored lower on cognitive tests at the start of the study, although their scores were within the normal range.
"We found that changes in brain structure are present in clinically normal people an average of four years before MCI diagnosis," study author Dr. Charles D. Smith, of the University of Kentucky Medical Center in Lexington, said in a prepared statement.
"We knew that people with MCI or Alzheimer's disease had less brain volume, but before now, we didn't know if these brain structure changes existed, and to what degree, before memory loss begins," he said.
Low blood pressure in elderly linked to mortality
Aggressive treatment of high blood pressure (hypertension) in patients who are 80 years or older is associated with lower five-year survival rates than their counterparts with blood pressure levels at or higher than treatment target levels, researchers report.
Physicians should therefore "use caution in their approach to blood pressure-lowering in this age group," they advise in the Journal of the American Geriatric Society.
Dr. Daniel J. Oates of the Boston Medical Center and his co-workers evaluated five years of data from 10 Veterans Affairs sites and
Social Security files. The study group involved 4,071 ambulatory patients 80 years or older with hypertension.
The researchers found that patients with normal or higher blood pressures were less likely to die during follow-up than those with lower blood pressures. Specifically, for each 10-point increase in blood pressure, the researchers estimated that the mortality risk increased by about 17 percent.
This effect was seen up to a systolic blood pressure of 139 mmHg (the top number) and a diastolic blood pressure of 89 mmHg (the bottom number).
However, in patients with uncontrolled hypertension, defined as systolic pressure of 140 mmHg or higher and diastolic pressure of 90 mmHg or higher, there was "no significant association between survival and blood pressure levels."
These findings "suggest that overly aggressive control of blood pressure might be harmful in this age group," the investigators conclude. They cite other studies that also show higher blood pressures are protective in older patients.
Older patients with low blood pressure need to be monitored for fainting, which would put them at risk of falls, the team notes. This group should also be watched for nonspecific symptoms, such as weakness, weight loss and memory loss.
SOURCE: Journal of the American Geriatric Society, March 2007.
Internet gambling a major risk for Parkinson's patients
Online gambling presents a special peril for people with Parkinson's, a disease that boosts compulsive risk-taking, doctors warn in this week's British Medical Journal (BMJ).
Internet casinos, poker and other online games can result in secret debts that can destroy a family, they say.
Parkinson's, a disease of the nerve system, is commonly known for problems with motor function, causing trembling, shaking and jerkiness.
But, the BMJ editorial points out, Parkinson's patients also have problems with pathological gambling and other addictive behaviours. The phenomenon is worsened by dopamine agonists -- the drugs that many take to ease their symptoms.
A study published last year in the journal Neurology found that the prevalence of addicted gambling among Parkinson's patients was 3.4 percent, which more than doubled to 7.2 percent among those who take dopamine agonists.
People who develop Parkinson's at a younger age are at even higher risk.
By comparison, in the general British population, compulsive gambling afflicts around one percent of people.
"We have noted that our patients are often secretive about their gambling and may end up thousands of pounds (dollars, euros) in debt before the problem is realised," say authors Sui Wong and Malcolm Steiger, who are neurologists at the Walter Centre in Liverpool, northwestern England.
"Many internet gambling companies actively lure gamblers with pop-ups to place free bets. This marketing technique is pervasive and can make it hard for vulnerable people to wean themselves off gambling."
They say doctors can help to identify the problem at an early stage by asking patients and carers about any change in behaviour or development of new compulsion.
For patients that become hooked on online gambling, doctors may consider such strategies as reducing or stopping dopamine agonists, while families can install firewalls to block Internet pop-ups and gambling sites or control the patient's finances if need be, they add.
Tag elderly people with dementia, British minister suggests
Elderly people with dementia could be electronically tagged to make tracking their movements easier, a British minister suggested in comments cited by the BBC Thursday.
Science Minister Malcolm Wicks said that the move would give sufferers "freedom to roam around their communities" and would have to be done with permission either from them or their family.
"This is about dignity and independence in old age," he told the BBC.
"They could have the safety and security that they would wish for themselves and certainly their families would feel more reassured."
The Department of Health refused to comment on whether the proposal is likely to become government policy.
Wicks's comments received a cautious welcome from one charity which works with old people.
Kate Jopling, of Help The Aged, said tagging might be a way of helping elderly people with dementia to live more independently.
"At first glance, these proposals may smack of the Big Brother state, but we shouldn't dismiss the potential of new technologies to afford dignity and opportunity to vulnerable older people," she said.
"The key issue would, of course, be the involvement and consent of the individual, and their family and carers, to ensure that the technology means better care -- not just care that's cheaper or more convenient."
But Shami Chakrabarti, director of civil rights group Liberty, warned against "gimmicks" which appear to offer "cheap and quick fixes".
There are currently some 700,000 people with dementia in Britain and the figure is likely to increase to 1.7 million by 2050.
The condition costs the country 17 billion pounds (25 billion euros, 34 billion dollars) a year.
Dairy food linked with Parkinson's disease in men
A new study has confirmed a relationship between consuming large amounts of dairy products and an increase in the rate of Parkinson's disease in men, but the reason for this relationship remains a puzzle.
Researchers found that among more than 130,000 U.S. adults followed for 9 years, those who ate the largest amount of dairy foods had an increased risk of developing Parkinson's disease, a disorder in which movement-regulating cells in the brain die or become impaired.
There was a clear pattern seen among men, whose Parkinson's risk increased in tandem with consumption of diary, particularly milk. The results were more ambiguous among women, however.
The findings, which appear in the American Journal of Epidemiology, echo those of earlier studies that found a link between dairy consumption and Parkinson's in men, but not women.
For now, it's not clear what effect, if any, dairy foods might have on women's risk of the disease. Nor is it known why there is a relationship seen in men, lead study author Dr. Honglei Chen, a researcher at the National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, told Reuters Health.
Larger studies are needed to find out which dairy products might be responsible, and why, according to Chen.
The findings are based on detailed dietary and lifestyle information collected from 57,689 men and 73,175 women who took part in a cancer prevention study. Over 9 years, 250 men and 138 women were diagnosed with Parkinson's disease.
Men with the highest levels of dairy consumption were 60 percent more likely to develop the disease than those who consumed the least amounts of dairy, the study found. Men in the highest-intake group consumed an average of 815 grams of dairy per day, which is roughly equivalent to three to four glasses of milk; those in the lowest-intake group consumed 78 grams of dairy per day, on average.
Milk, rather than dairy products like yogurt and cheese, explained most of the association, according to Chen's team.
This study and previous ones indicate that calcium, vitamin D and fat are not responsible for the link between dairy foods and Parkinson's disease. One theory is that pesticides or other nerve-damaging toxins present in milk could contribute to Parkinson's disease over time. However, dairy foods would likely be only a small part of most people's exposure to these chemicals, according to Chen.
Furthermore, pesticide residues may also be present in other foods, but no other foods were related to Parkinson's disease risk in this study, the researcher noted.
For now, Chen said there is no reason to shun dairy because of the potential relationship to Parkinson's disease. "Given some of the potential health benefits of dairy foods, people can still enjoy their moderate amounts."
However, the researcher added, since the dairy-Parkinson's link has now been seen consistently in different studies, further research is needed to understand why.
SOURCE: American Journal of Epidemiology, May 1, 2007.
Five million children obese in EU
Around 22 million of the European Union's 75 million children are overweight and 5.1 million are obese, delegates told a conference that started here on Sunday.
"It's an extraordinary figure and there are 300,000 more obese children each year," Tim Lobstein of the London-based International Association for the Study of Obesity told a press briefing at the start of the four-day meeting.
He said the scientific community knows little about preventing child obesity but added: "we may have focused too much on the child and not enough on the environment."
One study to be presented at the conference, which will bring together some 2,500 European obesity specialists, found that a programme developed by Paul Sacher of the University College London led to significant improvements in overweight and obese children over a period of one year.
Sacher developed the nine-week multi-disciplinary programme, combining exercise, nutrition and empowerment, to fight excess weight and obesity, which affects one in three children in the United Kingdom.
Scientists also said that a lack of specialisation among doctors made it more difficult to treat obese children in Europe.
Obesity rising in Europe, especially in children
The number of overweight people in Europe is rising and there is an especially worrying trend of increasing childhood obesity and in the number of people who are grossly obese, according to recent studies.
Europe is facing major health and social burdens and the rise in obesity is reaching "epidemic" proportions, the 15th European Congress on Obesity in Budapest was told on Sunday.
Estimates show there are around 1.1 billion overweight people in the world, of whom 312 million are obese, and that in Europe 10-20 percent of men are obese and almost half the population is overweight.
Some 30 percent of children in Britain are obese or overweight, and percentages are rising in southern Europe, while in new
European Union states in eastern Europe, rates of obesity are surging at a time when health spending is being curtailed.
"More than 80 percent of children who are already obese will stay obese as adults," said Martin Fried of Prague's Charles University, who authored a major study on the effect of surgery on obese patients.
Fried estimates that there are around 11 million Europeans who are grossly obese, with a body mass index of 40 or more.
Body mass index (BMI) is a measure of body fat based on height and weight in which normal weight is in a BMI range of 18.5-24.9.
Obese people are far more likely to suffer early deaths, have health problems like type-2 diabetes, and have a lower quality of life, as well as being unable to participate in work, Fried told journalists on the sidelines of the conference.
Fried said surgery was increasingly a workable solution for obese adults and that far from competing for health resources, it was better than for example continuing to treat type-2 diabetes with drugs, as surgery offered a once-and-for-all solution for 80 percent of cases after six months to a year.
In Britain, which has one of the highest levels of childhood obesity in Europe, a study showed that community-based programs had a major impact on overweight and obese children.
Results of a 9-week trial program conducted by University College London (UCL) and Great Ormond Street Hospital for Children involving 107 families showed significant improvements in BMI, waistlines, lifestyle and self-esteem.
These results were sustained over 12 months, the study said.
"Obesity costs the nation 7 billion pounds a year. This popular community-based program has the potential to underpin effective national strategies for obesity treatment and preservation," said Professor Alan Lucas of UCL's child health department.
Friday, April 20, 2007
Asians rate sex lives so-so
Asia's lovers rate sex far less highly than those elsewhere around the globe, spend less time having intercourse and are not as likely to reach orgasm, according to a survey released Tuesday.
The international survey of more than 26,000 people in 26 countries found Asians ranked themselves among the least satisfied with their sex lives.
The Global Sexual Wellbeing Survey was conducted by condom-maker Durex and released at this week's World Congress on Sexual Health in Sydney.
The survey found most people around the globe had sex 106 times a year, with the Japanese the most infrequent on 48 and the Greeks putting in an Olympian effort on 164.
It might explain why respondents from Japan were the least satisfied with their sex lives, with only 10 percent ranking it as exciting, well behind the global average of 49 percent, led by Nigerians on 78 percent.
Hong Kong (32 percent), Australia (40), Singapore (41), Thailand (42) and New Zealand (43) were also among the bottom 10 nations in the exciting sex life stakes.
India's lovers were the world's quickest, taking 13.2 minutes per session compared to the global average of 18.3 minutes, with the ranking again topped by Nigeria, on a leisurely 24 minutes.
Singapore, Hong Kong, Japan, Thailand and Australia were also well below the world average for time spent on intercourse.
However, China's lovers were the seventh most lengthy in the world on 20 minutes, a heartbeat behind Malaysia's on 19.9.
Only 24 percent of respondents from Hong Kong and China reported always experiencing an orgasm during sex, the lowest in the survey, followed by Japan on 27 percent and Singapore on 36.
On average, 59 percent of respondents strongly agreed that sex was important to them, with the lowest rankings coming from Thailand on 38 percent, Japan (39) and Hong Kong (48 percent).
Gabrielle Morrissey, a sex expert from Australia's Bond University, said the survey reflected cultural issues to sex in Asia.
"Work is a lot more important than sex in many Asian countries and the survey shows that it's ranked a low priority in the life-work balance and can suffer as a result," she told AFP.
"It's very much lifestyle-driven, there are also negative attitudes to sex and myths that can have an impact."
Morrissey said improved sex education and communication between couples could improve sex lives in the region.
Antipsychotic drugs often affect sexual function
Patients taking antipsychotic drugs for schizophrenia often produce little or no hormone in the sex glands, a condition known as hypogonadism, and commonly develop subsequent problems in sexual function, according to the findings published in the Journal of Clinical Psychiatry.
Dr. Oliver D. Howes and colleagues from the Institute of Psychiatry, London, examined rates of sexual dysfunction and hypogonadism in 103 patients with schizophrenia or schizoaffective disorder who had been on stable antipsychotic medication for at least 6 months.
These patients were compared with 62 normal untreated subjects recruited from primary care practices and with 57 subjects recruited from a sexual dysfunction clinic.
The participants were assessed using the Sexual Functioning Questionnaire (SFQ), in which higher scores indicate greater impairment.
Patients on antipsychotics had significantly greater average total SFQ scores -- 9.9 in women and 7.8 in men --- compared with normal subjects, who had scores of 4.1 and 4.09, respectively. The scores in the treated patients were similar to those in the patients who attended the sexual dysfunction clinic -- 7.2 in women and 9.9 in men).
Compared with normal subjects, the likelihood of patients having sexual dysfunction was increased by 15-fold in women and 9-fold in men.
Hypogonadism was common, with 79 percent of premenopausal women with low estrogen production and 92 percent with low progesterone levels. Twenty-eight percent of men had low testosterone production."
"The high rates of hypogonadism suggest that patients are at increased risk of cardiovascular disease and osteoporosis," Howes and colleagues say. "Clinicians are advised to inquire about sexual dysfunction and monitor...hormone levels in patients taking antipsychotics."
SOURCE Journal of Clinical Psychiatry, March 2007.
Schools need systems to spot troubled kids
Strategies put together by the U.S. Secret Service and the Department of Education after the 1999 Columbine shootings might help schools detect and act on clues ahead of violent massacres like this week's Virginia Tech shooting, experts said on Friday.
The tragedy at Virginia Tech, they said, underscores the need for an early warning system that school officials, students and faculty could use to report troubling behavior and potentially head off deadly acts of violence.
Cho Seung-Hui, the 23-year-old Virginia Tech gunman, left some pretty clear warning signs, mental health experts said, but those details were never pieced together until after he killed 32 people and took his own life.
"We may not always be able to find the needle in a haystack of troubled people, but we certainly can design systems to respond more appropriately to those who are known to be troubled and needing help," said Randy Borum, a psychologist at the Florida Mental Health Institute and one of the authors of the 2002 report about school safety.
That report -- Threat Assessment in Schools: A Guide to Managing Threatening Situations and to Creating Safe School Climates -- was based on a system devised by the U.S. Secret Service to identify people who might attack public figures such as the president of the United States.
