RxPG News : Epidemiology

UC Davis leads attack on deadly new diseases

Fri, 23 Oct 2009 03:59:36 PST

( from http://www.rxpgnews.com ) In hopes of preventing the next global pandemic and a possible deathtoll into the millions, UC Davis today launches an unprecedentedinternational effort to find and control diseases that move betweenwildlife and people.

The global early warning system, named PREDICT, will be developedwith funding of up to $75 million over five years and is one of fivenew initiatives of the U.S. Agency for International Development(USAID) known in combination as the Emerging Pandemic ThreatsProgram. Building on its long-standing programs in diseasesurveillance and response, USAID is developing these initiatives tohelp prepare the world for infectious diseases like H1N1 flu, avianflu, SARS and Ebola.

UC Davis' primary PREDICT partners, which have formed a globalconsortium to implement PREDICT around the world, are: WildlifeConservation Society, Wildlife Trust, Global Viral Forecasting Inc.,and Smithsonian Institution.

Predicting where new diseases may emerge from wild animals, anddetecting viruses and other pathogens before they spread amongpeople, give us the best chance to prevent new pandemics, said JonnaMazet, the UC Davis scientist leading PREDICT. Mazet directs the UCDavis Wildlife Health Center within the new One Health Institute atthe School of Veterinary Medicine.

The concept of 'One Health' -- that human, animal and environmentalhealth are inextricably linked and should be considered holistically-- is a core principle of the PREDICT team.

To establish and maintain global pathogen surveillance, we will workdirectly with local governments and conservation organizations tobuild or expand programs in wildlife and human health. Together wewant to stop the next HIV, Mazet said. This collaborative approachis key to PREDICT's success.

The PREDICT team will be active in global hotspots where importantwildlife host species have significant interaction with domesticanimals and high-density human populations. They may include SouthAmerica's Amazon Basin, Africa's Congo Basin and neighboring RiftValley, South Asia's Gangetic Plain, and Southeast Asia. Asactivities in targeted regions come on-line, the team will focus ondetecting disease-causing organisms in wildlife before they spillover into people.

While no one can predict with certainty where the next pandemicdisease will emerge, being ready for early detection and rapidresponse will minimize its potential impact on our social andeconomic well-being, said Murray Trostle, deputy director of theAvian and Pandemic Influenza Preparedness and Response Unit of USAID.

UC Davis will bring on emerging-disease authority Stephen S. Morse ofColumbia University Mailman School of Public Health as director ofPREDICT. Morse said that, historically, pandemics -- epidemics thatspread around the world -- occurred perhaps every 30 to 40 years.But in our modern world, the chances of novel diseases or even a newpandemic emerging are higher than ever, because of how we live andthe extent to which we travel, Morse said. Our human settlements androadways push deeper into forests and wild areas where we now raiselivestock and poultry; and we transport ourselves, our animals andour food farther and faster around the globe.

Those conditions enable the spread of microbes, especially virusesand bacteria, from animals to humans. Among the 1,461 pathogensrecognized to cause diseases in humans, at least 60 percent are ofanimal origin.

Notable outbreaks of these animal-to-human diseases, or zoonoses(pronounced ZO-oh-NO-sees), include:

Health care is only part of the puzzle: Social scientists analyze society's health and success

Fri, 16 Oct 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Cambridge, Mass., October 16, 2009 -- As health care moves to the forefront of the national discourse, new research in the social sciences argues that the health of the population and the success or failure of many public health initiatives hinges as much on cultural and social factors as it does on doctors, facilities, or drugs.

Michele Lamont and Peter A. Hall of Harvard University are co-editors of a new collection of essays that analyze how the cultural frameworks and institutional practices that structure day-to-day life influence societal health, titled Successful Societies: How Institutions and Culture Affect Health (Cambridge University Press, 2009).

While access to health care is important to people's health in broad terms, says Hall, we think that the health of the population turns less on the quality of the health care, or on the amount of spending that goes into health care, and more heavily on the quality of everyday life.

Hall, Krupp Foundation Professor of European Studies, and Lamont, Robert I. Goldman Professor of European Studies, professor of sociology and of African American studies, are both in Harvard's Faculty of Arts and Sciences. They led an interdisciplinary group of social scientists -- from fields such as epidemiology, psychology, and political science -- who contributed to this volume posing the scholarly question: What makes a successful society?

Societal success has many potential definitions, and so the researchers focused their research agenda on issues of public health. Better health outcomes such as lower infant mortality or longer life expectancy can be perceived as universally desirable and benchmarks for assessing societal success.

While the book examines many themes relevant to contemporary debates about health care, it also moves beyond issues of economic resources to consider the social and cultural factors that affect health.

Previous research has demonstrated the effects of social networks on health. Building on work in social epidemiology about the adverse health effects of inequality, the book's essays examine the factors feeding into the wear-and-tear of everyday life, as well as the social resources people can rely on to reduce the daily stressors that take a toll on their health.

These questions of culture, collective faith that empowers people, and collective identity simply haven't factored very much so far into the ways that epidemiologists think about questions of public health, says Lamont. The chapters of this book are meant to put these questions onto the table, to begin a conversation around them.

In her chapter, Lamont examines how African Americans react to discrimination. She considers whether they internalize this message or develop their own empowering message, and in turn, how that sense of identity affects physical health.

In another chapter, Ann Swidler, a sociologist at the University of California, Berkeley, compares the response to the AIDS epidemic in Uganda and Botswana. While Botswana is typically perceived as the better governed country, Uganda has been more successful in combating the disease. Swidler finds that networks of social solidarity in Uganda's local communities support more effective programs than in Botswana.

Funded by the Canadian Institute for Advanced Research, the researchers in this Successful Societies Program intend to continue their inquiry through further statistical analyses of inequalities, by examining how individuals deal with negative stereotypes, and by investigating the conditions under which of effective institutional practices can be transferred across nations and societies.

This country is locked in an intense debate about whether it should expand access to health care, and whether it can afford to do so, says Hall. What we suggest is that access to health care is not ultimately the solution to better health. That solution has to lie in measures that improve the quality of social relations across the entire populations. The health care debate is only the tip of an iceberg.

Lessons learned from H1N1 virus pandemic

Thu, 08 Oct 2009 03:59:36 PST

( from http://www.rxpgnews.com ) A comprehensive study has revealed, for the first time, the impact of swine flu on the health of the general public in Australia and New Zealand.

The lessons learned in Intensive Care Units (ICUs) across the two countries on the impact of the H1N1 (swine flu) virus are being shared with countries in the Northern Hemisphere to help them prepare for their upcoming flu season.

The three-month study, conducted at the height of the pandemic between June and August, reveals that 722 patients were admitted to ICUs and that at the peak of the epidemic up to 20 per cent of ICU beds were occupied by patients with swine flu infection.

The study was co-coordinated by the Monash University-based Australian and New Zealand IntensiveCare Research Centre (ANZIC-RC). The study involved all ICUs in Australia and New Zealand with the affected patients being treated in 109 of these units. The study was conducted utilising the resources of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG).

Dr Ian Seppelt, a specialist in Intensive Care Medicine and based at Sydney's Nepean Hospital, saidthe impact of the virus on ICUs across Australia and New Zealand was dramatic.

Intensive Care Units specialise in the management of patients with life-threatening illness and thesurge of patients with H1N1 placed substantial strain on staff and resources. The most severely affected patients had pneumonia affecting both lungs that was caused by the virus. The number of patients admitted to ICUs with this complication represented a 600 per cent increase compared toprevious years, Dr Seppelt said.

Clinical Associate Professor Steve Webb, from the Intensive Care Unit at Royal Perth Hospital, wasanother key researcher on the project and said the information, which surfaced from the study willbenefit other countries about to head into their winter flu season.

Unlike previous 'seasonal' influenza strains, which impact heavily on elderly people and people withsevere coexisting medical conditions, the H1N1 virus affected a different profile. Critical illness due toswine flu was most common in infants and middle aged people; with pregnant patients, the overweight,and indigenous patients particularly affected. Overall, about one-third of patients admitted to anICU because of swine flu had no underlying health problems. Associate Professor Webb said.

Professor Rinaldo Bellomo, Foundation Chair of the ANZICS CTG and Director of Intensive CareResearch at Austin Health, Melbourne said the results of the study would be shared with health authorities in other countries to assist them better prepare for their flu season.

We have come through our flu season and our assessment of the impact of the H1N1 strain will assist them prepare for any outbreak. The H1N1 virus has taken hold in many countries already, but many countries in the Northern Hemisphere will benefit from the lessons we have learned, Professor Rinaldo Bellomo said.

Fortunately a vaccine is now available to prevent the complications of swine flu and it is important thatall members of the community and especially those with risk factors, consider being vaccinated, hesaid.

$7M grant establishes new UIC center to eliminate health disparities

Tue, 04 Aug 2009 03:59:36 PST

( from http://www.rxpgnews.com ) The University of Illinois at Chicago has been awarded a $7.2 million federal grant to establish the UIC Center of Excellence in Eliminating Health Disparities.

The new center, funded by a five-year grant from the National Center on Minority Health and Health Disparities of the National Institutes of Health, will focus on health disparities in prostate and colorectal cancer, community-based breast cancer initiatives, and training and educating the next generation of health disparities researchers.

The new center will be a multi-faceted, university-wide resource to integrate health disparities research and activities, said Elizabeth Calhoun, associate professor of health policy and administration at the UIC School of Public Health, and director and principal investigator of the new center. We plan to engage new investigators in health disparities, reaching not only into our undergrad and graduate populations, but even into high school, to build a pipeline of researchers interested in health disparities.

Carol Ferrans, professor and associate dean for research at the UIC College of Nursing, is co-director of the center.

Researchers at the center will build upon prior UIC research to implement a community project to eliminate breast cancer disparities in South Side Chicago communities disproportionately affected by high rates of breast cancer deaths. The project will use culturally sensitive messages to promote mammography screening, address beliefs that contribute to screening reluctance, and address personal and health system barriers to screening.

The center's primary research projects will specifically look at disparities in prostate and colorectal cancer.

Colorectal cancer is the second most common cancer among African-American women and the third most common for African-American men. Late stage diagnosis, method of detection, delays from detection to surgical intervention, and disparities in treatment may all contribute to African Americans having the highest mortality from this disease of any racial or ethnic group, according to researchers.

In one study, led by Garth Rauscher, UIC assistant professor of epidemiology, researchers will enroll 500 African-American patients newly diagnosed with colorectal cancer to obtain information about screening, stage at diagnosis and treatment. The researchers will look at personal barriers such as cultural beliefs about cancer, social support, transportation, housing, literacy, perceived stress, fear, medical trust, as well as access barriers such as insurance status.

A second study, led by Vince Freeman, UIC assistant professor of epidemiology, will compile data on prostate and colorectal cancer cases diagnosed between 1995 and 2008 in Chicago to conduct a population-based analysis of clinical, socioeconomic and health care factors that account for mortality differences between African Americans and Caucasians.

Ultimately, these statistical models will allow researchers to predict hot-spot areas heavily burdened with disease, said Calhoun, and provide effective measures for deploying resources such as targeted cancer screenings.

The center has a research core, a training and education core, and a community engagement core, led by Richard Warnecke, Faye Davis, and Carol Ferrans, respectively, who are researchers at the UIC Institute for Health Research and Policy.

Rauscher and Freeman are researchers at the UIC Institute for Health Research and Policy and the UIC Cancer Center.

The new UIC Center of Excellence in Eliminating Health Disparities will involve faculty from all six of UIC's health sciences colleges, the UIC Institute for Health Research and Policy, the UIC Center for Clinical Translational Science, and the UIC Cancer Center to develop a comprehensive strategy to incorporate research, education, policy changes and community partnerships to reduce health disparities in Chicago and beyond.

A child's IQ can be affected by mother's exposure to urban air pollutants

Tue, 21 Jul 2009 03:59:36 PST

( from http://www.rxpgnews.com ) A mother's exposure to urban air pollutants known as polycyclic aromatic hydrocarbons (PAHs) can adversely affect a child's intelligence quotient or IQ, a study reports. PAHs are chemicals released into the air from the burning of coal, diesel, oil and gas, or other organic substances such as tobacco. In urban areas motor vehicles are a major source of PAHs.

The study, funded by the National Institute of Environmental Health Sciences (NIEHS), a component of the National Institutes of Health, the U.S. Environmental Protection Agency and several private foundations, found that children exposed to high levels of PAHs in New York City had full scale and verbal IQ scores that were 4.31 and 4.67 points lower than those of less exposed children. High PAH levels were defined as above the median of 2.26 nanograms per cubic meter (ng/m3). A difference of four points, which was the average seen in this study, could be educationally meaningful in terms of school success, as reflected, for example, in standardized testing and other measures of academic performance. However, the researchers point out that the effects may vary among individual children.

This research clearly shows that environmental PAHs at levels encountered in an urban setting can adversely affect a child's IQ, said Linda Birnbaum, Ph.D., director of NIEHS. This is the first study to report an association between PAH exposure and IQ, and it should serve as a warning bell to us all. We need to do more to prevent environmental exposures from harming our children.

The study was conducted by scientists from the Columbia University Center for Children's Environmental Health. It included children who were born to non-smoking black and Dominican-American women age 18 to 35 who resided in Washington Heights, Harlem or the South Bronx in New York. The children were followed from utero to 5 years of age. The mothers wore personal air monitors during pregnancy to measure exposure to PAHs and they responded to questionnaires.

At 5 years of age, 249 children were given an intelligence test known as the Wechsler Preschool and Primary Scale of the Intelligence, which provides verbal, performance and full-scale IQ scores. The test is regarded as a well validated, reliable and sensitive instrument for assessing intelligence. The researchers developed models to calculate the associations between prenatal PAH exposure and IQ. They accounted for other factors such as second-hand smoke exposure, lead, mother's education and the quality of the home caretaking environment. Study participants exposed to air pollution levels below the average were designated as having low exposure, while those exposed to pollution levels above the median were identified as high exposure.

The decrease in full-scale IQ score among the more exposed children is similar to that seen with low-level lead exposure, said lead author Frederica P. Perera, Dr.P.H., professor at Columbia's Mailman School of Public Health and director of the Columbia Center for Children's Environmental Health.

This finding is of concern, said Perera. IQ is an important predictor of future academic performance, and PAHs are widespread in urban environments and throughout the world. Fortunately, airborne PAH concentrations can be reduced through currently available controls, alternative energy sources and policy interventions.

New study uses wastewater to map large-scale patterns of illicit drug use

Fri, 17 Jul 2009 03:59:36 PST

( from http://www.rxpgnews.com ) A team of researchers has mapped patterns of illicit drug use across the US state of Oregon using a method of sampling municipal wastewater before it is treated.

Their findings provide a one-day snapshot of drug excretion that can be used to better understand patterns of drug use in multiple municipalities over time. Municipal water treatment facilities across Oregon volunteered for the study to help further the development of this methodology as a proactive tool for health officials.

Applying analytical methods advanced at Oregon State University (OSU), researchers from the University of Washington, McGill University and OSU collected single-day samples from 96 municipalities across Oregon and tested the samples for evidence of methamphetamine, cocaine, and ecstasy or MDMA.

This work is the first to demonstrate the use of wastewater samples for spatial analyses, a relatively simple and cost-effective approach to measuring community drug use, said Caleb Banta-Green, lead author of the paper and epidemiologist at the University of Washington Alcohol and Drug Abuse Institute. Current measures of the true prevalence of drug use are severely limited both by cost and methodological issues. We believe these data have great utility as a population measure of drug use and provide further evidence of the validity of this methodology.

Municipalities across the state generously volunteered to help us test our methods by collecting samples more or less simultaneously, providing us with 24-hour composite influent samples from one day - March 4, 2008, said OSU's Jennifer Field, who led the laboratory analyses of the samples.

Using these samples from 96 municipalities, the researchers calculated the presence, measured as index loads, of three stimulant drugs: methamphetamine, ecstasy, and benzoylecgonine (BZE, a cocaine metabolite).

They found that the index loads of BZE were significantly higher in urban areas and below the level of detection in some rural areas. Methamphetamine was present in all municipalities, rural and urban. MDMA or ecstasy was at quantifiable levels in less than half of the communities, with a significant trend toward higher index loads in more urban areas.

Researchers said the study validates wastewater drug testing methodology that could serve as a tool for public health officials. Officials could, for example, use the methodology to identify patterns of drug abuse across multiple municipalities over time.

The research team said data used for this study are inadequate as a complete measure of drug excretion for a community or entire state. The team looked at a single day, mid-week sample, for instance. Results might be altered depending on the day or time of year the sample was gathered.

We believe this methodology can dramatically improve measurement of the true level and distribution of a range of illicit drugs, said Banta-Green. By measuring a community's drug index load, public health officials will have information applicable to a much larger proportion of the total population than existing measures can provide.

Currently, Field and Banta-Green are working on a project funded by the National Institutes of Health to determine the best method for collecting data in order to get a reliable annual estimate of drug excretion for a community.

New research to reduce drug side-effects

Fri, 10 Jul 2009 03:59:36 PST

( from http://www.rxpgnews.com ) They are a group of drugs which millions of people rely on to keep pain at bay but they can have unwanted side-effects which are sometimes more serious than the original health problem. Now scientists at The University of Nottingham are taking part in the largest-ever study on the safety of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) that has ever been performed.

The project is called SOS (Safety Of non-Steroidal anti-inflammatory drugs) and will study the medical information of 35 million people in Europe to assess the incidence and nature of harmful side-effects on the cardiovascular and gastrointestinal systems of patients. It's hoped the results will lead to better guidance for doctors on how to balance the advantages of prescribing the drugs with the associated risks of heart and digestive problems.

NSAIDS are widely used in medicine for treating pain, inflammation and degenerative diseases like arthritis. The most commonly-used are aspirin and ibuprofen. But their use is associated with an increased risk of minor and serious gastrointestinal complications. It's estimated that there are thousands of these cases in the European Union every year. Prompted by these problems, a new class of NSAIDS called 'Coxibs' have been developed to reduce the risk of this type of side-effect, but the use of these new drugs has since been linked with an increased risk of heart problems such as heart attack and stroke.

Clinicians and scientists now agree that the risk of stomach problems has to be balanced against the risk of cardiovascular interference. Both risks may differ in one person and for the 30 different types of NSAIDS available in the EU. Up to now research studies have been too small to be effective in terms of providing decision models for doctors and drug regulators but it's hoped this new large survey will result in a much more accurate prescription method to minimize drug-related harm.

Over the next two and a half years, published literature on previous clinical trials and observational studies will be scrutinized to identify any methodological inconsistencies and knowledge gaps and this information will be used to design and carry out an EU-wide observational study. This study will be the biggest of its kind ever undertaken in this field. It will include data from more than 35 million Europeans, taken from existing healthcare databases in the UK, the Netherlands, Germany and Italy. The researchers will use the data to create a variety of decision models to help doctors prescribe the most suitable type of NSAID for a particular patient and lower the risk of unwanted gastrointestinal or cardiovascular side-effects.

The University of Nottingham is working with ten other leading European research institutions on the three-year project which is being funded with a 2.8 million Euros grant from the EC's 7th Framework Programme. Fundamental to the project is QResearch, a not-for-profit partnership between The University of Nottingham and leading primary care system supplier EMIS, which uses data collected over the past 17 years.

Professor of Clinical Epidemiology and General Practice, Julia Hippisley-Cox, who founded QResearch, said: The SOS project will help quantify and compare the risks of different NSAIDs based on an individual's profile and should help lead patients and doctors make better decisions regarding treatment options.

New research to reduce drug side-effects

Fri, 10 Jul 2009 03:59:36 PST

New supplement may help slow sight loss in elderly

Fri, 19 Jun 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Queen's University Belfast academics have helped develop an antioxidant supplement which may slow down sight loss in elderly people.

The supplement may help those affected by the leading cause of blindness in the Western World, a five-year research programme has found.

Professor Usha Chakravarthy, from Queen's Centre of Vision and Vascular Science (CVVS), co-ordinated the study, which looked at nutritional supplements for patients with early age-related macular (AMD) degeneration and found they helped sharpen vision.

Details of the findings are being presented in Belfast today (Friday) by Professor Chakravarthy and Dr Stephen Beatty, Head of Vision Research at the Waterford Institute of Technology.

They co-designed the study and the antioxidant supplement was developed with the advice of Professor Ian Young from the School of Medicine, Dentistry and Biomedical Sciences at Queen's and scientists in eyecare companies Dr Mann Pharma and Bausch and Lomb.

AMD is an incurable eye disease which causes blurring of central vision because of its effects on the macula, the central part of the retina.

Over 400 people across Ireland took part in clinical trials investigating whether carotenoids, rich antioxidants which are found in fruit and vegetables, could prevent progression to the more serious late AMD.

When the eye disease progresses to late AMD patients are unable to read, watch television or recognise people's faces as they only have peripheral vision, not central vision.

Professor Chakravarthy, who is also a Consultant Ophthalmic Surgeon at the Royal Hospital in Belfast, said: Late AMD causes severe sight loss and has a huge economic impact both in terms of the effects of sight loss itself and in terms of the expensive treatments that are needed to deal with the condition.

Up to 500 people a year in Northern Ireland will lose sight in one or both eyes as a result of late AMD.

We wanted to carry out the study as prevention of progression to late AMD can result in a reduced financial and societal burden.

As the macula of the eye is very rich in antioxidants the researchers wanted to see if a supplement called CARMA (Caroteneoids and Co-antioxidants in Age-related Maculopathy) containing the carotenoids lutein and zeaxanthin could help slow down AMD.

The supplement also contained vitamins C,E and Zinc, which had been used in a previous study.

The latest study showed that intake of high levels of both carotenoids preserved the macular pigments, slowing down the progression from early AMD to late AMD.

In contrast, the macular pigments of participants in a placebo group declined steadily.

Dr Chakravarthy added: These findings are important because this is the first randomised controlled clinical trial to document a beneficial effect through improved function and maintained macular pigments.

Further research is needed to confirm these findings and to identify the numbers needed to treat to prevent 1 case from progressing from early to late AMD.

Soap-sniffing technology encourages hand washing to reduce hospital-acquired infections, save money

Wed, 03 Jun 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Call it a Breathalyzer for the hands.

Using sensors capable of detecting drugs in breath, new technology developed at University of Florida monitors health-care workers' hand hygiene by detecting sanitizer or soap fumes given off from their hands.

By reminding workers to clean their hands to remove disease-causing organisms such as the bacteria MRSA, the system could help reduce hospital-acquired infections and save millions of dollars now spent to treat them.

The trademarked system, called HyGreen, logs, down to the second, the frequency of hand cleaning and contact with patients in a database that clinical supervisors can review immediately.

This is the first system that enables real-time monitoring of hand washing.

This isn't big brother, this is just another tool, said Richard J. Melker, M.D., Ph.D., a UF College of Medicine anesthesiology professor who developed the technology along with professors Donn Dennis, M.D., and Nikolaus Gravenstein, M.D., of the anesthesiology department, and Christopher Batich, Ph.D., a materials science professor in the College of Engineering. A hospital worker never wants to be responsible for someone getting sick or dying from an infection acquired in the hospital.

HyGreen is now being tested in the Neuro Intensive Care Unit at Shands at UF medical center, and will be presented at the annual meeting of the Association for Professionals in Infection Control and Epidemiology June 6 to June 9 in Fort Lauderdale, Fla.

Here's how it works: The health-care worker squirts sanitizer gel or soap into his or her hand before passing it under a wall-mounted sensor. A wireless signal from a badge worn by the worker activates a green light on the hand-washing sensor. When the worker enters a patient room, a monitor near the bed detects the status of the badge, and flashes green if the person has clean hands. If the person has not washed, or too much time has passed between washing and approaching the patient, the badge will give a gentle reminder vibration.

I do wash my hands more often, said nurse Carrie McGirr, R.N., who volunteered to help test the HyGreen system. It's a fairly simple process to learn.

Close to 2 million hospital-acquired infections occur each year and more than 250 related deaths occur each day in the United States, according to the Centers for Disease Control and Prevention.

A substantial number of those are preventable, and also one of the key modes of transmission is via the hands of health-care personnel and patients, said Dr. Lennox Archibald, a professor of infectious diseases at the UF College of Medicine, and the Shands at UF epidemiologist leading the evaluation of HyGreen.

Six pathogens, including the ones known as MRSA and VRE, account for two-thirds of all hospital-acquired infections and are readily transmitted by hand.

Studies have shown that up to half of all hospital-acquired infections might be prevented if health-care workers washed their hands according to guidelines set forth by the CDC.

It costs at least $30 billion a year in additional spending to treat hospital-acquired infections. The Center for Medicare and Medicaid Services last year ruled that it would no longer reimburse hospitals for the expense of treating the infections.

Today, more than 160 years after Hungarian physician Ignaz Semmelweiss was ridiculed for suggesting that hand washing by doctors who moved directly from working with cadavers to delivering babies could reduce fatal cases of birth-related infection, the practice still meets with resistance.

But it's not because people don't want to do it, Archibald said. It's not inherent in people's behavior to wash their hands, for some reason.

Various studies show that health-care workers wash their hands less than half the time after direct contact with patients. The reasons people give include skin irritation caused by hand hygiene products, a preference for gloves or simply failure to remember.

Pandemic warning system keys on 'human factors'

Tue, 12 May 2009 03:59:36 PST

( from http://www.rxpgnews.com ) WEST LAFAYETTE, Ind. - Researchers are proposing a new system that would warn of an impending pandemic before the first case of disease emerged in a given population by detecting subtle signals in human behavior.

The goal is a public information and awareness system for pandemic with the same level of credibility, timeliness and visibility as storm-warning icons presented on television screens, said Barrett Caldwell, a Purdue University associate professor of industrial engineering.

The system works by monitoring event phases of human behavior leading up to a pandemic, such as an increase in people purchasing flu-related medications or foraging on the Internet for certain types of information related to the flu.

Understanding these phases might be a way to overcome a fundamental hurdle in controlling pandemic: Conventional approaches require public-health officials to know when certain events leading to pandemic begin, Caldwell said.

The problem with this requirement is that by the time you know an event has happened, it's often too late to do much about it, he said.

Caldwell and former Purdue industrial engineering doctoral student Sandra K. Garrett have proposed a new approach to warn the public of an impending pandemic.

If you can recognize the triggers, the signals suggesting an event is likely to occur, you can start responding to it, gathering resources, preparing and mobilizing people, said Garrett, an assistant professor of industrial engineering at Clemson University. Our basic research idea could be used for any pandemic, or even other types of disasters.

Garrett and Caldwell detailed the findings in a paper that will be presented June 2 at the Industrial Engineering Research Conference in Miami.

The paper shows how pre-pandemic events are separated into four categories of human factors, or social behavior: a period during which it is first possible to detect signals of an emerging pandemic; a time when it is possible to begin early efforts to prevent or mitigate spread; a time when it is critical to implement such measures; and a period when it is time to complete mitigation steps.

The method is an elaboration of signal-detection theory, conceived decades ago.

Normally, when psychologists study signal detection, they are looking at very rapid changes, like whether a tone changes, whether a light changes color or turns on and off, Caldwell said.

The new approach proposes to make signal detection sensitive to more gradual events that are slower to develop.

This is important because a pandemic is not a single point in time but a scenario that may take place in several waves over a period of months, he said. One of the challenges is that the way influenza spreads, you don't know that someone's sick until several days later, and by then they have had the opportunity to infect other people. At that point you have to project backward to see where people have first been sick and where certain flu-related events have happened. You are reactive, rather than proactive.

The researchers envision a system that uses icons similar to those used to alert the public about an impending blizzard, hurricane or tornado. The new approach would enable public health officials to properly manage event deadlines, or respond to a problem before it's too late.

For example, by now we have many cases in the United States, so the event deadline for closing travel boarders with Mexico has already passed, Caldwell said.

The method also would enable officials to recognize a critical trigger that marks when people are prompted to act in certain ways based on a mental preview of what they think may happen in the near future.

This trigger could be that something has already happened or you think that something is going to happen so you are doing something to prepare yourself, Caldwell said. There are no swine flu cases yet, but you think there might be cases near where you live. You go out and buy cans of food and extra juice, and so on.

A need for such a warning system can be seen in the World Health Organization's unexpectedly rapid response to swine flu, Caldwell said.

Health officials were very surprised that the World Health Organization went from a phase 3 pandemic alert to phase 5 in 48 hours, he said. The pandemic preparation materials produced a few years ago stated that these sorts of decisions could be expected to evolve over several days to maybe two weeks, but not two days. So the events have unfolded much faster than people were expecting.

The research was funded by a grant from the Indiana State Department of Health through Purdue's Healthcare Technical Assistance Program, based at Purdue's Discovery Park, which strives to improve health-care performance and delivery.

In related work, the researchers have collaborated with health officials and hospitals in Indiana to determine an alternative care system that may need to be activated once a pandemic reaches the local area.

A pandemic flu alternative care system is designed to respond to concerns that the existing hospital structures may not have the capacity to respond to the number of flu cases, Caldwell said. One of the problems that we uncovered in research was that a really complex alternative care system requires even more advance planning and even more coordination of signals to know when and how to activate. Something that starts out with just a flu-information telephone number isn't bad, but we had looked at systems all the way up to temporary satellite hospitals that just handled incoming flu patients.

Previous research emphasized that counties should recognize when and what type of alternative care system would be required based on the signals officials received, determining when to activate the system based on where cases were being reported.

Clinical trials for shingles drug take an important step forward

Mon, 11 May 2009 03:59:36 PST

( from http://www.rxpgnews.com ) A possible new anti-viral drug designated FV-100, which could alleviate the suffering of millions of people with herpes zoster or shingles, has entered the second stage of clinical testing in patients.

Developed and patented by scientists based at Cardiff University, a Phase II clinical trial with FV-100 has recently been initiated in America. Previous research has shown the drug to be up to 10,000 times more potent than existing treatments in early lab tests.

The drug was discovered by a team in the Welsh School of Pharmacy and a virology group at the Rega Institute in Belgium, and is being further developed in collaboration with the U.S - based biopharmaceutical company, Inhibitex Inc. If it successfully demonstrates both safety and biological activity in this and subsequent trials, the treatment has the potential to improve the lives of over 2.5 million herpes zoster patients worldwide.

Shingles is caused by the same viral infection that causes chicken pox. It is estimated that around one in five people in the U.S., Europe and Japan will be affected by the debilitating condition during their lifetime. It is generally characterised by skin lesions, blisters and rash, and acute pain, and in many cases, post-herpetic neuralgia (PHN), which is a painful and often highly distressing condition resulting from nerve damage caused by the virus. Inhibitex believes FV-100 has the potential to reduce all of these symptoms.

Cardiff University's Professor of Medical Chemistry Chris McGuigan, who led the team which discovered the anti-viral drug said:

We believe this drug has the potential to be the most powerful inhibitor ever discovered to treat shingles.

Each year only 25 new medicines are approved for clinical use [worldwide or by the FDA]. Although FV-100 is early in its overall development plan, the chances of it becoming an approved medicine improves the further we successfully progress through each of the clinical stages. We are incredibly excited at the prospect of FV-100 becoming commercially available in the future, and potentially being the first drug discovered in Cardiff University to make it to the marketplace.

In Phase I trials of FV-100, Inhibitex reported no serious adverse events in healthy volunteers and data supported the potential for once-a-day dosing in future trials. Inhibitex anticipates completing its first Phase II trial of FV-100 in the first half of 2010.

Russell H. Plumb, president and chief executive officer of Inhibitex, Inc said: We have more than 20 U.S sites qualified to enroll patients, and plan to ultimately utilise a total of 50-60 sites in this trial. We believe this enthusiastic response from the clinical community reflects its recognition of the significant unmet medical needs of the increasing number of shingles patients.

Increased food intake alone explains the increase in body weight in the United States

Fri, 08 May 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Amsterdam, the Netherlands: New research that uses an innovative approach to study, for the first time, the relative contributions of food and exercise habits to the development of the obesity epidemic has concluded that the rise in obesity in the United States since the 1970s was virtually all due to increased energy intake.

How much of the obesity epidemic has been caused by excess calorie intake and how much by reductions in physical activity has been long debated and while experts agree that making it easier for people to eat less and exercise more are both important for combating it, they debate where the public health focus should be.

A study presented on Friday at the European Congress on Obesity is the first to examine the question of the proportional contributions to the obesity epidemic by combining metabolic relationships, the laws of thermodynamics, epidemiological data and agricultural data.

There have been a lot of assumptions that both reduced physical activity and increased energy intake have been major drivers of the obesity epidemic. Until now, nobody has proposed how to quantify their relative contributions to the rise in obesity since the 1970s. This study demonstrates that the weight gain in the American population seems to be virtually all explained by eating more calories. It appears that changes in physical activity played a minimal role, said the study's leader, Professor Boyd Swinburn, chair of population health and director of the World Health Organization Collaborating Centre for Obesity Prevention at Deakin University in Australia.

The scientists started by testing 1,399 adults and 963 children to determine how many calories their bodies burn in total under free-living conditions. The test is the most accurate measure of total calorie burning in real-life situations.

Once they had determined each person's calorie burning rate, Swinburn and his colleagues were able to calculate how much adults needed to eat in order to maintain a stable weight and how much children needed to eat in order to maintain a normal growth curve.

They then worked out how much Americans were actually eating, using national food supply data (the amount of food produced and imported, minus the amount exported, thrown away and used for animals or other non-human uses) from the 1970s and the early 2000s.

The researchers used their findings to predict how much weight they would expect Americans to have gained over the 30-year period studied if food intake were the only influence. They used data from a nationally representative survey (NHANES) that recorded the weight of Americans in the 1970s and early 2000s to determine the actual weight gain over that period.

If the actual weight increase was the same as what we predicted, that meant that food intake was virtually entirely responsible. If it wasn't, that meant changes in physical activity also played a role, Swinburn said. If the actual weight gain was higher than predicted, that would suggest that a decrease in physical activity played a role.

The researchers found that in children, the predicted and actual weight increase matched exactly, indicating that the increases in energy intake alone over the 30 years studied could explain the weight increase.

For adults, we predicted that they would be 10.8 kg heavier, but in fact they were 8.6 kg heavier. That suggests that excess food intake still explains the weight gain, but that there may have been increases in physical activity over the 30 years that have blunted what would otherwise have been a higher weight gain, Swinburn said.

To return to the average weights of the 1970s, we would need to reverse the increased food intake of about 350 calories a day for children (about one can of fizzy drink and a small portion of French fries) and 500 calories a day for adults (about one large hamburger), Swinburn said. Alternatively, we could achieve similar results by increasing physical activity by about 150 minutes a day of extra walking for children and 110 minutes for adults, but realistically, although a combination of both is needed, the focus would have to be on reducing calorie intake.

He emphasized that physical activity should not be ignored as a contributor to reducing obesity and should continue to be promoted because of its many other benefits, but that expectations regarding what can be achieved with exercise need to be lowered and public health policy shifted more toward encouraging people to eat less.

Gene variants may determine lung function and susceptibility to maternal smoking

Thu, 26 Mar 2009 03:59:36 PST

( from http://www.rxpgnews.com ) A tiny variation within a single gene can determine not only how quickly and well lungs grow and function in children and adolescents, but how susceptible those children will be to exposure to second-hand tobacco smoke, even in utero, according to researchers from the University of Southern California.

Many factors can affect lung function and growth, including genetic variation and environmental exposures such as tobacco smoke and air pollutants, said Carrie Breton, Sc.D., lead author of the study conducted at the University of Southern California. We wanted to determine whether specific gene variations would have measurable and predictable effects on lung function growth and susceptibility to environmental insults. We looked at a class of genes known to be involved in antioxidant defense, the glutathione-s transferase (GST) genes. Overall, we found that variation in several of the GST genes was important. This was particularly true for children of mothers who had smoked during pregnancy.

The researchers analyzed eight years' worth of lung function metrics and genotyping data from more than 2,100 children from two cohorts of fourth-graders. The lung function measurements used were maximal mid expiratory flow rate (MMEF), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).

FEV1 is a measure of large airways, FVC of total lung volume and MMEF of smaller airways, so they measure slightly different things and we wouldn't necessarily expect to see all outcomes behaving the same, said Dr. Breton.

They found that for three of the specific haplotypes (patterns of genetic variation within genes) they investigated, each had a significant effect on lung function.

For one gene, GSTM2, two variant patterns were analyzed. These patterns occurred in 30-35 percent of the white population. One was found to promote stronger lung function, while the other variant was correlated with poorer lung function and greater susceptibility to damage caused by maternal cigarette smoking during pregnancy. Moreover, the reduction in lung function was greater in children who had two copies of the variant pattern that reduced lung function, compared to children with only one copy.

For a relatively rarer haplotype in GSTM3, occurring in only 6-8 percent of the white population, they found a strong negative effect on MMEF.

Finally, another haplotype in GSTM4, occurring in 16-22% of the population, showed significantly decreased rates of growth for FEV1, FVC and MMEF. Like GSTM2, the reduction in lung function was greatest in children who had two copies of the variant pattern that reduced lung function.

The researchers suggest that the gene variants may not alter the development of the lung, but its ability to defend itself against damage caused by free radicals. The GST genes are important to the detoxification of reactive oxygen species, including carcinogens and environmental exposures, such as cigarette smoke. We speculate that the patterns of genetic variation we investigated may alter this process, thereby reducing the lung's ability to detoxify harmful agents and causing a cascade of other events that promote inflammation, bronchial constriction, airway hyperresponsiveness and asthma-like symptoms, said Dr. Breton.

The next step would be to investigate how these genes interact with one another to jointly effect lung development. Future studies should also investigate the timing and quantity of tobacco smoke exposure during pregnancy in combination with variation in these genes to further understand how they jointly affect fetal lung development, said Dr. Breton.

Codeine use and accident risk

Tue, 24 Mar 2009 03:59:36 PST

( from http://www.rxpgnews.com ) The risk of being involved in a traffic accident with personal injury is significantly higher among codeine users than non-users. However, sporadic or moderate use of codeine alone does not carry an increased risk, according to a newly published study from the Norwegian Institute of Public Health.

Codeine and tramadol are painkillers in the opiate group, used for mild to moderate pain. In Norway, codeine is included in Paralgin forte and Pinex forte, and tramadol, amongst others, in Nobligan. Norway has a higher consumption of codeine preparations than other European countries.

Earlier studies have given conflicting results when evaluating traffic accident risk linked to the use of codeine and tramadol. In this new study from the Norwegian Institute of Public Health, anonymised data from the Norwegian Prescription Database and Road Traffic Accident Register was used to study whether codeine- or tramadol users have an increased risk of being involved in a traffic accident with personal injury.

During the 33 months of the study, 181 road traffic accidents were registered with personal injury where the driver had been exposed to codeine and 20 after exposure to tramadol. Exposure is defined as the first 7 days after the dispensing of a prescription for a codeine- or tramadol preparation.

The study showed that the risk of being involved in a road traffic accident with personal injury was twice as high in the period after having a prescription for codeine dispensed. For those who had used more than approximately 400 tablets per year, the risk of being involved in a traffic accident was 3 times as large. When the use of other potential impairing medicines was excluded, the risk of accident sank significantly. For sporadic codeine users there was no increased risk of accident. There was not a significantly higher risk for tramadol.

- We have previously seen that large users of codeine preparations often use benzodiazepines (anxiolytics- and hypnotics) or carisoprodol (muscle relaxants /painkillers) in addition. This is an important contributory factor when evaluating the accident risk, says the study's leader Liliana Bachs.

98 of the 181 drivers exposed to codeine who were included in the study had also been dispensed other medicines with abuse potential in the week prior to the accident.

- One can conclude that sporadic or moderate use of codeine alone to a small degree increases the chance of being involved in accidents with personal injury. Simultaneous use of benzodiazepines or carisoprodol gives a clear increase in the risk of accidents, explains Bachs.

UIC researchers measure health effects of Chicago's waterways

Mon, 23 Mar 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Researchers at the University of Illinois at Chicago School of Public Health are conducting a study to determine the health effects associated with recreational activities such as boating, canoeing, kayaking and fishing on Chicago's waterways.

The Chicago Health, Environmental Exposure, and Recreation Study, or CHEERS, is funded by the Metropolitan Water Reclamation District of Greater Chicago.

The project aims to determine the rate of illness for people who participate in water activities other than swimming and establish water quality standards for people who enjoy activities on the waterway.

Local and federal regulations have been developed to protect people who swim at beaches, but water quality standards do not exist to protect people who row, paddle, boat or fish. This is the first study in the U.S. to evaluate health and environmental factors associated with recreation on water.

The researchers are enrolling people who participate in activities on Chicago area waterways and will follow them over time to see if they get sick, according to Dr. Samuel Dorevitch, research assistant professor of environmental and occupational health sciences at UIC and principal investigator of the study.

We also have a comparison group of people who are outdoors on the same days at about the same places doing recreational activity that doesn't involve water, Dorevitch said. By comparing the two, the researchers hope to uncover any short-term health effects of water recreation, such as gastrointestinal infections, skin infections, or eye, ear or respiratory conditions.

Participants will be surveyed before and after activities on the water. The amount of water swallowed, inhaled, or splashed on skin will also be measured in some people. Two of the novel ways for measuring water exposure were developed at UIC.

Aerosol samplers will be used to measure the amount of water that people may be inhaling during water sports. Sponges clipped to the shirts of subjects will show how much water the skin is exposed to, Dorevitch said. Amounts of water ingested during recreational activity will be measured at several local swimming pools.

Study participants will then receive phone calls over three weeks following exposure to see if they have developed any symptoms or infections.

A unique aspect of the study is that the researchers will measure the actual pathogens in the water that cause disease, Dorevitch said. Most prior research has looked at indicators of sewage pollution in the water, like E. coli bacteria.

It's not usually E. coli that makes people sick, Dorevitch said. But the presence of E. coli in the water indicates that there may be sewage contamination.

The new study, he said, will measure not only E. coli, but also such pathogens as giardia, cryptosporidium and norovirus that actually do make people sick.

Study finds extensive patient sharing among hospitals; could impact spread of infectious diseases

Thu, 19 Mar 2009 03:59:36 PST

( from http://www.rxpgnews.com ) San Diego, CA (March 19, 2009) - Findings from the first in-depth study of patient sharing show that hospitals share large numbers of patients with other acute care facilities without knowing it. In the new study released today at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA), researchers found that only one in nine shared patients is directly transferred from one hospital to another, whereas most patients were discharged before being readmitted to another hospital. This high underestimation of patient sharing has important implications for handling the potential spread of infectious disease among acute care facilities, since patient sharing could be an avenue of transmission if a major disease outbreak were to occur.

We were surprised to find extensive interlinking of all the hospitals included in the study, said Susan S. Huang, MD, MPH, assistant professor and hospital epidemiologist, University of California Irvine School of Medicine and SHEA member. The level of patient sharing among hospitals is grossly underestimated because patients often don't transfer directly between hospitals.

The study included nearly 240,000 patient admissions. Researchers assessed direct and indirect transfers among all 31 acute care hospitals in Orange County, CA, a large metropolitan county of three million people, using a retrospective evaluation of 2005 California Hospital Discharge Data. Huang and colleagues examined the likelihood that adult patients admitted to each hospital in 2005 would subsequently be transferred or admitted to another hospital in the county in the 365 days following their discharge. This research did not include skilled nursing homes, psychiatric hospitals or rehabilitation facilities, which according to Huang could mean that the amount of patient sharing among all healthcare facilities is even higher than their study found.

A large number of people (22 percent) who are discharged from acute care facilities are readmitted elsewhere within one year. Huang attributed the intricate and broad connections among hospitals to three primary factors: patient choice, insurer agreements among hospitals and immediacy of needing care.

Huang emphasized that the objective of this research is not to change patient behavior but to comprehend the extent of patient sharing and its impact on potential public health responses. If we better understand the 'traffic patterns' of patients and the interlinking of hospitals, we've added an important component to preventing the spread of disease, said Huang. In the event of a public health problem, being aware of the extent of patient sharing could give us a better idea of where to intervene first, she added.

This research is particularly important for infectious agents with a substantial incubation period or prolonged carrier state such as methicillin-resistant

Clinical trial finds microbicide promising as HIV prevention method for women

Thu, 05 Mar 2009 04:59:36 PST

( from http://www.rxpgnews.com ) March 5, 2009 -- A clinical trial involving more than 3,000 women in the U.S. and southern Africa demonstrates for the first time the promise of a vaginal microbicide gel for preventing HIV infection in women. According to findings presented at the Conference on Retroviruses and Opportunistic Infections (CROI), one 0.5 % dose of a microbicide designed to prevent HIV from attaching to cells in the genital tract, was 30% effective. While the results are encouraging, researchers on the study, known as HPTN 035, report that additional evidence is needed to determine more definitively its effectiveness.

These findings provide the first signal that a microbicide gel may be able to prevent women from HIV infection, says Salim S. Abdool Karim, MD, PhD, professor of clinical Epidemiology at Columbia University Mailman School of Public Health, pro vice-chancellor (research) at the University of KwaZulu-Natal in Durban, South Africa, and director the Center for the AIDS Program of Research in South Africa, who led the multi-center study for the U.S.-based Microbicide Trials Network (MTN). Indeed, for the millions of women at risk for HIV, especially young women in Africa, there is now a glimmer of hope. But these findings also indicate that more research is needed; we can't yet say that we have an effective microbicide.

Microbicides are substances intended to reduce or prevent the sexual transmission of HIV and other sexually transmitted infections when applied topically. Several candidate microbicides are being tested in clinical trials, although none is yet approved or available for use. Earlier trials have yielded disappointing results or were stopped prematurely.

Currently, women comprise half of all people worldwide living with HIV. In sub-Saharan Africa, women represent nearly 60 % of adults living with HIV, and in several southern African countries young women are at least three times more likely to be HIV-positive than young men. In most cases, women become infected with HIV through sexual intercourse with an infected male partner. Although correct and consistent use of male condoms has been shown to prevent HIV infection, women often cannot negotiate condom use with their male partners. An effective microbicide could provide women with an HIV prevention method they initiate.

HPTN 035 evaluated the safety and effectiveness of two candidate microbicides for preventing male-to-female sexual transmission of HIV. The study was conducted between February 2005 and September 2008 and involved 3,099 women at six sites in Africa and one in the United States. In Africa, the sites were located in Durban and Hlabisa, KwaZulu-Natal, South Africa; Harare, Zimbabwe; Lusaka, Zambia; Blantyre, Malawi; and Lilongwe, Malawi. The U.S. site was in Philadelphia.

I am particularly impressed by and grateful to the women who took part in HPTN 035, commented Sharon Hillier, PhD, vice chairman and professor, department of obstetrics and gynecology and reproductive sciences at the University of Pittsburgh School of Medicine, and MTN principal investigator. We have reached an important milestone in HIV prevention research, and these women deserve credit for the success of the study.

Reduced breast cancer risk: Physical activity after menopause pays off

Thu, 15 Jan 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Several studies had previously suggested that regular physical exercise reduces the breast cancer risk of women. However, it had been unknowned just how much exercise women should take in which period in life in order to benefit from this protective effect. Moreover, little was known about which particular type of breast cancer is influenced by physical activity.

Answers to these questions are now provided by the results of the MARIE study, in which 3,464 breast cancer patients and 6,657 healthy women between the ages of 50 and 74 years were questioned in order to explore the connections between life style and breast cancer risk. Participants of the study, which was headed by Professor Dr. Jenny Chang-Claude and conducted at the German Cancer Research Center and the University Hospitals of Hamburg-Eppendorf, were questioned about their physical activity during two periods in life: from 30 to 49 years of age and after 50.

A comparison between control subjects and breast cancer patients showed that women in the control group had been physically more active than patients. The scientists calculated the relative breast cancer risks taking account of the effect of other risk factors. Results show that the risk of developing breast cancer after menopause was lower by about one third in the physically most active MARIE participants compared to women who had generally taken little physical exercise.

For this reduced risk it is not necessary to work out hard at the gym. The women in the physically most active group, for example, walked for two hours every day and cycled for one hour, while the most inactive study participants walked for only about 30 minutes every day. The epidemiologists also discovered that physical activity in the postmenopausal period is particularly beneficial for reducing breast cancer risk.

A closer look at the types of breast cancer revealed that physically active women are less frequently affected, in particular, by tumors that form receptors for the two female sexual hormones, estrogen and progesterone. These malignant 'hormone receptor positive tumors' accounted for 62.5 percent of breast cancers among MARIE participants. Other tumor markers, such as HER2 receptor formation or differentiation stage of cancer cells, were found to be unrelated to physical activity.

The effect of physical activity was independent of weight gain, total energy intake or body mass index. Therefore, researchers assume that physical exercise reduces the risk of cancer through hormonal mechanisms instead merely by a reduction of body fat or other changes in physical constitution, as it has often been assumed.

It doesn't always have to be sports, says Associate Professor Dr. Karen Steindorf of DKFZ, who has headed this analysis. In our calculations we have also taken account of activities such as gardening, cycling or walking to the shops. Our advice to all women is therefore to stay or become physically active also in the second half of your life. You will not only reduce your risk of breast cancer, but it has been proven that your bones, heart and brain also benefit from it.

Estrogen therapy could be dangerous for women with existing heart risk

Tue, 25 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---Hormone therapy could accentuate certain pre-existing heart disease risk factors and a heart health evaluation should become the norm when considering estrogen replacement, new research suggests.

The research also showed that in women without existing atherosclerosis, hormone therapy use included some positive effects on lipids but also some negative effects related to heart health, said MaryFran Sowers, lead researcher and professor of epidemiology at the University of Michigan School of Public Health.

The U-M study came about, Sowers said, in trying to explain what's behind the so-called timing hypothesis. The timing hypothesis suggests that if a woman implements a hormone therapy program within six years of her final menstrual period, this narrow window is enough to deter heart disease from developing with the onset of menopause. But the U-M findings suggest that explanation isn't quite so simple, Sowers said.

Even within the six-year window, there were negative aspects related to heart disease. While the positive outcomes on HDL and LDL cholesterol levels were observed, Sowers said, researchers also saw negative outcomes in terms of the inflammation process---which can be related to heart disease.

Sowers said the research shows it's critical for women considering hormone therapy to discuss their heart health with their doctor.

If the woman walks into the doctor's office with a certain degree of (heart disease) burden already, then she and her health care provider may decide that hormone therapy adds too much to the burden, Sowers said. If she doesn't have that burden, they may decide that hormone therapy is an acceptable burden.

The woman should say to her health care provider, 'What kind of information do we need to gather in order to make an informed decision about whether or not hormone therapy should be pursued,' Sowers said. 'I understand there could be some heart disease risk, but that the risk may be based upon where I am now, and can you tell me where that is?'

Heart disease risk can be measured through lipid panels, which are standard, but also by measuring inflammation markers, Sowers said. Tests for inflammation markers exist but their measurement isn't standard when a women is considering hormone therapy, Sowers said.

Hormone therapy has been controversial for years, and there was a time when there was an almost knee jerk reaction against it, Sowers said. This backlash occurred after the findings from the Women's Health Initiative study showed that some women on estrogen therapy had increased heart disease risk. The six-year timing hypothesis was an attempt to explain the findings in the WHI study, Sowers said.

Individuals with HIV have higher risk of non-AIDS cancers

Tue, 18 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) WASHINGTON, D.C. - The risk of non-AIDS cancer is higher for individuals infected with HIV than for the general population, according to a meta-analysis presented here at the American Association for Cancer Research's Seventh Annual International Conference on Frontiers in Cancer Prevention Research.

Compared with the general population, the risk for non-AIDS cancers was 2.3 times higher for men with HIV and 1.5 times greater for women with HIV. Among individuals with HIV, however, incidence rates were similar for those with AIDS and those without, relative to the general population.

Although the researchers did not examine why non-AIDS cancers may occur at a greater rate among individuals with HIV, clinicians should be aware of this potential increased risk when examining patients with HIV, said Meredith Shiels, M.H.S., an epidemiologist at Johns Hopkins School of Public Health.

In particular, clinicians of HIV-infected patients should inquire about well-known modifiable cancer risk factors, she said. For example, the prevalence of cigarette smoking, which is a cause of many types of cancer, is known to be higher among HIV-infected individuals.

Modern drug therapy has led to a longer life for patients with HIV. Because cancer risk increases with age, investigating the risk of cancer among patients with HIV is important. Although some cancers are known to be associated with HIV, such as Kaposi's sarcoma, non-Hodgkin's lymphoma and cervical cancer, limited research has been conducted on risk of non-AIDS cancers.

Shiels and her colleagues analyzed data from 11 U.S. and international studies comparing cancer incidence in individuals with HIV with the general population. Individual studies were excluded if they included data that overlapped with more recent studies. The meta-analysis combined standardized incidence ratios from each study and examined whether they differed by gender and prior AIDS diagnosis.

We observed an overall elevated risk for all non-AIDS cancers combined among HIV-infected individuals compared with the general population, Shiels said. The elevated risk appears to be greater among men than women.

Relative to the general population, the incidence of non-AIDS cancer appeared higher for individuals with and without an AIDS diagnosis. When the researchers adjusted the data for gender and study design, the estimates were similar: the risk of non-AIDS cancer was about two times greater than the general population for HIV-infected individuals both with and without AIDS.

When managing patients with HIV, clinicians should be aware of the potential for increased risk of non-AIDS related cancers. It is important for regular cancer screening to take place and for clinicians to encourage patients to modify factors that could affect cancer risk, such as cigarette use and nutrition.

The meta-analysis did not investigate possible reasons for the increased risk of non-AIDS cancers among patients with HIV. Understanding the link may lead to better management of cancer among patients with HIV and could be a topic for future study.

Burroughs Wellcome Fund award creates new Ph.D. path linking laboratory and population sciences

Tue, 18 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) The Burroughs Wellcome Fund (BWF) has selected Emory University for a $2.5 million, five-year award aimed at training new biomedical scientists whose expertise in research and teaching will bridge laboratory and population sciences.

The Emory program is one of three new BWF programs funded nationally within the Institutional Program Unifying Population and Laboratory Based Sciences. The other two programs will be located at the University of California, Los Angeles (metabolic diseases) and the University of Texas, Houston Health Science Center (gene-environment interaction).

The training awards, focused on understanding and improving human health, were created to connect population and computational sciences with laboratory-based biological sciences. The goal is to establish training programs that partner researchers in schools of medicine with those in schools of public health, as well as with a diverse range of other partners.

Emory's program, housed within the Emory University Graduate School, will create a new doctoral pathway called Human Health: Molecules to Mankind (M2M), with the theme of Understanding human health: integrating biology, behaviors, environments and populations. Each doctoral student will train within two existing PhD programs, one in a laboratory science and one in a population science.

Kenneth Brigham, MD, director of the Emory/Georgia Tech Predictive Health Institute, will direct the M2M program with Michele Marcus, PhD, director of graduate studies and professor in the Department of Epidemiology at Emory's Rollins School of Public Health.

The M2M program will create a bridge between these two areas of laboratory and population sciences, with the goal of creating a new kind of biomedical scientist, says Brigham. With Emory's emphasis on cross-disciplinary education and research, and with a strategic plan that includes predictive health, global health, and computational and life sciences, our university is ideally positioned to become fully engaged in this pioneering program with our students and faculty.

Students will enroll in the Emory Graduate School and will align with existing PhD programs or with a new proposed PhD program in predictive health in Emory School of Medicine and the Rollins School of Public Health. Emory College will be a key participant, along with collaborators at the Centers for Disease Control and Prevention and the Georgia Institute of Technology. A collaboration with the Atlanta Clinical and Translational Science Institute also involves the Morehouse School of Medicine, Kaiser Permanente of Georgia and Children's Healthcare of Atlanta.

Lisa A. Tedesco, PhD, dean of the Graduate School, is excited about the project. The M2M program brings together faculty and resources from many areas to train a new generation of scientists who can approach biomedical research with a new level of comprehensive and interconnected skill and expertise, she says. It is an excellent example of reconfiguring graduate education to address difficult problems at a new level, and we are pleased to be a part of it.

Emory and partner institutions will provide an extensive background of related research projects, partnerships, and research and educational infrastructure that will enrich the new M2M training program. These include, among others, the Emory/Georgia Tech Predictive Health Institute, Emory Global Health Institute, the Hubert Department of Global Health and the Department of Epidemiology in the Rollins School of Public Health, the Emory Graduate Division of Biological and Biomedical Sciences, the joint Coulter Department of Biomedical Engineering at Georgia Tech and Emory, and the Emory-led Atlanta Clinical and Translational Science Institute (ACTSI).

The program initially will include four tracks, although others could be included as the program develops:

1918 Spanish flu records could hold the key to solving future pandemics

Sun, 09 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Ninety years after Australian scientists began their race to stop the spread of Spanish flu in Australia, University of Melbourne researchers are hoping records from the 1918 epidemic may hold the key to preventing future deadly pandemic outbreaks.

This month marks the 90th anniversary of the return of Australian WWI troops from Europe, sparking Australian scientists' race to try and contain a local outbreak of the pandemic, which killed 50 million people worldwide.

Researchers from the University of Melbourne's Melbourne School of Population Health, supported by a National Health and Medical Research Council grant, are analysing UK data from the three waves of the pandemic in 1918 and 1919.

They hope that modern high-speed computing and mathematical modeling techniques will help them solve some of the questions about the pandemic which have puzzled scientists for close to a century.

Professorial Fellow John Mathews and colleagues are analysing the records of 24,000 people collected from 12 locations in the UK during the Spanish flu outbreak including Cambridge University, public boarding schools and elementary schools.

He says gaining a better understanding of how and why the virus spread will help health authorities make decisions about how to tackle future pandemics.

In the 1918/19 pandemic, mortality was greatest among previously healthy young adults, when normally you would expect that elderly people would be the most likely to die,'' Professor Mathews says We don't really understand why children and older adults were at lesser risk.

One explanation may be that children were protected by innate immunity while older people may have been exposed to a similar virus in the decades before 1890 which gave them partial but long-lasting protection.

Those born after 1890 were young adults in 1918. They did not have the innate immunity of children and as they weren't exposed to the pre-1890 virus they had little or no immunity against the 1918 virus. We can't prove it but it is a plausible explanation.

Another striking feature is that the pandemic appeared in three waves, in the summer and autumn of 1918 and then the following winter.

One theory being examined to explain why some people were only affected in the second or third wave is that because of recent exposure to seasonal influenza virus they had short-lived protection against the new pandemic virus.

The attack rates in the big cities weren't as high and this is probably because many people had been exposed to ordinary flu viruses, giving short-lived immunity,'' he says.

In the English boarding schools, where there was social demarcation, children were probably less exposed to seasonal influenza viruses in earlier years; without that protection, pandemic attack rates were much higher than in ordinary government elementary schools.

If we can provide a detailed time course of epidemics and the attack rates at different times, that information can be extremely useful in determining how a future pandemic might progress,'' says Professor Mathews.

He says initial findings point strongly to the value of short-lived immunity to provide protection or partial protection against the early waves of a virus.

This is particularly important when considering the stockpiling of drugs and vaccines to protect the community against a virus.

The early implications of our study are that there may be benefit in providing short-lived immunity that is broadly based rather than specific,'' he says.

If another flu pandemic were to come along and you have a vaccine, it may be better to use it even if it is against a different sub-type of the virus.

Panel advocates improved understanding of hepatitis B and screening of high-risk populations

Thu, 23 Oct 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Management of hepatitis B is a challenge for physicians and patients due to an incomplete understanding of the disease course, complex treatment indications, and the lack of large studies focusing on important health outcomes. To examine these issues, the NIH convened an independent, impartial panel this week to weigh the available evidence on the management of hepatitis B.

While more than 95 percent of U.S. children are routinely vaccinated for hepatitis B, the vaccine does not protect individuals already infected with the virus. In unprotected individuals, acute infection with the hepatitis B virus is usually resolved by the body's immune system and does not cause long-term problems. The transition from acute to chronic infection appears to occur when the immune system does not effectively destroy and clear virus-infected cells.

A number of antiviral therapies approved by the U.S. Food and Drug Administration are available for use in fighting chronic hepatitis B infection including interferons and nucleos(t)ides. We know that these therapies have positive effects on indicators such as viral load, but further controlled trials are needed to substantiate that these agents prevent disease progression to liver failure, cancer, or death, explained panel chair Dr. Michael F. Sorrell, Professor of Medicine at the University of Nebraska Medical Center.

To address this gap in the evidence, the panel recommended several avenues for future research. Among these, they gave top priority to large andomized studies, including placebo-controlled trials, testing single drug and combination therapies' effects on liver failure, cancer, and death. The panel also proposed representative prospective cohort studies to define the natural history of the disease to optimize management across diverse patient subgroups. This would also help decide which patients are most in need of immediate therapy and which could be carefully followed without drug therapy.

The panel is encouraged by the National Institute of Diabetes and Digestive and Kidney Disorders' plans to launch the Hepatitis B Clinical Research Network to promote translational research on this challenging condition. It is anticipated that the recommendations in the consensus statement will inform the consortium's research agenda.

The panel identified elevated hepatitis B DNA blood levels and elevated levels of ALT (alanine aminotransferase, a liver enzyme) as the most important indicators for progression to cirrhosis and liver cancer (hepatocellular carcinoma). Older age, male sex, family history of liver cancer, coinfection with hepatitis C or HIV, and elevated blood levels of hepatitis B DNA were also found to be key predictors.

The panel recommends routine hepatitis B screening for newly arrived immigrants from countries where hepatitis B prevalence is greater than two percent. These practices are intended to facilitate access to care for infected individuals and their families and to provide valuable data on disease prevalence, not to exclude immigrants in any way.

The panel recommends therapy for certain patients, including those with acute liver failure and complications from cirrhosis. However, immediate therapy is not indicated for patients with inactive forms of the disease.

The panel's complete consensus statement will be available later today at

Integrating antiretroviral therapy with TB treatment for co-infections reduces mortality

Thu, 16 Oct 2008 03:59:37 PST

( from http://www.rxpgnews.com ) October 16, 2008 -- A South African treatment study conducted by researchers in the Department of Epidemiology at the Mailman School of Public Health shows that mortality among TB-HIV co-infected patients can be reduced by a remarkable 55%, if antiretroviral therapy (ART) is provided with TB treatment at the same time. The randomized, known as the SAPIT (Starting Antiretrovirals at three Points in Tuberculosis) trial, randomly assigned TB-HIV co-infected patients to receive ART. Patients who received ART together with their TB treatment (integrated treatment arm) were compared with patients assigned to receive ART upon completion of TB treatment (sequential treatment arm).