It was modified to address school shootings, particularly after Columbine, and offers a model for detecting potential threats in schools. Being attuned to warning signs and having a centralized place for reporting that information can help reduce risks, Borum said in a telephone interview.
The 2002 report found that incidents of targeted violence in school were "rarely impulsive." Most attacks, it found, were planned out in advance with planning behavior that could often be observed.
"Prior to most attacks, other children knew that the attack was to occur," the report reads.
But most students and many faculty members do not know where to turn when they come across disturbing behavior.
"There's no systematic way for pieces of the puzzle to come together. This is a major factor in my view of why school shootings look so foreseeable after the fact," Borum said.
"It's because a lot of people knew pieces of information but nobody communicated with each other. After the fact, you've got it all ... and everybody says, 'How could this have happened?"' he added.
"Everybody just thinks about their own little node." And the problem is not just limited to schools.
"Look at the government post 9-11," he said. "Everybody was saying, "Gosh, if only those systems talked to each other."'
With a little training, school faculty, deans and student resident advisers could be taught to recognize simple warning signs that could help identify potential threats, said Alan Lipman, director Center for the Study of Violence at Georgetown University in Washington.
He said schools should put in place a kind of crisis hotline that students, faculty and others could use as a clearinghouse for such concerns.
"With someone like Cho, there are such clear warning signs that they really are the kind of things even non-health professionals ... can spot," Lipman said.
Potential rabies treatment fails two children
An experimental rabies treatment that saved the life of a teen-ager in 2004 has failed to help two other children infected with the deadly virus, U.S. experts said on Friday.
A 10-year-old Indiana girl and an 11-year-old boy in California both died despite getting the treatment that involves putting patients into a drug-induced coma and giving them antiviral drugs.
This means it is critical for parents and doctors to recognize quickly if a child may have been exposed to rabies and get treatment as quickly as possible, the team at the U.S. Centers for Disease Control and Prevention said.
Quick vaccination after exposure -- usually via a bite or some other contact with the saliva of an infected animal -- can save lives. But if a person begins showing symptoms, which are vague enough to be confusing, it is usually too late.
Rabies kills 55,000 people a year globally and affected 24 people in the United States in 2006.
In 2004 a 15-year-old Wisconsin girl was successfully treated for rabies infection a month after she was bitten by a bat. It took doctors six days to figure out why she was ill but they quickly used drugs to put her into a coma, used a ventilator to keep her breathing and gave her the antiviral drug ribavirin.
She survived -- the first time anyone with documented rabies illness has lived without a rabies vaccination.
But the so-called Wisconsin protocol failed on the two U.S. children who became ill in September and November of last year, the
CDC team said.
"To consider use of the Wisconsin rabies treatment protocol, the disease must be diagnosed as early in the course as possible, which requires enhanced clinical awareness of the disease among health-care providers," the CDC said in its report.
The 10-year-old Indiana girl's symptoms started with pain in her arm. It was days before her mother remembered that the girl had reported having been bitten by a bat that flew into her window the previous June.
The child died after 26 days in the hospital.
In the second fatal case, the 11-year-old boy had apparently been bitten by a rabid dog in the Philippines, perhaps two years before.
"Typical rabies incubation periods vary from 1 to 3 months after exposure," the CDC said.
Aid agencies hail millions of measles vaccinations in NKorea
More than 16 million children and adults have been vaccinated against measles in
North Korea in the last two months, marking one of the fastest responses to a major outbreak of the disease, international relief agencies said on Friday.
The United Nations Children's Fund (UNICEF), the World Health Organisation and the International Federation of Red Cross and Red Crescent Societies funded and organised the campaign after a request from the North Korean authorities in February.
"This was a remarkable example of good cooperation between different organisations," said Jaap Timmer, head of the Red Cross delegation in the authoritarian and secretive communist state.
"The local Red Cross volunteers, who have been trained in first aid and community health, reinforced the vaccination teams to enable them to finish the two phases in such a short period of time," he added.
Measles made its first appearance in a decade in North Korea last November, leading to four deaths and 3,600 infections.
Sextuplet mother doing well in hospital
An Algerian woman who was told she would never able to have children is doing well in hospital after giving birth to six girls, doctors said on Thursday.
The 27-year-old mother had been receiving fertility treatment for the past three years.
She had been expecting seven children, but one, a boy, died in utero, hospital gynaecologists said.
Both mother and babies are said to be in good health in hospital in Kouba, a suburb to the east of Algiers.
However one doctor admitted that were "some concerns" for the smallest child, weighing just 700 grams, saying that she was suffering from "respiratory problems."
The parents expressed their joy at becoming parents as they had lost all hope of having any children.
"I really wanted a child and God has granted me six!" the mother said.
It is believed that this is Algeria's first multiple birth (more than four) for over thirty years, according to experts quoted Thursday in the Algerian press.
Kids' Diarrhea Virus Makes Its Way Into Blood
Rotavirus, the most common cause of severe diarrhea in children, can cause a systemic infection, not just infection confined to the intestines, a new study confirms.
The finding suggests that children may carry and pass on the bug even if they don't have diahhrea.
That's something experts have suspected for a while. "Until about three years ago, we thought the virus only infected cells in the small intestine," noted lead researcher Margaret Conner, an associate professor of molecular virology and microbiology at Baylor College of Medicine in Houston. "We thought the virus was restricted to the gastrointestinal tract."
In 2003, however, Conner's lab and others reported that rotavirus really appeared to be more of a systemic infection.
Now, Conner and her colleagues from other universities and medical centers have tested samples of blood from children hospitalized with gastroenteritis and compared them with samples from children admitted with noninfectious conditions and from healthy adults.
In all, the researchers tested blood samples obtained from children with gastroenteritis, including 57 youngsters with stools that were rotavirus-positive and 41 with rotavirus-negative stools, 58 children with bronchiolitis (a respiratory tract infection) of known viral origin, 17 with bronchiolitis of unknown viral origins, and 17 children with non-infectious conditions. They also tested 28 healthy adults.
"We looked for an antigen, a marker of whether the infectious virus is there," Conner said. The antigen is actually a protein fragment from the surface of the virus.
They found the antigen was in the blood of 51 of the 57 children with rotavirus-positive stools, in 8 of 9 in children without diarrhea but with rotavirus-positive stool, in 2 of 17 kids with bronchiolitis of unknown viral cause without gastroenteritis and in 5 of 41 children with gastroenteritis but with negative stools. The antigen was not found in the blood samples of any other group.
The findings are reported in the April issue of PloS Medicine.
The new report, Conner said, "adds strength to the idea that rotavirus is systemic." The study also shows that children who don't have diarrhea, in whom doctors wouldn't suspect rotavirus, may be infected. "It shows that even without the diarrhea symptom, kids can be infected [with rotavirus]," the researcher said.
"Our study is the first to show that even if a child does not have diarrhea, you can have rotavirus in the blood," Conner said.
In the United States, an estimated 3.5 million children become infected every year with rotavirus, Conner said. About 55,000 children are hospitalized in the U.S. each year, according to the federal Centers for Disease Control and Prevention.
The incubation period is about two days. Symptoms include vomiting and watery diarrhea for three to eight days, with fever and abdominal pain often occurring. Dehydration is a risk.
The virus is spread by the fecal-oral route. For instance, young kids who didn't properly wash their hands after toileting may play with a ball at school, contaminate it, and give the ball to another child, who may lick the ball and become infected, Conner said.
The virus gets into the intestine, replicates, and then can also escape from the intestine and go into the bloodstream, the new research shows.
Whether it will make kids sicker if it escapes into the bloodstream is not yet known, the researchers said.
Another expert called the study "extremely interesting." The advice for parents who suspect rotavirus doesn't change, even with this new information, said Mary Beth Koslap-Petraco, a certified pediatric nurse practitioner in the Suffolk County Department of Health Services for Long Island, N.Y.
"During rotavirus season, which varies in different parts of the country, parents should be careful about washing their own hands after diaper changing," she said, along with being sure young children wash their hands often.
Koslap-Petraco recommends using waterless cleaners to help kill rotavirus. A vaccine, given to infants, is also available to protect against the bug. Parents should ask their doctor about the vaccine and for details on when rotavirus is circulating in their region of the country, she said.
Two US lawmakers seek to protect abortion rights
Two US lawmakers introduced legislation Thursday aimed at codifying a woman's right to terminate a pregnancy, one day after the Supreme Court banned a controversial late-term abortion procedure.
The proposed law would codify abortion rights for the first time, said Democratic Representative Jerrold Nadler (news, bio, voting record), who joined the effort launched by Senator Barbara Boxer (news, bio, voting record).
The legislation "would bar government -- at any level -- from interfering with a woman's fundamental right to choose to bear a child, or to terminate a pregnancy," Nadler said.
"We can no longer rely on the Supreme Court to protect a woman's constitutional right to choose" he said.
"This Supreme Court may have gone out of the business of protecting women's rights; it is time that Congress stand up to the challenge."
A divided Supreme Court voted 5-4 Wednesday to uphold a 2003 law passed by Congress banning what critics call "partial birth abortion."
The bellwether ruling was a major victory for conservative forces in the United States, which have battled for decades to reverse the landmark 1973 Roe v. Wade decision establishing a woman's legal right to terminate a pregnancy.
It is the first time the high court has upheld a ban of a specific abortion procedure since Roe v. Wade.
The fate of the legislation offered Thursday is unclear as Democratic leaders, who control Congress since January, did not promise a debate on the divisive issue.
Teen's rabies cure failed in others
An unusual drug combination that helped an unvaccinated teenager survive rabies has failed to save three other infected children, federal health officials reported Thursday.
It wasn't clear why the treatment succeeded with one child and failed with the others. Factors could include the strain of the virus, the dosing of the drugs and the time between infection and treatment, said Dr. Charles Rupprecht, chief of the rabies program at the U.S. Centers for Disease Control and Prevention.
"We believe speed is of the essence," said Rupprecht, a co-author of a report in this week's issue of the CDC's Morbidity and Mortality Weekly Report.
Rabies is a viral disease most often transmitted through the bite of an infected animal. It attacks the central nervous system and, if untreated, can lead to anxiety, confusion, paralysis, hypersalivation, difficulty swallowing, and fear of water. Death usually occurs within a week of the onset of symptoms.
In October 2004, a 15-year-old Wisconsin girl, Jeanna Giese, was hospitalized a month after she was bitten by a bat in church. She recovered after Milwaukee doctors used drugs to induce a coma and then gave her antiviral medications including ribavirin, ketamine and amantadine.
The success of the so-called Wisconsin protocol was reported in the
New England Journal of Medicine.
But treatment based on the same protocol did not succeed in at least three children who developed symptomatic rabies last year. Two of the cases were detailed in the CDC report.
One was a 10-year old Indiana girl who contracted the virus from a bat and died in November. The other was an 11-year-old California boy who apparently got rabies from a dog while he was living in the Philippines and died in December.
A third case from Texas was not included because the report's authors did not receive necessary information before publication, Rupprecht said. That case, reported by the media, involved a Houston teenager bitten by a bat who died last May.
Health officials believe the Indiana girl was infected more than three months before she was treated, and were told the California boy was bitten by a dog about two years before he got sick.
Rabies kills about 55,000 people each year, mostly in Asia and Africa. About 40,000 Americans are exposed each year. Nearly all are successfully treated before symptoms appear, through five doses of vaccine and immune globulin.
The rarity of U.S. cases and other difficulties of constructing a proper study will make examining the Wisconsin protocol difficult, said Dr. David Weber, an infectious diseases specialist at the University of North Carolina.
The emphasis should be on preventing rabies, he added. The Wisconsin protocol involves weeks of specialized attention in a hospital intensive care unit, which is more available in the United States than in many countries where rabies is more common.
"This is not a practical treatment for virtually any other country in the world," Weber said.
Canada mom freezes eggs so daughter can have child
A Montreal woman has frozen her eggs so they can be used by her seven-year-old daughter, who cannot have children because of a genetic condition.
Doctors at McGill University Reproductive Centre in Montreal, which has pioneered a freezing program for cancer patients and those who want to delay childbearing, say the decision by 36-year-old Melanie Boivin is unprecedented in North America and raises ethical questions.
If the girl chooses to become pregnant using her mother's eggs, she will be giving birth to her biological half-sister. Boivin will then become a mother and a grandmother.
"She is donating her eggs to help her daughter to have children. It's mother's love," Seang Lin Tan, director of the McGill Reproductive Centre and a prominent expert on infertility treatments, said in an interview on Wednesday night.
"It's like donating a kidney to your own child, nobody will have problem with that," he said.
While there are about 60 cases of women freezing their eggs in North America, mother-to-daughter donation is the first, Tan said. The case has been reviewed and endorsed by the ethical committee of the McGill University Health Centre, he said.
Tan said Boivin decided to donate her eggs after finding out that her daughter is sterile because she has Turner's syndrome, in which one of the two X chromosomes normally found in females is missing or incomplete.
The most common characteristics of Turner's syndrome, which occurs in one out of 2,500 female births, include short stature and lack of ovarian development.
"Parents are there to help (their) children, and if she would have needed anything else, an organ, a kidney, I would give it to her without hesitation," Boivin told the Globe and Mail newspaper.
She has since declined to be interviewed, saying the discussion has caused some problems for her daughter.
Boivin's eggs will be frozen for 20 to 25 years, using a freezing method called vitrification that was developed by Tan's team, and which has drastically increased the egg survival rate.
The frozen eggs are stored in a protective device until they are ready for use. Pregnancy rates with vitrification eggs are almost the same as with fresh eggs, Tan said.
It will be up to Boivin's daughter to decide whether she wants to use the frozen eggs, he said.
"It takes time for people to get used to the idea," Tan said, adding that many people disapproved of test-tube baby technology 30 years ago.
Better Testing Shields Hospitalized Kids From 'Superbugs'
Aggressive screening for two antibiotic-resistant "superbugs" in children should cut infection risks, say experts at Johns Hopkins Hospital in Baltimore.
They began such a testing program in March, after a study found that more thorough screening reduced the risk of infection and the spread of the bacteria.
All children admitted to the pediatric intensive care unit are now carefully checked for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). This goes well beyond standard hospital practices, where tests for these bacteria are only ordered after a young patient develops symptoms or shows signs of early infection, Hopkins officials said.
The hospital already had a screening program for adults admitted to intensive care units.
While infections caused by MRSA and VRE are rarely fatal, people with these bacteria are at greater risk for dangerous infections.
The new screening program for young intensive care patients was prompted by a Hopkins study last year that found that weekly screening was much more effective than conducting tests for the bacteria only after a patient develops skin rash, fever or pain.
The four-month study of 330 patients in the pediatric intensive care unit found that weekly swab testing and bacterial growth cultures detected six times more patients with VRE and one-and-a-half times more patients with MRSA than routine testing.
The study was presented this week at the annual meeting of the Society of Health Care Epidemiology of America in Baltimore.
Many Kids in ICU Don't Need Transfusions
Less may be more when it comes to blood transfusions for children cared for in hospital intensive care units (ICUs), a new study shows.
Researchers say that, in some cases, withholding transfusions from anemic, hospitalized children has no adverse effects and may even reduce risks.
"Most critically ill adults and most critically ill children -- unless there is some pressing indication to transfuse them -- do as well with fewer transfusions as they do with more transfusions," said Dr. Howard L. Corwin, from the Dartmouth-Hitchcock Medical Center, Lebanon, N.H.
Corwin was not involved in the study but wrote an accompanying editorial in the April 19 issue of the
New England Journal of Medicine.
Transfusions are given based on the level of hemoglobin, the oxygen-transporting part of the blood. However, doctors still aren't certain as to the optimal hemoglobin level needed before a transfusion. Earlier studies in adults showed that withholding transfusions when hemoglobin levels were low was safe and did not result in adverse effects.
Now, the new study shows that, "in children sick enough to be in the ICU, but who have been stabilized, giving a red blood cell transfusion when the hemoglobin is between 7 and 9.5 grams per deciliter is not better or worse than giving no transfusion," said lead researcher Dr. Jacques R. Lacroix, from Sainte-Justine Hospital in Montreal, Canada.
"This means that we can decrease the number of transfusions," Lacroix said. "For blood banks, this will help relieve the pressure, because we are probably giving too many transfusions," he added.
In the trial, Lacroix's team randomly assigned 637 children cared for in ICUs to different hemoglobin thresholds before transfusions. For one group, the threshold was 7 grams per deciliter, and for the other, it was 9.5 grams per deciliter.
Among children in the 9.5 grams per deciliter group, there were 44 percent fewer transfusions. In fact, 174 patients in that group did not receive a transfusion, compared with just seven patients in the other group.
The frequency of new or progressive cases of a serious complication called multiple-organ dysfunction syndrome was 12 percent in both groups, the researchers reported. In addition, 14 children in each group died. There were no significant differences in other outcomes, including adverse events, between the two groups, the researchers said.
Lacroix believes the results outline the parameters guiding the need for transfusions in pediatric patients.
"Between the upper and lower range of hemoglobin, it is safe to give or not give a red blood cell transfusion," Lacroix said. "Over 7 grams per deciliter, transfusions are probably not so good, but below 7 grams per deciliter, they are warranted," he said.
Corwin agreed that giving kids transfusions solely to increase hemoglobin levels is not justified.
"Giving transfusions to critically ill adults or children with high hemoglobin levels is not necessarily advantageous," he said. "Patients do as well with a more conservative transfusion strategy."
According to Corwin, giving fewer transfusions also cuts down on the risks, such as infection, associated with blood transfusions. "Not giving blood doesn't subject you to risks," Corwin said. "There is less risk, and you are not sacrificing any benefit."
Some moms of autistic kids prone to depression
Mothers of children with autism may be prone to depression if they feel responsible for the cause or outcome of their child's disorder, a new study suggests.
Autism is a developmental brain disorder that impairs, to varying degrees, a person's use of language and ability to communicate, interact socially and form relationships. While its cause is not completely understood, genetic vulnerability plays a role. And "bad" parenting definitely does not.
Still, with so many questions surrounding autism -- its exact cause, the difficulty in diagnosing the disorder or predicting how well a child will do -- parents constantly deal with uncertainties. Such ambiguity may leave some mothers vulnerable to depression, according to the new study, published in the journal Family Relations.
Specifically, mothers with high levels of "identity ambiguity" -- which included blaming themselves for their child's autism and holding themselves responsible for their outcomes -- reported more depressive symptoms and feelings of stress.
"One of the big messages here is that mothers are not to blame," said study author Dr. Marion O'Brien, director of the Family Research Center at the University of North Carolina at Greensboro.
And while mothers can push for better services for their autistic children, O'Brien told Reuters Health, they shouldn't hold themselves personally responsible for their children's ultimate outcomes, which vary widely from child to child.
"Mothers, by themselves, cannot determine the long-term outcome," she said.
O'Brien based her findings on interviews with 63 mothers of children with autism spectrum disorders, which range from autism to Asperger syndrome, a condition marked by much milder behavioral impairments.
She found that many mothers expressed feelings of "ambiguous loss," the conflicting feelings and ideas caused by finding out your child is different from the one you'd expected to raise.
Parents of children with autism, O'Brien explained, have to constantly balance optimism with realism -- having hope for their children's future, while recognizing that they have a lifelong, serious disorder.
For those who, like some mothers in this study, feel overwhelmed or depressed, a family therapist might be helpful, according to O'Brien. It's important to not simply treat the depression symptoms, she explained, because parents need to realize that it's not a "personal failing," but the uncertainty of their situation, that makes them feel distressed at times. Other parents of children with autism might also be able to help, O'Brien noted.
On the positive side, she said that most families with autistic children are highly resilient, and with time learn how to deal with their challenges.
SOURCE: Family Relations, April 2007.
"Glycemic load" of diet has no effect on weight loss
When it comes to losing weight, the number of calories you eat, rather than the type of carbohydrates, may be what matters most, according to a new study.
The findings, published in the American Journal of Clinical Nutrition, suggest that diets low in "glycemic load" are no better at taking the pounds off than more traditional -- and more carbohydrate-friendly -- approaches to calorie-cutting.
The concept of glycemic load is based on the fact that different carbohydrates have different effects on blood sugar. White bread and potatoes, for example, have a high glycemic index, which means they tend to cause a rapid surge in blood sugar. Other carbs, such as high-fiber cereals or beans, create a more gradual change and are considered to have a low glycemic index.
The measurement of glycemic load takes things a step further by considering not only an individual food's glycemic index, but its total number of carbohydrates. A sweet juicy piece of fruit might have a high glycemic index, but is low in calories and grams of carbohydrate. Therefore, it can fit into a diet low in glycemic load.
However, the effort of figuring out what's an allowable carb might not be worth it, if the new study is any indication.
Principal investigator Dr. Susan B. Roberts, of Tufts University, Boston, and colleagues found that a reduced-calorie diet, whether glycemic load was high or low, was effective in helping 34 overweight adults shed pounds over one year.
Study participants who followed a low-glycemic-load diet ended up losing roughly 8 percent of their initial weight, as did those who followed a high-glycemic-load diet.
"The bottom line is that in this study we don't see one single way to eat that is better for weight loss on average," Roberts told Reuters Health. Of course, that doesn't mean "anything goes" as long as you're cutting calories."
A super-sized serving of French fries won't do any dieter any good, she noted.
Both diets her team used in the study were carefully controlled. For the first 6 months, participants were provided with all the food they needed, and both diets were designed to cut their calories by 30 percent while providing the recommended amount of fiber, limiting fat and encouraging healthy foods like fruits and vegetables.
The comparable outcomes suggest that, among healthy diets, no single one stands out as better, according to Roberts. So the focus should be on calories, rather than specific foods to avoid or include.
"Focusing on calories is something we need more of, especially when portion sizes are so absurd," Roberts said, referring to the portions served at so many U.S. restaurants.
This doesn't mean, however, that there's no place for diets that focus on glycemic load, according to the researcher. Some studies, for example, have found that low-glycemic index foods might help control blood sugar in people with type 2 diabetes.
And in their own research, Roberts said she and her colleagues have found that low-glycemic index diets do seem more effective for overweight people who naturally secrete high levels of the hormone insulin, which regulates blood sugar.
SOURCE: American Journal of Clinical Nutrition, April 2007.
Morbidly obese: bigger Britons need fatter furnaces
Britain's growing obesity problem is forcing crematoria to build bigger furnaces because of the broader coffins of their expanding clientele, officials said Wednesday.
Standard coffins are typically between 22-26 inches (55-65 centimetres) wide, but many undertakers now use super-size 40 inch-wide casks to accommodate bigger bodies.
"As long as the nation keeps on piling on the pounds, pressure will continue to be placed on crematoria," said Hazel Harding of the Local Government Association (LGA), which has to deal with funding for the building work.
"This is just another demonstration of how the UK's obesity problem is putting a real strain on public services."
The development follows a trend in the United States, where "supersize" coffins up to 44 inches across have been available for a number of years.
At the Institute of Cemetery and Crematorium Management, officials are well aware of changing needs.
"The Institute has received calls from funeral directors from all parts of the country whose local crematorium is unable to cremate large coffins," said spokesman Tim Morris.
"The likelihood is that a large number of facilities will be upgraded to meet these requirements, with some taking this opportunity to install a larger cremator at this time."
About 430,000 people are cremated in Britain each year.
"By upgrading their crematoria and widening furnaces, councils are changing the services people use for the better, to make sure that relatives are not put out," Harding added.
Rattlesnake Capsules Linked to Salmonella Poisoning
Capsules of dried rattlesnake meat -- a Hispanic folk remedy purported to cure a host of health problems including acne, impotence, AIDS and cancer -- can be contaminated with a potentially lethal strain of salmonella bacteria, a U.S. infection control expert warns.
John James, a microbial epidemiologist at Children's Hospital in Denver, said the life-threatening strain of bacteria -- Salmonella arizonae -- in capsules of dried rattlesnake meat caused a child to become seriously ill. The child survived.
James talked about that case and the overall issue on Saturday at the annual scientific sessions of the Society for Healthcare Epidemiology of America in Baltimore.
"Anecdotal evidence linking capsules of dried rattlesnake meat to salmonella poisoning has been reported for years. For the first time, however, we've used DNA molecular testing to prove definitively that the salmonella bacteria found in the dried meat was the cause of a life-threatening case of salmonella blood poisoning in a patient treated at our hospital," James said in a prepared statement.
Salmonella arizonae is commonly found in snakes and lizards.
"Unfortunately, the rattlesnake capsules -- believed by some to treat many types of diseases -- are often given to people whose immune systems already are compromised," James said. The child in this case had systemic lupus.
"These capsules should be removed from the market, or the manufacturers should be required by the U.S.Food and Drug Administration to irradiate the product before it is sold," James said.
Tuesday, April 17, 2007
Dementia Care Costs Worldwide Reach $315 Billion
Longer life spans pushed up the cost of caring for the 6 million-plus Americans with Alzheimer's disease and other forms of dementia to an estimated $76 billion in 2005.
That is approximately one-sixth of what the U.S. government is expected to spend this year on Medicare, the federal insurance program that covers 44 million seniors and disabled people.
Worldwide, the cost of providing for 29.3 million people with dementia in 2005 was $315 billion, according to another estimate published Monday in the journal Alzheimer's & Dementia: The Journal of the Alzheimer's Association. This figure is significantly higher than the 2003 worldwide estimate of $250 billion by the same researchers, revealing that costs have accelerated in just two years and underscoring the need for more research into the disease.
The $315.4 billion figure is higher than the total budget of all but eight of the world's countries -- the United States, Japan, Germany, France, Great Britain, Italy, China and Spain, the researchers said.
Lead author Dr. Anders Wimo of the Karolinska Institutet in Stockholm attributed the rise to the "graying of the world," together with the higher gross domestic product in developing countries that boosts the wages of medical personnel and caregivers. Just over half -- 54 percent -- of the world's dementia patients live in developing countries and account for 23 percent of the total costs, according to the study.
Dementia refers to cognitive and intellectual deficiencies involving memory, language, motor skills, organizing, reasoning and recognition of familiar faces. Alzheimer's disease is the most common cause of dementia in Americans, the majority of them seniors. Dementia strikes 1 percent of those between 60 and 64, and becomes more common with the advancement of age, affecting 45 percent in the 95-plus age group.
Wimo calculated the cost of dementia by combining estimates of its prevalence with medical and non-medical charges in each country. The worldwide total also included $105 billion for the cost of "informal care," the lost wages of caregivers -- many of whom are retired spouses -- responsible for providing "support in personal activities of daily life," such as bathing, dressing and grooming. The researchers calculated that 90 percent of dementia patients lived at home in developing countries and relied on 1.6 hours of informal care per day, the same amount for those in developed countries, of which 73 percent lived at home.
The study figures came as no surprise to Dr. Sam Gandy, chairman of the Alzheimer's Association's Medical and Scientific Advisory Council. "The study suggests very clearly that we will need to expand the Medicare budget, otherwise all funding will only cover dementia," he said.
Gandy decried the decline in research dollars by the
National Institutes of Health, a trend that started in 2003 and has hit Alzheimer's harder than cancers and
HIV, he said. "The NIH has had to prioritize its resources, and diseases that affect younger people may be considered a higher priority," he said.
Available drugs for Alzheimer's patients only treat symptoms of the disease. But nine drugs currently being tested in clinical trials show promise in halting the progression of Alzheimer's, he said.
"We hope to have an effective medication within the next five years. We're also hoping to have developed a blood or brain scan to identify people at risk, so we can start treatment before the disease develops," Gandy said.
Meanwhile, doctors treating patients with dementia believe the No.1 funding priority should be finding a cure. Dr. Charles DeCarli, director of the Alzheimer's Disease Center at the University of California, Davis, said that "hot on the heels of finding a cure" is a pressing need to develop a "social infrastructure" that provides more efficient care for patients and relieves some of the burden on family members.
"We're finding patients with dementia overuse the system for all the wrong reasons. Patients come in by ambulance, because they forgot their meds and faint, or they're found confused in the streets, and a concerned neighbor will call 911," he said.
DeCarli advocates more adult day-care centers, where dementia patients can be cared for around the clock. "We're seeing one or two, but what we really need is one in every neighborhood," he said.
Monday, April 16, 2007
Can Too Much Weight Cause Ear Infections in Kids?
Scientists in South Korea have uncovered a possible connection between body fat in children and a certain kind of ear infection, but several specialists in the United States are expressing doubts about the research.
If the link does exist, however, it could provide doctors with yet another indication of how extra fat is bad for kids just as it is for adults. "We have to pay close attention to decrease childhood obesity," said study co-author Dr. Seung Geun Yeo, a researcher at Kyung Hee University in Seoul.
Ear infections in children remain very common, affecting as many as eight or nine of every 10 kids. Doctors blame the middle ear, which often cannot fully drain fluid as it is developing.
Doctors typically prescribe antibiotics, although there is concern that the germs are developing immunity to them.
In the new study, the researchers looked at two groups of children aged 2 to 7 -- 155 who had tubes implanted in their ears to help them drain fluid and recover from ear infections, and 118 who were in the hospital for other reasons.