The study shows that integrating TB and HIV treatment and care saves lives, says Salim S. Abdool Karim, MD, PhD, professor of clinical Epidemiology at the Mailman School of Public Health and director of the Centre for the AIDS Program of Research in South Africa (CAPRISA), who led the SAPIT trial. The trial was conducted at the CAPRISA eThekwini TB-HIV Clinic which is attached to the largest TB clinic in Durban, South Africa. The study was initiated in June 2005 and completed enrollment of 645 patients with TB and HIV co-infection in July 2008. It is estimated that about 70% of all TB patients in South Africa are infected with HIV, or about 250,000 of the 353,879 TB patients diagnosed in 2007.

As a result of the higher mortality rate in patients in the sequential treatment arm versus the mortality rate for those patients in the integrated treatment arm, the study's independent Safety Monitoring Committee recommended in their review of the trial in September 2008 that the sequential arm of the trial be stopped and that ART be initiated in this group as soon as possible. The Committee further recommended that the two sub-groups within the integrated treatment arm (early TB-HIV treatment and post-intensive phase TB-HIV treatment) should continue as per protocol.

Dr. Peter Piot, executive director of UNAIDS, commented: These important results show that a ''two diseases, one patient, one response integrated approach to TB/HIV treatment avoids unnecessary deaths from TB, the leading cause of death in people living with HIV in Africa. TB is the most common disease occurring in the late stages of HIV infection in southern Africa. As a result, many people throughout southern Africa are first identified as HIV infected when they develop TB. The findings of the SAPIT study call for the accelerated implementation of routine HIV testing in TB treatment services.

The SAPIT trial results provide compelling evidence to support the World Health Organization's call for the greater collaboration between TB and HIV treatment services and provide empiric evidence of the benefits from the initiation of antiretroviral therapy in TB-HIV co-infected patients. Dr Paul Nunn, of the Stop TB Department at the World Health Organization commented, The results to date clearly show the urgent necessity to make ART available to HIV infected patients with TB worldwide. In South Africa alone, it would result in an additional 100,000 to 150,000 TB patients being initiated on ART resulting in about 10,000 deaths being averted each year.

Ambassador Mark Dybul, Coordinator of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) said: Scaling up collaborative TB/HIV activities is a priority for PEPFAR. We remain committed to increasing screening for both HIV and TB, which will allow greater numbers of patients to benefit from these study results.

International Diabetes Federation calls for global action to keep all children with diabetes alive

Mon, 13 Oct 2008 03:59:37 PST

( from http://www.rxpgnews.com ) The International Diabetes Federation (IDF) announced today that it is bringing together key opinion leaders to push for action to secure care for the thousands of children with diabetes in developing countries without access to care.

The meeting, Access to Essential Diabetes Medicines for Children in the Developing World, will be held on Saturday, October 25 in London, United Kingdom. The International Diabetes Federation has invited Ministries of Health from various developing countries, leaders from the pharmaceutical industry, philanthropic foundations, leading supply-chain management firms, diabetes associations, as well as professional societies in paediatrics and diabetes education.

We are bringing together the people and the organizations that can provide not only the interim humanitarian response to save lives but can lay the groundwork for sustainable solutions that will benefit all children with diabetes, said Dr Martin Silink, President of the International Diabetes Federation (IDF).

Diabetes is one of the most common chronic diseases to affect children. Every day more than 200 children are diagnosed with type 1 diabetes, requiring them to take multiple daily insulin shots and monitor the glucose levels in their blood. It is increasing at a rate of 3% each year among children and rising even faster in pre-school children at a rate of 5% per year. Currently, over 500,000 children under the age of 15 live with diabetes.

For children in the developing world with type 1 diabetes, the picture is bleak. Close to 75,000 children in low-income and lower-middle income countries are living with diabetes in desperate circumstances. These children need life-saving insulin to survive. Even more children are in need of the monitoring equipment, test strips and education required to manage their diabetes and avoid the life-threatening complications associated with the disease. A child's access to appropriate medication and care should be a right not a privilege.

The stark reality is that many children in developing countries die soon after diagnosis, said Dr Jean-Claude Mbanya, President-Elect of the International Diabetes Federation. It's been 87 years since the discovery of insulin, yet many of the world's most vulnerable citizens, including many children, die needlessly because of lack of access to this essential drug. This is a global shame. We owe it to future generations to address this issue now.

In many developing countries, particularly in Sub-Saharan Africa and some parts of Asia, life-saving diabetes medication and monitoring equipment is often unavailable or unaffordable. As a result, many children with diabetes die soon after diagnosis, or have poor control and quality of life, and develop the devastating complications of the disease early.

In order to support some of those children, the International Diabetes Federation created its Life for a Child Program in 2001. The program, which is operated in partnership with Diabetes Australia-NSW and HOPE worldwide, currently supports a total of 1000 children in Azerbaijan, Bolivia, The Democratic Republic of Congo, Ecuador, Fiji, India, Mali, Nepal, Nigeria, Papua New Guinea, The Philippines, Rwanda, Sri Lanka, Sudan, The United Republic of Tanzania, Uzbekistan and Zimbabwe.

The 1000 children that we support represent a pitifully small number of those in need, said Dr. Silink, who co-founded the Program. It seems unthinkable that diabetes care remains beyond the reach of so many. Solutions are available now to address the issues of affordability and accessibility. The means exist to strengthen healthcare systems and provide the diabetes education of healthcare professionals and the families of those affected by diabetes to make a significant step forward.

The timing of the London meeting is no accident, falling as it does just ahead of World Diabetes Day, November 14. The theme of the United Nations Health Day is diabetes in children and adolescents. The campaign led by the International Diabetes Federation with the endorsement of the World Health Organization sets out to establish the message that no child should die of diabetes.

Scientist plans to test for blood pressure genes affected by age

Wed, 24 Sep 2008 03:59:37 PST

( from http://www.rxpgnews.com ) A geneticist at The University of Texas Health Science Center at Houston plans to scan the genomes of about 4,000 people in the hopes of finding out why blood pressure often increases as young adults age.

The two-year study by principal investigator Myriam Fornage, Ph.D., is funded with a new $1.1 million grant from the Genes, Environment and Health Initiative (GEI) of the National Institutes of Health. The grant was one of six announced today during the second round of funding from the program aimed at finding genetic factors that influence common disorders.

High blood pressure is the single most important predisposing factor to cardiovascular disease, said C. Thomas Caskey, M.D, director/chief executive officer of The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (IMM), a part of the UT Health Science Center. This research could lead to the identification of genes through which environmental factors such as aging act to accelerate disease. Knowledge of these genes opens new opportunities for therapeutic targets.

The GEI researchers receiving grants will use genome-wide association studies. In such studies, researchers rapidly scan markers across the complete sets of DNA, or genomes, of large groups of people to find genetic variants associated with a particular disease, condition or trait.

According to Peter Doris, Ph.D., an IMM professor, Age is clearly the most important environmental risk factor for high blood pressure. What is novel and potentially powerful about Dr. Fornage's project is the focus on age and blood pressure interaction.

Fornage said little is known about the genetic cause of high blood pressure and that her study is among the first to look at blood pressure genes in the context of age. We're trying to determine how genes influence the gradual rise in blood pressure experienced by many people as they move from being a young adult to a middle-aged person, she said.

The study will begin by examining the genomes of about 4,000 people who were recruited into a research project in the mid-1980s and who have had their blood pressure checked periodically. The project is called the Coronary Artery Risk Development in Young Adults (CARDIA) Study and participants were between 18 and 30 when it began.

To confirm the findings, scientists from the Human Genetics Center at The University of Texas School of Public Health will attempt to replicate the results with participants in: the Bogalusa (La.) Heart Study; the Atherosclerosis Risk in Communities Study (ARIC); and the Rochester (Minn.) Family Heart Study.

D. Michael Hallman, Ph.D., an assistant professor at the UT School of Public Health, will coordinate tests with the Bogalusa (La.) Heart Study. Alanna Morrison, Ph.D., an associate professor at the UT School of Public Health, will coordinate tests with the Rochester (Minn.) Family Heart Study.

Our ultimate goal is to discover pathways that could be targeted for therapeutic intervention, Fornage said.

Cancer incidence and mortality in young people decreases with increasing deprivation

Mon, 09 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) London, UK: Results of research into the associations between cancer and socio-economic deprivation and affluence have shown that, in contrast to cancers in older people, the numbers of new cases and deaths from the disease in teenagers and young adults (TYAs) decrease with increasing deprivation.

Professor Jillian Birch told Teenage Cancer Trust's Fifth International Conference on Teenage and Young Adult Cancer Medicine today (Monday) that research by her group also showed increases in the incidence of a number of cancers, including two potentially preventable cancers among younger people: cervical cancer and melanoma.

Prof Birch, Director of the Cancer Research UK Paediatric and Familial Cancer Research group, University of Manchester (UK), explained: Strong associations with socio-economic deprivation and affluence are seen for many diseases. Overall cancer incidence and mortality increase with increasing deprivation. However, different cancers and age groups show different patterns. Geographical variations in incidence, trends over time, and associations with deprivation and affluence can point to lifestyle or other environmental factors as possible causes. Until recently, very little was known about the detailed patterns of cancer in TYAs, but my group has carried out a series of studies to rectify this. The most recent studies have looked at geographical variations, time trends and associations with deprivation.

Results show that in contrast to cancers in older people, in TYAs incidence and mortality decreases with increasing deprivation. This is because the more common types of cancers that occur in young people are associated with affluence, including lymphomas, brain tumours, germ cell tumours and melanoma. These cancers also show significant regional variations in incidence and are increasing over time. However, carcinoma of the cervix, which is one of the more common cancers seen in young women, shows increasing rates with increasing deprivation and an upward trend in incidence over time.

Prof Birch's team showed that the incidence of cervical cancer in TYAs had increased by 1.6% per year during 1979-2003. However, national data show that across all ages, incidence is falling. We therefore analysed trends in 15-39 year olds to look at the changing pattern with age. We found that in 15-19 year olds, rates were increasing by 6.8% per year and by 1.4% per year in 20-24 year olds, but rates were decreasing among those aged 25 and over, she said.

Similar analyses for melanoma showed increasing rates at all ages but a greater rate of increase in 20-29 year olds than at older ages. In 20-24 year olds the annual percentage change was 4.1 and 4.0 in 25-29 year olds, but declined to 3.3 in 30-34 year olds and 2.5 in 35-39 year olds.

Overall, the research showed that cancer incidence rates between 1979-2001, varied from 173 per million person years (per mpyr) in the North East to 208 per mpyr in the South East and South West [1]. National rates have increased during this time period by 1.5% per year. For the whole period, melanoma incidence varied from 12 per mpyr in the East Midlands and London, to 20 per mpyr in the South West. Incidence of melanoma increased nationally by 3.8% per year but the trend was strikingly different in different regions. During 1979-1983 highest rates of around 15 per mpyr were seen in the South and West of England but the rates increased over time more rapidly in the North, so that during 1999-2003 highest rates of between 22 and 32 per mpyr were seen in Northern regions.

Prof Birch said: It is important that public health messages about these two mainly preventable cancers are targeted appropriately. For other TYA cancers, the results of our analyses provide a basis for designing studies to look at possible causes.

Simon Davies, CEO at Teenage Cancer Trust said: It is worrying that cervical cancer and melanoma, two preventable cancers, are increasing in teenagers faster than in other groups. More education is desperately needed so young people can change their behaviour before it's too late. This is why Teenage Cancer Trust funds an education programme for teenagers and young adults throughout schools and colleges in the UK. We are targeting hundreds of thousands of teenagers this summer in our sun safety campaign, fronted by Leona Lewis.

Organizers of cancer clinical trials are neglecting teenagers and young adults

Mon, 09 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) London, UK: Teenagers and young adults with cancer are being failed by medical researchers who are not designing clinical trials with the 13-24 age group in mind and who are not recruiting sufficient numbers of young people to those trials that do exist, according to new figures announced today (Monday).

Dr Lorna Fern, from University College Hospital, London, told Teenage Cancer Trust's Fifth International Conference on Teenage and Young Adult Cancer Medicine that young people aged between 15 and 24 were particularly neglected, with an average of just 16.6% joining clinical trials between April 2005 and March 2008, compared to 44.1% of 5-14 year-olds who joined trials over the same period.

Improvements in cancer treatments and outcomes for the older age group will continue to stagnate until this situation changes and more teenagers and young adults (TYAs) are recruited into clinical trials, said Dr Fern, who is research and development co-ordinator for the National Cancer Research Institute's Teenagers and Young Adult Clinical Studies Development Group.

Our figures show there was considerable variation in the proportion of newly diagnosed patients entering trials between cancer types and between years. Some cancers had particularly poor accrual rates: in England, up until 2006/07, no young people over 16 years had been recruited to cancer treatment trials for brain tumours despite four trials being open during the study period, However, the new data for 2007/08 show that two patients have been entered in the past year, perhaps as a consequence of highlighting this issue. Brain tumours are one of the commonest causes of cancer from which young people die and as reported earlier in the conference, the incidence of some types is rising.

Dr Fern analysed 23 trials of 4,429 patients aged 0-59 years recruited between April 2005 and March 2008 in England, Scotland and Wales. Accrual rates fell considerably for patients aged 20-24 years in all three years. In 2005/6, 42.6% of 10-14 year olds with cancer were recruited to clinical trials, 22.9% of 15-19 year-olds and 13.4% of 20-24 year-olds. In 2006/7, there were slight increases in accrual rates for 15-19 year olds (41.3% aged 10-14, 27.3% aged 15-19), but a drop for 20-24 year-olds to 10.9%. Dr Fern expressed concern that these trends would continue as analysis of the 2007/08 data suggested that recruitment of 20-24 year olds has fallen to approximately 7.5%, compared to 39.7% of 10-14 year olds and 25.4% of 15-19 years.

She said: There are a number of reasons for the low level of recruitment of teenagers and young adults to trials, particularly for the 20-24 year-olds. These include inappropriate trial design, poor accessibility to trials for TYAs, and too many young people not being treated by specialist cancer teams.

At present, the design and age eligibility criteria for trials tend to reflect whether the trial organisers treat children or adult patients, rather than the biology of the particular cancer, and the age group which it is mostly likely to occur in. Traditionally, trials will have an age cut off between 16 and 20. TYAs are constantly falling through the gap created by the tendency for paediatricians to treat the younger ages, and for the older ages to be treated in adult cancer wards.

If we are to see improvements in the treatments and outcomes for TYAs with cancer, there needs to be closer dialogue between research groups when they are planning cancer trials. They should give particular consideration to the specific needs of this over-looked age group so that a more appropriate trial portfolio for TYAs can be established in the UK.

Dr Fern said she thought that particular effort was needed to improve the recruitment of 20-24 year-olds to clinical trials. One of the reasons why there is a relatively higher level of 10-14 year-olds entering trials is because they tend to be treated in specialised paediatric units, which, in the UK, run Children's Cancer and Leukaemia Group (CCLG) trials. No such co-ordinated body exists for teenagers and young adults aged 17-24 years. They will most likely be treated in an adult ward and so access to CCLG trials is limited or non existent.

However, amending the age eligibility criteria of trials may not completely address the problem of recruiting teenagers and young adults to trial. Dr Jeremy Whelan, Chief Investigator of the EURAMOS-1 trial (an international osteosarcoma trial) and a consultant medical oncologist at UCH, spoke of a fall off in recruitment beyond the age of 15 despite an age eligibility criteria which spans the whole paediatric and TYA population. Average accrual to EURAMOS-1 in Accrual to EURAMOS-1 in England, Scotland and Wales has demonstrated a decline in accrual from 42.7% for patients aged 10-14 years, 38.3% for those aged 15-19, and 15.7% of patients aged 20-24 during the 2005-2008.

Differences in gaining consent for entering a trial between children and teenagers and young adults has been cited as a reason for poor accrual of teenagers and young adults. However, there are currently no data to show whether gaining consent for trial participation is harder to achieve with teenagers and young adults than for adults or children through proxy of their parents, but Whelan believes it should be no different.

Dr Whelan said: The problem is not teenagers not wanting to take part in clinical trials, but actually teenagers not being offered the chance to participate.

Dr Whelan and Dr Fern feared that significant improvements in outcomes from cancer for teenagers and young adults would remain elusive without a coalition of forces including funders, policy makers, biologists, clinicians and patients.

Long-term pesticide exposure may increase risk of diabetes

Wed, 04 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Licensed pesticide applicators who used chlorinated pesticides on more than 100 days in their lifetime were at greater risk of diabetes, according to researchers from the National Institutes of Health (NIH). The associations between specific pesticides and incident diabetes ranged from a 20 percent to a 200 percent increase in risk, said the scientists with the NIH's National Institute of Environmental Health Sciences (NIEHS) and the National Cancer Institute (NCI).

The results suggest that pesticides may be a contributing factor for diabetes along with known risk factors such as obesity, lack of exercise and having a family history of diabetes, said Dale Sandler, Ph.D., chief of the Epidemiology Branch at the NIEHS and co-author on the paper. Although the amount of diabetes explained by pesticides is small, these new findings may extend beyond the pesticide applicators in the study, Sandler said. Some of the pesticides used by these workers are used by the general population, though the strength and formulation may vary. Other insecticides in this study are no longer available on the market, however, these chemicals persist in the environment and measurable levels may still be detectable in the general population and in food products. For example, chlordane, which was used to treat homes for termites, has not been used since 1988, but can remain in treated homes for many decades. More than half of those studied in the National Health and Nutrition Examination Survey in 1999-2002 had measurable evidence of chlordane exposure. This is not cause for alarm, added Sandler since there is no evidence of health effects at such very low levels of exposure.

Overall, pesticide applicators in the highest category of lifetime days of use of any pesticide had a small increase in risk for diabetes (17 percent) compared with those in the lowest pesticide use category (0-64 lifetime days). New cases of diabetes were reported by 3.4 percent of those in the lowest pesticide use category compared with 4.6 percent of those in the highest category. Risks were greater when users of specific pesticides were compared with applicators who never applied that chemical. For example, the strongest relationship was found for a chemical called trichlorfon, with an 85 percent increase in risk for frequent and infrequent users and nearly a 250 percent increase for those who used it more than 10 times. In this group, 8.5 percent reported a new diagnosis of diabetes compared with 3.4 percent of those who never used this chemical. Trichlorfon is an organophosphate insecticide classified as a general-use pesticide that is moderately toxic. Previously used to control cockroaches, crickets, bedbugs, fleas, flies and ticks, it is currently used mostly in turf applications, such as maintaining golf courses.

This is one of the largest studies looking at the potential effects of pesticides on diabetes incidence in adults, said Freya Kamel, Ph.D., a researcher in the intramural program at NIEHS and co-author in the paper appearing in the May issue of the American Journal of Epidemiology. It clearly shows that cumulative lifetime exposure is important and not just recent exposure, said Kamel. Previous cross-sectional studies have used serum samples to show an association between diabetes and some pesticides.

Diabetes occurs when the body fails to produce enough insulin to regulate blood sugar levels or when tissues stop responding to insulin. Nearly 21 million Americans have diabetes. The cause of diabetes continues to be a mystery, although genetics and environmental factors such as obesity and lack of exercise appear to play roles.

To conduct the study, the researchers analyzed data from more than 30,000 licensed pesticide applicators participating in the Agricultural Health Study, a prospective study following the health history of thousands of pesticide applicators and their spouses in North Carolina and Iowa. The 31,787 applicators in this study included those who completed an enrollment survey about lifetime exposure levels, were free of diabetes at enrollment, and updated their medical records during a five-year follow-up phone interview. Among these, 1,171 reported a diagnosis of diabetes in the follow-up interview. The majority of the study participants were non-Hispanic white men.

International Diabetes Federation grant supports study to prevent type 2 diabetes in India

Fri, 30 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) - The International Diabetes Federation (IDF) BRIDGES translational research grant programme will fund a lifestyle intervention trial that seeks to reduce the risk of for people developing type 2 diabetes in Chennai, India.

The community based diabetes prevention programme will determine optimal ways to translate the programs developed for research studies of lifestyle interventions for diabetes prevention to real-life settings in Chennai (formerly Madras) India. The Rollins School of Public Health at Emory University will collaborate with a team of investigators from Madras Diabetes Research Foundation (MDRF) and will facilitate a study of 700 people with pre-diabetes in Chennai. The study is designed to explore ways to identify and evaluate culturally appropriate, low-cost, feasible and sustainable ways to promote changes in health behaviours, improved diet, weight loss and increased physical activity to prevent diabetes in those in South India.

The messages will be tailored to the unique dietary patterns and physical activity programmes of Indian communities and will be designed to determine if these targeted interventions are effective and cost-effective.

This grant will help researchers and clinicians to better understand how to create and deliver culturally tailored programs for the prevention of diabetes in high-risk populations. The project is designed to produce a permanent, community-based program for promoting diabetes prevention and healthy lifestyle changes said Dr. K.M. Venkat Narayan, principal investigator of the study and a world leader in translational research.

The International Diabetes Federation's Diabetes Atlas reports that India has the highest number of people with diabetes in the world. Currently, 40.9 million Indians have diabetes and by 2025, this number will rocket to 69.9 million. In addition, 35 million Indians are at risk for diabetes -impaired glucose tolerance (IGT). India is not alone in facing the diabetes epidemic. Over 250 million people worldwide live with diabetes and by 2025, over 380 million people will have the disease. (1)

All South Asians, including those with diabetes, could benefit from making the positive changes in diet, activity, and behaviour that are taught in this program, said Dr. Narayan.

Data and results from the trial will be used to design and advocate policy and public health recommendations, which will result in broader diabetes prevention efforts in India and other South Asian countries.

India is at the epicentre of the diabetes pandemic. Every effort must be taken to prevent the devastating human, social and economic effects of diabetes, said Dr. Linda Siminerio, Chair of the IDF BRIDGES Review Committee. The Chennai trial led by Dr. Narayan and Indian investigators will help to address the major public health issue

The Federation, through BRIDGES, is committed to converting research findings into useful practices for the provision of quality care and services delivered by healthcare providers. The culturally specific randomized trial in India, along with the 10 other selected translational research projects, was chosen because of its innovative idea, demonstration of the potential for health care cost savings, sustainability plans and the opportunity for its results to be widely replicated in other settings.

Active social life may delay memory loss among US elderly population

Thu, 29 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Boston, MA -- One of the features of aging is memory loss, which can have devastating effects on the quality of life among older people. In a new study, Harvard School of Public Health (HSPH) researchers found evidence that elderly people in the U.S. who have an active social life may have a slower rate of memory decline. The study appears in the July 2008 issue of the American Journal of Public Health and appears in an advance online edition on May 29, 2008.

We hope this study adds to and advances our growing understanding of the important role that social forces play in shaping health, said Karen Ertel, postdoctoral fellow in the Department of Society, Human Development and Health at HSPH.

Previous studies have suggested that an active social life may reduce the risk of dementia and cognitive decline among the elderly. Memory loss is a strong risk factor for dementia, a syndrome estimated to affect up to 10% of the U.S. population 65 years and older. The researchers wanted to test whether memory loss might also be associated with social connectedness.

Ertel and her HSPH colleagues, senior author Lisa Berkman, chair of the Department of Society, Human Development and Health, and Maria Glymour, assistant professor, Department of Society, Human Development and Health, used data gathered from 1998 to 2004 from the Health and Retirement Study, a large, nationally representative population of U.S. adults 50 years and older. (Previous studies were conducted outside of the U.S. or using smaller, non-representative population samples.) Memory was assessed in 1998, 2000, 2002 and 2004 by reading a list of ten common nouns to survey respondents, then asking them to recall as many words as possible immediately and after a five-minute delay. Social integration was assessed by marital status, volunteer activities, and contact with parents, children and neighbors.

The results showed that individuals with the highest social integration had the slowest rate of memory decline from 1998 to 2004. In fact, memory decline among the most integrated was less than half the rate among the least integrated. These findings were independent of sociodemographic factors (such as age, gender, and race) and health status in 1998. The researchers found that the protective effect of social integration was largest among individuals with fewer than 12 years of education.

The researchers found no evidence that the results could be due to reverse causation, that is, poor memory or memory decline causing social withdrawal.

Social participation and integration have profound effects on health and well being of people during their lifetimes, said Berkman. We know from previous studies that people with many social ties have lower mortality rates. We now have mounting evidence that strong social networks can help to prevent declines in memory. As our society ages and has more and more older people, it will be important to promote their engagement in social and community life to maintain their well being.

Memory loss and dementia pose a major public health burden among the elderly U.S. population. The results suggest that increasing social integration may help slow memory decline among older Americans and could help alleviate the public health burden, particularly because the aging population in the U.S. is expected to increase substantially. We need to understand more about how social integration reduces the risk of memory decline in order to target interventions that can help slow the decline, said Ertel. Future research should focus on identifying the specific aspects of social integration most important for preserving memory.

Study identifies trends of vitamin B6 status in US population sample

Tue, 20 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) BOSTON- (May 20, 2008) In an epidemiological study, Tufts University researchers identified trends of vitamin B6 status in a sample of the United States population based on measures of plasma pyridoxal 5'- phosphate (PLP) levels in the bloodstream. Plasma PLP is the indicator used by the federal government to set the current Recommended Dietary Allowance (RDA) of vitamin B6, a nutrient essential for red blood cell function and important for maintaining a healthy immune system and blood glucose levels.

Across the study population, we noticed participants with inadequate vitamin B6 status even though they reported consuming more than the Recommended Daily Allowance of vitamin B6, which is less than 2 milligrams per day, says Martha Savaria Morris, PhD, an epidemiologist at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. We also identified four subgroups where this trend seemed most prominent: women of reproductive age, especially current and former users of oral contraceptives, male smokers, non-Hispanic African-American men, and men and women over age 65. Someone with inadequate vitamin B6 status is at risk of becoming Vitamin B6 deficient should their vitamin B6 levels drop too low.

Corresponding author Morris and colleagues studied 7,822 blood samples of men and women ages one-year and older collected from the 2003-2004 National Health and Nutrition Examination Survey (NHANES). Vitamin B6 inadequacy was defined as a plasma PLP concentration less than 20 nmol/L. To the authors' knowledge, the current study is the first large scale study to use plasma PLP concentrations to evaluate vitamin B6 status in free-living people of all ages. The investigators were also able to consider whether the current RDA guaranteed adequate vitamin B6 status because study participants were questioned about supplement use and two days' worth of food intake.

Eleven percent of supplement users and nearly a quarter of non-users demonstrated plasma PLP blood levels of less than 20 nmol/L. Within the four sub-groups where vitamin B6 inadequacy was most prominent, the prevalence of low plasma PLP levels significantly exceeded 10 percentɤeven among those who consumed 2 to 2.9 milligrams per day of vitamin B6. The RDAs for vitamin B6 in men and women who are not pregnant or lactating are as follows: 1.3 mg per day for men and women ages 19-50, 1.7 mg per day for men over age 50 and 1.5 mg for women over age 50.

Writing in the May 2008 issue of the American Journal of Clinical Nutrition, Morris and colleagues noted a stark contrast in plasma PLP levels between women of childbearing age (ages 13 to 54) and their male peers. When we looked specifically at the plasma PLP levels in women of childbearing age, we noticed they were significantly lower than in males in approximately the same age group. Morris continues, Most importantly, the data suggest that oral contraceptive users have extremely low plasma PLP levels. Three quarters of the women who reported using oral contraceptives, but not vitamin B6 supplements, were vitamin B6 deficient.

A pattern of low vitamin B6 status also surfaced in menstruating women who reported using oral contraceptives but who were no longer using them at the time of the NHANES survey. Among women in this sub-group who were not taking vitamin B6 supplements, 40 percent demonstrated plasma PLP blood levels below the cut-off for vitamin B6 inadequacy. Morris says, that although these results are somewhat surprising, the link between oral contraceptive use and vitamin B6 deficiency remains unclear. The vitamin could be stored elsewhere in the bodies of the oral contraceptive users, or in a different form, since our study only examined plasma PLP.

To further support their findings, Morris and colleagues measured homocysteine levels in the blood and compared them against the plasma PLP measures. Homocysteine is an amino acid that can accumulate in the blood if vitamin B6 levels are too low. Though study participants using oral contraceptives at the time of the survey did not demonstrate elevated homocysteine levels, the homocysteine concentrations of former users were significantly higher than those of women who had never used oral contraceptives. Morris says this could mean that oral contraceptive use has an effect on vitamin B6 status that is masked during use by acute effects of the exposure.

Because the study shows association and not causation, Morris stresses that further research is necessary to determine whether the RDA for vitamin B6 is high enough. We have identified populations with a high prevalence of apparently inadequate vitamin B status, Morris says. However, it is important to recognize that signs of deficiency are not seen at plasma PLP concentrations of 20 nmol/L and that dietary assessment is imperfect.

According to the National Institutes of Health (NIH), vitamin B6 deficiency is rare in the United States, but it can cause a form of anemia similar to iron deficiency anemia. Vitamin B6 is widely distributed in the American diet, and baked potatoes, bananas, 100 percent fortified cereals and chicken are particularly good sources. Morris says, The question our study raises is whether, due to aging, genetics, or exposures, some population subgroups need supplements to achieve the current biochemical definition of adequate status.

Risk of hospitalization from violent assault increases when local alcohol sales rise

Mon, 12 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) The risk of being hospitalized from being violently assaulted increases when there is increased alcohol sales near the victim's residence, finds a new study in this week's PLoS Medicine.

Joel Ray and colleagues at the University of Toronto and the Institute for Clinical Evaluative Sciences, Canada, studied the link between alcohol sales and violent assaults in Canada's largest province, Ontario. Most alcohol in Ontario is sold in government-run liquor stores and the province is able to track these sales. In addition, Ontario keeps detailed computerized medical records of people hospitalized as a result of violent assault.

The researchers identified 3,212 people aged over 13 years who had been hospitalized over a 32-month period because of a serious assault. They compared the volume of alcohol sold at the liquor store nearest to the victim's home the day before the assault with the volume sold at the same store a week earlier (this type of study is called a case-crossover study).

For every extra 1,000 l of alcohol sold per store per day (a doubling of alcohol sales), the overall risk of being hospitalized for assault increased by 13%. At peak times of alcohol sales, the risk of assault was 41% higher than at times when alcohol sales were lowest.

Dr Ray and colleagues found that the risk was highest in three subgroups of people: men (18% increased risk for every 1,000 l alcohol sold daily), youths aged 13 to 20 years (21% increased risk for every 1,000 l alcohol sold daily), and those living in urban areas (19% increased risk for every 1,000 l alcohol sold daily).

A total of 1,150 assaults (36%) involved the use of a sharp or blunt weapon, and 1,532 (48%) arose during an unarmed brawl or fight.

Because the study considers only serious assaults and alcohol sold in shops (i.e., not including alcohol sold in bars), it probably underestimates the link between alcohol and assault. It also does not indicate whether the victim or perpetrator of the assault (or both) had been drinking, and its findings may not apply to countries with different drinking habits.

In an expert commentary on this study, Russell Bennetts and Rachel Seabrook of the Institute of Alcohol Studies, London, UK, who were not involved in conducting the research, say: This new study illustrates the role that alcohol sales from retail outlets play in affecting the risk of suffering a serious assault. The findings suggest that the relevant officials should consider restricting availability of alcohol from retail stores if they wish to reduce the likelihood of violence in their area of jurisdiction.