Technically, the children suffered from a form of ear infection known as otitis media with effusion. Some of the symptoms of ear infections, including ear ache and fever, aren't present when this condition occurs.
The children who were treated for ear infections were fatter than the other children, based on their body mass index (BMI), a ratio of weight to height.
According to the study, the children with ear infections had an average BMI of 22, compared to 16 for the other group. This suggests that extra fat boosts the risk of ear infections.
Total cholesterol was also higher in the children with ear infections.
The researchers also looked at the children with ear infections specifically and divided them into fatter and thinner children. They didn't find any indication that being fatter made kids more likely to have more drainage tubes inserted.
The study was published in the April issue of Archives of Otolaryngology-Head & Neck Surgery.
Two American ear, nose and throat specialists said they weren't impressed with the South Korean study.
Dr. Jack Paradise, professor of pediatrics and otolaryngology at the University of Pittsburgh School of Medicine, said one "glaring" problem was that the researchers weren't comparing similar groups of children to each other. Among other things, he said, the study didn't look at the socioeconomic levels of the children -- a major factor in the development of ear infections -- or factors like exposure to other children or the season of the year -- infections are more common in winter.
Paradise added that it's difficult to generalize medical trends by simply looking at hospital records, because there are so many factors that affect whether children have tubes put in their ears. These can include everything from parents' sensitivity to their children's symptoms to accessibility of health care, he said.
Dr. David Darrow, of Children's Hospital of The King's Daughters in Norfolk, Va., noted that the study authors never offered a theory about why obesity might be connected to ear infections. The research "lacks a physiological explanation for the conclusion," he said.
In fact, said Paradise, a connection between obesity and ear infections is "not biologically plausible."
However, Dr. Jordan S. Josephson, an otolaryngologist at Lenox Hill Hospital in New York City and author of Sinus Relief Now, said it's possible that childhood obesity may be associated with ear infections.
"Obesity, as we know, causes people to have a large appearance outwardly, but what most people do not realize is that when people gain weight, their internal spaces get crowded by the bulk of the weight that we put on," he said in a prepared statement. "That means that their eustachian tubes that drain their ears are narrowed, and that can lead to otitis media with effusion. Even worse, as the diameter of their nose and airway is reduced, these people can develop snoring and sleep apnea."
In an interview, study co-author Yeo said some research has suggested a link between obesity and inflammation, and that could be a possible cause. But he acknowledged that the possible connection between obesity and ear infections remains to be explained.
Breastfeeding may protect against breast cancer
Breastfeeding may offer broad protection against breast cancer that extends to women who delay having children, according to a study released on Monday.
Previous studies have shown that giving birth before age 25 and having many children protects against certain types of breast cancers, while delayed childbirth is associated with a higher risk of breast cancer.
The most important finding of the new study is that breastfeeding seems to lower the risk of developing breast cancer that comes from having children later in life, said Dr. Giske Ursin, associate professor of preventive medicine at the University of Southern California medical school and the study's lead author.
Results of the study were announced at the annual meeting of the American Association for Cancer Research in Los Angeles.
"As more women may choose to delay pregnancy until after 25, it is important to note that breastfeeding provides protection against both estrogen and progesterone receptor positive and negative tumors," Ursin said.
Women who develop breast cancer that is hormone receptor negative have a much poorer prognosis than women with other types of breast cancer.
The researchers analyzed data for women aged 55 and older -- including 995 invasive breast cancer patients -- and found that breastfeeding appears to have a protective effect regardless of when they started giving birth.
This is important since having many children was only protective among women who began having children at an early age, Ursin said.
"Evidence suggests that women who have children after age 25 can reduce their risk of breast cancer by choosing to breastfeed," Ursin says.
According to U.S. Census data, 25 is the average age that women in the U.S. first give birth.
The study was funded by the National Institute of Child Health and Human Development and by the National Cancer Institute.
Two drugs comparable for diabetes in children
Glimepiride (Amaryl) appears to be safe and effective for treating type 2 diabetes in children and adolescents, and it reduces A1C levels, a measure of long-term blood sugar control, to a similar extent as the older drug metformin, researchers report in the journal Diabetes Care.
Dr. Michael Gottschalk of the University of California, San Diego Medical Center and colleagues note that although the safety of glimepiride is well documented in adults, there is less evidence available for younger patients.
To investigate further, the researchers randomly assigned 285 subjects who were an average of 14 years old to receive glimepiride once daily or metformin twice daily.
At 24-week follow-up, the two drugs had reduced A1C levels to a similar extent. In each group, just under half of the patients had achieved the goal A1C levels less than 7 percent.
The groups were also comparable in daily blood sugar and cholesterol levels. Patients in the glimepiride group, however, did gain more weight than those in the metformin group.
Weight gain is a known side effect of the "sulfonylurea" drug group that glimepiride belongs to, say the investigators, so this finding came as no surprise.
The results "indicate that glimepiride is safe and effective for use in the pediatric population," the researchers conclude, but also call for further studies.
SOURCE: Diabetes Care, April 2007.
Heavy kids may be more likely to need ear tubes
Obesity may increase the likelihood that a child will need to have tubes inserted in the ears to drain fluid, to prevent the recurrence of chronic middle ear infection, South Korean researchers report.
Otitis media with effusion, or middle ear inflammation with the collection of fluid in the area, usually improves without treatment, but if the fluid does not go away on its own, a child may need to have drainage tubes placed in their ears.
Middle ear infection is becoming increasingly common, while overweight and obesity among kids is also on the rise, Dr. Jong Bin Kim of Kyung Hee University in Seoul and colleagues note in their report.
To determine if excess weight might be associated with an increased risk of middle ear infections with fluid, they compared a group of 155 children, 2- to 7-years old, who had ear tubes inserted to treat middle ear infections, with 118 children who had no history of middle ear infection, were undergoing surgery for other reasons.
The average weight in the middle ear infection group was significantly higher than in the group without middle ear infection, Kim's team found. These children also had higher cholesterol levels, but their triglyceride levels were not elevated.
However, when the researchers compared the frequency of tube insertion between the obese and non-obese groups, they found no significant difference.
Nevertheless, the researchers conclude, the study "suggests that childhood obesity could have an effect on the development of middle ear infection with fluid."
SOURCE: Archives of Otolaryngology and Head and Neck Surgery, April 2007.
UN, MILF to immunise children in Philippines
The United Nations Children's Fund on Monday launched a massive immunisation and health programme in the southern Philippines.
Under an agreement with the 12,000-member Moro Islamic Liberation Front (MILF), Unicef is to provide basic health services to 707 small villages on Mindanao and other southern islands.
Unicef's country representative for the Philippines, Nicholas Alipui, said: "It is time for us to bridge the gap and reduce the stark disparities that affect children in the Philippines."
"We are building bridges that will help consolidate peace and development as we work together to bring about more investment in programmes for children."
Unicef said some 30,000 infants would be immunised against preventable diseases between April 16 and the end of June.
The health services would cover many of the poorest areas of the Philippines and would eventually include vitamin supplements (beginning with Vitamin A), a de-worming programme and tetanus shots for 16,500 expectant mothers.
The joint communique signed by Unicef and the MILF also called for the delivery of "additional basic services" including "birth registrations, malaria control, educational supplies," and the setting up of "community-based health programmes in selected areas."
Most of the target villages were chosen by the MILF. The campaign will be jointly managed by the MILF development agency and Jesus Dureza, President Gloria Arroyo's adviser on peace talks with the the Muslim rebels.
"The Days of Peace campaign requires a commitment to full cessation of hostilities from all parties to facilitate maximum delivery of services for children," the joint communique said.
"The MILF will be in charge of providing access and guaranteeing security for the service delivery teams."
The Philippine government is observing a three-year-old ceasefire with the MILF, helped by a small team of international monitors from Malaysia, Libya and Brunei.
However, peace talks have stalled since September last year over MILF demands for a share of revenues in areas in the south that it considers part of the large Muslim minority's "ancestral domain".
The Philippines is a largely Roman Catholic nation that has battled Muslim separatism since the early 1970s.
It signed a peace treaty with another faction, the Moro National Liberation Front in 1996 that gave limited Muslim self-rule in several impoverished Muslim provinces in the south.
Gene mutation associated with male infertility
A gene mutation that causes formation of abnormally shaped sperm results in male infertility, according to a report in the advance online publication of Nature Genetics.
The mutation, which is located in the aurora kinase C gene (AURKC), is associated with large-headed sperm with too many sets of chromosomes and multiple flagella, or tails, which allow the cells to move. Previous research identified only deletions of the Y chromosome as a cause of altered sperm formation, the authors explain.
Dr. Pierre F. Ray from Centre Hospitalier Universitaire de Grenoble, France and associates performed a gene scan on 14 infertile men of North African descent. The subjects all had a deletion of two copies of the amino acid cytosine in AURKC, whereas there were no mutations detected in 100 chromosomes from European men and only 1 in 100 chromosomes from fertile North African men
Despite having this gene-related infertility, men with this deletion showed no obvious physiological or anatomical defects, the report indicates. Moreover, men with only one copy of the gene mutation were not infertile.
Ray and his colleagues "intend to carry out a larger epidemiological study of both fertile and infertile North Africans to estimate the prevalence of (the AURKC mutation) and evaluate the impact it may have on the reproductive fitness of this population."
SOURCE: Nature Genetics, April 15, 2007.
Health Tip: Risk Factors for Sunburn
Certain people are more susceptible to sunburn than others because of age, skin type or medications they are taking.
The U.S. National Library of Medicine says these factors increase a person's risk of sunburn:
- Babies and children have skin that is more sensitive than adult skin, so they are more likely to be badly sunburned if unprotected.
- People with fair skin are more likely to get a sunburn than people with darker skin -- although all skin types and complexions can burn.
- Certain medications, including some antibiotics and birth control pills, can increase the likelihood of a sunburn.
- Using a tanning bed can cause dangerous sunburns.
- Being outside during the sun's peak hours -- 10:00 a.m. to 4:00 p.m. -- and being on reflective sand or water can increase one's risk of severe sunburn.
Imported food rarely inspected
Just 1.3 percent of imported fish, vegetables, fruit and other foods are inspected — yet those government inspections regularly reveal food unfit for human consumption.
Frozen catfish from China, beans from Belgium, jalapenos from Peru, blackberries from Guatemala, baked goods from Canada, India and the Philippines — the list of tainted food detained at the border by the
Food and Drug Administration stretches on.
Add to that the contaminated Chinese wheat gluten that poisoned cats and dogs nationwide and led to a massive pet food recall, and you've got a real international pickle. Does the United States have the wherewithal to ensure the food it imports is safe?
Food safety experts say no.
With only a minuscule percentage of shipments inspected, they say the nation is vulnerable to harm from abroad, where rules and regulations governing food production are often more lax than they are at home.
"FDA doesn't have enough resources or control over this situation presently," said Mike Doyle (news, bio, voting record), director of the University of Georgia's Center for Food Safety, which works with industry to improve safety.
Last month alone, FDA detained nearly 850 shipments of grains, fish, vegetables, nuts, spice, oils and other imported foods for issues ranging from filth to unsafe food coloring to contamination with pesticides to salmonella.
And that's with just 1.3 percent of the imports inspected. As for the other 98.7 percent, it's not inspected, much less detained, and goes to feed the nation's growing appetite for imported foods.
Each year, the average American eats about 260 pounds of imported foods, including processed, ready-to-eat products and single ingredients. Imports account for about 13 percent of the annual diet.
"Never before in history have we had the sort of system that we have now, meaning a globalization of the food supply," said Robert Brackett, director of the FDA's Center for Food Safety and Applied Nutrition.
FDA inspections focus on foods known to be at risk for contamination, including fish, shellfish, fruit and vegetables. Food from countries or producers previously shown to be problematic also are flagged for a closer look.
Consider this list of Chinese products detained by the FDA just in the last month: frozen catfish tainted with illegal veterinary drugs, fresh ginger polluted with pesticides, melon seeds contaminated with a cancer-causing toxin and filthy dried dates.
But even foods expected to be safe can harbor unexpected perils. Take wheat gluten: Grains and grain byproducts like it are rarely eaten raw and generally pose few health risks, since cooking kills bacteria and other pathogens.
Even so, the FDA can't say for sure whether the ingredient used in the pet foods was inspected after it arrived from China. And if the wheat gluten was, officials said, it wouldn't have been tested for melamine. Even though the chemical isn't allowed in food for pets or people, in any quantity, it previously wasn't believed toxic.
How did the melamine wind up in the wheat gluten? Investigators still don't know. Meanwhile, China is struggling to overhaul its food system and improve safety standards, but still faces major hurdles.
Farmers use pesticides and chemical fertilizers to build produce yields and antibiotics are used on seafood and livestock. Heavy metals also can be introduced into the food chain by widespread industrial pollution.
Increasingly, those foods are sold in a now global marketplace.
While the
European Union, Canada and Mexico still top the list of food exporters to the U.S., China is coming up fast. Since 1997, the value of Chinese food imports, including commodities like wheat gluten, has more than tripled, to $2.1 billion from $644 million, according to Agriculture Department statistics. It accounts for 3.3 percent of the total food the U.S. buys abroad.
For suspect imported products — and wheat gluten is now one of them — the FDA issues alerts to its inspectors. The FDA flags Chinese food and other imported products it regulates, like cosmetics, for that extra scrutiny more than any other country except Mexico.
To safeguard its export business, China is looking at separating foods by their ultimate destination, domestic or foreign, according to Michiel Keyzer, director of the Center for World Food Studies at Amsterdam's Vrije Universiteit.
U.S. government statistics suggest China still has a way to go.
The FDA has been stopping Chinese food import shipments at the rate of about 200 per month this year. Shippers have the right to appeal the detentions, after which the government can order products returned or destroyed.
How do you know the origin of the food you eat? The 2002 Farm Act called for fish, fruit and vegetable imports to be labeled by country of origin, though implementation for the latter two foods has been delayed.
Meanwhile, the U.S. imports more and more, though the increase in value is partially due to the weaker dollar.
All told, the U.S. is expected to import a record $70 billion in agricultural products for the 12 months ending in September, according to an Agriculture Department forecast. The value of those imports will be about double the nearly $36 billion purchased overseas in 1997.
Contributing to that growth are the fresh fruits and vegetables imported during the offseason, when domestic production dwindles or ends.
About one-quarter of our fruit, both fresh and frozen, is imported. For tree nuts, it's about half. And for fish and shellfish, more than two-thirds come from overseas.
Even as the amount of imported food increased, the percentage of FDA inspections declined — from 1.8 percent in 2003 to 1.3 percent this year to an expected 1.1 percent next year.
"Inspections have a very important role but they're not the solution. They are the verification," FDA commissioner Dr. Andrew von Eschenbach said.
The FDA and the USDA have adopted a "risk-based" inspection philosophy, focusing on specific foods, sources or producers that they believe represent the largest potential risk to the public's health.
"The public at large is not at any increased risk," said Craig Henry, senior vice president and chief operating officer for scientific and regulatory affairs of the Grocery Manufacturers-Food Products Association, an industry group.
Caroline Smith DeWaal, director of food safety at the Center for Science in the Public Interest, an advocacy group, countered that "risk-based" is just shorthand for "reduced resources."
"Whenever they say 'risk-based approach,' it often means they don't have enough staff to actually do the job. They're doing triage. They're trying to hit what's most important to inspect but they're missing a lot," DeWaal said.
Groups lobbying to increase the FDA's budget say its spending on food safety has languished, despite the agency's outsized role in ensuring the safety of the nation's food supply.
A recent
Government Accountability Office report noted that most of the $1.7 billion the federal government allocates to food safety goes to the USDA, which is responsible for regulating about 20 percent of the food supply. The FDA, responsible for most of the other 80 percent, gets about 24 percent of the total spent on food safety.
Unlike the FDA, the USDA requires foreign inspection certificates to accompany all products it regulates, which include meat and poultry. Those imports are then reinspected at each port of entry before they are allowed into this country — something that doesn't happen to all FDA-regulated imports.
Under the Bioterrorism Act of 2002, anyone importing food into the United States is required to notify the FDA of the shipment before it arrives by land, air or sea. That allows the FDA to intercept contaminated products before they reach the marketplace, though agency officials acknowledge it doesn't always work that way.
"We have better control than we did a few years ago but it is largely the responsibility of the importer to make sure those products are safe," said Stephen Sundlof, the FDA's top veterinarian.
ChemNutra Inc., the Las Vegas importer of the tainted wheat gluten, said it was "particularly troubled" that its supplier did not disclose it contained melamine.
Doyle, of the University of Georgia, warned the contaminated pet food could be an unsavory taste of what's to come.
"This is not the first and will not be the last but it certainly is a wakeup call for the public to get a better appreciation for where this country is going with imports and imported foods," Doyle said.
Brackett, the FDA official, said the globalization of the food supply means the agency is going to have to be more creative and strategic in ensuring its safety. "I am not quite sure how we're going to do that yet," he said, "except to know that that's the direction that we're going to be heading."
Sunday, April 15, 2007
An ulcer is a sore in the lining of the digestive tract. While it can be treated with medication -- including antibiotics and those that reduce stomach acid -- you should also make certain dietary and lifestyle changes, the American Academy of Family Physicians says.
The academy recommends avoiding the following if you have an ulcer:
* Foods or beverages that contain caffeine.
* Alcoholic beverages.
* Smoking.
* Anti-inflammatory drugs like aspirin and ibuprofen.
* Spicy foods.
Health Tip: Brain Health
Maintaining a healthy brain is as important as maintaining a healthy body, especially as you age.
Here are some suggestions to help keep your mind sharp, courtesy of AARP:
* Don't drink excessive amounts of alcohol, smoke, or use illegal drugs.
* Get regular exercise and enough sleep.
* Learn how to reduce stress.
* If you notice significant changes in your memory or brain function, speak with your doctor.
* Prescription medications -- especially when taken in combination -- may affect your mental and physical performance, so let your doctor know about all medications that you take.
* Stay physically and socially active, and avoid staying at home by yourself.
Abstinence classes don't stop sex
Students who took part in sexual abstinence programs were just as likely to have sex as those who did not, according to a study ordered by Congress.
Also, those who attended one of the four abstinence classes that were reviewed reported having similar numbers of sexual partners as those who did not attend the classes. And they first had sex at about the same age as other students — 14.9 years, according to Mathematica Policy Research Inc.
The federal government now spends about $176 million annually on abstinence-until-marriage education. Critics have repeatedly said they don't believe the programs are working, and the study will give them reinforcement.
However, Bush administration officials cautioned against drawing sweeping conclusions from the study. They said the four programs reviewed — among several hundred across the nation — were some of the very first established after Congress overhauled the nation's welfare laws in 1996.
Officials said one lesson they learned from the study is that the abstinence message should be reinforced in subsequent years to truly affect behavior.
"This report confirms that these interventions are not like vaccines. You can't expect one dose in middle school, or a small dose, to be protective all throughout the youth's high school career," said Harry Wilson, the commissioner of the Family and Youth Services Bureau at the Administration for Children and Families.
For its study, Mathematica looked at students in four abstinence programs around the country as well as students from the same communities who did not participate in the abstinence programs. The 2,057 youths came from big cities — Miami and Milwaukee — as well as rural communities — Powhatan, Va., and Clarksdale, Miss.
The students who participated in abstinence education did so for one to three years. Their average age was 11 to 12 when they entered the programs back in 1999.
Mathematica then did a follow up survey in late 2005 and early 2006. By that time, the average age for participants was about 16.5. Mathematica found that about half of the abstinence students and about half from the control group reported that they remained abstinent.
"I really do think it's a two-part story. First, there is no evidence that the programs increased the rate of sexual abstinence," said Chris Trenholm, a senior researcher at Mathematica who oversaw the study. "However, the second part of the story that I think is equally important is that we find no evidence that the programs increased the rate of unprotected sex."
Trenholm said his second point of emphasis was important because some critics of abstinence programs have contended that they lead to less frequent use of condoms.
Mathematica's study could have serious implications as Congress considers renewing this summer the block grant program for abstinence education known as Title V. The federal government has authorized up to $50 million annually for the program. Participating states then provide $3 for every $4 they get from the federal government. Eight states decline to take part in the grant program.
Some lawmakers and advocacy groups believe the federal government should use that money for comprehensive sex education, which would include abstinence as a piece of the curriculum.
"Members of Congress need to listen to what the evidence tells us," said William Smith, vice president for public policy at the Sexuality Information and Education Council of the United States, which promotes comprehensive sex education.
"This report should give a clear signal to members of Congress that the program should be changed to support programs that work, or it should end when it expires at the end of June," Smith said.
Smith also said he didn't have trouble making broader generalizations about abstinence programs based on the four reviewed because "this was supposed to be their all-star lineup."
But a trade association for abstinence educators emphasized that the findings represent less than 1 percent of all Title V abstinence projects across the nation.
"This study began when (the programs) were still in their infancy," said Valerie Huber, executive director of the National Abstinence Education Association. "The field of abstinence has significantly grown and evolved since that time and the results demonstrated in the Mathematica study are not representative of the abstinence education community as a whole."
The four programs differed in many respects. One was voluntary and took place after school. Three had mandatory attendance and served youth during the school day. All offered more than 50 hours of classes. Two were particularly intensive. The young people met every day of the school year.
Common topics included human anatomy and sexually transmitted diseases. Also, classes focused on helping students set personal goals and build self-esteem. The young people were taught to improve communication skills and manage peer pressure.
Brain, not heart, causes high blood pressure
The brain, not the heart is responsible for high blood pressure, according to details of a study by British researchers released Sunday.
The scientists said that hypertension, which can lead to heart attacks, strokes and kidney damage, is an inflammatory vascular disease of the brain rather than the heart, as previously thought.
They discovered that a protein located in the brain, JAM-1, trapped white blood cells, which can then cause inflammation and obstruct blood flow, leading to poor oxygen supply to the brain.
Professor Julian Paton, from Bristol University, western England, said the findings could lead to new ways of treating the condition.
"We are looking at the possibility of treating those patients that fail to respond to conventional therapy for hypertension with drugs that reduce blood vessel inflammation and increase blood flow within the brain," he added.
"The future challenge will be to understand the type of inflammation within the vessels in the brain, so we know what drug to use and how to target them.
"JAM-1 could provide us with new clues as how to deal with this disease."
Conventional treatment for reducing high blood pressure includes eating low fat food, reducing salt intake and regular exercise.
The associate medical director of the British Heart Foundation, Professor Jeremy Pearson, said: "This exciting study is important because it suggests there are unexpected causes of high blood pressure related to blood supply to the brain.
"It therefore opens up the possibility of new ways to treat this common, but often poorly managed condition."
About one in three people in Britain and more than 600 million people worldwide are thought to suffer from hypertension.
The findings are to be published in the next edition of medical journal Hypertension.
Women Under-Treated for Ovarian Cancer
Ovarian cancer is one of the most lethal cancers women can get, yet one out of three U.S. patients diagnosed with the disease doesn't get the full, recommended surgical treatment, a new study finds.
"It's very concerning that we see such a large proportion of women with ovarian cancer not being treated up to what we would consider a minimal standard for surgery," said the study's lead author, Dr. Barbara A. Goff, director of the division of gynecologic oncology at the University of Washington, Seattle.
Her team published the findings online April 9 in the journal Cancer.
According to the American Cancer Society, ovarian cancer is diagnosed in about 24,000 women in the United States each year, and 14,300 die annually from the disease. The cancer typically shows few symptoms until it is diagnosed in its advanced stages.
The new study builds on previous research, Goff said.
"People [in previous studies] have looked at this on a state-by-state basis. What this study really did was look across a broad geographic area of the U.S. It gave us a good sense of what is happening in our country," she said.
"Minorities, women who live in low-income areas, elderly women [over 70] and those who live in rural areas are significantly less likely to get comprehensive care compared to those women who don't meet those [criteria]," according to Goff.
The Seattle team analyzed hospital data from up to nine states for the period between 1999 to 2002, looking at factors associated with comprehensive surgical care.
Only 67 percent of the 10,432 women whose cases were reviewed got the recommended comprehensive surgical procedures. A third of women were treated at a hospital that performed fewer than 10 ovarian cancer surgeries a year -- not at the high-volume facilities that are considered superior.
Almost half received treatment from a surgeon who performed fewer than 10 such procedures a year, not the best scenario for a good outcome. One-fourth got care from a doctor who did only one ovarian cancer surgery annually.
Much previous research has found that women who are treated by specialists -- in this case gynecologic oncologists -- have better survival, and that those who have complete removal of the tumor (which is more often done by a specialist) have better survival.
An opinion issued by the American College of Obstetricians and Gynecologists in 2002 stressed the importance of referral to a gynecologic oncologist if ovarian cancer is suspected. A U.S.National Institutes of Health consensus panel issued similar recommendations on comprehensive surgery for ovarian cancer more than a decade ago.
Another expert said the study confirms the importance of seeing a gynecologic oncologist, as the ACOG opinion recommends.
"It matters who does the surgery," said Dr. Ilana Cass, director of the gynecologic oncology fellowship program at Cedars-Sinai Medical Center, Los Angeles, and a gynecologic oncologist.
The new study, she added, has more complete numbers than previous research.
The experts' prime advice for women diagnosed with ovarian cancer or suspected ovarian cancer: Seek out a specialist.
That's easier said than done, however, they added. The problem, Goff said, is that the diagnosis is usually made at the time of surgery. If ovarian cancer is even suspected, she said, women should seek a referral to a center with a high volume of ovarian cancer surgeries, performed by a specialist.
She defines "high volume" as 10 or more such surgeries per year. If a woman cannot find a center that does 10-plus procedures, finding a center and a physician that does at least more than one a year is next-best option. "Those doctors who did 2 to 10 ovarian cancer surgeries were significantly better than those who did only one," Goff noted.
Cass agreed that asking to be referred to a high-volume center and to be seen by a physician who is a gynecologic oncologist are both good steps.
"Women have to be advocates for themselves," she said.
Hispanic Women's Biology May Spur More Aggressive Breast Cancer
Biological factors, rather than simply differences in access to health care, may explain why Hispanic women in the United States are more likely to be diagnosed with more advanced and aggressive breast cancers, a new study finds.
Previous research has shown that the incidence of breast cancer varies according to race and ethnicity.
This study, by researchers at the University of Colorado Health Sciences Center and Kaiser Permanente Colorado, found that among women with equal access to health care services such as mammography and regular doctor visits, Hispanics were at significantly higher risk for being diagnosed with more advanced and more aggressive breast cancer and to be diagnosed at a younger age than non-Hispanic women.
Published in the May 15 issue of the journal Cancer, the study found that Hispanic women were nearly three times more likely to be diagnosed with stage IV disease and about twice as likely to have large tumors with cellular characteristics that predict poorer outcomes.
The study, which included 139 Hispanic and more than 2,100 non-Hispanic breast cancer patients, also found that Hispanic women were diagnosed at an average age of 56, compared to 61 for non-Hispanic women.
The racial differences persisted even after the researchers adjusted for the women's socioeconomic status and the length of time they'd been enrolled in the managed health care system.
The authors concluded that "the persistent findings of earlier mean age at diagnosis, advanced state, poorer grade, larger tumor size and fewer cases with estrogen receptors may suggest that true biological differences exist in breast cancer by ethnicity."
Coffee Lovers, Smokers at Lower Parkinson's Risk
Could smoking cigarettes and drinking coffee protect you from Parkinson's disease?
That's the startling suggestion of a new U.S. study of families that also found NSAID use has no impact on the disease risk.
Previous studies have reported that consuming caffeine, smoking and taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen may help prevent Parkinson's disease, according to background information in the study. But there's been little family-based research done to examine these links.
The new study, led by researcher Dana B. Hancock of Duke University Medical Center in Durham, N.C., included 356 Parkinson's patients (averaging about 66 years of age) and 317 of their family members (averaging almost 64 years of age).
The people with Parkinson's disease were 44 percent less likely to report ever smoking and 70 percent less likely to report current smoking compared with unaffected relatives, the study authors found.
"Increasing intensity of coffee drinking was inversely associated with Parkinson's disease," they added. "Increasing dosage and intensity of total caffeine consumption were also inversely associated, with high dosage presenting a significant inverse association with Parkinson's disease."
The study found no link between NSAID use and Parkinson's disease.
The findings are published in the April issue of the journal Archives of Neurology.
It's not known how smoking or caffeine consumption may help reduce the risk of developing Parkinson's disease.
"Given the complexity of Parkinson's disease, these environmental factors likely do not exert their effects in isolation, thus highlighting the importance of gene-environment interactions in determining Parkinson's disease susceptibility," the study authors wrote. "Smoking and caffeine possibly modify genetic effects in families with Parkinson's disease and should be considered as effect modifiers in candidate gene studies for Parkinson's disease."
Diabetes May Lead to Precursor of Alzheimer's
Adults with diabetes may be at higher risk for developing mild cognitive impairment, a condition that is often seen as a precursor to Alzheimer's disease, new research found.
"There is mounting evidence that diabetes is bad for cognition," said Dr. Jose A. Luchsinger, the lead author of the study and an assistant professor of medicine at Columbia University. "The mechanisms need to be elucidated. Type 2, or adult-onset diabetes, which the study refers to, is increasing in the U.S. and in the world. The consequences of the potential cognitive complications of diabetes could be devastating from a public health standpoint."