IOF calls for concerted support for second EU osteoporosis audit

Wed, 16 Apr 2008 03:59:37 PST

( from http://www.rxpgnews.com ) The International Osteoporosis Foundation (IOF) has urged all 27 EU countries to continue to seek government recognition and action to overcome the growing burden that osteoporosis places on health systems throughout Europe, as work continues on the second report to measure the status of osteoporosis management across member states.

The IOF is working with EU Osteoporosis Consultation Panel members to prepare the report, Osteoporosis in the European Union in 2008: Ten years of progress and ongoing challenges, for launch on the occasion of World Osteoporosis Day 2008. This report will compare current findings with the original Eight Recommendations published in 1998 by the European Commission and the Osteoporosis in the European Community: A Call to Action, published in 2001, to assess progress in diagnosis, treatment, reimbursement policies, research, and education.

Speaking today in Brussels at the meeting of the EU Osteoporosis Consultation Panel, Professor John Kanis, IOF President, noted, Across Europe, osteoporosis is a major public health problem with serious medical and economic impact. While there have been many advances in the management of osteoporosis over the past 10 years, important care gaps still exist.

For example, the recommended number of bone mineral density (BMD) machines is 10.6 machines per one million inhabitants. While this has improved since 2001, only 12 countries report BMD availability beyond 10.6. Similarly, although effective, evidence-based treatments are widely available throughout the EU, there are often restrictive criteria for reimbursement, especially before the first fracture occurs, setting the stage for untreated patients being at higher risk for subsequent fractures. While 19 out of 27 countries report that these treatments are available before the first fracture, restrictions based on age or bone density testing often make them inaccessible.

Professor Juliet Compston, Chair of the EU Osteoporosis Consultation Panel, IOF Board Member and Professor of Bone Medicine, University of Cambridge School of Clinical Medicine, added, The impact of osteoporosis throughout the EU represents a significant drain on healthcare budgets. However, highly effective treatments are now available and significant savings can be made by preventing fractures, rather than treating them.

In 2000, throughout the region, there were an estimated 620,000 new hip fractures; 574,000 forearm fractures; 250,000 shoulder fractures; and 620,000 spinal fractures in men and women aged 50 years or over, accounting for 34.8% of such fractures worldwide.1 There are more than 2.7 million osteoporotic fractures in men and women in Europe at a direct cost of 36 billion euros.2 It is estimated that by 2050, direct costs related to hip fractures will increase to 76.7 billion euros.3

As part of today's Brussels meeting, EU Osteoporosis Consultation Panel members were joined by members of the European Parliament Osteoporosis Interest Group, all party MEPs who have supported health policy reform on osteoporosis.

1 in 7 cases of bird flu could be prevented by closing schools in event of pandemic

Wed, 09 Apr 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Closing schools in the event of a flu pandemic could slow the spread of the virus and prevent up to one in seven cases, according to a new study published today in the journal Nature.

School closure is the non-pharmaceutical policy option that health organisations and governments most often consider to control the spread of a future flu pandemic, but there had previously been little evidence about its potential effectiveness.

Researchers from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, working with colleagues in France, used computer modelling to explore how school closure would affect the spread of a theoretical pandemic H5N1 avian flu virus which had mutated to pass between humans. They extrapolated from data collected by French GPs, showing how school holidays alter the patterns of influenza transmission in France.

The new study shows that shutting down schools for a prolonged period in the event of a pandemic could prevent up to one in seven cases.

School closures would also slow and flatten the pandemic, reducing the numbers becoming ill in the worst week of the outbreak by up to 40%. The researchers suggest that this could be important in reducing pressures on healthcare services during this time so that hospitals and GP surgeries would be better able to cope.

However, the researchers caution that closing schools for a prolonged period would be a very costly measure, particularly because of its impact on working parents. Taking away the childcare that schools provide could also affect the spread of the virus, in ways that are difficult to model using existing information.

For example, parents might share childcare with each other or place their children with child minders, so that children would still mix and spread the virus between them, much as they would in a school setting. In addition, the number of healthcare professionals available to care for those with the virus might fall if some needed to stay home to look after their children.

Dr Simon Cauchemez, one of the authors of the study from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, said: Our research shows that school closures could be a useful measure in terms of slowing the spread of a flu pandemic. However, its effectiveness would very much depend on what other measures, like vaccination or antiviral drugs, were put in place as well.

Professor Neil Ferguson, another author of the study from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, added: Closing schools for a long time is not an option you can take lightly, because it has a big economic and social impact, and the extent to which there would be a knock-on effect on transmission is hard to predict.

Even though the children would not be in school, they would still mix with other children and adults in the community and spread the virus through this contact. We also think it's likely that parents would need to devise new childcare arrangements so that they could continue working, meaning that they would be setting up the equivalent of small schools where the virus could easily be transmitted, added Professor Ferguson.

The researchers reached their conclusions after analysing surveillance data collected since 1984 by 1,200 GPs in France, to see how the rate of influenza transmission is reduced during the country's school holidays. This data showed that holidays lead to a 20-29% reduction in the rate at which influenza is transmitted to children, but that they have no detectable effect on the contact patterns of adults. The French data also revealed that children were responsible for around 46% of all infections.

The researchers then extrapolated from this to explore how prolonged school closure might affect transmission in the event of a pandemic of mutated H5N1 in a country like France.

At present, the H5N1 strain of influenza is transmitted to people by birds and person-to-person transmission is very rare. However, the virus is so lethal that if it were to mutate and become more transmissible, as in the researchers' new model, the consequences of a global pandemic could be disastrous.

Major study links insurance status to advanced stage in multiple cancers

Sun, 17 Feb 2008 04:59:37 PST

( from http://www.rxpgnews.com ) ATLANTA -- A new American Cancer Society study of twelve types of cancer among more than 3.5 million cancer patients finds uninsured patients were significantly more likely to present with advanced stage cancer compared to patients with private insurance. The study, which appears in the March issue of The Lancet Oncology, is the first to use national data to investigate insurance status and stage of diagnosis for a large number of cancer sites. It finds the strongest association between insurance status and advanced cancer was for cancers that can be detected early by screening or evaluation of symptoms.

For their study, American Cancer Society researchers led by Michael Halpern, M.D., Ph.D., strategic director of health services research, compared insurance status and stage at diagnosis using the National Cancer Database, a hospital-based registry capturing patient information from approximately 1,430 facilities. The database includes information for approximately 73 percent of patients diagnosed with cancer in the U.S. The new analysis included patients in the database between ages 18 and 99 diagnosed with any of 12 cancers between 1998 and 2004.

The study found consistent associations between insurance status and stage at diagnosis across multiple cancer sites. Compared to patients with private insurance, uninsured patients had significantly increased likelihoods of being diagnosed with cancer at more advanced stages. The greatest risk for diagnosis at with moderately advanced cancer (stage II) instead of the earliest stage (stage I) was in colorectal cancer, while the highest risk for diagnosis at the most advanced stage of cancer (stage III/IV) was in breast cancer. Medicaid patients also had significantly increased risks of presenting with more advanced stage disease compared to patients with private insurance for many cancer sites. The greatest increase in risk of more advanced stage diagnosis among both uninsured and Medicaid-insured occurred for cancer sites that are part of routine screening (e.g., breast, colorectal) or sites with symptoms present at early stages (melanoma, urinary bladder).

In contrast, the likelihood of diagnosis at more advanced stages for pancreas or ovary cancer, while higher, was not significant or only marginally significant for uninsured and Medicaid patients compared to privately insured patients. These two sites characteristically present with advanced stage at diagnosis and do not have screening tests or specific symptoms to allow doctors to diagnose them at an early stage.

The authors note that some of the patients who were coded as having Medicaid insurance were likely to have been enrolled after diagnosis, and thus their later stage at diagnosis may not reflect ability to obtain cancer screening and timely diagnosis among individuals with Medicaid coverage but instead, barriers to medical care due to lack of health insurance.

The study also found African American patients were significantly more likely to be diagnosed at a more advanced stage diagnosis for many cancers, indicating that beyond the effects of health insurance, other barriers likely exist for Black patients related to early diagnosis and prompt medical care.

The findings of this major study are critical, not only for the 47 million Americans who have no health insurance, but also for our nation, said John R. Seffrin, Ph.D., chief executive officer for the American Cancer Society. The fact is, too many cancer patients are being diagnosed too late, when treatment is harder, more expensive, and has less chance of saving lives. We must begin to remove the barriers that stand in the way of early diagnosis and timely access to medical care if we are to give all cancer patients an equal chance in the fight.

Ebola virus disarmed by excising a single gene

Mon, 21 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) MADISON - The deadly Ebola virus, an emerging public health concern in Africa and a potential biological weapon, ranks among the most feared of exotic pathogens.

Due to its virulent nature, and because no vaccines or treatments are available, scientists studying the agent have had to work under the most stringent biocontainment protocols, limiting research to a few highly specialized labs and hampering the ability of scientists to develop countermeasures.

Now, however, a team of researchers from the University of Wisconsin-Madison has figured out a way to genetically disarm the virus, effectively confining it to a set of specialized cells and making the agent safe to study under conditions far less stringent than those currently imposed.

We wanted to make biologically contained Ebola virus, explains Yoshihiro Kawaoka, a professor of pathobiological sciences in the UW-Madison School of Veterinary Medicine and the senior author of a paper describing the system for containing the virus published today (Jan. 21, 2008) in the Proceedings of the National Academy of Sciences. This is a great system.

The Ebola virus first emerged in 1976 with outbreaks in Sudan and Zaire. There are several strains of the virus, which causes hemorrhagic fever and during outbreaks kills anywhere from 50-90 percent of its human victims.

At present, research on live Ebola virus is confined to the very highest level of biosafety, known as Biosafety Level 4 (BSL 4). Because such laboratories are rare, small and very expensive, basic research that is the basis for any potential drugs or vaccines to thwart the virus has been limited to perhaps half a dozen labs worldwide. The system devised by Kawaoka and his colleagues could provide a way to greatly expand studies of the pathogen and speed the development of countermeasures.

Taming Ebola virus, according to the new study, depends on a single gene known as VP30. Like most viruses, Ebola is a genetic pauper. It has only eight genes and depends on host cells to provide much of the molecular machinery to make it a successful pathogen. The virus's VP30 gene makes a protein that enables it to replicate in host cells. Without the protein, the virus cannot grow.

The altered virus does not grow in any normal cells, says Kawaoka. We made cells that express the VP30 protein and the virus can grow in those cells because the missing protein is provided by the cell.

It took years, Kawaoka explains, to find which viral protein was not toxic to cells and could thus be used to develop a system, using monkey kidney cells, to confine the virus.

And Kawaoka, an internationally noted virologist, is convinced of the safety of the new system: We did this work in a BSL 4, and the altered cells didn't produce any infectious virus after many passages or replication cycles.

With the exception that it is unable to grow in anything but cells engineered to express the VP30 protein, the virus is identical to the pathogen found in the wild, making it ideal for studies of basic biology, vaccine development and screening for antiviral compounds.

This system can be used for drug screening and for vaccine production, Kawaoka says, noting that getting the equipment and compounds for such work into a BSL 4 lab is extremely difficult. High throughput screening (for drugs) in a BSL 4 is almost impossible.

Currently, live Ebola virus can be studied only in a BSL 4 laboratory. Any proposal to permit studying the pathogen in lower safety level labs is certain to generate controversy.

But according to Kawaoka, making the agent available for study to a broader cross section of science is essential for thwarting the virus that kills a high percentage of its victims because there is now no defense against it. A new strain of Ebola, which so far has emerged only in remote areas of the world, was recently identified in Uganda and has killed at least 40 people.

This is an emerging virus and it's highly lethal, Kawaoka says. But because of the BSL 4 requirement, knowledge of this virus is limited.

Iowa State researchers look for smaller, cheaper, 1-dose vaccines

Tue, 15 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) A team of Iowa State University researchers is examining a new vaccine method that may change the way we get vaccinations.

Michael Wannemuehler and his team of researchers is hoping to find a way to produce vaccines that work better, use smaller doses and require only one trip to the doctor's office.

Traditionally, injectable vaccines have often been prepared from killed bacteria. The vaccinated person's immune system then learns to recognize the bacteria as a threat and consequently builds up defenses against it. Then, if the individual is exposed to the live version of the infectious agent, his or her body is already prepared to defend itself.

Wannemuehler's research is focused on the use of just a part of the bacteria -- a protein -- as a vaccine, instead of the entire bacteria, coupled with novel polymers that will be used to deliver these vaccines. This combination of new approaches will allow vaccines doses to be smaller, safer and induce fewer side effects.

As we move away from using whole bacteria, we're going to more molecular approaches with purified proteins or portions of proteins, said Wannemuehler, a professor of veterinary microbiology and preventative medicine. What these technologies should allow us to do is, instead of injecting 100 units to get protection, we can inject one unit, for example.

Wannemuehler's research targets the bacteria that causes plague, a disease that's rare in the United States, but is still found in other parts of the world.

Using select proteins of the bacteria coupled with unique polymers can reduce the amount of vaccine needed as well as costs for shipping and storage. That makes the vaccine economically feasible for areas at a great distance, such as Africa, where vaccines can be difficult to obtain.

Also, vaccinating a large population can be difficult if more than one dose or injection is required. In places where doctors are scarce, locating and vaccinating patients can be difficult. In addition, having the same patients return for their booster vaccinations can be even more complicated.

Another aspect is the hope that this would be single dose, said Wannemuehler. We hope we can get a robust response with one dose.

And there will likely be uses beyond the plague.

If this technology works here, said Wannemuehler, it's completely transferable to any protein, with minor changes.

Wannemuehler is working with BioProtection Systems Corp. of Ames on this research. BPSC hopes to supply lower-cost vaccines to government agencies for use where the plague is still a threat.

We are thankful that the Iowa Values Fund supports our collaboration with Iowa State University and allows us to combine our broadly applicable vaccine technology with theirs for the development of more effective vaccines, said Joe Lucas of BPSC, located at the Iowa State University Research Park.

Transplant drug sirolimus shrinks tumors, improves lung function

Wed, 09 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) CINCINNATI - The drug sirolimus, normally used to help transplant patients fight organ rejection, may eventually be used as a less invasive treatment for a tumor called angiomyolipomata in patients with who would otherwise face surgery. The finding is reported by investigators from Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine in the Jan.10 edition of The New England Journal of Medicine.

One year of treatment with sirolimus significantly reduced the size of angiomyolipomata by nearly 50 percent in patients with tuberous sclerosis complex (TSC), a rare genetic multi-system disease, or lymphangioleiomyomatosis (LAM), a rare cystic lung disease, according to results of the phase I/II proof-of-concept trial. Sirolimus also improved lung function in the LAM patients. Both TSC and LAM are associated with gene mutations that result in inappropriate activation of mTOR (mammalian target of rapamycin), an enzyme that helps control the growth and proliferation of all cells. Sirolimus inhibits mTOR signaling, researchers said.

Less invasive therapies are clearly needed to treat the angiomyolipomata that people with TSC and LAM develop, and a drug that maintains or shrinks tumor size may reduce the need for procedures such as surgery, said John Bissler, M.D., lead author of the study and a physician/scientist in the Division of Nephrology and Hypertension at Cincinnati Children's. Our data suggest that mTOR inhibition with sirolimus may hold promise for treating these and other disease manifestations in patients with TSC and LAM.

In the study, tumor volume in 20 patients treated with sirolimus for 12 months had significant reductions of about 50 percent. In 18 patients evaluated 12 months after sirolimus treatment stopped average tumor volume had increased again to about 85 percent of the original size.

Five of the 18 patients evaluated 12 months post treatment had a persistent tumor volume reduction of 30 percent or more. Bissler and his coauthors speculate that regression in angiomyolipoma size might stem from a form of programmed cell death called apoptosis or cell-volume reduction.

In 11 study participants with LAM, 12 months of sirolimus treat resulted in a 10 to 15 percent improvement in expiratory air flow, a standard measurement of lung function. One year after sirolimus treatment ended, the treatment effect waned somewhat, but remained substantially above the level of lung function that would have been expected over two years with no treatment. Researchers said improved pulmonary function was likely caused by a reduction of gas trapping in the lungs and a decrease in airflow obstruction. Lung function for people with LAM often declines to the point that patients require oxygen and eventually a lung transplant.

Sirolimus treatment led to several side effects, including mouth ulcers, diarrhea, upper respiratory infections and joint pain.

Researchers also noted limitations in the study's open-label design, lack of a control group and small number of study participants. However, given the effects of sirolimus in the trial the researchers at Cincinnati Children's are optimistic about its potential.

Support for the phase I/II proof-of-concept study came from the patient advocacy groups, the LAM Foundation and the Tuberous Sclerosis Alliance (made possible in part by a grant from the Kettering Fund), Wyeth, the National Cancer Institute and National Institutes of Health.

Dr. Bissler and his colleagues are pursuing additional trials to further define the relative risks and benefits of mTOR inhibitors in patients with LAM and TSC. Dr. Bissler is leading another trial to see if different dosing of mTOR inhibitors improves the effectiveness of treating angiomyolipomata tumors, and is working to launch a placebo-controlled multinational trial to better understand the effects of this therapy on angiomyolipomata. Frank McCormack, M.D., a physician and researcher at the UC College of Medicine, is leading multi-institutional Phase III trial of sirolimus involving 120 patients with LAM that is randomized, double-blind and placebo-controlled. David Franz, M.D., a physician and researcher at Cincinnati Children's, is conducting a trial to see if mTOR-inhibitor therapy helps the specific TSC-related brain lesion subependymal giant cell astrocytoma, and is working on a second placebo-controlled, multinational trial for this treatment.

Dr. Lewis Drusin receives American College of Physicians James D. Bruce Memorial Award

Wed, 19 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Dec. 19, 2007) -- In recognition of his distinguished contributions in preventive medicine, epidemiologist Dr. Lewis Drusin of NewYork-Presbyterian Hospital/Weill Cornell Medical Center has been selected by the American College of Physicians to receive the prestigious James D. Bruce Memorial Award, one of 17 awards in internal medicine for 2008.

The convocation ceremony will take place on May 15, 2008, at the annual meeting of the American College of Physicians in Washington, D.C.

Past recipients include such notables as Nobel Prize winner Dr. Jonas Salk (polio vaccine), Dr. Donald Henderson (smallpox) and NewYork-Presbyterian/Weill Cornell's Dr. Walsh McDermott, who served as a mentor to Dr. Drusin.

Dr. Drusin is professor of clinical medicine and professor of clinical public health at Weill Cornell Medical College, and attending physician at NewYork-Presbyterian/Weill Cornell, where he was formerly director of the Division of Epidemiology.

We want to extend our congratulations to Dr. Drusin, whose career-long contributions to preventive medicine make him very deserving of this special honor, say Dr. Antonio M. Gotto, Jr., the Stephen and Suzanne Weiss Dean of Weill Cornell Medical College, and Dr. Herbert Pardes, president and CEO of NewYork-Presbyterian Hospital.

Dr. Drusin has made outstanding contributions to the prevention and study of nosocomial infections and sexually transmitted diseases, publishing more than 50 papers and book chapters. At Weill Cornell, he directs a program placing Public Health and Community Medicine clerkship students in field locations, and has helped establish an endowment that offers international rotations to medical students. He served as president of the American Venereal Disease Association (now the American STD Association), and he has held prominent roles in many international scientific congresses and study groups relating to sexually transmitted diseases. Since 1995, he has served as the main representative of the International Union Against Sexually Transmitted Infections to the Economic and Social Council of the United Nations. He is a fellow of the American College of Physicians, a fellow of the Royal College of Physicians of London and one of only two American honorary life members of the British Association for Sexual Health and HIV.

He earned his undergraduate degree at Union College (Schenectady, N.Y.) and received his medical degree from Cornell University Medical College (now Weill Cornell Medical College). Dr. Drusin also holds an M.P.H. from the Columbia University School of Public Health.

I am deeply honored to be considered among such esteemed company, says Dr. Drusin. It is exiting when you make your career choices according to what's fun to do, and then you find out later that other people have appreciated what you've done.

MSU researcher helps develop computer game for Ugandan children recovering from cerebral malaria

Tue, 23 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) EAST LANSING, Mich. �The computer program Captain�s Log � originally used with individuals diagnosed with attention deficit hyperactivity disorder, brain injuries or learning disabilities � is being adapted to rehabilitate Ugandan children who are survivors of cerebral malaria.

Michael Boivin, a Michigan State University associate professor of neurology and ophthalmology and of psychiatry, and Bruno Giordani, a University of Michigan associate professor of psychiatry, are leading the project.

�So far as we know, this will be the first attempt to implement a cognitive rehabilitation training program in Uganda with children in the aftermath of brain injury,� Boivin said. �Such programs for children with special needs are readily available in America, and in other parts of the developed world, but not in Africa.�

Every 30 seconds a child in Africa dies from malaria - around 1 million every year, he said. Cerebral malaria is a severe form of malaria that affects the brain and is fatal in about 15 percent to 30 percent of the cases for hospitalized children.

�Our most recent follow-up evaluation of our cerebral malaria children indicates that 26 percent of them have persisting mild to moderate cognitive impairment, mostly in the area of attention and to some extent in visual-spatial working memory,� Boivin said.

The computer game is a comprehensive set of computerized cognitive training programs consisting of five modules including developmental, visual motor skills, conceptual skills, numeric concepts with memory skills and attention skills.

The research team is hoping that this intervention can help cerebral malaria-affected school-age Ugandan children improve their cognitive skills, leading to improvements for both activities of daily living and school-related learning and skill development.

�The program attempts to do so with the use of 33 multilevel brain-training exercises designed to help develop and remediate attention, concentration, memory, eye-hand coordination, basic numeric concepts, problem solving-reasoning skills, self-esteem and self-control,� Boivin said.

Originally developed in 1985, the program is used with children 6 years and older and adults and has been used in a variety of therapeutic, school and home settings in all 50 states, U.S. territories and 23

foreign countries. Also, the program has been adapted for use in a wide range of non-English speaking settings.

Boivin and Giordani have trained a Ugandan study team to help implement and evaluate the program.

�We trained our study team at Mulago Hospital in Uganda, and they helped us in testing the program,� Boivin said. �The onsite project research manager, Paul Bangirana, can now program and set up Captain's Log on his own.�

Exposure to sunlight may decrease risk of advanced breast cancer by half

Thu, 18 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) WINSTON-SALEM, N.C. -- A research team from the Northern California Cancer Center, the University of Southern California, and Wake Forest University School of Medicine has found that increased exposure to sunlight � which increases levels of vitamin D in the body -- may decrease the risk of advanced breast cancer.

In a study reported online this week in the American Journal of Epidemiology, the researchers found that women with high sun exposure had half the risk of developing advanced breast cancer, which is cancer that has spread beyond the breast, compared to women with low sun exposure. These findings were observed only for women with naturally light skin color. The study defined high sun exposure as having dark skin on the forehead, an area that is usually exposed to sunlight.

The scientists used a portable reflectometer to measure skin color on the underarm, an area that is usually not directly exposed to sunlight. Based on these measurements, they classified the women as having light, medium or dark natural skin color. Researchers then compared sun exposure between women with breast cancer and those without breast cancer. Sun exposure was measured as the difference in skin color between the underarm and the forehead.

In women with naturally light skin pigmentation, the group without breast cancer had significantly more sun exposure than the group with breast cancer. The fact that this difference occurred only in one group suggests that the effect was due to differences in vitamin D production � and wasn�t just because the women were sick and unable to go outdoors. In addition, the effect held true regardless of whether the cancer was diagnosed in the summer or in the winter. The difference was seen only in women with advanced disease, suggesting that vitamin D may be important in slowing the growth of breast cancer cells.

�We believe that sunlight helps to reduce women�s risk of breast cancer because the body manufactures the active form of vitamin D from exposure to sunlight,� said Esther John, Ph.D., lead researcher on the study from the Northern California Cancer Center. �It is possible that these effects were observed only among light- skinned women because sun exposure produces less vitamin D among women with naturally darker pigmentation.�

These new findings about breast cancer risk and sun exposure based on skin color measurements are consistent with previous research by John and colleagues that had shown that women who reported frequent sun exposure had a lower risk of developing breast cancer than women with infrequent sun exposure.

The researchers stressed that sunlight is not the only source of vitamin D, which can be obtained from multivitamins, fatty fish and fortified foods such as milk, certain cereals and fruit juices. Women should not try to reduce their risk of breast cancer by sunbathing because of the risks of sun-induced skin cancer, they said.

�If future studies continue to show reductions in breast cancer risk associated with sun exposure, increasing vitamin D intake from diet and supplements may be the safest solution to achieve adequate levels of vitamin D,� said Gary Schwartz, Ph.D., a co-researcher from the Comprehensive Cancer Center at Wake Forest University School of Medicine.

�Since many risk factors for breast cancer are not modifiable, our finding that a modifiable factor, vitamin D, may reduce risk is important,� said Sue Ingles, Ph.D., a co-researcher from University of Southern California Keck School of Medicine.

The researchers compared 1,788 breast cancer patients in the San Francisco Bay area with a matched control group of 2,129 women who did not have breast cancer. They included non-Hispanic white, Hispanic and African-American women, thus women with a wide range of natural skin color and a wide range of capacity to produce vitamin D in the body. Skin color is an important factor that determines how much vitamin D is produced in the body after sun exposure. Dark-skinned individuals produce up to 10 times less vitamin D than light-skinned individuals for the same amount of time spent in the sun. People with darker skin are also more likely to be vitamin D deficient than people with lighter skin.

Even occasional use of spray cleaners may cause asthma in adults

Fri, 12 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Using household cleaning sprays and air fresheners as little as once a week can raise the risk of developing asthma in adults, say researchers in Europe. Such products have been associated with increased asthma rates in cleaning professionals, but a similar effect in nonprofessional users has never before been shown.

�Frequent use of household cleaning sprays may be an important risk factor for adult asthma,� wrote lead author Jan-Paul Zock, Ph.D., of the Centre for Research in Environmental Epidemiology at the Municipal Institute of Medical Research in Barcelona, Spain.

The epidemiological study, the first to investigate the effects of cleaning products on occasional users rather than occupational users, appeared in the second issue for October of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

The investigators used baseline data from the first phase of the European Community Respiratory Health Survey (ECRHS I), one of the world's largest epidemiologic studies of airway disease, and interviews conducted in the follow-up phase, ECRHS II. Altogether, the study included more than 3,500 subjects across 22 centers in 10 European countries. Subjects were assessed for current asthma, current wheeze, physician-diagnosed asthma and allergy at follow-up, which took place an average of nine years after their first assessment. They were also asked to report the number of times per week they used cleaning products.

Two-thirds of the study population who reported doing the bulk of cleaning were women, about six percent of whom had asthma at the time of follow-up. Fewer than ten percent of them were full-time homemakers.

The risk of developing asthma increased with frequency of cleaning and number of different sprays used, but on average was about thirty to fifty percent higher in people regularly exposed to cleaning sprays than in others. The researchers found that cleaning sprays, especially air fresheners, furniture cleaners and glass-cleaners, had a particularly strong effect.

�Our findings are consistent with occupational epidemiological studies in which increased asthma risk was related to professional use of sprays among both domestic and non-domestic cleaning women,� wrote Dr. Zock. �This indicates a relevant contribution of spray use to the burden of asthma in adults who do the cleaning in their homes.�

The design of the study was not intended to determine the biological mechanism behind the increase in asthma with exposure to cleaning sprays, but Dr. Zock and colleagues propose a number of hypotheses, including the possibility that asthma is partially irritant-induced, that sprays contain sensitizers that are specific to asthma, and/or that an inflammatory response is involved in asthma development. �There is a need for researchers to conduct further studies to elucidate both the extent and mechanism of the respiratory toxicity associated with such products,� noted Dr. Zock.

Despite the uncertainty of the biological mechanism, the findings have important clinical relevance. �Clinicians should be aware of the potential for cleaning products used in the home to cause respiratory symptoms and possibly asthma,� wrote Kenneth D. Rosenman, M.D., professor at Michigan State University, in an editorial in the same issue of the journal.

The research may have also significant implications for public health. �The relative risk rates of developing adult asthma in relation to exposure to cleaning products could account for as much as 15 percent, or one in seven of adult asthma cases,� wrote Dr. Zock.

Researchers find evidence linking stress caused by the Sept. 11 disaster with low birth weights

Wed, 10 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Researchers have found evidence of an increase in low birth weights among babies born in and around New York City in the weeks and months after the terrorist attacks on the World Trade Center. Writing in the journal Human Reproduction [1], they suggest that stress may have contributed to the effect.

Professor Brenda Eskenazi and colleagues studied data from birth certificates of 1,660,401 babies born in New York between January 1996 and December 2002. They divided the babies into those born in New York City (NYC) � whose mothers would, therefore, have been living closest to the disaster zone � and those born in �upstate� New York, which they defined as anyone living outside NYC, including Nassau, Suffolk and Westchester Counties.

When they compared data from babies born in the week before the disaster with those born in the week after in NYC, they found a shift in the distribution of low birth weights (LBW), with a higher proportion of babies being born weighing less than 2,000g. �Normal� birth weight is considered to be above 2,500g.

Prof Eskenazi said: �In New York City in the week after 9/11 we found there was a slightly increased risk (44%) of new-born babies weighing below 1,500g and a 67% increased risk of babies weighing between 1,500g and 1,999g compared with the three weeks before the disaster. There were no statistically significant changes in any LBW category in upstate NY, or in babies being born preterm in either location.�

However, there was non-statistically significant evidence that the increase in LBW in the first week after 9/11 was due to babies being born early. Gestational age data were provided to researchers in relatively broad categories which limited a more detailed investigation. In addition, the researchers were hampered by unreliable data on gestational age, based on last reported menstrual period, and the lack of medical reasons for LBW. �I think that the measures of gestational age on birth certificates are often not accurate, and the associations we are seeing with birth weight likely reflect shorter gestation and earlier births, rather than a reduction in foetal growth,� explained Prof Eskenazi, who is Professor of Maternal and Child Health and Epidemiology and Director of the Center for Children�s Environmental Health at the School of Public Health, University of California, Berkeley, USA.

Overall, moderately pre-term births (32-36 weeks) were reduced in both areas for the first month post-9/11. �We think that probably the most vulnerable foetuses were miscarried or born prematurely in that first week after 9/11, leaving behind those who were the strongest,� said Prof Eskenazi. �Another possibility is that one response to stress might be to �hold onto� the foetus and to deliver later.�

At Christmas/New Year and around April/May, the researchers found another increase in the odds of LBW. These periods were when, at the time of the disaster, the babies would have been in either their first or second trimester of gestation or being conceived.

In NYC there was a 36% increased risk of babies being born weighing less than 1,500g in December 2001, and a 28% increased risk in January 2002. In upstate NY, there was a similar peak around the new year, with a 46% increased risk in January of LBW less than 1,500g. In the April/May period in NYC there was a 29% increased risk, and a 32% increased risk in upstate NY.