Still, there are perhaps more questions than answers in the new study, which was published Monday in the April issue of Archives of Neurology.
"What is the real message for diabetes control?" asked Dr. Larry Deeb, president of medicine and science for the American Diabetes Association. "If the message is that you're at greater risk for MCI (mild cognitive impairment) no matter what, that's one thing. If taking good care of blood sugar makes a difference, as seems to be the case for most other complications of diabetes, that's another thing. One would hope this might be another argument for controlling diabetes."
Health experts already knew that type 2 diabetes can be a risk factor for Alzheimer's disease. The evidence has been less clear on whether diabetes is related to a higher risk of mild cognitive impairment, often considered a bridge state between normalcy and Alzheimer's.
"There are few studies looking at the outcome of mild cognitive impairment," Luchsinger said.
More than 10 percent of the elderly population of the United States has diabetes. And the prevalence is twice as high among black Americans and Hispanics as it is among non-Hispanic whites.
For this study, Luchsinger and his colleagues looked at 918 men and women older than 65 (average age 75.9) who did not have mild cognitive impairment or dementia at the start of the study. The participants, all from northern Manhattan in New York City, were assessed every 18 months with an in-person interview as well as physical and neurological examinations.
Almost one-quarter -- 23.9 percent -- of the participants had diabetes, 68.2 percent had high blood pressure, 33.9 percent had heart disease, and 15 percent had suffered a stroke.
During follow-up that averaged 6.1 years, 334 of the participants developed mild cognitive impairment. And people with diabetes had a higher risk of having mild cognitive impairment, especially amnestic MCI, which affects memory more than non-amnestic MCI.
Overall, 8.8 percent of cases of mild cognitive impairment among the study participants could be attributable to diabetes. And the rates were higher for black Americans (8.4 percent) and Hispanics (11 percent) than for non-Hispanic whites (4.6 percent). This makes sense, given that minority populations in the United States have a higher prevalence of diabetes.
What explains the possible link between diabetes and impairment?
Diabetes could contribute to plaque build-up in the brain, with such a build-up a hallmark of Alzheimer's, the study authors said.
But, they added, more research is needed.
"Studies are needed to see if preventing diabetes prevents cognitive impairment and how diabetes treatment affects cognition," Luchsinger said. "We also need to see how cognitive impairment in persons with diabetes affects their ability to follow their treatment, which is usually complex and involves several medications."
Other experts applauded even the tentative findings.
This type of research may help target populations who could one day benefit from drugs, said Maria Carrillo, director of medical and scientific relations at the Alzheimer's Association.
"This supports the idea that risk factors are real," Carrillo added. "The field has now matured to a point where we can start looking at earlier and earlier aspects of the disease. It makes sense to look even earlier than that and try to tease out what the risk factors look like in that population, in case we have a disease-modifying drug coming up in near future."
"This is documenting what we know a little bit better and emphasizing that patients should control their blood sugar as well as they can early in the disease," added Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City. "This is another piece of information, more wood to the fire."
Change of Season Brings Lawn Mower Warning
Each year in the United States, about 9,400 children are treated for lawn-mower related injuries such as lacerations, fractures and amputations of the fingers, hands, toes, feet and legs, say experts at Johns Hopkins Children's Center.
"The No. 1 advice to parents is: Treat the lawn mower as hazardous equipment, not a toy. You don't let a child play with an electric saw, and that's exactly what a lawn mower is," Carol Gentry, pediatric OR nurse manager, said in a prepared statement
Of the lawn mower accident cases treated at the Johns Hopkins Children's Center between 2000 and 2005, 95 percent involved amputations that required reattachment or reconstructive surgery.
The Hopkins experts offer tips for preventing mower-related injuries:
* Children younger than age 6 should be kept indoors while a power mower is being used.
* No child younger than age 12 should use a walk-behind mower.
* Children under age 16 should not be on riding mowers, even if they're with an adult.
* If you're mowing and see a child running toward you, turn off the mower immediately. Children can fall and slip into the blade, especially if the grass is wet.
* Wear protective goggles and closed-toe shoes when operating a mower or when near one.
* Before mowing, clear the lawn of debris such as sticks and stones, which may get caught in the mower blades and be propelled out.
* If someone suffers a mower-related injury, call 911 immediately and apply pressure to the wound to stop bleeding while you wait for an ambulance.
* Buy mowers with a no-reverse safety feature that requires the operator to turn around and look behind before shifting the mower into reverse.
Abstinence education doesn't work
Abstinence-only education programs meant to teach children to avoid sex until marriage failed to control their sexual behavior, according to a U.S. government report.
Teenagers who took part in the programs as elementary and middle school students were just as likely to have sex as those who did not take part in them, the survey found.
The report, ordered by Congress, was not released by the Health and Human Services Department, but by activists and by California Democratic Rep. Henry Waxman (news, bio, voting record)'s office. An HHS spokeswoman did not answer a request for a comment.
The report revived the debate on government abstinence-only education programs, which are strongly supported by the administration of President George W. Bush.
"For both the program and control group youth, the reported mean age at first intercourse was identical, 14.9 years," says the report, available on the Internet at http://aspe.hhs.gov/hsp/abstinence07/index.htm.
Teens in both groups were just as likely to use condoms or birth control, the report found -- countering the fears of critics of abstinence-only education, who say children ignorant of how to protect themselves from pregnancy and sexually transmitted diseases will simply have more unprotected sex.
For the report, Christopher Trenholm and colleagues at Mathematica Policy Research, Inc. interviewed more than 2,000 teenagers with an average age of 16 1/2. They lived in rural and urban communities in Florida, Wisconsin, Mississippi and Virginia.
About 1,200 of them had taken part in abstinence-only education programs four to six years before.
"Over the last 12 months, 23 percent of both groups reported having had sex and always using a condom; 17 percent of both groups reported having had sex and only sometimes using a condom; and 4 percent of both groups reported having had sex and never using a condom," the researchers wrote.
SEVERAL PARTNERS
"Program and control group youth also did not differ in the number of partners with whom they had sex," they added.
About 25 percent in both groups had already had sex with three or more partners.
"This data supports what a growing body of public health evidence has indicated: Abstinence-only programs don't protect teen health," said Waxman, chairman of the House of Representatives Government Oversight Committee.
"In short, American taxpayers appear to have paid over one billion federal dollars for programs that have no impact."
The report said the federal government has spent $87.5 million annually since 1998 for abstinence-only education programs.
Activists said the findings showed that children need more comprehensive education about abstinence, contraception and sex in general.
"The vast majority of the public does not see abstinence and contraception as an either/or proposition -- they want teens to be informed of both," Sarah Brown, Executive Director of the National Campaign to Prevent Teen Pregnancy, said in a statement.
"We have been promoting ignorance in the era of AIDS, and that's not just bad public health policy, its bad ethics," added James Wagoner, president of Advocates for Youth.
But proponents of abstinence-only education said the report just suggested more such education is needed.
"To the contrary, the report specifically indicates that programs should continue with changes where necessary to make them more effective, particularly 'promoting support for abstinence among peer networks' as an important feature." said Dr. Gary Rose, president of The Medical Institute.
Rattlesnake Capsules Linked to Salmonella Poisoning
Capsules of dried rattlesnake meat -- a Hispanic folk remedy purported to cure a host of health problems including acne, impotence, AIDS and cancer -- can be contaminated with a potentially lethal strain of salmonella bacteria, a U.S. infection control expert warns.
John James, a microbial epidemiologist at Children's Hospital in Denver, said the life-threatening strain of bacteria -- Salmonella arizonae -- in capsules of dried rattlesnake meat caused a child to become seriously ill. The child survived.
James talked about that case and the overall issue on Saturday at the annual scientific sessions of the Society for Healthcare Epidemiology of America in Baltimore.
"Anecdotal evidence linking capsules of dried rattlesnake meat to salmonella poisoning has been reported for years. For the first time, however, we've used DNA molecular testing to prove definitively that the salmonella bacteria found in the dried meat was the cause of a life-threatening case of salmonella blood poisoning in a patient treated at our hospital," James said in a prepared statement.
Salmonella arizonae is commonly found in snakes and lizards.
"Unfortunately, the rattlesnake capsules -- believed by some to treat many types of diseases -- are often given to people whose immune systems already are compromised," James said. The child in this case had systemic lupus.
"These capsules should be removed from the market, or the manufacturers should be required by the U.S. Food and Drug Administration to irradiate the product before it is sold," James said.
Friday, April 13, 2007
Yoga shown to help women with breast cancer
Women with breast cancer that has spread beyond the breast may benefit from participating in a tailored yoga program that includes gentle yoga postures, breathing exercises, and meditation, new research suggests.
"The benefits could include less pain and fatigue, and more vigor, relaxation, and acceptance," study leader Dr. James W. Carson, from Duke University Medical Center, Durham, North Carolina, told Reuters Health.
Effective ways to curb cancer-related symptoms are needed for women with advanced breast cancer, Carson and his associates note in the Journal of Pain and Symptom Management. The "Yoga of Awareness" program, which is specifically designed and tailored to address patients' pain, fatigue, and emotional distress, seems to fit the bill, according to results of a pilot study.
Thirteen women with breast cancer that had spread to other sites in the body attended the yoga classes once weekly for 8 weeks. The women were an average of 59 years old and had been first diagnosed an average of 7 years beforehand.
The program proved "helpful in significantly boosting daily invigoration and a sense of acceptance," the investigators report. "There were also trends for improvement in pain and relaxation."
They also found that "greater practice on a given day was associated with improvements not only on the same day, but the next day as well."
This study "provides some of the first, tentative evidence for yoga's potential benefits in this vulnerable population of women with limited life expectancy," Carson and colleagues conclude.
SOURCE: Journal of Pain and Symptom Management, March 2007.
Senate panel approves Medicare drug price bill
The U.S. Senate Finance Committee on Thursday approved a bill that would permit the government to negotiate for Medicare prescription drug prices, throwing down a challenge to the powerful drug industry.
Moved forward by the committee on a 13-8 vote, the bill is expected to go next week to the full Senate, where debate is likely to be intense, Senate aides said.
The House of Representatives in January passed a tougher version of the bill.
President George W. Bush has vowed to veto the House bill. It would require, not just permit, direct negotiation over prices by the government with drug companies.
Medicare is a national health insurance program that covers more than 40 million elderly and disabled Americans. It was expanded last year to add a prescription drug benefit. Coverage is managed for Medicare by dozens of private companies.
The legislation expanding Medicare -- passed when Republicans ran Congress -- prohibited the government from negotiating over drug prices with manufacturers, such as Pfizer, Merck or Eli Lilly.
Democrats now in charge on Capitol Hill want to eliminate the negotiation bar. They say government negotiation would save money both for the government and for older Americans by helping the private firms get the best drug prices possible.
The negotiation bar prevents "efforts to make the drug benefit work better for seniors. It should be eliminated," said Finance Committee Chairman Max Baucus (news, bio, voting record), a Montana Democrat and the bill's chief sponsor, at a committee meeting.
But many Republicans, drug makers and other opponents say such a move would limit patient choices, while achieving no cost savings. Medicare officials also say drug coverage is working fine now and is costing less than expected.
The Congressional Budget Office said on Tuesday in letters to lawmakers that allowing government price negotiation could achieve savings among some drugs, but "would have a negligible effect on federal spending."
Iowa Sen. Chuck Grassley, senior committee Republican, said, "Having the government negotiate drug prices for Medicare might be a good sound bite, but it's not sound policy."
At present, he said, the private companies managing the drug benefit for Medicare compete among themselves and negotiate over prices with drug manufacturers.
"We have lower drug prices for beneficiaries, lower program costs for the government, and prescription drug choices ... Competition is working," Grassley said.
Some Senate Democrats endorsed a more forceful approach like the House-passed bill. But they praised Baucus for seeking a political middle ground by leaving price negotiation up to the discretion of the Secretary of Health and Human Services, whose department is in charge of the Medicare program.
Minimally Invasive Lung Procedure Boosts Chemotherapy
Lung cancer patients who have minimally invasive surgery called thoracoscopic lobectomy to remove their tumors may have better chemotherapy outcomes than patients who have traditional open chest surgery, a new study says.
The patients who have thoracoscopic lobectomy -- performed through two or three small incisions in the side of the chest -- may also have shorter hospital stays and shorter recovery times, according to the Duke University Medical Center study published in the April issue of the journal Annals of Thoracic Surgery.
Researchers looked at the outcomes of 100 lung cancer patients treated with either thoracoscopic lobectomy or traditional surgery. Of those who had the minimally invasive surgery, 18 percent experienced delayed chemotherapy, compared with 58 percent of patients who had traditional surgery. In addition, 26 percent of patients who had thoracoscopic lobectomy experienced a reduction in the dosage of their planned chemotherapy regimen, compared with 49 percent of patients who had traditional surgery.
"This study showed that patients who had the minimally invasive operation were less likely to experience delays in receiving chemotherapy or a reduction in the amount of chemotherapy we were able to give," senior investigator and lung surgeon Dr. Thomas D'Amico said in a prepared statement.
"Chemotherapy after surgery has been shown to improve survival in lung cancer patients, so the more effectively we deliver that chemotherapy, the better."
Currently, thoracoscopic lobectomy is used in about 10 percent of lung cancer surgeries in the United States, but more than half of all patients who require surgery to remove lung cancer could be candidates for the procedure, D'Amico said.
Antidepressant promising for tension headaches
For some patients seeking relief from frequent tension-type headaches, the antidepressant Effexor XR may reduce the number of days with headache, according to results of a small study conducted in Greece.
The team of researchers, led by Dr. N. P. Zissis, at Wyeth Hellas in Athens, recruited patients with tension headaches that occurred more often than on five days per month.
The 60 participants were randomly assigned to Effexor (known generically as venlafaxine) XR or an inactive placebo. They could also take aspirin or paracetamol/acetaminophen but no other pain killers, according to a report in the medical journal Cephalalgia.
At the end of the 12-week trial, the average reduction in the numbers of days with headache was significantly greater in the venlafaxine group (45 percent) compared with the placebo group (16 percent).
The total hours of headache and headache intensity also improved more with active treatment, but the differences were not significant from a statistical standpoint.
This pilot study suggests that "treatment with venlafaxine XR was generally safe and, compared with placebo, resulted in less days with tension-type headache," Dr. Zissis and colleagues conclude.
SOURCE: Cephalalgia, April 2007.
Human sperm made from bone marrow cells
Scientists have succeeded in turning human stem cells into immature sperm cells which researchers said could lead to treatments for male infertility in a study published Friday.