�We think that the increased incidence in low birth weights is mainly due to stress-initiated early deliveries. We had hypothesised that women further away from the disaster might have less stress associated with the event. We observed immediate effects in NYC, but longer-term effects both in NYC and upstate,� said Prof Eskenazi. �This may indicate that higher levels of stress are necessary to induce acute effects on birth outcome, such as early delivery with the consequent low birth weight, but that, in the longer term, women in both locations suffered stress as a result of the disaster and this is reflected in the later peaks in low birth weights.�

She said it was difficult to explain why these later peaks occurred. �It might be directly related to the disaster having occurred early in gestation, perhaps when the foetus was more susceptible to the effects of stress. Another hypothesis is that the Christmas and New Year holiday was a particularly emotional time after the disaster. The increase in very low birth weights (less than 1,500g) 33-36 weeks after September 11th suggests that exposure around the time of conception may also impact birth outcomes, although the exact mechanisms remain unknown.�

Prof Eskenazi concluded: �We have thoroughly reviewed the literature on preterm birth and low birth weight, and there is, thus far, a paucity of hard data to support the anecdotal information that women are more likely to have a spontaneous preterm birth immediately after a stressful event. Although we can't say for sure that our findings of increased births weighing less than 2,000g immediately after the events of September 11th are directly attributable to preterm delivery, we think that our results support this hypothesis and the paper supports the idea that stressful community events can impact the health of the foetus.�

Grid computing offers new hope in race against bird flu

Fri, 05 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Budapest, 4 October 2007 -- Last month a collaboration of European and Asian researchers launched a new attack against the deadly bird flu virus, harnessing the combined power of more than 40,000 computers across 45 countries to boost the pace of anti-viral drug discovery.

Called Enabling Grids for E-sciencE, the computing grid connects ordinary PCs to form a super-sized supercomputer that is being used during this challenge to analyse the potential of more than 500,000 drug-like molecules over the next few weeks.

This effort comes as new data released last week by Peking University in Beijing, China, shows that the H5N1 bird flu virus can pass through the placenta of pregnant women to the unborn fetus, and can infect organs other than the lungs in adults. A rapid response to any pandemic outbreak of the virus would be essential to its control.

Dr Ying-Ta Wu, biologist at the Genomics Research Center of the Academia Sinica, says computing grids like EGEE are the fastest and cheapest way to discover new drug leads.

�We are using EGEE to find new molecules that can inhibit the activities of the influenza virus,� Dr Ying-Ta Wu explains �During previous challenges using the EGEE grid we discovered about 200 molecules with the potential to become drugs against bird flu.�

The EGEE computing grid powers drug discovery software that allows researchers to compute the probability that a drug-like molecule will dock with active sites on the virus and thus inhibit its action. Using the results of such in silico screening, researchers can predict which compounds are most effective at blocking the virus. This accelerates the discovery of novel potent inhibitors by minimising the non-productive trial-and-error approach in a laboratory.

�Asian flu remains a threat to world health and we are well aware that any pandemic could quickly spread throughout Europe said Viviane Reding, European Commissioner for Information Society and Media. I am pleased that the European project EGEE has found such an important application for computer grid technology as speeding-up drug discovery against neglected and emerging diseases. Collaboration between Europe and Asia is essential if we are to address world wide threats to public health�.

At the EGEE�07 conference in Budapest, Ulf Dahlsten, Director of �Emerging Technologies and Infrastructures� in the Information Society and Media Directorate-General of the European Commission, used the example of EGEE�s success with bird flu to illustrate the potential contributions of e-Infrastructures to science. Computer Grids have achieved a productivity increase of more than 6000% in the identification of potential new drugs he said. 300,000 molecules have already been screened using the EGEE grid. Of these, 123 potential inhibitors were identified, of which seven have now been shown to act as inhibitors in in-vitro laboratory tests. This is a six percent success rate compared to typical values of around 0.1 percent using classical drug discovery methods.

UMass Medical School awarded National Children's Study contract

Thu, 04 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) WORCESTER, Mass.�The National Institute of Child Health and Human Development (NICHD) announced today that the University of Massachusetts Medical School (UMMS) was awarded a competitive contract to participate in the landmark National Children�s Study (NCS), the largest study to be conducted in the United States to assess the effects of environmental and genetic factors on child and human health. The study will follow 100,000 children from before birth to age 21, seeking information to prevent and treat some of the nation�s most pressing health problems, including autism, birth defects, diabetes, heart disease and obesity.

�This is a watershed moment for UMass Medical School as the Commonwealth�s research institution,� said Terry R. Flotte, MD, executive deputy chancellor of UMMS and dean of the School of Medicine. �We have long held public health as our passion and our obligation, and we are exceptionally proud to be chosen as one of a select few to make such an important contribution to the body of knowledge related to child health and development. This contract award is a testament to the Medical School�s demonstrated ability to conduct exceptional public health and epidemiological research and our capacity to engage the community in this study.�

�UMMS is uniquely positioned to accept this charge from the NICHD in part because of the partnerships we have established throughout the community and the trust we have earned over decades of caring for families and children,� said Marianne E. Felice, MD, chair of pediatrics for UMMS and physician-in-chief of UMass Memorial Children�s Medical Center. Felice is the principal investigator of the UMMS arm of the NCS, which will be known as the Massachusetts Children�s Health Indicators and Life Determinants study (MassCHILD). �Many of our faculty are already recognized in the community for the important public health research they have conducted, and we believe parents will work enthusiastically with us on this study. We�re delighted that families of Worcester County will be able to contribute to the health of the nation for generations to come. Furthermore, by being participants in this prestigious study, we may be able to identify solutions to issues of children�s health that are important to us in this area, such as infant mortality.�

UMMS is one of 22 new study centers of the NCS, which began in response to the Children�s Health Act of 2000, when Congress directed the NICHD and other federal agencies to undertake a national, long-term study of children�s health and development in relation to environmental exposures. Through the NCS, contracted centers will collect a broad range of biological and environmental samples and data to generate a comprehensive database of material that will provide researchers, health care providers and public health officials with information from which to develop preventive strategies and health and safety guidelines. Data will be collected in 105 specific previously designated counties in the U.S. There are only two counties in Massachusetts that qualify for the NCS �Worcester and Bristol counties�but the current funding is only designated for Worcester County. The 105 counties were selected through a national probability sample that took into account factors such as race and ethnicity, income, education level, number of births, and number of births of low birth weight babies, and together are representative of the entire U.S. population.

The Medical School�s contract represents more than $16 million for the first five-year phase, during which UMMS will begin recruiting and training the equivalent of 88 full-time staff and working with community leaders in preparation for opening enrollment into the study in the summer of 2009. Funding for the 22 study centers and the study�s initial phase is a result of a $69 million appropriation from Congress in fiscal year 2007. Funding is expected to increase for subsequent phases over the life of the study. Additional contracts are to be awarded at a later date, but will probably total no more than 35 to 40 centers to collect data from all 105 counties. UMMS will work with faculty from Clark University for their expertise in geographic information systems, which will be instrumental in household selection for the survey. Each study site, or county, is expected to enroll 1,000 participants in four years, which will likely require identification of more than 13,000 households in which there may be pregnant women in the first trimester of pregnancy or women who could become pregnant in the next year. In fact, 25 percent of the children are to be identified before they are even conceived.

Additional UMMS faculty serving as co-investigators on the MassCHILD team are Thomas McLauglin, ScD (Co-Principal Investigator); Onesky Aupont, MD, PhD (Operations Manager and Co-Investigator); Katherine Luzuriaga, MD (Co-Investigator); Janet Hardy, PhD (Co-Investigator); Tiffany Moore-Simas, MD, MPH (Co-Investigator); and Judith Ockene, PhD, MEd, MA (Co-Investigator).

In addition to UMMS, 21 other study centers were named today, representing 25 other study locations: Brown University (Providence, R.I.); Children�s Hospital of Philadelphia (Schuylkill, Pa., and New Castle, Del.); Emory University (DeKalb and Fayette Counties, Ga.); Johns Hopkins University (Baltimore, Md.); Michigan State University (Wayne County, Mich.); Mount Sinai School of Medicine (Nassau County, N.Y.); Northwestern University (Cook County, Ill.); St. Louis University (Macoupin County, Ill., and St. Louis, Mo.); University of California, Davis (Sacramento County, Calif.); University of California, Irvine (San Diego County, Calif.); University of California, Los Angeles (Los Angeles County, Calif.); University of Hawaii at Manoa (Honolulu County, Hawaii); University of Minnesota (Ramsey County, Minn.); University of Mississippi (Hinds County, Miss.); University of New Mexico (Valencia County, N.M.); University of North Carolina at Chapel Hill (Rockingham County, N.C.); University of Pittsburgh (Marion County, W.Va., and Westmoreland County, Pa.); University of Texas Health Science Center at San Antonio (Bexar County, Texas); University of Utah (Cache County, Utah); University of Washington (King County, Wash.); and Yale University (New Haven County, Conn.).

Researchers identify key step bird flu virus takes to spread readily in humans

Thu, 04 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) MADISON - Since it first appeared in Hong Kong in 1997, the H5N1 avian flu virus has been slowly evolving into a pathogen better equipped to infect humans. The final form of the virus, biomedical researchers fear, will be a highly pathogenic strain of influenza that spreads easily among humans.

Now, in a new study a team of researchers from the University of Wisconsin-Madison report the identification of a key step the virus must take to facilitate the easy transmission of the virus from person to person.

Writing today (Oct. 4, 2007) in the journal Public Library of Science Pathogens, a team of researchers led by virologist Yoshihiro Kawaoka of the UW-Madison School of Veterinary Medicine has identified a single change in a viral protein that facilitates the virus' ability to infect the cells of the upper respiratory system in mammals. By adapting to the upper respiratory system, the virus is capable of infecting a wider range of cell types and is more easily spread, potentially setting the stage for a flu pandemic.

The viruses that are in circulation now are much more mammalian-like than the ones circulating in 1997, says Kawaoka, an internationally recognized authority on influenza. The viruses that are circulating in Africa and Europe are the ones closest to becoming a human virus.

As its name implies, bird flu first arises in chickens and other birds. Humans and other animals in close contact with the birds may be infected, and the virus begins to adapt to new host animals, a process that may take years as small changes accumulate. Over time, an avian virus may gather enough genetic change to spread easily, as experts believe was the case with the 1918 Spanish flu, an event that killed at least 30 million people worldwide.

In the new study, which was conducted in mice, the Wisconsin team identified a single change in a viral surface protein that enabled the H5N1 virus to settle into the upper respiratory system, which may provide a platform for the adaptation of avian H5N1 viruses to humans and for efficient person-to-person virus transmission.

Other currently undetermined changes are required for the virus to become a human pathogen of pandemic proportions, Kawaoka explains, but establishing itself in the upper respiratory system is necessary as that enables easy transmission of the virus through coughing and sneezing.

To date, more than 250 H5N1 human infections worldwide have been reported. Of those, more than 150 have been fatal, but so far efficient human-to-human transmission has not occurred. Most infections have occurred as a result of humans being in close contact with birds such as chickens that have the virus.

According to Kawaoka, the avian virus can be at home in the lungs of humans and other mammals as the cells of the lower respiratory system have receptors that enable the virus to establish itself. Temperatures in the lungs are also higher and thus more amenable to the efficient growth of the virus.

The new study involved two different viruses isolated from a single patient -- one from the lungs, the other from the upper respiratory system. The virus from the upper respiratory system exhibited a single amino acid change in one of the key proteins for amplification of influenza virus genes.

The single change identified by the Wisconsin study, says Kawaoka, promotes better virus replication at lower temperatures, such as those found in the upper respiratory system, and in a wider range of cell types.

This change is needed, but not sufficient, Kawaoka explains. There are other viral factors needed to cause a viral pandemic strain of bird flu.

However, Kawaoka and other flu researchers are convinced it is only a matter of time, as more humans and other animals are exposed to the virus, before H5N1 virus takes those steps and evolves into a virus capable of causing a pandemic.

Genes linked to suicidal thinking during antidepressant treatment

Thu, 27 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Specific variations in two genes are linked to suicidal thinking that sometimes occurs in people taking the most commonly prescribed class of antidepressants, according to a large study led by scientists at the National Institutes of Health�s (NIH) National Institute of Mental Health (NIMH). Depending on the particular mix inherited, these versions increased the likelihood of such thoughts from 2- to15-fold, the study found. About 1 percent of adult patients were deemed to be at high genetic risk, 41 percent at elevated risk and 58 percent at lower risk.

If confirmed, the findings may hold promise for genetic testing, as more such markers are identified.

Risk increased proportionately if a participant had two, as opposed to just one of the suspect versions. Both genes code for components of the brain�s glutamate chemical messenger system, which recent studies suggest is involved in the antidepressant response.

Overall, about 6 percent of 1,915 patients with depression reported that they started to have suicidal thoughts while taking an antidepressant. This rate soared to 36 percent among the few patients with both of the suspect gene versions; 59 percent of the patients who had suicidal thoughts had at least one of the versions.

Francis J. McMahon, M.D., Gonzalo Laje, M.D., NIMH Mood and Anxiety Disorders Program, and colleagues at the National Human Genome Research Institute (NHGRI), Mount Sinai School of Medicine, and the University of Texas Southwestern Medical Center, report on their findings in the October, 2007 issue of The American Journal of Psychiatry.

�These data suggest that genetics may soon help us in our quest to individualize treatments for depression,� said NIMH Director Thomas R. Insel, M.D.

�In the future, we hope that genetic testing will help doctors identify those few patients who are at high risk for suicidal thinking during antidepressant therapy and need close monitoring or alternative treatments,� said McMahon. �This should help allay concerns for the vast majority of patients. The best way to prevent suicide is to treat depression.�

In the most comprehensive study of its kind to date, McMahon and colleagues screened genetic material from 1,915 adult participants with major depression in level one of the NIMH-funded STAR*D (Sequenced Treatment Alternatives for Depression) trial. Study participants were treated with the selective serotonin reuptake inhibitor (SSRI) citalopram. The researchers looked for associations between self-reports of suicidal thinking and more than 700 sites in 68 suspect genes where letters in the genetic code vary across individuals, creating different versions of the same gene.

The researchers found that certain versions of two genes that code for glutamate receptors � the receiving stations for the neurotransmitter�s chemical messages � were more prevalent in patients with suicidal thinking. How the newly identified versions affect the workings of glutamate receptors to confer increased risk remains to be discovered. It�s also not yet known whether the findings generalize to other antidepressants.

One percent of the study participants had a version of the kainate receptor gene, GRIK2, that increased the odds for suicidal thinking more than 8-fold. Forty-one percent of participants had a version of the AMPA receptor gene, GRIA3, that raised the odds nearly 2-fold. About one-half of 1 percent of participants had both high risk gene versions, boosting the odds 15 fold � but this was the case for only 11 participants, of whom four developed suicidal thinking.

Neither version was related to self-reported history of suicide attempts. This suggests that the versions are specific to suicidal thoughts that occur during antidepressant treatment, rather than the much more common suicidal thoughts and behavior that occur outside of the treatment setting.

More than 40 percent of those who developed suicidal thoughts lacked either of the two versions, indicating that other genes and environmental factors were also likely involved. But the potential value of predictive testing is increasing as more genes are analyzed. McMahon�s group will report at a genetics conference in October on identification of additional versions that emerged from a scan of the whole genome in STAR*D patients. In July, NIMH funded researchers at Massachusetts General Hospital reported an association between variations in the CREB1 gene and treatment-emergent suicidal thinking among men in the STAR*D sample.

Earlier studies had shown that about 4 percent of youth treated with antidepressants experience suicidal thinking compared with about 2 percent of those taking placebos.

The resultant climate of concern culminated in the 2004 Food and Drug Administration decision requiring that antidepressants carry a black box warning about risk of suicidal thinking for children and adolescents � and later proposing that it be extended to young adults up to age 24. In 2004, the Centers for Disease Control recorded the largest spike in youth suicide rates in 15 years. NIMH-funded researchers recently suggested that this may have been related to a drop in antidepressant prescriptions for youth. By contrast, they note that suicide rates reached a record low in 2004 for adults over 60, for whom antidepressant prescription rates continued to rise; this inverse relationship held with increasing age. A more definitive analysis must await release of 2005 U.S. suicide rate data later this year, researchers say.

However, evidence suggests that neither suicidal thoughts, nor the high-risk gene versions, are necessarily related to actual suicide attempts, according to McMahon. Other studies have shown that the rate of such attempts is higher before antidepressant treatment begins � and suicide attempts are not always preceded by suicidal thoughts. For example, in the current study, one of the two participants who actually attempted suicide carried high-risk versions, but denied experiencing suicidal thoughts.

Even if suicidal thinking does not predict suicidal behavior, it is associated with a poorer response to antidepressant medication, the researchers say. Only 25 percent of patients with suicidal thinking fully recovered from their depression during the initial phase of the STAR*D trail, compared with 42 percent of patients not affected by such thoughts.

McMahon and colleagues hope that the newly identified versions may prove useful in identifying patients who need closer monitoring, alternative treatments and/or specialty care � while reassuring those for whom antidepressants are appropriate.

New molecular clock from LLNL and CDC indicates smallpox evolved earlier than believed

Tue, 25 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Smallpox is older than thought, according to results of a new technique reported in the Sept. 24 issue of the Proceedings of the National Academy of Sciences by researchers from Lawrence Livermore National Laboratory and the Centers for Disease Control (CDC).

The researchers created a molecular clock by looking at the rate of random mutations in the smallpox-causing virus collected in 47 locations around the world, from 1946 � 1977. The variation between the strains was compared to sequences from the most similar animal poxes.

The results indicated that a mild and more severe strain diverged either 16,000 or 68,000 years before present, depending on whether accounts from East Asia or Africa are used to calibrate the molecular clock. In either case, this divergence stretches further back in time than previously believed.

The authors compare hypotheses about where and when strains of the virus evolved. No one hypotheses is ruled out, but an ancient origin seems most plausible since the slowly evolving virus now exclusively infects humans, implying that any intermediate link to an animal host has long since died out.

Collaboration between LLNL�s Pathogen Bioinformatics group and the CDC�s Sequencing and Poxvirus groups took place under a Memorandum of Understanding between the Laboratory and the CDC initiated in early 2003.

The initial research focused on determining viral signatures by looking at unique genetic characteristics. The CDC had recently sequenced the genomes of the various smallpox strains, based on the repository it holds for the World Health Organization (the world�s only other declared smallpox storehouse is in Russia).

The disease was considered eradicated in 1980, three years after the last naturally occurring case in 1977. Vaccinations had been stopped in 1972, following an intensive worldwide effort to wipe out the virus. Smallpox, in its most severe form, was deadly in up to 30 percent of cases.

The researchers said the correlation of historical record and a molecular clock provides a framework that could be applied to studying the natural history of other diseases. Although no particular hypotheses of its evolution is supported or disproved, said corresponding author Inger Damon, M.D., Ph.D., acting chief of the CDC�s Poxvirus and Rabies Branch. �It shows the delineation of tantalizing potential connections between different isolates.�

Analysis of isolates from geographically dispersed areas indicated that local pools of old, and perhaps ancient, strains existed. The human disease may have originated from a rodent-borne virus in Africa. The evolutionary analysis suggests that smallpox disease slowly spread westward from East Asia, which would agree with the oldest smallpox-like descriptions from ancient China as far back as 1122 BC. It is unclear when it first reached the New World � some evidence suggests an ancestral virus arrived with early humans and diversified into a mild version there.

The slow spread out of Asia could explain why smallpox descriptions are missing from ancient Greece or Rome as well as the Old and New Testaments.

The Laboratory�s Shea Gardner and CDC�s Yu Li devised a way to concentrate point mutations in the viral DNA, single nucleotide polymorphisms, or �SNPs.� Four nucleotide bases, arranged in varying sequences, spell out the hereditary information encoded in DNA, the genetic material.

As cells multiply and divide, occasional errors creep in to new copies of the genetic instructions. Some errors are more critical than others. The variation allows some individuals among the offspring to be better-adapted to changing conditions, providing an evolutionary advantage that is passed down to their progeny. Over time, some lines flourish and others die out.

For a reliable molecular clock, it would be nice to see the steady rate of mutation in a general sense without a marked effect of change, pro or con, in any particular gene or subset. So the researchers created a simplified approach for looking across the nearly 200,000 DNA base pairs of the virus genome. They concentrated the mutations for comparing sequences by excerpting stretches in which a single change at one point was flanked by seven unchanged bases at each side.

�We assumed there was a molecular clock ticking,� Gardner said. �The question was what was the rate?�

The Laboratory�s intensive computing capabilities complemented the CDC contribution of calibrating the information with historical accounts, Li said.

�It was a valuable opportunity to be able to compare the genomes,� added Lab scientist Beth Vitalis, who helped analyze the data. She added that additional, related studies of virulence factors are in process.

Childhood vaccination may protect adult eyes

Wed, 19 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Childhood vaccination for the rubella virus may have also almost entirely eliminated an inflammatory eye disease from the U.S.-born population, according to a study by researchers at the University of Illinois at Chicago.

The study is published in the September issue of the American Journal of Ophthalmology.

Fuchs heterochromic iridocyclitis, or FHI, is a chronic inflammatory disease of the eye that causes cataract and glaucoma and can lead to blindness. There is no effective treatment.

We don't know what causes FHI, says Dr. Debra Goldstein, associate professor of ophthalmology and visual sciences at UIC. But we were seeing changes in the incidence of the disease and in the makeup of the patient population with the disease -- fewer American-born FHI patients, and those we did see were older.

Although not able to establish the cause of FHI, earlier studies had found antibodies for rubella in the eyes of patients with FHI, suggesting that the rubella virus might be involved. The UIC researchers looked for epidemiological evidence that might link childhood vaccination for rubella, commonly known as German measles, with the decrease in the incidence of FHI they had observed.

We hypothesized that if there was a relationship between rubella and FHI, then the proportion of FHI cases we were seeing at UIC would decrease after the institution of the national rubella vaccination program and that an increasing percentage of the FHI cases would be in patients coming from countries without a vaccination program, Goldstein said.

Patients with FHI and two other types of inflammatory eye disease who were seen at UIC between 1985 and 2005 were grouped by the decade of their birth to determine whether the percentage with FHI decreased relative to the two other inflammatory eye diseases. The percentage of foreign-born versus U.S.-born patients with FHI and the two control groups was also compared.

For U.S.-born patients born before rubella vaccinations (1919-1958) the percentages of FHI and two other eye inflammatory diseases were about equal. But there was a 69 percent drop in FHI in patients born the following decade (1959-1968) and a further 40 percent drop in patients born from 1969 to 1978. Only one FHI patient born during the decade 1979-1988 was seen.

Over the same periods, the percentage of foreign-born patients with FHI increased compared with the controls.

Rubella vaccination was implemented in the United States in 1969. By 1977, an estimated 60 percent of children had been vaccinated, with an 80 percent decline in cases.

Currently, children commonly receive two doses of the vaccine by the time they are six years old. As a result of the vaccination program, the majority of U.S. rubella cases now occur in foreign-born individuals.

The vast majority of eye inflammatory diseases have no known cause, according to Goldstein. Although this kind of study has its limitations, it's exciting to find convincing epidemiological support for earlier research implicating the rubella virus as a cause of FHI, she said.

Children in affluent countries more likely to develop allergy-related asthma

Fri, 14 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Children with allergic sensitizations in economically developed countries are much more likely to develop asthma than similarly sensitized children in poorer countries, according to a team of international researchers.

The global research study is the first to link economic development to differences in rates of asthma symptoms and allergic sensitization, based on examination of a large, multi-center cross-sectional study of 8- to 12-year-old children who participated in Phase Two of the International Study of Asthma and Allergy in Childhood (ISAAC).

The findings were published in the second issue for September of the American Thoracic Society�s American Journal of Respiratory and Critical Care Medicine.

�Atopic sensitization has long been known to be related to childhood asthma,� wrote Gudrun Weinmayr, M.D., M.P.H., of the Institute of Epidemiology of Ulm University in Germany, and lead investigator of the study. Dr. Weinmayr noted that the strongest relationships have been found in studies in affluent western countries. �Thus, it may be that the link between asthma and atopic sensitization differs between countries.�

Dr. Weinmayr and colleagues evaluated parents� answers about their children�s respiratory symptoms from over 54,000 standardized questionnaires; assessed the results of more than 31,000 skin-prick tests; and analyzed the serum levels of allergen-specific IgE in nearly 9,000 children from 22 countries, from rural African to urban Europe.

They then determined the degree to which allergic sensitizations and asthma symptoms varied with the gross national income per capita (GNI) of the country from which they were collected.

�We observed large variations in the prevalence of asthma symptoms and of atopic sensitization among populations,� wrote Dr. Gundmayr. The association between current wheeze, an indicator of asthma, and skin prick sensitivity, an indicator of allergic reaction, was strong in virtually all affluent countries, but much weaker in less affluent settings.

Altogether, children living in affluent countries with allergic sensitizations were 4 times as likely to have asthma than their non-sensitized counterparts; in non-affluent countries, children with allergic responses were only 2.2 times as likely to have asthma.

�This means that local environmental factors may affect asthma and allergy in different ways,� said Renato T. Stein, M.D., Ph.D., of the Pontificia Universidade Catolica do Rio Grande do Sul, in Brazil, another researcher involved in the study.

�Another way to interpret these findings is that asthma in [more affluent] cities is predominantly atopic asthma, while in socially less developed areas asthma may be more of the non-atopic phenotype,� said Dr. Stein.

The researchers speculated that a possible explanation could be that some factors that protect children with allergic sensitization from developing asthma are less present in affluent settings, or that acquired commensal bacteria (gut flora), which may also differ with GNI, play a role in development of tolerance and immune function.

�A wide range of different factors, including nutrition, microbial and allergen exposure, housing conditions, and exposure to pollutants, and so forth may have played a role,� they wrote, remarking that a �center level correlation with GNI does not imply a similar relation at the individual level with personal wealth.�

The research will continue with further investigations in other risk factors in asthma development, including diet, the presence of rhinitis, and eczema. �Data to study the impact of genetics in asthma and allergies has been collected and is a central part in the next steps of this study,� said Dr. Stein.

Long-awaited international ethical guidelines for biobank researchers

Fri, 14 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Many sets of guidelines and regulations, and great differences among countries. This is what medical researchers encounter if they want to use previously collected samples from biobanks in their research. For one thing, this makes it extremely complicated to carry out major international studies. In the latest issue of Nature Biotechnology, Swedish ethics researchers at the Center for Bioethics (CBE), together with leading biobank researchers, put forward a pioneering solution: a set of practical ethical guidelines for biobank research.

Biobanks consist of systematically gathered biological samples and are valuable for both research and medical treatments. When tissues samples are linked to good clinical data, they become indispensable to medical science. At the same time a number of ethical issues are raised regarding the use of these samples. For instance, can we be certain that information about an individual will not reach the wrong people, such as employers and insurance companies

�It is crucial to be able to weigh the conflicting interests, so that the regulation of biobank research doesn�t become a patient security problem in diagnosis, care, and treatment,� says Mats G. Hansson, professor of biomedical ethics and director of the Center for Bioethics at the Karolinska Institute and Uppsala University in Sweden.

Today there is a plethora of extremely comprehensive guidelines and regulations in different countries, which entails major complications for biobank scientists, especially in international collaborative projects. In other words, there is a crying need for a simple model providing a comprehensive ethical balancing of medical needs and personal integrity concerns.

The article in Nature Biotechnology presents for the first time an ethical framework for research using previously collected tissue samples, guidelines that can be used as a practical and direct instrument for researchers. Together with an article by the same researchers in the journal The Lancet Oncology from 2006, which provides guidance for the collection of new samples, and an article by Mats G. Hansson published in the latest issue of Pathobiology presenting a manual for biobank research, central issues involving biobank research have now been given a comprehensive solution. Hansson feels that it is important that ethical questions surrounding medical research be discussed and examined in the same forum as the scientific discussion is carried on.

�It�s also important that proposals regarding the ethical balancing of various interests be put through the same type of independent scrutiny by being peer-reviewed in established scientific journals, just like medical research,� he avers.

�The framework is not only an instrument for researchers, but can also serve as a guide for ethics committees throughout Europe.�

Mathematics might save you a trip to the ER

Wed, 12 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BOSTON �Since the days of Hippocrates, people have known that certain illnesses come and go with the seasons. More recently, researchers have learned that these cyclic recurrences of disease, known as seasonality, are often related to the weather. In order to accurately predict when outbreaks of disease will occur, and how many people will be effected, Elena Naumova, PhD, associate professor in the Department of Public Heath and Family Medicine at Tufts University School of Medicine in Boston, and colleagues, are studying seasonality by creating mathematical models based on environmental factors like outdoor temperature.

�Until recently, public health workers and epidemiologists have eyeballed outbreak cycles relative to the weather in order to estimate when the next outbreak will strike a population,� explains Naumova. �But having a more accurate and reliable method of disease surveillance is crucial to forecasting outbreaks in order to implement warning systems,� says Naumova. She and colleagues have developed mathematical models that will more accurately assess seasonality in an effort to better predict when an outbreak will peak and how many people may fall ill.

Naumova and colleagues tested their mathematical models with data gathered from the Massachusetts Department of Public Health on six diseases: giardiasis, cryptosporidiosis, salmonellosis, campylobacteriosis, shigellosis and hepatitis A, all characterized by nausea, diarrhea, abdominal cramping and often fever. Whereas many previous epidemiological studies investigating seasonality have used monthly data or quarterly data, Naumova and colleagues used daily data, enabling the researchers to detect more subtle changes in disease patterns that may have been previously overlooked.

�With more than 1,000 cases of salmonellosis alone each year in Massachusetts, awareness of these subtle changes is crucial because if the public can be alerted to an outbreak even a few days earlier, it would save time, healthcare costs, and most importantly, may save many people a trip to the hospital,� says Naumova.

Using ten years of data (1992-2001), researchers analyzed the timing, duration and magnitude of each of these enteric, or intestinal, diseases and compared these values to the corresponding average daily outdoor temperature in Massachusetts. Both salmonellosis and cryptosporidiosis peaked at the end of July; the hottest time of year in Massachusetts. However, giardiasis, shigellosis and cryptosporidiosis outbreaks spiked one month after the temperature peak. There was no observable trend for hepatitis A.

�Several factors may explain the one-month delay of giardiasis, shigellosis and cryptosporidiosis,� explains Naumova, �including different routes of transmission of each pathogen, greater spread of a disease due to close person-to-person contact, and different symptoms among patients. More than likely it is a combination of factors.� Naumova also notes that this second peak in disease may be linked to recreational water use. �By August in Massachusetts, recreational water sources are at their warmest, having been heated all summer long. This higher water temperature, combined with close person-to-person contact, may be the reason for the second peak of outbreaks observed with these three pathogens.�

Disease surveillance and alert systems are crucial to preventing the spread of disease. �At both the global and community level, public health officials are working with epidemiologists to develop standardized alert and response systems at the first signs of an outbreak,� says Naumova. �It is our hope that this mathematical model, based on daily data, will contribute a degree of accuracy in the field of outbreak forecasting and disease surveillance.�

UNH, state health agency, private industry and NASA to tackle Lyme disease

Wed, 12 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) DURHAM, N.H. -- Armed with satellite imagery, field samples, human Lyme disease case data, and mathematical models, an interdisciplinary research team from the University of New Hampshire, the New Hampshire Department of Health and Human Services, and the private sector will conduct work on the ecology and risk factors of Lyme disease in New Hampshire and neighboring states in an effort to eventually identify hot spots and issue early warning to help prevent human exposure and disease. The project will expand an emerging field of research at UNH that applies space technology to study disease ecology and address public health issues.

The research team, comprised of five UNH professors, a private sector scientist, and two state public health officials, was recently awarded nearly $750,000 by the National Aeronautics and Space Administration to conduct the work for a three-year period beginning January 1, 2008.

That such work is needed in the state is made clear by the numbers: while human Lyme disease cases have doubled across the U.S. over 15 years, New Hampshire has experienced a nearly 16-fold increase in cases of the tick-borne disease from 1997 to 2006 - from 39 to 617, or about 47 cases per 100,000 people in 2006. Surrounding New England states have also seen increases greater than the national average.

Despite this rapid increase, the state currently lacks much of the capacity for doing the tick surveillance, data integration, and epidemiological modeling necessary to respond to the public health needs of this disease. Moreover, changes in climate, land use, and socio-economic conditions in the near future are likely to further alter the patterns and dynamics of coupled human-environmental systems thereby substantially affecting the pathogen-vector-host relationships of infectious diseases.

Over time, the team will build the capacity to identify potential hot spots for transmission of Lyme to humans thus making an early warning system possible. This infrastructure could also be applied to the study and tracking of other vector-borne diseases such as Eastern equine encephalitis, West Nile virus, both of which have shown up in the state, and the deadly form of avian flu, which has the potential to appear in the U.S., including New Hampshire.

That predictive ability is something we'll achieve down the road, says project co-investigator Xiangming Xiao of the UNH Complex Systems Research Center within the Institute for the Study of Earth, Oceans, and Space (EOS). Xiao specializes in the applications of satellite remote sensing and geographical information systems (GIS) technologies to ecosystems science and natural resources. He adds, Before we can make predictions we have to build the research and education capacity.

Ultimately, that capacity will involve combining the remotely sensed data with data from a new systematic tick surveillance and testing program. In turn, these data will be integrated into a mathematical model to generate a diagnostic and a predictive capability. The remotely sensed data includes highly detailed biophysical and biochemical information derived from satellite-based optical and radar imagery of the landscape favored by white-tailed deer and small rodents - important hosts for the tick species responsible for transmitting Lyme disease.

Lyme is an emerging disease in the state, says project co-investigator Jason Stull, who holds a dual appointment as the State Public Health Veterinarian with the New Hampshire Health Department and as assistant clinical professor in the UNH Department of Health Management and Policy. Information provided by this project will be critical in order to better understand the ecology and human risk of Lyme disease in the state, which in turn will directly assist in its prevention and control, Stull adds.

The successful proposal, entitled Enhancing Research and Education Capacity for Integration of Earth Observations, Infectious Diseases Ecology and Public Health in New Hampshire, is part of NASA's Experimental Program to Stimulate Competitive Research.

The federal EPSCoR program is designed to assist states in establishing an academic research enterprise directed towards a long-term, self-sustaining and competitive capability that will contribute to the states' economic viability and development.

NASA's EPSCoR program in the state is managed by the New Hampshire Space Grant Consortium - one of 52 university-based consortia around the country funded by the space agency. Space Grant is a national network of colleges and universities that contributes to the nation's science and technology enterprise by funding research, education, and public service projects.

UNH research professor David Bartlett directs the state's Space Grant program and also is the principle investigator on the Lyme project. Bartlett notes that the recent award will galvanize an emerging area of research strength at UNH and across the state.

Applying space technology to disease ecology is a promising new field, and this project will further develop existing technologies as well as help initiate a training program for students in a variety of fields, Bartlett says. He adds, This innovative collaboration of specialists in remote sensing, geographic information systems, ecology, and public health places New Hampshire to lead future efforts in the state, in the region, and around the globe.

The long-term goal of the research team is to establish a center of excellence in the application of geospatial technology - satellite remote sensing, global positioning systems, and GIS - for disease ecology and public health at UNH. The program aims to substantially raise the competitiveness of research programs in the state and to promote economic development and job opportunity in the fields of geospatial technology, science, mathematics, and health in New Hampshire.

Other project investigators include scientist Rob Braswell of EOS, Ernst Linder of the UNH Department of Mathematics and Statistics, Rosemary Caron of the UNH Department of Health Management and Policy, state epidemiologist Jose Thier Montero of the Department of Health and Human Services, and William Salas, president and chief scientist of Applied Geosolutions in Durham.

Study links education to risk of cancer death

Tue, 11 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) A new American Cancer Society study finds having at least some education beyond high school is associated with a decreased risk of cancer death. The study finds higher education levels were strongly associated with decreased cancer mortality among black men, white men, and white women. The difference in mortality for all groups was greatest between those with 12 or fewer years of education and those with more than 12 years.

Previous studies have found that death rates are higher among people with less education, but the current study is the first to analyze mortality by race/ethnicity, and is the first to look at the four major causes of cancer death. Led by Jessica Albano, MPH, Society researchers found that death rates for all cancers combined as well as for lung, colorectal, breast, and prostate cancers were strongly associated with years of education in white men, black men, and white women.

For all cancer sites combined, death rates among white and black men with the lowest (0-8 years) level of education were about three times higher than those with the highest (17+ years) level of education. At every level of education, death rates were higher for black than white men. Relationships between level of education and cancer death rates were weaker for women than for men, and also weaker for black women compared to white women. Nonetheless, cancer death rates were significantly higher among black women with 12 or fewer years of education compared to those with more education.

Several findings of the study were new and notable. A very strong relationship between years of education and prostate cancer was found for black men. Although level of education was strongly associated with prostate cancer mortality in both black and white men, at each level of education death rates for black men were substantially higher than those for white men. Also, the study for the first time found white women with higher levels of education had lower breast cancer death rates than those with less education, reversing the historical pattern that more-educated women were more likely to develop and die of breast cancer because of delayed childbirth and other reproductive risk factors. This change may reflect in part the increasing importance of early detection and timely and appropriate treatment in preventing deaths from breast cancer.

�Our study shows socioeconomic factors, as measured by years of education, play an important role in the risk of dying of cancer,� said Elizabeth Ward, Ph.D., American Cancer Society director of surveillance research and study co-author. �The relationships between socioeconomic status and race are complex and the strengths of the relationships we see depend in large part on what is measured in particular studies. Although this study measured differences in cancer mortality by individual level of education and race, the observed disparities likely result from multiple factors that influence health and health care at the individual, community and national level. Differences in cancer mortality by level of education should continue to be measured and used to track progress as we work to eliminate health disparities.�

The study adds to the body of evidence that cancer disparities result from by social and economic factors that are, at least in principle, preventable. The authors say these differences likely reflect relationships between education and other factors that are more directly associated with risks of developing and dying from cancer, such as tobacco use, cancer screening and access to timely and appropriate healthcare. Higher cancer mortality among blacks compared to whites at similar levels of education likely reflect differences in educational and employment opportunities, income, housing, overall standard of living, and access to medical care that are not fully captured by the single measure of socioeconomic status (i.e. years of education) available for their analysis.

Low vitamin D during pregnancy linked to pre-eclampsia

Fri, 07 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) PITTSBURGH, Sept. 7 � Vitamin D deficiency early in pregnancy is associated with a five-fold increased risk of preeclampsia, according to a study from the University of Pittsburgh Schools of the Health Sciences reported this week in the Journal of Clinical Endocrinology and Metabolism.

A serious complication of pregnancy marked by soaring blood pressure and swelling of the hands and feet, preeclampsia is the leading cause of premature delivery and maternal and fetal illness and death worldwide, conservatively projected to contribute to 76,000 deaths each year. Preeclampsia, also known as toxemia, affects up to 7 percent of first pregnancies, and health care costs associated with preeclampsia are estimated at $7 billion a year in the United States alone, according to the Preeclampsia Foundation.

�Our results showed that maternal vitamin D deficiency early in pregnancy is a strong, independent risk factor for preeclampsia,� said Lisa M. Bodnar, Ph.D., M.P.H., R.D., assistant professor of epidemiology at the University of Pittsburgh Graduate School of Public Health (GSPH) and lead author of the study. �Women who developed preeclampsia had vitamin D concentrations that were significantly lower early in pregnancy compared to women whose pregnancies were normal. And even though vitamin D deficiency was common in both groups, the deficiency was more prevalent among those who went on to develop preeclampsia.�

For this investigation, Dr. Bodnar and her colleagues evaluated data and banked blood samples taken from women and newborns between 1997 and 2001 at Magee-Womens Hospital of the University of Pittsburgh Medical Center (UPMC) and affiliated private obstetrician practices. Data were analyzed for 1,198 women enrolled in the Pregnancy Exposures and Preeclampsia Prevention Study, a prospective survey designed to examine factors that may predispose women to preeclampsia. Out of this group, 55 cases of preeclampsia and 220 controls were selected for further study.

Samples of maternal blood were taken prior to 22 weeks pregnancy and again just before delivery. Samples of newborn umbilical cord blood also were tested for 25 hydroxyvitamin D, an indicator of vitamin D status.

�Low vitamin D early in pregnancy was associated with a five-fold increase in the odds of preeclampsia,� said Dr. Bodnar, who also is an assistant investigator at the university-affiliated Magee-Womens Research Institute (MWRI). �Data showed this increase risk persisted even after adjusting for other known risk factors such as race, ethnicity and pre-pregnancy body weight. Also troubling was the fact that many of the women reported taking prenatal vitamins, which typically contain 200 to 400 International Units of vitamin D,� she said.

�Even a small decline in vitamin D concentration more than doubled the risk of preeclampsia,� noted James M. Roberts, M.D., senior author of the study and MWRI founding director. �And since newborn�s vitamin D stores are completely reliant on vitamin D from the mother, low vitamin levels also were observed in the umbilical cord blood of newborns from mothers with preeclampsia.�

A vitamin closely associated with bone health, vitamin D deficiency early in life is associated with rickets � a disorder thought to have been eradicated in the United States more than 50 years ago � as well as increased risk for type 1 diabetes, asthma and schizophrenia.

In the developing world, preeclampsia accounts for up to 80 percent of maternal deaths. And while treatment is more available in developed countries, preeclampsia remains the leading cause of maternal death. Infants born to mothers with preeclampsia have a risk of mortality five times greater than those born to women with normal pregnancies. In the United States alone, nearly 15 percent of preterm deliveries are a result of preeclampsia.

Connection between virus and Colony Collapse Disorder in bees

Thu, 06 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) A team led by scientists from the Columbia University Mailman School of Public Health, Pennsylvania State University, the USDA Agricultural Research Service, University of Arizona, and 454 Life Sciences has found a significant connection between the Israeli Acute Paralysis Virus (IAPV) and colony collapse disorder (CCD) in honey bees. The findings, an important step in addressing the disorder that is decimating bee colonies across the country, are published in the journal Science this week.

In colony collapse disorder, honey bee colonies inexplicably lose all of their worker bees. CCD has resulted in a loss of 50-90% of colonies in beekeeping operations across the U.S. The consortium of scientists who have been studying the role of infection in this phenomenon includes Diana Cox-Foster, professor in the Department of Entomology at Pennsylvania State University, Ian Lipkin, director of the Center for Infection and Immunity at Columbia University Mailman School of Public Health, Jeffery Pettis, research leader of the ARS Bee Research Laboratory, and Nancy Moran, Professor at the University of Arizona, Tucson.

Ian Lipkin, MD, professor of Epidemiology, Neurology, and Pathology at Columbia, and his team at the Mailman School�s Center for Infection and Immunity, together with a team at 454 Life Sciences, used revolutionary genetic technologies, to survey microflora of CCD hives, normal hives, and imported royal jelly. Candidate pathogens were screened for significance of association with CCD by examining samples collected by the USDA and Penn State from several sites over a period of three years.

Using the 454 Life Sciences high-throughput DNA sequencing platform, and analytical methods developed at Columbia, Dr. Lipkin�s team searched for footprints of viruses, bacteria, fungi, and parasites in thousands of sequences. Candidates were further characterized by more detailed sequence analysis to ascertain their specificity for CCD and relationship to known and unknown pathogens.

IAPV, an unclassified dicistrovirus not previously reported in the U.S. that is transmitted by the varroa mite, and Kasmir bee virus were only found in CCD hives. The researchers report that IAPV was found in all four affected operations sampled, in two of four royal jelly samples, and in the Australian sample. KBV was present in three of four CCD operations, but not in the royal jelly. One organism was significantly correlated with CCD: finding IAPV in a bee sample correctly distinguished CCD from non-CCD status 96.1 percent of the time.

�This is a powerful new strategy for looking at outbreaks of infectious disease and finding cause. Dr. Cox-Foster recruited us into this project, making a persuasive case for applying our state-of-the-art methods for differential diagnosis of infectious disease in humans, to this challenge in agricultural epidemiology,� said Dr. Lipkin. �The profound synergy within the group�bringing entomology, microbiology, and bioinformatics together�enabled us to work toward a solution to this extraordinarily complex problem.�

This is the first report of IAPV in the United States. IAPV was first described in 2004 in Israel where infected bees presented with shivering wings, progressed to paralysis and then died just outside the hive. Importation to the U.S. of bees from Australia began in 2004, coinciding with early reports of unusual colony declines.

IAPV was found in non-CCD hives in some cases, which could reflect strain variation, co-infection, or the presence of other stressors, such as pesticides or poor nutrition. The varroa mite, for example, absent in Australia, immunosuppresses bees making them more susceptible to infection by other organisms, including viruses. Other stressors may include chemical pesticides used on plants pollinated by bees and in hives to control pests.

�Our results indicate that IAPV is a significant marker for CCD. This discovery may be helpful in identifying hives at risk for disease. The next step is to ascertain whether IAPV, alone or in concert with other factors, can induce CCD in healthy bees,� added Dr. Lipkin.

Bees play an integral role in the world food supply, and are essential for the pollination of over 90 fruit and vegetable crops worldwide, with the economic value of these agricultural products placed at more than $14.6 billion in the U.S. In addition to agricultural crops, honey bees also pollinate many native plants within the ecosystem. Recently, the increased deaths in bee colonies due to CCD seriously threaten the ability of the bee industry to meet the pollination needs of fruit and vegetable producers in the U.S.

Rutgers Genetics receives $7.8 million for autism research

Wed, 05 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The Simons Foundation, through its Autism Research Initiative, has signed a $7.8 million, two-year contract with the Rutgers University Cell and DNA Repository (RUCDR) to establish a collection of DNA samples for autism studies. The samples will be collected from 2,000 families that have a single autistic child.

�The Simons Simplex Collection, as this project is known, will constitute the core resource for a new and different line of research into the genetics of autism,� said RUCDR Scientific Director Jay Tischfield, who is also the Duncan and Nancy MacMillan Professor of Genetics at Rutgers. �We will be looking not only at autism that is passed from generation to generation, but also at autism that derives from �sporadic� genetic changes that may occur within one generation. It is now recognized that such sporadic mutations may account for a large fraction of autism cases.�

Blood samples from the 8,000 participating family members will be collected at 11 centers around the United States and Canada, and shipped to Rutgers for processing into DNA and cell lines that will then be preserved and stored in vaults of liquid nitrogen. Autism researchers will be able to access these genetic specimens through the auspices of the Simons Foundation.

�We are proud to have been chosen by the Simons Foundation to construct and maintain this unique and unprecedented resource, a tool that can help unlock some of the mysteries of autism,� said Richard L. McCormick, president of Rutgers, The State University of New Jersey. �The opportunity to contribute to this initiative is due in great measure to the leadership position that Rutgers scientists have achieved in the field of medical genetics.�

Autism is a disorder that manifests early in life and has no known cure. It is tied to a child�s early brain development and is usually diagnosed in the first three years of life.

Autistic children typically have difficulties with behavior, social interaction and communications skills; but there is a broad spectrum of symptoms and characteristics, expressed in combinations from extremely mild to quite severe.

Most scientists agree that there is a genetic basis for autism, with an assortment of environmental factors possibly conspiring with the altered genes to produce the many forms of the disorder. Many believe that genetic analyses will point the way for future research and potential therapies.

The Simons Simplex Collection will supply the groundwork for a different approach to autism genetics. The strategy is based on the premise that new genetic alterations occur in the germ line (sperm or eggs) of one of the parents, but they are not found in other tissues of the parents. Such new or �sporadic� mutations may account for a large fraction of autism cases. They may also explain why the incidence of autism increases with parental age.

Tischfield said that, in general, there may be several different kinds of genetic deficiencies in autism and that many cases may not be due to mutations that are passed on from generation to generation, as in other disorders , such as cystic fibrosis or hemophilia. Consistent with this, geneticists are finding that in sporadic autism cases, where there are no other affected children, there is a high frequency of relatively large, new DNA deletions that are probably not inherited.

�You do not find them in the parents � and that is the key,� Tischfield said. To find individuals with sporadic mutations the project will seek out families with only one affected child. In a family where several children display autism, there is probably a defect in a gene that is inherited in the usual sense.

Clinicians and scientists working with the Simons Simplex Collection are establishing new and rigorous diagnostic criteria to ensure that the selected individuals represent this sporadic type of autism. Molecular tests will eliminate individuals with other diseases that might mimic autism, such as fragile X syndrome � the most common cause of mental retardation in males.

�The genetic bases of this new autism mechanism are only distinguishable with novel technologies, and that is why we missed them in the past,� Tischfield said.

�Ultimately, we want to determine the mechanism that is responsible for these mutations and how the deletions cause autism,� he added. �this understanding will give us a better idea of genes involved in brain development and could lead to better treatment in the short term and, possibly, prevention in the future.�

Genes, Environment and Health Initiative invests in genetic studies, environmental monitoring

Tue, 04 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The National Institutes of Health (NIH) has selected the first projects to be funded as part of the Genes, Environment and Health Initiative (GEI), a unique collaboration between geneticists and environmental scientists.

This is ground-breaking research in understanding the complex factors that contribute to health and disease, said Department of Health and Human Services Secretary Mike Leavitt. Researchers have long known that our genes, our environmental exposures and our own behavioral choices all have an influence on our health. This new initiative will use innovative genomic tools as well as new instruments for measuring environmental factors � from diet and physical activity to stress and substance addiction � in order to begin sorting out how these different factors affect a person�s risk for a number of health conditions.

Secretary Leavitt first launched the GEI initiative in February 2006 as a proposal in the President's budget for fiscal year 2007. The funding announced today is for the first research grants under the new initiative. They are part of a broader effort across HHS agencies to build on recent advances in genomic science and medicine, including the Secretary's Initiative on Personalized Health Care. NIH received $40 million in new funding as part of its fiscal year (FY) 2007 budget to support GEI. NIH institutes already planned to spend some $28 million in FY 2007 on the kinds of studies GEI will conduct. And finally, two institutes chose to add a total of $9 million in additional funding for targeted studies under the Genes, Environment and Health Initiative.

To identify the genetic risks, researchers will use the rapidly evolving technologies used in genome-wide association studies to focus on common conditions, such as tooth decay, heart disease, cancer and diabetes. This genetic component of GEI uses a strategy which relies on the newfound ability to swiftly identify genetic differences throughout the genome between people with an illness and those who are healthy, leading to an understanding of the underlying genetic contribution to the disease. The environmental component will begin by developing new technologies that accurately measure personal exposures with small, wearable sensors that can be used to assess environmental agents. The final component of the research strategy is to determine whether the effect of genetic variants that increase disease risk is different in the presence of environmental exposures. In the first year, NIH will fund eight genome-wide association studies, two genotyping centers, a coordinating center and more than 30 environmental technology projects.

�Genome-wide association studies have proven themselves to be powerful tools for discovering the genetic contributions to common diseases,� said Elias A. Zerhouni, M.D., director of the NIH, which is part of HHS. �Early findings from such studies have identified new genetic variants associated with a higher risk of common diseases such as prostate cancer, diabetes and heart disease, but researchers have only scratched the surface. The genetic studies being funded today will identify many novel genetic variants associated with an increased risk for these health conditions.�

The genome-wide association studies will be led by the National Human Genome Research Institute (NHGRI), part of NIH. First-year funding for the studies was contributed by all NIH institutes and centers, including an extra investment by NIH�s National Institute of Dental and Craniofacial Research (NIDCR).

The principal investigators, approximate funding levels and health condition to be focused on are:

Terri Beaty, Ph.D., Johns Hopkins University, Baltimore

Hepatitis E in Europe -- are pigs or pork the problem?

Mon, 03 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Hepatitis E virus infections can be fatal in pregnant women, but until recently doctors thought the disease was confined to China, India and developing countries. Now Europeans are also contracting the disease here, say scientists today (Monday 3 September 2007) at the Society for General Microbiology�s 161st Meeting at the University of Edinburgh, UK, which runs from 3-6 September 2007.

Hepatitis E virus is one of the few viruses which has been shown to be transmitted directly from animals through food. It was recently thought to be confined to developing countries, and although scientists are still unsure exactly how it spreads to people, direct contact with pigs or eating contaminated pork products is a likely route.

�If this proves to be a relevant route for pig to human infection for Hepatitis E in Europe, food safety regulations might need to be adapted accordingly�, says Dutch researcher Erwin Duizer. �Where we do find Hepatitis E virus identified in Europe then the strain is usually closely related to the viruses found in pigs in the same country�.

Far fewer cases of Hepatitis E virus are reported than actually occur, since doctors currently rarely ask for the relevant diagnostic tests in many industrialized countries. Although they do not yet know the exact route for most infections, the scientists do know that these viruses can infect people if they eat infected pig�s livers without cooking them.

Genetic material from Hepatitis E viruses has already been detected in pig livers being offered for sale in Japan, USA and the Netherlands, proving that European pigs are in contact with Hepatitis E. Wild boar products could present a similar risk.

�To improve understanding of this disease, doctors should routinely start asking for Hepatitis E screening tests, even if the patient has not been travelling in India, China or other countries where they might expect to be at risk of infection� says Erwin Duizer. �Once more people are correctly diagnosed with viral Hepatitis E, they can be treated more effectively and we can learn more on the transmission routes. Current rates of diagnosis are up to13% of acute viral hepatitis patients in European countries, but we think the true rate is much higher. Up to 3% of blood donors in Europe show evidence of exposure to the virus through detectable antibodies�.

�We also need to quickly work out the local route of infection in Europeans, as knowing if Hepatitis E is directly caused by eating pork meat or liver, or caused by foods or people being in contact with pig faeces, will make it possible to implement effective preventive measures�, says Erwin Duizer.

Brown study finds link between depression and household mold

Wed, 29 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) PROVIDENCE, R.I. [Brown University] � A groundbreaking public health study has found a connection between damp, moldy homes and depression. The study, led by Brown University epidemiologist Edmond Shenassa, is the largest investigation of an association between mold and mood and is the first such investigation conducted outside the United Kingdom.

Shenassa said the findings, published in the American Journal of Public Health, came as a complete surprise. In fact, after a few U.K. studies published in the last decade had suggested a link, Shenassa and his skeptical team set out to debunk the notion that any link existed.

�We thought that once we statistically accounted for factors that could clearly contribute to depression � things like employment status and crowding � we would see any link vanish,� said Shenassa, the lead author of the study and an associate professor in the Department of Community Health at Brown. �But the opposite was true. We found a solid association between depression and living in a damp, moldy home.�

Shenassa noted the study, an analysis of data from nearly 6,000 European adults, does not prove that moldy homes cause depression. The study wasn�t designed to draw that direct conclusion. However, Shenassa�s team did find a connection, one likely driven by two factors. One factor is a perceived lack of control over the housing environment. The other is mold-related health problems such as wheezing, fatigue and a cold or throat illness.

�Physical health, and perceptions of control, are linked with an elevated risk for depression,� Shenassa said, �and that makes sense. If you are sick from mold, and feel you can�t get rid of it, it may affect your mental health.�

The study was a statistical analysis of data from the Large Analysis and Review of European Housing and Health Status (LARES), a survey on housing, health and place of residence conducted in 2002 and 2003 by the World Health Organization (WHO). To conduct the survey, WHO interviewers visited thousands of homes in eight European cities and asked residents a series of questions, including if they had depressive symptoms such as decreased appetite, low self-esteem, and sleep disturbances. WHO interviewers also made visual checks of each household, looking for spots on walls and ceilings that indicate mold.

Shenassa�s team analyzed LARES data from 5,882 adults in 2,982 households.

�What the study makes clear is the importance of housing as indicator of health, including mental health,� Shenassa said. �Healthy homes can promote healthy lives.�

Shenassa and his team are conducting follow-up research to see if mold does, indeed, directly cause depression. Shenassa said that given the results of the current study, he wouldn�t be surprised if there is a cause-and-effect association. Molds are toxins, and some research has indicated that these toxins can affect the nervous system or the immune system or impede the function of the frontal cortex, the part of the brain that plays a part in impulse control, memory, problem solving, sexual behavior, socialization and spontaneity.

Report on patients' access to cancer drugs 'uses flawed methods to reached flawed conclusions'

Wed, 29 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) A leading epidemiologist has attacked Swedish research that looked at inequalities in patients� access to cancer drugs across Europe and the world. In a commentary published in the September issue of the cancer journal, Annals of Oncology [1], Professor Michel Coleman says the Karolinska report is so badly flawed that no safe conclusions can be drawn from it about cancer survival, and he highlights the role played by a major drug company in funding the research.

In May 2007 Annals of Oncology published �A global comparison regarding patient access to cancer drugs� by Dr Nils Wilking, a clinical oncologist at the Karolinska Institute in Stockholm and Dr Bengt J�nsson, director of the Centre for Health Economics at the Stockholm School of Economics [2].

Their report concluded there was a link between national cancer survival rates and access to cancer drugs, with some countries being better at making new drugs available quickly and, according to the authors of the report, having better cancer survival than other countries as a result.

However, in his commentary, entitled �Not credible: a subversion of science by the pharmaceutical industry�, Prof Coleman, who is professor of epidemiology and vital statistics at the London School of Hygiene and Tropical Medicine, writes that the report �uses flawed methods to reach flawed conclusions about the link between cancer drug �vintage� and cancer survival in European countries�.

He says that the survival estimates in the Karolinska report are not survival estimates at all. �The �survival rates� in the report are not even calculated from the cancer patients� actual duration of survival, which has been standard practice for over 50 years,� he writes. Furthermore, he says the estimates are wrong, and he gives an example for France, where the Karolinska report estimates five-year survival from all cancers combined as 71% for women and 53% for men, whereas cancer survival specialists at the French Cancer Registry Network estimate crude five-year survival rates as 55% and 36%, respectively, some 16-17% lower than the Karolinska team.

He also points out that the cancer drug data come from patients treated around 2003, whereas the cancer survival rates with which they are compared are for completely different patients who were diagnosed during 1990-94. �The authors side-step this issue by claiming that national cancer drug uptake in 2003 is still likely to be representative of uptake in or around 1993,� writes Prof Coleman. �Such a speculative assumption cannot reliably underpin the conclusion that low usage or expenditure on cancer drugs today is the cause of low survival for patients diagnosed ten years ago. It is all the more surprising because the report focuses on anti-cancer drugs licensed after 1995, such as rituximab (Mabthera, 1997), trastuzumab (Herceptin, 1998) and imatinib (Glivec, 2001), which were not even available to treat patients diagnosed during 1990-1994.�

Other criticisms include:

Treating diabetes during pregnancy can break link to childhood obesity

Tue, 28 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) August 28, 2007 (Oakland, Calif) -- Treating diabetes during pregnancy can break the link between gestational diabetes and childhood obesity, according to a Kaiser Permanente study featured in the September issue of Diabetes Care.

The largest study of its kind, this research shows that the risk of childhood obesity rises in tandem with a pregnant woman�s blood sugar level and that untreated gestational diabetes nearly doubles a child's risk of becoming obese by age 5 to 7. The study also shows for the first time that by treating women with gestational diabetes, the child�s risk of becoming obese is significantly reduced. In fact, children whose moms were treated for gestational diabetes had the same risk for becoming obese as children whose mothers had normal blood sugar levels.

Researchers at Kaiser Permanente�s Center for Health Research (CHR) in Portland and Hawaii used the organization�s integrated databases to analyze medical records of 9,439 mother-child pairs. The subjects were members of the health plan in Oregon, Washington and Hawaii and gave birth between 1995 and 2000. The authors found that treating gestational diabetes lowers the child's risk of becoming obese during childhood to the same levels of those pregnant mothers with normal blood sugar levels.

Gestational diabetes, the condition in which pregnancy triggers insulin resistance and raises the woman�s blood glucose level (hyperglycemia), affects up to 8 percent of pregnant women each year in the United States. The rate of childhood obesity in this country more than doubled in the last two decades, so much so that it is now one the nation�s fastest growing health conditions. Nearly 7 million overweight and obese children in the United States today will grow up to become overweight or obese adults.

Hyperglycemia during pregnancy is clearly playing a role in America's epidemic of childhood obesity, said Teresa Hillier, MD, MS, an endocrinologist and senior investigator at CHR Northwest and Hawaii, and the lead author of the study. The key finding here is that the risk of overweight and obese children rises in step with higher levels of blood sugar during pregnancy. The good news for pregnant women is that by treating gestational diabetes, your children's risk of becoming overweight or obese drops considerably.

My advice to pregnant women is three-fold: Discuss gestational diabetes screening with your doctor, usually between weeks 24 and 28 of pregnancy; if you have gestational diabetes, work with your physician to treat it, and stick with the treatment during your pregnancy. It's the best thing you can do to reduce your child's risk of obesity, said Dr. Hillier.

Funded by a grant from the American Diabetes Association, the study was made possible by Kaiser Permanente's interlinked, computerized databases. As the nation's largest and oldest integrated care delivery system, Kaiser Permanente researchers can anonymously review patient records dating back many years and look for connections with the patient's family members and other aspects of the members� health.

The women in the study were screened during pregnancy for blood sugar level and gestational diabetes. The women's children were measured for weight between the ages of 5 and 7 � the so-called adiposity rebound period, a strong predictor of adult obesity. The relationship between maternal blood sugar and childhood obesity was then analyzed.

Children of mothers with high levels of blood sugar who were untreated were 89 percent more likely to be overweight and 82 percent more likely to be obese by the time they were 5 to 7 years of age, compared to children whose mothers had normal blood sugar levels during pregnancy.

�The obesity risk of children whose mothers had the highest blood sugar levels�and were treated for gestational diabetes�was not statistically different than children of mothers with normal blood sugar levels. This suggests that the 'metabolic imprinting' for childhood obesity that results from gestational diabetes in pregnant women may be reversible, Hillier said.

Clearance of hepatitis C viral infection after liver transplantation

Tue, 28 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Touching stories of living donor transplantation are continuously happening in hospitals. One of these stories is reported recently in the August 14 issue of the World Journal of Gastroenterology because of its shining significance in hepatology. This article is going to bring comfort to many families.

It is about a desperate patient brought to Dr. Tatsuki Ichikawa in the Nagasaki University Hospital, Japan in 2004. This patient was quite a challenge for Dr Ichikawa. She was 60 years old with liver cirrhosis (LC) and liver cancer caused by hepatitis C virus (HCV); she had been diagnosed diabetic since 1995; and previous chemotherapies aiming to remove cancer did not bring any satisfactory result.