The lead scientist, Karim Nayernia, last year succeeded in using sperm cells created from mouse embryonic stem cells to fertilize mice eggs, resulting in seven live births.
Experts in cell biology, however, cautioned that the results must be evaluated with caution and may not lead to the hoped for developments.
The results of the experiment, conducted in Germany, were published in the journal Reproduction: Gamete Biology.
Nayernia and his colleagues took bone marrow from human volunteers and isolated a type of stem cell that normally grows into other body tissue, especially muscle.
They then cultured the cells in a laboratory in such a way that they became male reproductive cells, bearing genetic markers specific to partly-developed sperm.
In most men, these "proto-sperm" -- known as spermatagonial cells -- develop into mature, functioning sperm, but in the experiment the growth stopped at the most preliminary stage.
"We're very excited about this discovery, particularly as our earlier work in mice suggests that we could develop this work even further," said Nayernia in a statement.
"Our next goal is to see if we can get the spermatagonial stem cells to progress in mature sperm in the laboratory," he said.
But other experts suggest that it is too soon to conclude that therapies could evolve directly out of these experiments.
"The observations are interesting but one must be cautious about drawing conclusions based purely on the expression of a few molecular markers, without supporting functional data," said Peter Andrews, a bio-medical scientist and co-director of the Centre for Stem Cell Biology and the University of Sheffield in England.
In general, manipulating stems cells, he warned, can cause lasting genetic changes with unpredictable results.
Stem cell research faces not only scientific barriers, but legal and ethical ones as well. Many countries-- including the United States and France -- have placed very strict limitations on stem cell research, especially when the cells originate from human embryos.
The British government has recently proposed a ban on using artificially created sperm or eggs in human reproduction.
Earlier this month, researchers at the Imperial College London announced that they had succeeded in growing tissue from stem cells in bone marrow that works in the same way as the valves in human hearts, opening up the possibility that replacement tissue could be used in transplants for heart disease patients.
Growing replacement tissue from stem cells has been a key goal of scientists. Damaged body part replaced by tissue that is genetically matched to the patient cannot be rejected.
To date, scientists have grown tendons, cartilage and bladders, but no complex organs organs.
Antibiotic Ointment Treats Impetigo
An antibiotic ointment called Altabax (retapamulin) has been approved to treat children and adults with a bacterial skin infection called impetigo, the U.S. Food and Drug Administration said Friday.
The drug, a new molecular entity not previously approved in the United States, can be used on people aged nine months or older, the FDA said.
The approval was based on a study of about 3,000 people who received either Altabax, different antibiotics, or a non-medicinal placebo. The most common side effect among those using Altabax was irritation at the site where it was applied. This occurred in less than two percent of people who used the ointment, the FDA said.
Altabax, which will be available by prescription, is made by North Carolina-based GlaxoSmithKline.
90% of Elementary School Kids Are Bullied
Nine out of 10 elementary school kids have been subjected to physical or psychological bullying by their peers, while six in 10 have been bullies themselves, according to a new study.
"The results show that even going down to young ages, we have very high levels of bullying and victimization," said study lead author Dr. Thomas P. Tarshis, who conducted the research while with the division of child and adolescent psychiatry at Stanford University Medical Center.
Citing the lack of a fast and insightful way to gauge elementary school bullying, Tarshis first teamed with Stanford colleague Dr. Lynne C. Huffman to design a new and simple questionnaire that could be completed by children quickly and reliably.
The survey was restricted to a single page of multiple-choice questions aimed at a third-grade reading level and was designed to be completed in a classroom setting within five to 10 minutes. The children were asked 22 questions describing one of two bullying scenarios -- "direct" bullying involving physical violence or the threat of harm and "indirect" bullying involving social ostracizing, teasing, giving "looks" or spreading rumors.
With funding from the U.S.
National Institutes of Health, Tarshis and Huffman administered the questionnaire in 2004 to 95 boys and girls attending fourth through sixth grades at two California elementary schools and 175 students attending third through fourth grade in one school in Arizona. The schools from which the kids were drawn were approximately 60 percent white, 20 percent Hispanic and 6 percent African-American.
Of the nine out of 10 students who indicated they had been a victim of bullying at some point, most said they had been subjected to several types of bullying at least "sometimes" -- a finding the researchers defined as a "high level" of victimization.
The percentage of children who said they had been bullies themselves did not vary significantly between grades. By contrast, fewer fifth graders said they had been a victim of bullying, compared to children in the other grades.
The findings are published in the April issue of the Journal of Developmental and Behavioral Pediatrics.
Tarshis, who is now director of the Bay Area Children's Association in Cupertino, Calif., and Huffman suggested that the new test seems to be a useful and easy-to-administer tool to help educators get a quick handle on the degree of bullying going on in schools. It can also be used to spark discussion among students on what appears to be a widespread problem, the researchers said.
"We need to shift the mindset that being bullied in school is OK, because we know that kids who are victimized and bullied have poor outcomes in the future," he said. "And, in reality, it's affecting a majority of kids in our schools."
"So, we need to increase awareness, and parents need to talk to their kids about what's going on in school," Tarshis said. "Children and their peers, teachers and school staff, and parents and guardians, all need to be involved."
But Dr. Christopher Lucas, associate professor of psychiatry at New York University's Child Study Center and director of its Early Childhood Service, thinks the problem of bullying may not be quite so pervasive as the new survey suggests.
"I'm very skeptical about nine out of ten," said Lucas. "That number is huge. But you have to keep in mind that when little kids self-report, there tends to be a lot of over-reporting. And my suspicion is that they may well be including behaviors that wouldn't be regarded by most people as bullying in terms of either frequency or intensity."
Lucas' own research suggests considerably lower levels of bullying -- along the lines of 50 percent saying they've been bullied and 15 percent saying they've bullied themselves.
But he agreed that bullying is a widespread problem that needs serious attention.
"New ways of bullying -- not always violent -- are constantly developing, such as the name-calling and insulting that's happening now on social networking sites like 'Facebook' and 'Myspace.com,' " he said. "And there are a lot of negative consequences for all kinds of bullying. It's one of the most common forms of stress among young people, and people who are bullied have more physical illness, more school absence, lower academic achievement, and are more likely to become bullies themselves over time. So, yes, it's serious."
Free Asthma Screenings to be Offered Across the U.S.
During May, adults and children across the United States can get checked for asthma during the 11th annual Nationwide Asthma Screening Program, sponsored by the American College of Allergy, Asthma & Immunology.
The free screenings will be conducted at 300 locations throughout the country as part of National Asthma and Allergy Awareness Month. In its first 10 years, the program screened more than 100,000 people and referred more than half of them for a professional diagnosis.
During a screening, adults complete a 20-question test developed by the ACAAI for the program, while children under age 15 fill out a test designed for them. And there's another version that parents fill out for children up to 8 years old.
The screening also includes a lung function test that involves blowing into a tube and a meeting with an allergist to discuss whether a person requires a more thorough examination in order to determine if they have asthma.
"A cough that bothers you at night, shortness of breath when going up stairs, colds that go right to your chest -- these are all symptoms of asthma, but few people recognize them," Dr. John Winder, chairman of the Nationwide Asthma Screening Program, said in a prepared statement.
"Instead, people often make unnecessary lifestyle compromises to live with their condition, and there's no reason to do that. People with breathing problems, or who think their asthma could be better managed, should attend a free asthma screening," Winder said.
About 23 million Americans, including nine million children, have asthma, which kills about 4,000 people a year. There are a number of ways to control asthma.
The screening program is supported by the drug maker AstraZeneca.
Scientists Frustrated in Search for Genital Herpes Vaccine
Experts say a lack of funds is slowing attempts to find a truly effective vaccine against genital herpes, a sexually transmitted disease that can be devastating for the one in five Americans over 12 who carry the virus.
Genital infection with the herpes simplex viruses (HSV) 1 or 2 is not just an inconvenience, doctors note. It is a painful, recurrent illness that causes psychological distress, raises health risks for newborns, and boosts the carrier's odds for a much more deadly virus,
HIV.
And even as the Herpevac trial -- the first major publicly funded trial of a preventive vaccine -- is set to get under way, a leader of that trial says the vaccine, even if successful, would not be the solution to the herpes epidemic.
"The Herpevac trial is a vaccine that is only going to affect the [uninfected] adolescent woman," said Dr. Lawrence Corey, head of infectious diseases and virology at the University of Washington, in Seattle. "It is not going to be effective in men or in those who are HIV-positive. We need to do better."
Prior, expensive failures have made the drug industry skittish about funding herpes vaccine trials, however. So, despite the fact that most adult Americans either have HSV-1 or 2, or are at very high risk of contracting it in their lifetime, not enough is being done to stop the pathogen.
"I would say that, at the moment, the genital herpes vaccine is a field that does not have much interest, does not have much money," Corey said. "The need for an HSV vaccine is really substantive, but there is not much of a program in the industrialized, developing world to develop such a vaccine."
Part of the problem lies in the complexity of the virus. While simpler viruses such as the flu simply mutate their outer coats to evade the human immune system, HSV and other persistent viral infections are much more stable.
However, they have another secret weapon. Compared to other viruses, HSV 1 and 2 "have a lot more genes and gene products that are redirecting and subverting the [host] immune response," Corey explained.
Although the two strains are similar and can infect either mouth or genitalia, HSV-1 is the prime cause of oral herpes (cold sores and fever blisters), while HSV-2 is the usual source of genital infections.
Another tactic keeps herpes well-shielded from immune attack. Unlike pathogens that spread in readily accessed blood, HSV hides out in nerve cells called dorsal ganglia, located in the back. Specific triggers, such as sun exposure or stress, can send the virus traveling through nerve pathways to mucosal sites of activity in the genitalia, mouth and even eyes.
These nerve cells are "a protected site, immunologically," explained Dr. Lawrence Stanberry, director of the Sealy Center for Vaccine Development at the University of Texas Medical Branch in Galveston. "Needless to say, we don't like to have our immune system attacking our nerves," he said, so vaccines with that kind of reach are hard to develop.
And yet, progress is being made. The Herpevac trial, funded by the U.S.
National Institutes of Health and drug maker GlaxoSmithKline, is focused on a preventive vaccine aimed solely at uninfected women. Preliminary, phase III studies completed last year found the vaccine to be 73 percent effective in shielding young women from infection after exposure to HSV-2.
A 73 percent effectiveness rate may not sound all that impressive, but Stanberry -- also an investigator on the Herpevac trial -- said no one is expecting 100 percent immunization.
"What one hopes for with a vaccine is that you get very high rates of effectiveness and then very broad uptake of the vaccine [in the population]," he explained. "So then, if almost everyone gets immunized, then the disease simply doesn't circulate in the population to the same extent."
Reducing the "pool" of available virus will be vital to lowering the infection rate, researchers say, because the Herpevac shot does not protect uninfected men and cannot eliminate HSV from people who are already infected.
The Herpevac trial is currently wrapping up recruitment of 7,000 healthy, HSV-negative U.S. women between the ages of 18 and 30. Participants will receive either the vaccine or a placebo and then be followed for 18 months to see if they become infected.
Stanberry said final results from the trial should be available by 2009, and -- if the vaccine proves effective -- a shot might be approved by 2010.
However, like most modern vaccine trials, the Herpevac trial relies on a piece or "subunit" of HSV to prime the human immune system against incoming virus.
Another researcher is advocating the use of the live -- but greatly weakened -- form of the virus, instead.
The problem with the subunit approach is that its effects don't last, said William Halford, a virologist at Montana State University, in Bozeman. "Once you deliver it into someone's body, it's there, but, in a few weeks, it is gone," he said.
Live virus vaccines have a long and effective history. In fact, one of the few effective vaccines against any herpes strain -- the chickenpox/shingles (herpes zoster) shot -- was developed from live virus back in the 1960s.
Since that time, doctors have gotten more skittish about injecting people with a live form of the virus, however, so the subunit approach took precedence.
But Halford believes it is time to revisit the idea of a live virus herpes vaccine.
"All we really have to do is to figure out a way to take away some of the genes or proteins that the virus needs to cause actual disease," he said. In other words, people would be infected with a very weak form of HSV, one that is sufficient to trigger a sustained immune response but too frail to trigger disease outbreaks.
Halford is specifically investigating a protein in HSV called ICP0. "If I take away the gene that codes for that protein, the virus is really weakened," he said.
The approach is controversial, but Corey believes it could have promise. "I certainly think that the live attenuated virus is a viable approach to talk about," he said.
Funding will be the real challenge, however, whatever the vaccine strategy. According to Corey, a series of expensive failures over the past two decades has dampened the enthusiasm of industry to invest in HSV vaccine research.
"I can give my own scenario in which we worked with [drug maker] Chiron and spent seven years and a lot of money -- decapitalizing the company by 25 percent -- on an antibody-based vaccine," Corey said. "At the time, we thought it would be sufficient to work, but it didn't."
So, with the private sector waiting on the sidelines, public funding becomes key.
"I think there needs to be more money from the publicly funded institutions -- whether they be foundations, the NIH or the
National Research Council, in vaccine development," Corey said.
"We also need to do more in defining a real path of success for a genital herpes vaccine," he added. "Once some pathway of success becomes defined, then you'll see the pharmaceutical companies move forward."
Drug-resistant gonorrhea spreads in US
Drug-resistant gonorrhea is spreading across the United States and new treatments are needed to combat the sexually transmitted disease, the federally run Centers for Disease Control said Friday.
The CDC is so alarmed at the spike in cases of gonorrhea, one of the most common STDs in America, that it is no longer recommending doctors treat it with kind of antibiotics typically prescribed in the past, it said in a statement.
The warning came after a study showed that the number of gonorrhea cases in men rose dramatically in 26 US cities between 2001 and 2006.
A full 13.3 percent of cases were found to be resistant to antibiotics known as fluoroquinolones in the first half of 2006, compared to less than one percent in 2001.
"We are running out of options to treat this serious disease," said Dr. Kevin Fenton of the CDC, adding there was "an urgent need for new, effective medicines to treat gonorrhea."
Previously, orally administered drugs known as ciprofloxacin, ofloxacin and levofloxacin were prescribed to treat the disease. Now the CDC is recommending a single class of antibiotics known as cephalosporins, often administered by injection.
Gonorrhea is believed to affect 700,000 Americans each year and is the second most commonly reported sexually transmitted disease after chlamydia. Gonorrhea can cause sterility in men and women and can make it easier to contract
HIV.
CDC alarmed at rise of drug-resistant gonorrhea
Gonorrhea in the United States is now resistant to all but one class of antibiotic drugs, threatening doctors' ability to treat the common sexually transmitted disease, officials said on Thursday.
The U.S. Centers for Disease Control and Prevention said it will no longer recommend antibiotics called fluoroquinolones to combat the bacterial disease because of the emergence of drug-resistant strains in recent years that thwart them.