To free the patient from the severely damaged liver, liver transplantation (LT) was considered by Dr. Ichikawa when a loving daughter of the patient decided to donate part of her liver to her mother. However, one possibility that concerned Dr. Ichikawa most was that the explanted liver would get re-infected and progress rapidly to LC, since previous data indicated that complete clearance of HCV is the prerequisite for patients to have a good outcome. To minimize this possibility, patients were traditionally treated with interferon (IFN) and/or ribavirin before LT.

Trying to save the life of the patient, Dr Ichikawa decided to introduce the more powerful medicine, PEGylated IFN, in the treatment before liver transplantation. PEGylation is a chemical modification incurring higher water-solubility and higher stability to the modified polypeptide medicine. Five weeks after the PEG-IFN treatment, HCV antigen was no longer detectable from the patient serum, but HCV-RNA persisted. Even after the long treatment for 18 weeks, HCV RNA was still detectable. Since the complete clearance of HCV RNA seemed impossible, the liver transplantation was performed.

Unexpectedly and excitingly, clearance of HCV RNA was achieved just one month after the successful liver transplantation and HCV was never detected in this patient thereafter. Thus, this is the first reported case in which a complete recovery from HCV infection was achieved after LT, with a patient who was diagnosed positive in HCV-RNA and negative in HCV core antigen before LT. Dr. Ichikawa suggested that the long acting of PEG-IFN might bring good outcome to similar patients awaiting liver transplantation.

This case no doubt brings promising future for many LC patients. Due to the high percentage of HCV infected population in the world and unavailability of commercial vaccine against HCV, the case reported by Dr Ichikawa surely worth the attention of both doctors and common people.

Study finds environmental tests help predict hospital-acquired Legionnaires' disease risk

Wed, 22 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) PITTSBURGH, Aug. 22 � A new study spearheaded by the University of Pittsburgh School of Medicine has determined that environmental monitoring of institutional water systems can help to predict the risk of hospital-acquired Legionella pneumonia, better known as Legionnaires� disease. Reported recently in the journal Infection Control and Hospital Epidemiology, the 20-hospital study also calls for reconsideration of the current national infection-control policy to include routine testing of hospital water systems for Legionella, the bacterial group associated with Legionnaires�.

�Only those hospitals that had high levels of Legionella bacteria in their water systems had patients who contracted Legionnaires� disease,� senior author Victor L. Yu, M.D., professor of medicine at the University of Pittsburgh School of Medicine, said of the study, which involved hospitals in 14 states. �Proactive monitoring of the hospital water supply alerted physicians to the hidden risk of Legionnaires� disease for their patients.�

Legionella bacteria first were identified as causing pneumonia in 1976 following an outbreak among attendees at an American Legion convention at a Philadelphia hotel, resulting in the name Legionnaires� disease. With an average fatality rate of 28 percent, Legionnaires� is estimated to be responsible for up to 20,000 cases a year in the United States, many of them hospital-acquired. Currently, the U.S. Centers for Disease Control and Prevention recommends that hospitals and other health care institutions monitor patients for pneumonia incidence before doing environmental surveillance of water systems that can harbor the bacteria.

�Based in part on our work, and in collaboration with the Allegheny County Health Department and the Three Rivers Association for Professionals in Infection Control, the development of proactive guidelines for hospital-acquired Legionnaires� disease prevention has led to the virtual disappearance of this infection in Pittsburgh,� said study first author Janet Stout, Ph.D., research assistant professor in Pitt�s department of civil and environmental engineering. �We first reported the connection between hospital water supply and these infections in 1982.�

For this investigation, Drs. Yu, Stout and colleagues evaluated samples of hospital system water at 20 facilities across the country from 2000 to 2002. Water samples were retrieved from at least 10 separate sites at each hospital on multiple occasions over the two-year period. When cases of Legionnaires� were identified, patient urine and sputum samples from 12 of the hospitals were tested to determine classification of Legionella, which has at least 48 strains.

The researchers found that 14 (70 percent) of hospital water systems tested positive for Legionella species, and that six (43 percent) positive hospitals had high-level colonization. Legionnaires� cases were among the 633 patients with hospital-acquired pneumonia whose urine or sputum samples were tested for Legionella bacteria. All were traced to hospitals with high-level colonization.

�Our study provides much-needed evidence to support a national policy change to include routine environmental surveillance of health care facility water systems along with stringent clinical monitoring of patients,� said Dr. Stout, who estimates that 39,000 people have died of Legionnaires� since 1982. �We think this long overdue approach should be adopted by infection control and infectious disease practitioners nationwide.�

Restless legs syndrome affects nearly 2 percent of US/UK children

Wed, 22 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Restless legs syndrome is a common problem in children 8 years of age and older in the United States and the United Kingdom, according to a new report from an international team of researchers.

Nearly 2 percent of children aged 8 to 17 are affected, and a significant proportion of those experience moderate to severe symptoms, including sleep disturbance and negative moods. The report appears in the August issue of the journal Pediatrics.

�This study suggests that restless legs syndrome is common and troublesome in children and adolescents, occurring more frequently than diabetes and epilepsy,� said principal investigator Daniel Picchietti, a professor of pediatrics in the University of Illinois College of Medicine and a pediatrician and sleep medicine specialist with the Carle Clinic Association and Carle Foundation Hospital in Urbana, Ill.

Restless legs syndrome (RLS) is a neurological sleep disorder characterized by sensations in the legs that create an urge to move. Symptoms are typically worse at night and during rest. RLS is closely associated with another condition, periodic limb movement disorder, in which a person�s legs jerk during sleep. Some people with periodic limb movement disorder also have RLS. Others lack the sensations in the legs that typify RLS.

Most of what is known about restless legs syndrome comes from research on adults. The new analysis is the first population-based prevalence study of RLS in children, and it is the first to use specific pediatric diagnostic criteria. The research team collected detailed data from 10,523 families in the U.S. and U.K.

The new study affirmed that there is a strong genetic component to RLS, Picchietti said. More than 70 percent of the children with RLS had at least one parent with the condition. In 16 percent of the affected children, both parents had RLS symptoms.

Two recent studies � appearing in July in the New England Journal of Medicine and in Nature Genetics � found genes associated with RLS.

�Restless legs syndrome runs in families. That is one of the major points of our study, and the discovery of associated genes really supports it,� Picchietti said.

Awareness of RLS in adults is increasing (depictions of � and jokes about � RLS are appearing more frequently in popular culture). It is less recognized in children, however, and parents and clinicians sometimes dismiss children�s complaints about unusual sensations in their legs as nothing more than �growing pains,� Picchietti said.

Many adults diagnosed with RLS report that their symptoms began in childhood. In the early 1990s, Picchietti began to notice that some children who came to his office because they had trouble sleeping or paying attention in school had symptoms of RLS. But there was scant research on the prevalence of RLS in children.

The new study included a rigorous analysis of participants� reported symptoms, and excluded those who did not meet all of the National Institutes of Health criteria for diagnosing children with RLS. A child who had periodic limb movements during sleep and no other symptoms of RLS would not be counted, for example. A child who reported leg cramps or growing pains would not be included unless he or she met all of the other diagnostic criteria for RLS.

Some parents are surprised to learn that conditions such as attention deficit hyperactivity disorder and depression appear to be more common in those diagnosed with RLS. Sleep disturbance, by itself, is known to aggravate ADHD and depression, which may explain the association, Picchietti said. But there may also be other reasons for the association.

Picchietti described the new findings as a major step forward in understanding how many children are affected by RLS. �But this is not the final answer,� he said. �While some children with RLS had significant sleep disturbance and daytime symptoms, others did not. Which children would benefit from treatment and what those treatments should be are important issues to be addressed. Much more study is needed.�

New report on smoking shows who's quitting, who's not

Tue, 21 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Quitting smoking is not easy, but thousands of New Yorkers succeed at it every year. Who�s trying to kick the habit, and who�s succeeding In a new report titled Who�s Still Smoking, the Health Department sheds light on both questions. The report, based on a large survey of New York City adults, shows that two thirds of the city�s smokers � almost 800,000 adults � tried to quit in the past year, but only 17% of those succeeded. Data from the survey identify emotional distress and binge drinking as possible obstacles to quitting, and finds that less than a fifth of New York City smokers are using nicotine replacement therapy � even though it doubles the chances of success. The report is available online at http://www.nyc.gov/html/doh/downloads/pdf/survey/survey-2007smoking.pdf.

New York City has 240,000 fewer smokers today than in 2002, but cessation rates vary widely by borough. Staten Island�s smoking rate has held steady since 2002, even as the citywide rate has dropped by 20%. Some 27% of Staten Island adults still smoke, the report shows, compared to 17.5% citywide. In comparison, the Bronx, Manhattan, and Queens, have all seen declines of more than 20%.

The Health Department today announced a nicotine-replacement giveaway specifically for Staten Islanders. Patches, gum and other medications can double smoker�s chances of quitting, but only 19% of smokers tried the patch in the past year, and only 3% tried oral medications like Zyban. The five-week giveaway will take place on Tuesdays through Thursdays beginning today, August 21, and will run through September 20 at the Staten Island Ferry�s Whitehall Terminal. The Health Department is also planning a targeted anti-tobacco media campaign and a qualitative study to determine why smoking is so widespread and persistent on Staten Island.

The new report also shows that men smoke more than women in New York City (20% versus 15%) but that both sexes are quitting at similar rates. Black and Hispanic smokers are more likely than whites to try quitting, the report shows, but less likely to succeed.

Smoking is an expensive habit, costing the average pack-a-day smoker $2,500 a year. Not surprisingly, 68% of low-income smokers (versus 60% of high-income smokers) report having tried to quit during the past year. Yet data show that poorer New Yorkers are less likely to succeed. Survey data also indicate that attempts to quit smoking also vary by education level. New Yorkers without a high school education are more likely to try to quit than those who have a college degree (70% versus 62%), but they succeed at a lower rate (14% vs. 20%).

Mailman School of Public Health study examines link between racial discrimination and substance use

Mon, 20 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) In one of the first studies to focus on the relationship between racial discrimination and health risk behaviors, researchers at the Columbia University Mailman School of Public Health with colleagues from the Universities of Minnesota, Alabama (Birmingham), and California (San Francisco), and Harvard University found African Americans experiencing racial discrimination were more likely to report current tobacco use or recent alcohol consumption and lifetime use of marijuana and cocaine.

Although racial discrimination was far less common in Whites (38%) than in African Americans (89%), the researchers assessed whether parallel associations exist in Whites and found similar associations with smoking, alcohol, and lifetime use of marijuana and cocaine as they did in African Americans. Thus, substance use may be an unhealthy coping response to perceived unfair treatment for some individuals regardless of their race/ethnicity. �However, it is worth noting that racial discrimination may be a different phenomenon for African Americans than it is for Whites, and thus, lead to very different consequences,� said Luisa N. Borrell, DDS, PhD, of the Mailman School of Public Health�s Department of Epidemiology and principal investigator of the study.

African Americans experiencing racial discrimination also reported having more education, higher income, and a stronger social network than those reporting no racial discrimination. In contrast to African Americans, Whites reporting racial discrimination reported less education and lower income than did those who reported none. Similar to African Americans, Whites reporting any discrimination were more likely to report less control of their life, more anger, less emotional support, and more negative interactions than did their counterparts reporting none.

�We found that African Americans reporting discrimination in three or more domains in both years had higher levels of education and income than did those who reported experiencing less or no discrimination,� said Dr. Borrell. �Possibly, African Americans with a higher socioeconomic position report more discrimination because they are more exposed to situations in which they are discriminated, or they may be more aware of subtle forms of discrimination,� noted Dr. Borrell.

According to the findings, in contrast, Whites with a low socioeconomic position may be more likely to be exposed to environments in which they are the minority and, therefore, be more likely to feel discriminated.

Among the strengths of the study are its population-based nature, the focus on young to middle-aged adults, the wide ranges of educational attainment and income, the information on illicit substance use, and socioeconomic position indicators. �It is possible that use of a recreational drug helps to cope with life stress resulting from perceived unfair treatment because of one�s race/ethnicity,� observed Dr. Borrell. �Our findings that current use of marijuana was not related to discrimination and that risk of being a former smoker was increased suggest that, by early middle age (average age, 40 years), people may have found other ways to cope. However, the finding of an excess of current smoking in this population, suggest that this addictive habit may be long lasting, even when alternative coping behaviors are adopted.�

Source of the data was the CARDIA study, a prospective study of cardiovascular risk among young adults. 3,330 persons aged 18�30 years examined at baseline (1985-1986) and re-examined again seven (1992-1993) and 15 years (2000-2001) later in the (CARDIA) Study were included in this study.

Pitt study finds inequality in tobacco advertising

Mon, 20 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) PITTSBURGH, Aug. 20 � Compared with Caucasians, African-Americans are exposed to more pro-tobacco advertising, according to a University of Pittsburgh School of Medicine study published in this month�s Public Health Reports.

Smoking remains the leading cause of preventable death and disease in the United States, causing more than 440,000 deaths annually and costing more than $150 billion in direct and indirect costs each year; African-Americans currently bear the greatest burden of this morbidity and mortality. Although exposure to pro-tobacco media messages is now known to be a potent risk factor for tobacco use, whether African-Americans are in fact exposed to more pro-tobacco advertising has been unclear until now.

�This review and meta-analysis demonstrates that African-Americans are indeed disproportionately exposed to pro-tobacco mass media messages in terms of both concentration and density,� said Brian A. Primack, M.D., Ed.M., senior author of the study and assistant professor of medicine and pediatrics at the University of Pittsburgh School of Medicine. �These findings will help us develop interventions and further research aimed at reducing tobacco-related health disparities.�

In the study, Dr. Primack and colleagues evaluated data from both predominantly African-American and Caucasian markets using studies from peer-reviewed journals. By extracting the number of total media messages the number of tobacco-related messages, and the number of residents living in each market area, they were able to calculate the concentration and density of tobacco advertising in each market.

Concentration of tobacco advertising can be defined as the number of tobacco advertisements divided by the total number of advertisements. �According to our data, the concentration of pro-smoking signage is approximately 70 percent higher for African-Americans ,� said Dr. Primack. �Our results also showed that there are about 2.6 times as many advertisements per person in African-American areas as compared to Caucasian areas.�

The findings, Dr. Primack notes, suggest that African-Americans may be special targets of the tobacco industry.

�This population may require specific public health interventions to counter the effect of unbalanced pro-tobacco promotion. Knowing that they may be targeted could motivate African-Americans to refuse to fall prey to industry tactics and help them avoid smoking,� he said.

The study authors point out important limitations worth noting. In particular, the studies that met criteria for inclusion in this review focused on older forms of advertising and promotion such as billboards and magazines. This suggests that additional research is needed on current media portrayals of smoking, such as tobacco promotions and smoking in films.

Most flu shot plans do not address how to vaccinate hard-to-reach populations

Wed, 15 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK CITY, August 15 Most flu immunization plans in the United States do not address how to vaccinate hard-to-reach populations (HTR)--undocumented immigrants, substance users, the homeless, homebound elderly, and minorities--and this potentially dangerous omission can lead masses of people to become ill during an outbreak of pandemic flu or other contagious disease, according to a new study by The New York Academy of Medicine in the current issue of the Journal of Urban Health.

Hard-to-reach populations are important to vaccinate not only because theyre personally vulnerable, but because they could be widely transmitting disease to others, said lead author David Vlahov, PhD, Director of the Academys Center for Urban Epidemiologic Studies (CUES) and Senior Vice President for Research. The importance of achieving high flu immunization rates is magnified by concern over pandemic influenza.

Influenza vaccination will begin to be offered by some U.S. healthcare providers as early as next month in preparation for flu season, which usually extends from November through April of each year. Considerable attention will be devoted once again to achieving high levels of vaccination, since the vaccine is the best way to reduce ones chance of getting the flu, according to the U.S. Centers for Disease Control and Prevention. Influenza is a serious disease, causing 36,000 deaths (mostly among those aged 65 years or older) and striking 10 to 20 percent of the American population each year.

Most health departments flu-shot recommendations address how to reach high-risk groups such as the elderly and those with chronic disease, but give less attention to covering HTR populations. Pandemic flu will spread faster if these large segments of the population are left unvaccinated, said Vlahov, who has been working under a $3 million National Institutes of Health grant to devise a plan for quickly finding and immunizing HTR groups. HTR populations in the United States are substantial, including as many as 12 million undocumented immigrants, 1.5 million injection drug users, and 744,000 homeless people, researchers note.

The health of HTR populations has broad implications for the health of the general public, Vlahov said. Some undocumented immigrants, for example, work in poultry processing, the food service industry, and in the home healthcare field, and homeless individuals often ride on subways and buses, coming in contact with large numbers of people.

The authors suggest several achievable strategies for increasing immunization coverage among HTR populations, including distributing vaccines in unconventional sites, such as needle-exchange programs and on street corners that are familiar locations to HTR people. The Academys CUES in 2004 developed Project VIVA, or Venue-Intensive Vaccines for Adults, a small-scale rapid-vaccination approach. Project VIVA involved vaccinating people on busy sidewalks in Harlem and by going door-to-door in housing projects in the South Bronx. Bilingual outreach workers from the Academy working with licensed nurses gave the flu vaccine to over 1,000 homeless, homebound elderly, immigrants, minorities, and injection drug users in a 10-day period during the 2005-06 flu season.

Even within conventional sites for immunizations, the authors suggest several achievable strategies for increasing immunization coverage among HTR populations. Patient reminders, in the form of computer-automated mailings and autodial telephone messages, used for elderly patients in upstate New York have resulted in dramatic increases in vaccination rates in high-risk groups. In addition, more healthcare workers should be vaccinated against the flu. Only about one-third to one-half of healthcare workers are currently immunized, researchers note. Providers who do not believe the vaccine is protective are less likely to recommend it to patients, Vlahov said.

The current federal recommendations for annual and pandemic vaccine do not prioritize the issue of HTR populations, Vlahov said. This problem is an epidemiologic, clinical, and ethical issue.

Adverse housing conditions contribute to diabetes risk

Mon, 13 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Studying people in their homes and neighborhoods, investigators have found that poor housing conditions contribute to the risk for diabetes in urban, middle-aged African-Americans.

A team of investigators from Washington University School of Medicine in St. Louis, Indiana University School of Medicine and other institutions conducted the study. They published their findings in the Aug. 15 issue of the American Journal of Epidemiology.

We looked at several risk factors to see if they could explain why some African-Americans were more likely to develop diabetes, explains Mario Schootman, Ph.D., assistant professor of epidemiology and medicine and chief of the Division of Health Behavior Research at Washington University. And we found that housing conditions somehow contribute to the development of diabetes.

The study looked at many risk factors for diabetes including weight, smoking, exercise, alcohol use, marital status and education. But when the researchers adjusted for all of those factors, housing conditions still influenced diabetes risk.

So far we can't explain why that is, Schootman says. It could potentially be related to lead. Lead is associated with the development of diabetes, and we know that in some poorer housing conditions, there's likely to be lead exposure. But it also could be related to other, unknown environmental contaminants.

Schootman also says stress might be involved. Individuals who live in poor housing conditions may be more likely to be under stress as a function of where they live. There are known links between stress and diabetes that could help explain the increased incidence of diabetes in this population.

But a counter-argument against that would be that diabetes risk was associated with housing but not neighborhoods, he says. We would have expected that if stress was playing a role, the neighborhood conditions also would be involved.

The researchers found that although there was no direct association with neighborhood conditions, sub-standard housing more than doubled diabetes risk. The two neighborhoods studied included a poor, inner-city area and a less-impoverished, suburban area that included several pockets of residents from a variety of socioeconomic backgrounds.

Interviewers spoke to participants in their homes. They gathered data about health status, access to medical care and demographic characteristics, but they also were trained to look for certain things in neighborhoods and houses.

They rated neighborhoods based on noise, air quality and the conditions of houses, streets, yards and sidewalks. Things like broken windows, bad siding on homes, cracks in the sidewalks and nearby industrial sites or traffic noise lowered a neighborhood's rating. Houses were rated based on cleanliness inside of the building and the physical condition of the building's interior and exterior, as well as the condition of the furnishings in the building. Neighborhoods and houses then were classified as fair, poor, good or excellent. Housing included both apartments and single-family homes, and housing conditions rated as fair or poor were associated with increased risks for diabetes.

It's not clear exactly how housing conditions are exerting this influence, says senior author Douglas K. Miller, M.D., the Richard M. Fairbanks Professor in Aging Research and Regenstrief Institute research scientist at Indiana University School of Medicine. But it is clear that it won't be possible to reduce disparities in health status among subgroups in the population without understanding how a person's environment can affect that person's health.

This study grew out of a larger health study involving African-Americans. In the original study, researchers looked at several factors responsible for the higher incidence of health problems experienced by later middle-aged and older African-Americans living in St. Louis. That original study gathered data from 998 African-Americans in the St. Louis area who were born between 1936 and 1950.

When that study began, diabetes already was very common in this population. More than 25 percent had the disease at the time initial interviews were conducted. The new study found that over the next three years another 10 percent developed diabetes.

I think that's a huge finding in and of itself, Schootman says. Think about how many middle-aged African-Americans live in a place like St. Louis, and if our sample is at all representative of the larger community, you can see that the number of people with diabetes is growing very rapidly over time. I also think it's likely that we would find comparable results if we had done similar research in Detroit or Atlanta or New York City.

Schootman says more studies will be needed to determine what specifically increased the risk of diabetes as a result of poor housing conditions, but many factors have already been ruled out.

Risk of common vaginal infection linked to preterm birth appears higher for blacks

Sat, 11 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BOSTON, Aug. 11 Risk of a common vaginal infection linked to preterm birth appears to escalate when even one partner is African-American, according to a University of Pittsburgh School of Medicine study presented today at the 34th annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology in Boston.

When a pregnant woman has bacterial vaginosis, her risk of preterm birth goes up, said Hyagriv Simhan, M.D., M.S.C.R., assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. And now we can say that gauging risk for bacterial vaginosis is not as simple as just looking at the woman. We also should consider her partner.

Bacterial vaginosis (BV) is a common gynecological infection that affects up to 50 percent of women in some populations. BV is characterized by an increase in vaginal alkalinity and an overgrowth of abnormal bacteria. Among the infections more prominent symptoms is a milky, foul-smelling discharge.

For years, clinicians have thought of BV infection as a minor problem, but in addition to increasing the risk for preterm birth, other studies have shown that women who have BV also are more likely to get herpes and other sexually transmitted diseases, including HIV, said Dr. Simhan, a maternal-fetal medicine specialist at the Magee-Womens Hospital of the University of Pittsburgh Medical Center.

For this observational study, Dr. Simhan and his colleagues considered 325 women who were in their first trimester of pregnancy. Among these women, 129 (39.7 percent) were white female/white male partnerships, 35 (10.8 percent) were white female/black male couples, 12 (3.7 percent) were black female/white male couples, and 149 (45.9 percent) were black female/black male partnerships.

Generally, BV was less common among white women compared to black women in the group. But notably, partner race also showed an influence on BV risk, Dr. Simhan said. Our results showed that when one partner is black whether male or female risk of BV goes up two-fold.

BV infection is commonly treated with a range of antibiotics. However, in some cases treatment fails and infections become resistant. Even women whose infection clears frequently can become re-infected later.

We found that paternal race is an independent risk factor for BV during pregnancy, and that this is at least as important a risk factor as maternal race, continued Dr. Simhan. Studies on the contribution of BV to adverse pregnancy outcomes should consider paternal race as an important factor.

A recent study from the U.S. Centers for Disease Control and Prevention found that preterm birth contributed to more than a third of infant deaths twice as many as previously thought, making it the leading cause of infant deaths yet the underlying causes of premature birth are not well understood.

Reasons for the observed variance in BV rates among racial groups also are not well understood, Dr. Simhan said.

There could be genetic differences that relate to why infection rates are different, and maybe some differences in nutritional status that could play a part. But we dont even know the differences in normal vaginal flora among racial groups, he said. More study is definitely needed. What we can say now is that its just not as simple as treating the woman.

Bacteria may not hasten death

Tue, 07 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Bacteria you can live without em, but it wont do you any good, according to a study of fruit flies by University of Southern California biologists.

Flies scrubbed clean of bacteria did not outlive their grubby siblings, the researchers report in the August 8 issue of Cell Metabolism.

The finding challenges the conventional wisdom that even harmless bacteria and the immune response they provoke suck up the energy of the host organism and hasten its death.

It seemed like it was dogma that if the organism has to spend energy doing something, it should shorten the animals life, said co-author and USC biologist Steven Finkel.

A research team led by John Tower, associate professor of molecular and computational biology at USC, compared normal fruit flies to ones kept in an axenic (bacteria-free) environment.

The surprise was that the flies grown under axenic conditions and the normal flies had the same life span, Tower said.

The experiment cannot be replicated in higher organisms, which need bacteria for proper digestion and other functions. But the result in flies still may be relevant to human aging research.

In both flies and humans, the number of bacteria living on the organism increases with age. The innate immune response to bacteria is similar in flies and humans, and it loses strength with age in both species.

The study suggests that all these factors may have nothing to do with aging.

I think a lot of people would just assume that if youre increasing bacterial load in an aging human, it must be bad, Finkel said.

And it might not just be bad, it just might be. Prior to this study, I would not have thought that.

The study is part of a broader effort in the Tower lab to eliminate irrelevant factors in aging and close in on its fundamental causes.

We want to determine what limits the life span of the fly, or any other animal, Tower said.

Towers team eliminated bacteria as a factor by comparing normal fruit flies to specimens born from eggs washed in antibiotic, raised in an axenic environment, and given disinfected food throughout their lives. A third group of flies was raised with bacteria and disinfected in adulthood.

Co-author Paul Webster, director of advanced electron microscopy and imaging at the House Ear Institute in Los Angeles, used scanning electron microscopy to visualize structures resembling bacteria biofilms on the surface of older flies.

Tower and co-author Chunli Ren, a graduate student, took bacteria samples from the surface and interior of the flies throughout their life span, confirming that the axenically grown flies were bacteria-free and that bacteria counts in normal flies increased dramatically as the flies got older.

But all the flies lived about as long approximately three months.

Michigan-CDC study supports value of social restrictions during influenza pandemics

Tue, 07 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich. Although physicians have imposed quarantine orders since at least 1374, when the Port of Venice officially isolated foreigners and shippers for 40 days to keep out infectious scourges, there has been no definitive evidence that public health measures like quarantining the sick and isolating people after exposure to ill people would save lives during an influenza pandemic.

Until now.

In a study published in the Aug. 8 Journal of the American Medical Association, a team of University of Michigan medical historians and epidemiologists from the federal Centers for Disease Control and Prevention say that social restrictions allowed 43 U.S. cities to save thousands of lives during the Spanish influenza pandemic of 1918-1919.

Although these urban communities had neither effective vaccines nor antiviral medicines, they were able to organize and execute a suite of classic public health measures called non-pharmaceutical interventions or NPIs before the pandemic gained full force.

The new study finds that cities whose NPIs were sustained and layered with multiple tactics had the best outcomes. In addition to quarantine and isolation, the NPIs examined in this study were school closures and cancellation of public gatherings.

Public health is everyones responsibility. In a world faced by the threat of newly emerging and re-emerging infectious diseases, it is critical to determine if costly and potentially socially harsh NPI measures can save lives and reduce the numbers of those infected, says lead author Howard Markel, M.D., Ph.D., the George E. Wantz Distinguished Professor of the History of Medicine, professor of pediatrics and communicable diseases, and director of the U-M Center for the History of Medicine. Now we know the answer is yes.

Markel adds that in todays world, implementing these measures in a layered, sustained fashion would also provide a cushion of time for the development and distribution of effective vaccines and antivirals, while reducing the crush on essential infrastructure.

By better understanding what worked in the past, we can better prepare for the future, says senior author Martin Cetron, M.D., director of the CDCs Division of Global Migration and Quarantine. Communities that were most successful during the 1918 pandemic quickly enacted a variety of measures. Those planning for the next pandemic need to carefully consider how to best use these strategies to protect people and decrease the potential impact of the next pandemic in their communities.

The 43 cities in the study were scattered from coast to coast and represented a combined population of approximately 23 million. In an exhaustive review of 1,144 primary and secondary sources that included U.S. census data, municipal records, newspapers and handbills covering a 24-week period Sept. 8, 1918 through Feb. 22, 1919 the researchers identified which NPIs were used in each city and when officials turned them on and off.

Using both actual death rates from pneumonia and influenza, and baseline rates for what would have been normal without a pandemic, the researchers found there were 115,340 excess pneumonia and influenza deaths attributable to the pandemic in these cities during the period studied. In comparing the death rates to when NPIs were turned on and off, they found that NPIs did mitigate the death rate, with a statistically significant association between increased duration of NPIs and reduced mortality.

Further, they discovered that city-to-city variation in mortality was associated with the timing, duration and combination of NPIs. St. Louis, Missouri, for example, closed schools and cancelled public gatherings relatively early in the pandemic and sustained these measures for about 10 weeks. The analysis shows that St. Louis had one of the largest drops in mortality while the NPIs were in force.

As a whole, the studys findings contrast markedly with the conventional wisdom that the Spanish Flu ravaged the United States and elsewhere, with little that could be done to stop its deadly toll.

Markel predicts that NPI measures will be socially painful in the next pandemic, but that the publics acceptance of NPIs is essential.

Green tea holds promise as new treatment for inflammatory skin diseases

Mon, 06 Aug 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Green tea could hold promise as a new treatment for skin disorders such as psoriasis and dandruff, Medical College of Georgia researchers say.

Researchers studied an animal model for inflammatory skin diseases, which are often characterized by patches of dry, red, flaky skin caused by the inflammation and overproduction of skin cells. Those treated with green tea showed slower growth of skin cells and the presence of a gene that regulates the cells life cycles.

Psoriasis, an autoimmune disease, causes the skin to become thicker because the growth of skin cells is out of control, says Dr. Stephen Hsu, an oral biologist in the MCG School of Dentistry and lead investigator on the study published in the Aug. 18 edition of Experimental Dermatology. In psoriasis, immune cells, which usually protect against infection, instead trigger the release of cytokines, which causes inflammation and the overproduction of skin cells.

Other autoimmune diseases with similar side effects include lupus, which can lead to skin lesions, and dandruff.

Green tea, already shown to suppress inflammation, helps by regulating the expression of Caspase-14, a protein in genes that regulates the life cycle of a skin cell.

That marker guides cells by telling them when to differentiate, die off and form a skin barrier, Dr. Hsu says. In people with psoriasis, that process is interrupted and the skin cells dont die before more are created and the resulting lesions form.

Animal models treated with green tea also showed reduced levels of proliferating cell nuclear antigen, a gene expressed when skin cells multiply. In psoriasis, the gene is over-expressed and speeds production of skin cells.

Before treatment, the antigen, PCNA, was present in all layers of the skin, Dr. Hsu says. Typically, PCNA is only found in the basal layer, the innermost layer where skin cells continually divide and new cells push the older ones to the skin surface, where they eventually slough off. After being treated with green tea, the animal models showed near-normal levels of PCNA in only the basal layers.

This research is important because some treatments for psoriasis and dandruff can have dangerous side effects, he says.

The traditional treatment of ultraviolet light and medication, while it can control the lesions and be used long term, may cause squamous cell carcinoma the second most common form of skin cancer, Dr. Hsu says. Some of the most effective anti-dandruff shampoos also have carcinogens in them. While the U.S. Food and Drug Administration allows that in small amounts, the bottom line is that we dont know the long-term effects of using those products continuously.