The
CDC said there is no indication the bacterium that causes gonorrhea is becoming resistant to the remaining class of antibiotics it recommends, known as cephalosporins.
"Although the cephalosporins offer several potential options for treating gonorrhea, the lack of additional classes of antibiotics is a serious concern. There are currently no new drugs for gonorrhea in the drug development pipeline," Dr. John Douglas, director of the CDC's Division of Sexually Transmitted Diseases Prevention, told reporters in a conference call.
The CDC released data showing gonorrhea resistant to fluoroquinolones has become widespread among heterosexual men after previously becoming so among homosexual and bisexual men.
"While we have not seen any significant resistance to cephalosporins to date, any emerging resistance would be a significant public health concern. Clearly, there is an urgent need for new, effective medicines to treat gonorrhea as we are running out of options to treat this serious disease," Douglas added.
The CDC said it recommends an injectable drug called ceftriaxone, sold by Roche Pharmaceuticals as Rocephin, to treat genital, anal and throat gonorrhea.
Drug-resistant strains also are on the rise in other parts of the world, the CDC said. All types of bacteria quickly mutate and can develop resistance to medicines designed to kill them.
RISE OF 'SUPERBUGS'
Gonorrhea is an example of the rise of "superbugs" that have evolved to beat antibiotics that once vanquished them. Many experts decry the overuse of antibiotics, which can fuel the emergence of drug-resistant bacteria.
Douglas said gonorrhea previously became resistant to other antibiotics, penicillin and tetracycline, before starting to conquer the fluoroquinolones.
"Gonorrhea has now joined the list of other superbugs for which treatment options have become dangerously few," Dr. Henry Masur, president of the Infectious Diseases Society of America advocacy group, said in a statement.
More than 700,000 Americans get new gonorrheal infections annually, the CDC estimates.
Gonorrhea can cause serious and permanent health problems. The bacteria thrive in the warm, moist areas of a woman's reproductive tract and in the urine canal of men and women. They also grow in the mouth, throat, eyes and anus.
The agency released data from 26 U.S. cities involving the infection of men, showing that resistance to fluoroquinolones increased from less than 1 percent of cases in 2001 to 13.3 percent in the first half of 2006.
Among homosexual and bisexual men, 38 percent of gonorrhea cases were resistant in the first half of last year. Among heterosexual men, 6.7 percent were resistant.
The CDC said the highest reported rates of infection are among sexually active teenagers and young adults, and the disease is seen disproportionately among U.S. blacks. Proper condom use and sexual abstention can prevent the spread of the disease, the CDC said.
CDC says gonorrhea is drug-resistant
The sexually transmitted disease gonorrhea is now among the "superbugs" resistant to common antibiotics, leading U.S. health officials to recommend wider use of a different class of drugs to avert a public health crisis.
The resistant form accounts for more than one in every four gonorrhea cases among heterosexual men in Philadelphia and nearly that many in San Francisco, according to a survey that led to Thursday's recommendation by the Centers for Disease Control and Prevention.
Gonorrhea, which is believed to infect more than 700,000 people in the United States each year, can leave both men and women infertile and puts people at higher risk of getting the
AIDS virus.
Since the early 1990s, a class of drugs known as fluoroquinolones has provided a relatively easy cure. These antibiotics, taken as tablets, include the drug Cipro.
But a growing number of gonorrhea cases is resistant to those drugs, and officials at the
CDC for the first time are urging doctors to stop using fluoroquinolones and switch to cephalosporins, a different class of antibiotics, to treat everyone.
Those drugs — which include the generic ceftriaxone or brand name Rocephin, made by Swiss drug maker Roche Holding AG — must be given as a shot and aren't as readily stocked as Cipro on most doctor's shelves.
"Gonorrhea has now joined the list of other superbugs for which treatment options have become dangerously few," said Dr. Henry Masur, president of the Infectious Disease Society of America. "To make a bad problem even worse, we're also seeing a decline in the development of new antibiotics to treat these infections."
The CDC made the new recommendation after discovering that nearly 7 percent of gonorrhea cases among heterosexual men in a survey of 26 U.S. cities last year were drug-resistant. In 2001, only about 0.6 percent of gonorrhea cases among heterosexual men were drug-resistant.
"That leaves us with a single class of highly effective antibiotics," said Dr. John Douglas Jr., director of the CDC's division of STD prevention. Other experts called the situation perilous.
"We are running out of options to treat this disease," added Douglas, who said there are "no new drugs for gonorrhea in the drug development pipeline."
Previously, CDC recommended against fluoroquinolones to treat drug-resistant gonorrhea among men who have sex with men and in certain states, including California and Hawaii where most of these cases were turning up.
Described by Douglas as a "very wily" disease, gonorrhea has worked its way through decades of other treatment regimens, from sulfa drugs used in the 1930s and 1940s, to penicillin, which was used from the 1940s until the mid-1980s.
Gonorrhea, spread through sexual contact, is the second most commonly reported infectious disease in the United States, trailing only chlamydia, which the CDC says affects more than 2.1 million people yearly in the U.S.
The highest rates of infection are among sexually active teens, young adults and African-Americans. Because many people don't have obvious symptoms, they can unknowingly spread it to others. And having it makes people more susceptible to
HIV. Gonorrhea's spread is preventable through consistent and proper use of condoms, experts said.
In women, the infection can cause pelvic inflammatory disease. In men, it can cause epididymitis, a painful condition of the testicles that can lead to infertility if untreated, the CDC said.
In the survey of gonorrhea cases among heterosexual men in 26 cities last year, Philadelphia had the highest percentage of drug-resistant cases with almost 27 percent, a dramatic increase from only 1.2 percent in 2004.
San Francisco's drug-resistant cases more than doubled between 2004 and 2006, from 10.3 percent to 22.5 percent. During the same period, Miami's cases spiked from 2.1 percent to 15.3 percent and Atlanta's climbed from 1 percent to 5.7 percent.
Senate panel approves Medicare drug price bill
The U.S. Senate Finance Committee on Thursday approved a bill that would permit the government to negotiate for Medicare prescription drug prices, throwing down a challenge to the powerful drug industry.
Moved forward by the committee on a 13-8 vote, the bill is expected to go next week to the full Senate, where debate is likely to be intense, Senate aides said.
The House of Representatives in January passed a tougher version of the bill. President George W. Bush has vowed to veto the House bill. It would require, not just permit, direct negotiation over prices by the government with drug companies.
Medicare is a national health insurance program that covers more than 40 million elderly and disabled Americans. It was expanded last year to add a prescription drug benefit. Coverage is managed for Medicare by dozens of private companies.
The legislation expanding Medicare -- passed when Republicans ran Congress -- prohibited the government from negotiating over drug prices with manufacturers, such as Pfizer, Merck or Eli Lilly.
Democrats now in charge on Capitol Hill want to eliminate the negotiation bar. They say government negotiation would save money both for the government and for older Americans by helping the private firms get the best drug prices possible.
The negotiation bar prevents "efforts to make the drug benefit work better for seniors. It should be eliminated," said Finance Committee Chairman Max Baucus (news, bio, voting record), a Montana Democrat and the bill's chief sponsor, at a committee meeting.
But many Republicans, drug makers and other opponents say such a move would limit patient choices, while achieving no cost savings. Medicare officials also say drug coverage is working fine now and is costing less than expected.
The
Congressional Budget Office said on Tuesday in letters to lawmakers that allowing government price negotiation could achieve savings among some drugs, but "would have a negligible effect on federal spending."
Iowa Sen. Chuck Grassley, senior committee Republican, said, "Having the government negotiate drug prices for Medicare might be a good sound bite, but it's not sound policy."
At present, he said, the private companies managing the drug benefit for Medicare compete among themselves and negotiate over prices with drug manufacturers.
"We have lower drug prices for beneficiaries, lower program costs for the government, and prescription drug choices ... Competition is working," Grassley said.
Some Senate Democrats endorsed a more forceful approach like the House-passed bill. But they praised Baucus for seeking a political middle ground by leaving price negotiation up to the discretion of the Secretary of Health and Human Services, whose department is in charge of the Medicare program.
Senate panel OKs negotiating drug prices
An effort to let the government negotiate drug prices on behalf of the elderly and the disabled moved a step closer to reality Thursday with the approval of legislation by a Senate committee.
Democratic lawmakers used their majority status to pass the measure. They said government negotiations in some cases could lower the cost of prescription drugs for Medicare beneficiaries. People in Medicare drug plans now rely on their insurers to conduct those negotiations.
"When you're negotiating on behalf of 43 million people, that's leverage," said Sen. Kent Conrad (news, bio, voting record), D-N.D.
The legislation approved Thursday simply strikes a clause that prohibits the secretary of Health and Human Services from interfering in the negotiations between drug makers, insurers and pharmacies. The committee approved the bill 13-8, with two Republicans, Sens. Olympia Snowe (news, bio, voting record) of Maine and Gordon Smith (news, bio, voting record) of Oregon, voting with the Democrats on the committee.
Sen. Max Baucus (news, bio, voting record), D-Mont., the bill's author, said the prohibition on government negotiations went too far. "We eliminated the government's role in getting fair drug prices for seniors," he said.
Republicans noted that the Congressional Budget Office, in reviewing the measure, found it would have a "negligible effect" on federal spending. Sen. Charles Grassley (news, bio, voting record), R-Iowa, said the bill made for a good sound bite, but not effective policy. He said the program is already costing less than expected and that Medicare beneficiaries say they're happy with the drug benefit.
"This bill does nothing more than keep alive a political pandering approach Democratic leaders have committed against Medicare beneficiaries and the public on the issue," Grassley said.
The Bush administration also objects to giving the secretary the authority to negotiate drug prices.
"This is not a debate about lowering the drug costs for seniors. That's already happening," HHS Secretary Mike Leavitt told reporters earlier. "This is a surrogate for a larger issue, which is government-run health care."
Drug curbs repetition in Alzheimer's patients
Treatment with the Alzheimer's drug galantamine (Shire Pharmaceutical's Reminyl) reduces repetitive verbalization by people with Alzheimer's disease, according to a new study.
"Verbal repetition is common in people with Alzheimer's disease, clinically important, and easily identified," Dr. Kenneth Rockwood, of Dalhousie University, Halifax, Nova Scotia, Canada, and colleagues write in the medical journal Neurology.
The team previously found that another Alzheimer's drug often improved verbal repetition, along with other aspects of the condition. This prompted them to look at data from a 4-month clinical trial of galantamine versus an inactive placebo in 130 patients with mild to moderate Alzheimer's disease.
After 4 months, 58% of galantamine-treated patients and 24% of placebo-treated patients showed a decrease in verbal repetition. Furthermore, a reduction in verbal repetition correlated with improvement in clinical measures.
"Although inadequate on its own as an assessment of treatment response, tracking changes in verbal repetition in patients in whom it is identified as a problem offers a convenient way to begin discussions about treatment and a valid example for patients and families about the sorts of benefits that treatment with galantamine can offer some patients with mild to moderate Alzheimer's disease," Rockwood's team concludes.
SOURCE: Neurology, April 3, 2007.
Smell Test Device May Sniff Out Health Problems
A new device to test for loss of smell could help alert doctors to problems ranging from a deviated septum to Alzheimer's disease, say University of Cincinnati researchers who are developing it.
Tests on five different prototypes of the Sniff Magnitude Test are scheduled to begin in the near future. The device would be used primarily by neurologists and otolaryngologists, said co-inventor and psychology professor Robert Frank.
"The whole test is based on the very simple observation that when you sniff and you detect a smell, you take a smaller sniff than if you inhaled and didn't detect a smell. For someone with normal sense of smell, the size of the sniff when detecting an odor is cut in half. For someone who cannot detect odor, the size of the sniff for just air and the size of the sniff for odor are the same," Frank said in a prepared statement.
The sense of smell is more susceptible to harm than other senses, because the brain doesn't devote much "neurological machinery" to it, he noted.
"So, that's the reason it might be acting a little bit like the canary in the mineshaft. Because it's more fragile, when you have insult to the brain, it may be sensitive to loss earlier in the disease process," Frank said.
If a person fails the Sniff Magnitude Test "that's a pretty good indication that there's something wrong with their sense of smell. Maybe there's an obstruction -- a deviated septum or polyps. Perhaps the olfactory nerve has been damaged due to a head injury or a viral infection," he said.
The test uses three odors to test a patient's sense of smell: a blend of ripe cheese and rancid meat; a burning smell combined with a skunk-like smell: and a banana-like smell.
Frank is currently exploring the pattern of smell loss that could be an indicator of Alzheimer's disease.
Radiation Therapy Benefits Elderly Brain Cancer Patients
A study of radiation therapy that bought elderly cancer patients a few extra months of life holds a lesson for the future of medicine, a French physician says.
"The importance is not in the results themselves," said Dr. Jean-Yves Delattre, chairman of the department of neurology at the Salpetriere Hospital in Paris, and lead author of a report in the April 12 issue of the
New England Journal of Medicine.
"The importance is in the fact that caring for elderly people will be the future of medicine, and all evidence-based medicine is based on trials done in younger people. We don't know how good we are or how harmful we are when we deal with this (elderly) population," he said.
The trial included 85 participants, with an average age of 73, who were newly diagnosed with glioblastoma, a kind of brain cancer. As the journal report noted, "There is no community standard for the treatment of glioblastoma in patients 70 years or older."
In the trial, 42 patients received the usual supportive treatment aimed at making them as comfortable as possible. The other 39 received the supportive treatment as well as radiation therapy.
The trial was cut short when it became clear that those getting radiation therapy were doing much better. Their average survival time was 29.1 weeks, compared to 16.9 weeks for those getting supportive care.
"In this population, the key problem was, are we going to destroy the quality of life by giving radiotherapy?" Delattre said. "Was this life going to be worth living?" As it turned out, periodic evaluations showed the quality of life to be essentially the same in both groups. Radiation therapy did not damage mental function.
Delattre noted that age also dictates the kind of treatment offered to children. "We know we do not treat a 2-year-old child as we treat a 40-year-old man. I think that in the future, when many patients will be in their 80s or 90s, we will have to do specific medicine for them as we do with children," he said.
The altruism of the people in the trial was very helpful, too, Delattre said. "It was extraordinary how our patients were able to understand a difficult study," he said. "There was a comfort arm, in which we did not offer extra treatment, and those people did it for the sake of future patients."
The trial could be a step toward "evidence-based medicine for a segment of the population that so far has not been studied a lot," he said.
While 60 percent of people with cancer are older, they usually represent only 10 percent to 20 percent of patients enrolled for clinical trials, said Dr. Lillian L. Siu, an associate professor of medicine specializing in cancer at the University o