Green tea, which is plant-derived, may be an alternative, he says. But scientists must work to overcome some barriers with the treatment.

The chemicals in green tea are so active that they are oxidized too quickly when mixed with other ingredients. They also dissolve in water, which cannot penetrate the skins barrier.

Researchers are looking for a balanced formula that can dissolve in fats, which can permeate the skin, Dr. Hsu says.

There are no cures for autoimmune diseases. But it is possible that this is a non-toxic way to regulate them. We need further study on humans to determine the full effects.

CeaseFire receives $1.7 million grant to expand outside of Illinois

Mon, 30 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The Chicago Project for Violence Prevention at the University of Illinois at Chicago School of Public Health has been awarded a $1.7 million grant from the Robert Wood Johnson Foundation to expand the CeaseFire program to cities outside of Illinois.

This grant recognizes that many cities around the country are struggling with violence and grappling with a lack of successful and specific intervention strategies to reduce shootings and killings, said Dr. Gary Slutkin, founder and executive director of the Chicago Project for Violence Prevention and research professor of epidemiology in the UIC School of Public Health.

The grant will support CeaseFire implementation in Baltimore, Cincinnati, and Newark, N.J. The cities, Slutkin says, were chosen due to high levels of violence and their strong desire to use CeaseFire's public health and epidemic control approach to reducing shootings and killings.

CeaseFire's violence prevention strategy combines community mobilization, outreach, faith leader involvement and police participation to reduce violence in the same way that other serious health threats -- such as AIDS and tuberculosis -- have been addressed.

The innovative program relies on clergy and community leaders -- including some former gang members with strong ties to high-risk individuals -- who work together to interrupt conflicts and to change behavioral norms in the community.

We are changing the perception of what is expected or normal, said Slutkin, a former World Health Organization epidemiologist. Violence is an epidemic that is beginning to respond to the same methods we have used before for reversing epidemics.

CeaseFire outreach workers have a unique connection and level of trust with the individuals who are committing these violent acts, according to Slutkin. They successfully mediate conflicts, prevent retaliations, and help people change their outlook and their direction.

In Chicago, police districts with the highest shooting and killing rates also have high rates of unemployment and poverty. CeaseFire workers connect individuals with programs and services to help them complete their education and obtain jobs.

After five years of research and development, CeaseFire was formally launched in 2000 in the West Garfield Park neighborhood in Chicago. In the first year, shootings in that community dropped by 67 percent.

CeaseFire is now operating in 16 neighborhoods in Chicago and eight other communities throughout Illinois through a partnership with the city and the state. The model has averaged a 42 percent reduction in shootings and killings in its first year of operation and up to an 82 percent reduction in shootings and killings over two to five years. The intervention has now been replicated 13 times and shows statistical differences when compared to comparison communities with similar rates.

The Chicago Project for Violence Prevention also received a three-year, $3 million grant from the Robert Wood Johnson Foundation in 2006 to develop a national CeaseFire partnership. The new funds further support the national roll-out.

Obesity spreads through social networks

Wed, 25 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BOSTON, Mass. (July 23, 2007) -- Public health officials have been working hard to account for the dramatic rise in U.S. obesity rates. Many obvious factors, such as poor diet and a sedentary lifestyle, certainly contribute to the swelling statistics. However, these and other explanations tend to focus exclusively on how individuals choices and behaviors affect their own weight.

Now, researchers from Harvard Medical School and the University of California, San Diego have found that obesity is hardly a private matter. Reporting in the July 26 edition of the New England Journal of Medicine, the researchers found that obesity spreads through social ties. When an individual gains weight, it dramatically increases the chances that their friends, siblings, and spouses will likewise gain weight. The closer two people are in a social network, the stronger the effect. Interestingly, geographical distance between persons in a social network appears to have no effect.

What we see here is that one persons obesity can influence numerous others to whom he or she is connected both directly and indirectly, says Nicholas Christakis, MD, PhD, a professor in Harvard Medical Schools Department of Health Care Policy. In other words, its not that obese or non-obese people simply find other similar people to hang out with. Rather, there is a direct, causal relationship.

Over the last 25 years, the incidence of obesity among U.S. adults has more than doubled, shooting from 15 to 32 percent. In addition, roughly 66 percent of U.S. adults are considered overweight. Christakis and U.C. San Diego researcher James Fowler, PhD, decided to analyze data from the Framingham Heart Study (an ongoing cardiovascular study begun in 1948) to see if any social patterns might elucidate these alarming rates.

Christakis and Fowler derived information from archived, handwritten administrative tracking sheets dating back to 1971. All family changes for each study participant, such as birth, marriage, death, and divorce, were recorded. In addition, participants had also listed contact information for their closest friends. Coincidentally, many of these friends were also study participants. Focusing on 12,067 individuals, Christakis and Fowler observed a total of 38,611 social and family ties. As they analyzed the data, the researchers also looked closely at the influence of gender, smoking, socioeconomic status, and geographic distance.

The study found that when an individual becomes obese, the chances that a friend of theirs will become obese increase by 57 percent. Their siblings have a 40 percent increased risk of obesity, and their spouse a 37 percent increased risk. However, that persons neighbor, if not a part of their social network, has no effect.

Gender played an important role in how these statistics broke down. In same-sex friendships, individuals experienced a 71 percent increased risk if a friend of theirs became obese. This pattern was also observed in siblings. Here, if a mans brother became obese, his chances of becoming obese increased by 44 percent. Among sisters, the risk was 67 percent. Friends and siblings of opposite genders showed no increased risk. While the researchers note that correlations among siblings provide evidence for a biological, and possibly even a genetic, component to obesity, patterns seen among friends indicate that theres more than biology at work.

Social connections seem to be key. Moreover, as Christakis notes, The fact that neighbors dont affect each other and that geographic separation doesnt influence the risk among siblings or friends tells us that environmental factors are not essential here, says Christakis. Most likely, the interpersonal, social network effects we observe arise not because friends and siblings adopt each others lifestyles. Its more subtle that that. What appears to be happening is that a person becoming obese most likely causes a change of norms about what counts as an appropriate body size. People come to think that it is okay to be bigger since those around them are bigger, and this sensibility spreads.

Obesity, the authors conclude, needs to be seen not simply as a clinical issue but as a public health problem.

We need to understand that a significant part of an individuals health is embedded in their network, says Fowler. In fact, we really need to revisit our whole notion of cost-effectiveness. The fact that certain healthcare approaches wont just affect the individual but will also cascade through their social ties means that healthcare interventions are far more cost-effective than previously thought.

The rising rate of obesity threatens to reverse the decline in disability in the older population, with major implications for the health care system, says Richard Suzman, Ph.D., director of the NIAs Behavioral and Social Research Program. This seminal study breaks important new ground in showing how social networks may amplify other factors and help account for the dramatic increase in obesity across the population.

Should adult male circumcision be recommended for HIV prevention in the US?

Mon, 23 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Three clinical trials in Africa found that adult male circumcision reduced the risk of men acquiring HIV infection from heterosexual sex by 51-60%. While adult male circumcision may also have a role to play in preventing HIV transmission in the US, say scientists at the US Centers for Disease Control (CDC) in a paper in PLoS Medicine, the extent of this role on a population basis is unknown.

Patrick Sullivan (Division of HIV/AIDS Prevention,CDC) and colleagues argue that the potential impact of adult male circumcision on HIV transmission rates in the US is hard to predict, given the many differences between the underlying HIV epidemics in Africa and the US, differences in the prevalence of male circumcision in Africa and the US, and the considerable gaps in knowledge that exist regarding the potential impact of circumcision on HIV transmission by malemale sex.

The HIV epidemics in Africa are substantially different from the US epidemic, they say. The predominant mode of HIV transmission in Africa is heterosexual sex whereas the US has a concentrated HIV epidemic with most sexual transmission occurring among men who have sex with men (MSM). The African trials did not study MSM. While some observational studies have suggested that circumcised MSM in the US may have a decreased risk of HIV infection, say the authors, it is impossible to draw firm conclusions from such observational research, which is prone to bias.

Adult male circumcision will likely have the largest impact in populations where circumcision has been rare, they say. Yet in the US circumcision is already very commonhospital discharge data show that in 1999 around two thirds of all newborn boys were circumcised.

Nevertheless, based on the data from the three African clinical trials, Sullivan and colleagues conclude that it is likely that circumcision will decrease the probability of a man acquiring HIV via penilevaginal sex with an HIV-infected woman in the US. Until public health recommendations are available for the US, they say, some sexually active men may consider circumcision as an additional HIV prevention measure, but should do so only in consultation with their physician or health care provider, and with a clear understanding of the costs and risks of circumcision and the need to continue use of other, proven prevention measures (e.g., reducing the numbers of sex partners and using condoms consistently and correctly). Men who choose to be circumcised should also be counseled about the importance of refraining from sexual intercourse following circumcision, until wound healing is complete. Men should also understand th at male circumcision has only proven effective in reducing the risk of infection through insertive vaginal sex.

Measles vaccinations need to be repeated to protect HIV-infected children

Tue, 17 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) HIV-infected children may require repeat measles vaccination for protection, according to new research from the Johns Hopkins Bloomberg School of Public Health and other institutions. The researchers found that only half of the HIV-infected children who survived without antiretroviral therapy maintained protective antibody levels 27 months after receiving measles vaccine. By comparison, 89 percent of children without HIV maintained their immunity, as did 92 percent of the HIV-infected children who were revaccinated in a mass measles immunization campaign during the 27 months of follow-up. The study results were published online June 19, 2007, by The Journal of Infectious Diseases, and will be included in the August 1, 2007, printed issue of the journal.

Despite recent progress in measles control, measles remains an important cause of child mortality in sub-Saharan Africa, says William Moss, MD, MPH, lead author of the study and an associate professor in the Bloomberg School of Public Healths Department of Epidemiology. The measles virus needs only a small proportion of susceptible children to sustain transmission and cause an outbreak. Vaccinated children with HIV could be susceptible to measles because of their waning immunity, impeding measles elimination efforts in regions with high HIV prevalence.

The study enrolled over 690 Zambian children, 2 to 8 months of age, who came to the Chawama Clinic in Lusaka, Zambia for routine childhood vaccinations. Within six months of measles vaccination at 9 months of age, 88 percent of HIV-infected children developed protective measles antibody levels, as did 94 percent of children born to HIV-uninfected mothers and 94 percent of children who did not have HIV but were born to HIV-infected mothers. The proportion of HIV-infected children who developed protective antibody levels was comparable to those achieved by the other children. However, 27 months after vaccination, measles antibody concentrations were 75 percent lower in children infected with HIV at the time of vaccination and 72 percent lower in the children who became HIV infected after vaccination, compared with HIV-uninfected children.

The World Health Organization recommends a second opportunity for measles vaccination for all children, either through repeated immunization campaigns or a routine second dose delivered through the primary health care system. These study results suggest that this practice is especially important in regions of high HIV prevalence because of waning immunity among HIV-infected children.

Sufficient resources must be invested to maintain high levels of population immunity against measles in regions of high HIV prevalence, as well as investing in strategies to prevent HIV infection and to treat HIV-infected people, said Moss.

The study authors also recommend that additional research be conducted to determine the duration of measles immunity in HIV-infected children receiving antiretroviral therapy and their response to revaccination against measles.

Common rheumatoid arthritis treatment shows potential for diabetes prevention

Tue, 10 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) PITTSBURGH, July 10 Far fewer rheumatoid arthritis patients treated with the drug hydroxychloroquine (HCQ) went on to develop diabetes compared to those who never took the drug, according to a 20-plus-year University of Pittsburgh School of Medicine-led study reported today in the Journal of the American Medical Association. In addition, those using HCQ who did develop diabetes were less likely to take medications to manage their disease after diagnosis.

The multi-center observational study of 4,905 adults with rheumatoid arthritis (RA) found that relative risk progressively declined by as much as 77 percent after four years of treatment with HCQ, a common antimalarial medication that also is used for rheumatoid arthritis and other autoimmune disorders.

Additional participating centers in the study are Stanford University, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), one of the National Institutes of Health (NIH) and the University of Cincinnati. Co-investigators at Stanford have directed the project database since its inception with support from the NIH.

This reduction in risk persisted even after adjusting for other diabetes risk factors among these patients, such as body-mass index, degree of disability and use of corticosteroids, said rheumatologist Mary Chester M. Wasko, M.D., M.Sc., associate professor of medicine, University of Pittsburgh School of Medicine. Because people with RA tend to be less active and take corticosteroids that can cause weight gain, they are often considered to be at higher risk for developing diabetes, a disease in which blood sugar levels become abnormally high because of the bodys inability to use or produce the hormone insulin.

Another interesting finding was that the rheumatoid arthritis patients who developed diabetes were less likely to need blood sugar-lowering medication to manage their disease, said Dr. Wasko, whose clinical research has focused on long-term health improvement in patients with RA. However, it is most exciting to consider that this drug might be appropriate for people with pre-diabetes as a preventive therapy much in the same way as a daily baby aspirin is suggested for people at high risk for heart disease.

Nationally, diabetes is the fifth leading cause of death, according to the American Diabetes Association. Many people first become aware of the disease when confronted with one of its life-threatening complications such as heart disease, blindness, high blood pressure, stroke, kidney disease or circulatory problems that can lead to amputation.

Results show that HCQs association with reduction in diabetes risk is comparable or superior to that of a number of other drugs studied in clinical trials for diabetes prevention and treatment, including rosiglitazone, hormones, metformin, acarbose and ramipril. And recent questions have arisen concerning rosiglitazone, marketed as Avandia, and a reported increased risk of heart attack.

Although HCQ is not without side effects nausea, headache and dizziness, for example the drug has a long history of being generally safe and well-tolerated. In addition, Dr. Wasko and her colleagues observed no apparent negative interactions between HCQ and other drugs commonly used by RA patients, such as methotrexate and prednisone. An important limitation of the study, however, is that investigators used self-report information from patients collected in follow-up twice yearly that did not include confirmation by laboratory tests.

Other studies of the blood sugar-lowering effects of HCQ have shown minimal use for the drug as a treatment for people with established diabetes, Dr. Wasko continued, stressing the treatments real promise may be prevention.

HCQ already has a role in long-term treatment for RA, potentially moderating lipids and having a weak anti-clotting effect. But, optimistically speaking, endocrinologists can identify people who are at high risk for diabetes, due to obesity, family history, lipid profile or other characteristics. HCQ may also have a role in delaying onset of diabetes, Dr. Wasko said. More research is needed to verify our findings in people with RA, and also to determine how this medicine works. But my ultimate hope is that this relatively inexpensive, safe drug will be studied as a way to reduce diabetes risk for people who do not have RA.

NYC syphilis cases double in first quarter of 2007

Mon, 09 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) After leveling off for more than two years, and declining in 2006, new syphilis cases spiked in New York City during the first three months of 2007. The Health Department announced today that doctors reported 260 cases of primary and secondary syphilis during January, February and March, compared with 128 cases during the same period last year. Interviews with patients suggest that the increase is concentrated among men who have sex with men, especially in the Chelsea area of Manhattan. As in past years, half of those newly diagnosed with syphilis also report being infected with HIV.

While men account for the vast majority (96%) of new syphilis cases, the infection may also be increasing among women. Ten cases were reported among women during the first quarter of 2007, compared to just three in the same period of 2006. Since the numbers are very small, it is not clear if the increase among women is significant, but if it were, it would be the first such increase in 10 years.

These increases are the latest in an ongoing outbreak among men who have sex with men in New York City. After plummeting during the 1990s, syphilis cases started rising in 1999. The rate leveled off in 2005 and 2006 but is now moving upward again. For the first time in several years, we are seeing a large spike in new cases of syphilis in New York City, said Dr. Susan Blank, the Health Department's Assistant Commissioner for Sexually Transmitted Disease Prevention and Control. It is critical that sexually active New Yorkers reduce their risk of getting syphilis. The infection itself can be devastating, and it fuels the spread of HIV.

The level of unsafe sexual behavior among HIV positive men is deeply concerning, said Dr. Monica Sweeney, the Health Department's Assistant Commissioner for HIV Prevention. Syphilis and HIV are both preventable, and we know how: reduce the number of sexual partners and use condoms every time you have sex. Also, every sexually active New Yorker should know his or her HIV status.

Last year, New York City's syphilis rate (7.2 cases per 100,000 people) was more than double the 2005 national rate (3.0). But the resurgence isn't confined to New York City. Other large cities, including Los Angeles and Chicago have experienced a recent rise in syphilis cases. Nationwide, the rate rose by 11% from 2004 to 2005, from 2.7 cases to 3.0 cases per 100,000.

The problem is not limited to exclusively gay men. In New York City, the proportion of men with syphilis who report having sex with both men and women increased from 13% in the first quarter of 2006 to 18% in the first quarter of 2007. This change could herald further increases in syphilis infections among women as well as in congenital syphilis cases.

In New York City, blacks and Hispanics continue to account for most new cases of syphilis (29% and 27% of cases, respectively), but whites are experiencing faster rates of increase. During the first quarter of 2007, incidence among white men was more than three times the comparable 2006 rate.

U-M, Israeli scientists report major advance in search for genes associated with colon cancer

Sun, 08 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich. - A 10-year study involving thousands of Israeli Jews and Arabs, led by researchers from American and Israeli institutions, has yielded important new information in the search for the genes that make a person more likely to develop colon cancer.

In a paper to be published in the July issue of Cancer Biology and Therapy, the international research team reports finding a significant link between genetic variation in a single region of human chromosome 8 and the risk of colorectal cancer.

The link was found by detailed comparisons of genetic material from thousands of colon cancer patients and non-patients, and by evaluating the incidence of colon cancer among the immediate family members of colon cancer patients.

In all, people who carry the specific genetic variation, called a marker, were found to be 23 percent more likely to have colon cancer than individuals without the marker. The researchers estimate that this single genetic variation might account for 14 percent of colorectal cancer cases in Israel, where colon cancer is the leading cause of cancer deaths. The specific marker is called the C allele of rs10505477.

Three other research teams are reporting similar findings today in the journal Nature Genetics, having simultaneously found their way to the same small area of chromosome 8, called 8q24, in the search for colon cancer genetic links. The fact that these studies were performed among other populations around the world suggests that this one genetic marker is highly influential across ethnic groups.

The new Cancer Biology and Therapy paper is by an international group of scientists from the University of Michigan Medical School and U-M School of Public Health, the Catalan Institute of Oncology in Spain, the CHS National Israeli Cancer Control Center and Technion - the Israel Institute of Technology.

Its the product of an ongoing Michigan-Israel collaboration, the Molecular Epidemiology of Colorectal Cancer project, which for 10 years has searched for clues to colon cancers genetic roots using samples from large numbers of people in Israel with known ancestral heritage. The project is funded by the National Cancer Institute, with additional funding from the Irving Weinstein Foundation.

The researchers compared the genetic makeup and family history of more than 1,800 colorectal cancer patients with that of 1,900 healthy people with the same breakdown of age, gender and ethnicity - either Ashkenazi Jew, Sephardic Jew or Arab/non-Jew. Samples of tumor tissue from many cancer patients were also tested. The genetic link between the marker and colon cancer was especially strong among patients diagnosed with colon cancer at a young age, under 50 years.

Stephen Gruber, M.D., Ph.D., the co-leader of the Michigan-Israeli team and first author of the new paper, says that the new finding is particularly interesting when considered alongside recent discoveries in the genetics of prostate and breast cancer.

The same genetic region that predisposes to colon cancer has also recently been shown to be an important region predisposing to breast cancer and prostate cancer, he says. The specific genetic cause for this joint susceptibility to three different cancers has not yet been discovered, but several groups are working to close in on the mechanism that might cause these cancers.

Gruber is an associate professor of internal medicine and of human genetics in the U-M Medical School, and of epidemiology in the U-M School of Public Health. He directs the Cancer Genetics program in the U-M Comprehensive Cancer Center, which focuses on inherited cancer risks.

Genetic discovery in Israel through MECC has already proven highly informative. Senior author Gad Rennert M.D., Ph.D., of the Carmel Medical Center and the B. Rappaport Faculty of Medicine at Technion in Haifa, Israel, says The study of populations in Israel has been shown to be exceptionally fruitful in contributing to knowledge about the genetics of leading cancers. This is due to the unique characteristics of the population and our ability to study it in a representative manner.

Unraveling the mysteries of the susceptibility to disease is moving rapidly since the publication of the complete sequence of the human genome in 2003. Says Gruber, The mystery of the relationship between our genetic code and disease is now starting to become clear, and many scientists are turning to the same chapter to find important clues to colorectal cancer. He and his colleagues plan to continue their effort to zero in on the genetic variations involved in cancer.

While there is not yet a screening test for the genetic variation that was pinpointed in the study, Gruber and his co-authors emphasize that genetic testing is available for other known genetic variations linked to colorectal cancer. People with a strong family history of colon cancer, especially cases that began when relatives were younger than age 50, should get genetic counseling and have colonoscopies or other screening tests starting earlier in life than age 50.

Colon cancer is one of the most common cancers in the United States, and the good news is that its largely preventable with early screening, says Gruber. The American Cancer Society estimates that some 150,000 new cases of colon cancer will be diagnosed in 2007, and more than 50,000 deaths from colorectal cancer will occur.

Although most cancers are not inherited, some families are particularly susceptible to cancer and may benefit from early detection or other risk reduction strategies. People concerned about a family history of cancer, or those who have been diagnosed with colon cancer before age 50 or after having two or more relatives diagnosed with the disease, should talk to their doctor about the possible benefits of genetic counseling, Gruber says. Counseling can be done for both patients and family members.

Germany's embryo protection law is 'killing embryos rather than protecting them'

Wed, 04 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Lyon, France: Instead of preserving life, Germanys embryo protection law has had the unintended consequence of increasing the number of foetuses killed after fertility treatment according to new figures presented at the European Society of Human Reproduction and Embryology today (Wednesday). A representative of the German IVF registry has called for the law to be changed urgently to ensure that this situation does not continue.

The German embryo protection law, passed in 1991, stipulates that no more than three embryos can be created per cycle of IVF and all three, regardless of their quality, must be transferred to the patients womb at one time, and cannot be frozen or discarded.

For the first time, figures for 2004 from the ESHRE European IVF monitoring consortium show that out of 8,500 deliveries in Germany in 2004 there were 222 foetal reductions performed (representing 2.6%). Foetal reductions are performed when a woman has a multiple pregnancy and doctors consider it necessary to reduce the number of foetuses she is carrying in order to increase the chances of the remaining ones surviving. It is also performed when doctors discover that foetuses are abnormal.

Professor Ricardo Felberbaum, from the German IVF registry and a member of the ESHRE European IVF monitoring consortium, said: Germanys embryo protection law is not in accordance with ART [artificial reproduction technology] practices now. Foetal reduction is being used in Germany much more than was expected and the German administration must face up to the situation that the 1991 law prevents optimal treatment of the patient and does not protect the embryo either. The law needs to be changed urgently to reflect the current state of the art.

It is far worse to kill embryos after they have implanted in a womans womb, than it is to take embryos before implantation, when they are no more than a collection of cells, freeze any surplus embryos and transfer no more than one or two embryos at one time. It is best that only those with the highest implantation potential are used, leading to healthy singleton pregnancies.

As the law currently stands it is killing embryos rather than protecting them, he concluded.

Other figures from the consortium show that the number of ART procedures in Germany has nearly halved since state funding for them was cut.

Professor Anders Nyboe Andersen told the conference that Germany was a stark illustration of the impact that state funding has on the availability of ART for infertile couples.

In 2003, Germany announced that it would be cutting its generous reimbursement of fertility treatment by 50% and in that year there was a sudden surge in the number of procedures from 84,819 in 2002 to 102,426 as couples rushed to take advantage of the existing funding arrangements. The following year, when the new reimbursement rules were implemented, total activity dropped by nearly 50 per cent to 60,425. Significantly, this was a persistent effect because the number of cycles remained at this lower level in 2005.

Prof Nyboe Andersen, of Rigshospitalet, Copenhagen, Denmark, was presenting data on behalf of the ESHRE European IVF monitoring consortium, which has been gathering information on ART procedures in Europe since 1997. These new figures relate to ART in Europe in 2004 the most recent year for which data are available.

The number of ART procedures has steadily increased over that time, said Prof Nyboe Andersen. In 2002 there was an overall increase of 13 per cent increase on 2002. However, in 2004 this rate of increase had slowed to just two per cent. This is almost entirely due to the drop in the number of cycles in Germany.

Prior to 2004, Germany carried out the most number of ART procedures in the whole of Europe, with France and the UK in second and third place respectively. However, in 2004 France performed the most ART procedures (nearly 70,000), followed by Germany (just over 60,000), Spain (nearly 41,000) and the UK (just over 40,000). There were 370,963 cycles in the 29 European countries reporting to the consortium in 2004. As a comparison, the USA carried out approximately 130,000 cycles.

The availability of ART as measured by number of cycles per one million inhabitants is highest in Denmark, where couples are entitled to at least three free cycles of fertility treatment, with 2,128 cycles per million in 2004. By comparison, availability in Germany dropped from 1,243 cycles per million in 2003 to 803 per million in 2004. Availability in France was 1,154 per million, in Belgium 1,974 per million and in the UK 665 per million.

The data confirms that the proportion of ICSI to IVF procedures has continued to move in favour of ICSI, with 166,711 ICSI (intracytoplasmic sperm injection) procedures (60 per cent) versus 114,512 IVF (in vitro fertilisation) procedures (40 per cent). The number of frozen embryo transfers has continued to increase, rising from around 18 per cent when the consortium first started collecting data to 26 per cent in 2004.

This is a very positive development, said Prof Nyboe Andersen. This means that patients are not having to go undergo repeated cycles of ovarian stimulation because enough eggs are being collected from the first cycle to freeze for use at a later date if the first cycle using the fresh eggs fails. This is much better for the health of the women.

The increasing use of frozen eggs has also led to improvements in the proportion of babies born after ART. In Finland, there were 4,761 ART cycles started and nearly 19 per cent resulted in births when fresh oocytes were used, but the cumulative delivery rate from both fresh and frozen oocytes was 30 per cent. By contrast, in the UK, from 30,495 cycles, 22% of the deliveries occurred after fresh oocytes were used, but the cumulative delivery rate (fresh and frozen oocytes) was only 25 per cent because there were proportionately fewer frozen embryo transfers.

Finland is the first country in the world to show at a national level that cryopreservation [freezing] is a very effective way of increasing the numbers of babies born after ART, because approximately third of all its ART deliveries were from frozen embryos, said Prof Nyboe Andersen.

Endometriosis increases the risk of certain cancers

Mon, 02 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Lyon, France -- Doctors in Sweden have shown for the first time that although endometriosis is associated with an increased risk of various cancers, this risk does not depend on the number of times women with the condition have given birth.

Dr Anna-Sofia Melin, told the 23rd annual meeting of the European Society of Human Reproduction and Embryology today (Monday 2 July): Several epidemiological studies have shown an increased cancer risk among women with endometriosis, especially ovarian cancer. Infertility and never having given birth (nulliparity) are also known risk factors for different types of cancer, such as breast and endometrial cancer. However, as far as we know, this is the first study to investigate cancer risk among women with endometriosis that also stratifies for parity.

Dr Melin, a specialist doctor in the department of obstetrics and gynaecology at the Karolinska University Hospital in Stockholm, Sweden, and epidemiologists at the Karolinska Institute looked at data from 63,630 women who had been discharged from hospital with a diagnosis of endometriosis between 1969 and 2002. They were identified and followed up via the National Swedish Inpatient Register, the National Swedish Cancer Register and the Swedish Multi-Generation Register.

The researchers identified 3,822 cases of cancer amongst the women with endometriosis. While they found no overall increased risk of cancer, they did find that the women had an elevated risk of certain types of cancer, but that there was no significant difference in risk between women who had never given birth and those who had.

We found that, contrary to what one might expect, endometriosis and nulliparity did not combine to give a higher risk of cancer, said Dr Melin.

The researchers found that endometriosis increased the risk of developing ovarian cancer by more than a third (37%) above the risk for the normal population of women without endometriosis. There were similar increases in risk for endocrine tumours (38%), kidney cancer (36%) and thyroid cancer (33%). Slightly lower increases were found for brain tumours (27%) and malignant melanoma (23%), and there was a small increased risk of breast cancer (8%). Interestingly, women with endometriosis had a reduced risk of cervical cancer of just under a third (29%).

There was no significant difference between nulliparous and parous women with endometriosis regarding cancer risk for any of the cancer types. We found a non-significant decrease in ovarian cancer risk the more children a woman had had, said Dr Melin.

Little is known about the possible mechanisms involved in the increased risk of cancer from endometriosis (or decreased risk, in the case of cervical cancer).

Dr Melin said: The fact that our study did not show an association between cancer risk and parity increases the possibility that it is the endometriosis disease in itself that causes the cancer and not the infertility issue.

Various theories have been suggested. For ovarian cancer it might be the exposure of the ovaries to the hostile endometrium cells that invade the ovary during the course of the endometriosis disease. Or it could be defects in the immune system that allow the endometriosis to grow and also might allow cancer cells to grow in different parts of the body. Maybe the treatment of endometriosis, hormonal or surgical, can influence cancer development. We do not know yet.

Dr Melin plans to investigate whether hormonal or surgical treatment of endometriosis might be involved in the increased cancer risk, and she also wants to identify which women are more at risk of developing cancer than others.

But she said that it was too early to use the results of her study to give advice to doctors about improved treatments for women with endometriosis.

Our hope is that doctors in general start to view the endometriosis disease as a serious disease that causes a lot of suffering to the patient and also may lead to cancer. We hope that in the future we will be able to identify those women with endometriosis that may have a more aggressive form of disease with more atypical cells, for instance, and that this may lead to better care for the patient and, hopefully, to a early diagnosis if cancer should occur, she concluded.

Alcohol survey reveals 'lost decade' between ages of disorder onset and treatment

Mon, 02 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) At some time during their lives, more than 30 percent of U.S. adults surveyed in 2001-2002 had met current diagnostic criteria[i] for an alcohol use disorder (AUD), according to an article in the current issue of the Archives of General Psychiatry. Many of those persons never received treatment, and many others did not receive treatment until well after AUD onset.

Of those with alcohol dependence[ii], only 24.1 percent had received any type of treatment, broadly defined to include treatment either by a physician or other health professional, or by 12-step programs, crisis centers, employee assistance programs, or others. Of those with alcohol abuse[iii], only 7.0 percent had received treatment. Although average age of alcohol dependence onset was 22.5 years, average age of first treatment was 29.8a lag time of 8 years. Average age of alcohol abuse onset was 21.9 years, but average age of first treatment was 32.1a lag time of 10 years.

A lost decade between AUD onset and treatment leads to personal disability and societal damage, according to National Institute on Alcohol Abuse and Alcoholism Director Ting-Kai Li, M.D. Todays report signals the need for intensive efforts to educate professionals and the public to identify and address AUDs early in their course.

Age of disorder onset, related disability, and treatment age and type are several of multiple new analyses from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative survey that involved 43,000 face-to-face interviews of noninstitutionalized U.S. civilians aged 18 years and older.

Conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with supplemental support from the National Institute on Drug Abuse, the NESARC is the largest study ever conducted on the co-occurrence of alcohol use, drug use, and related psychiatric conditions among gender, age and ethnic subgroups, including minority subgroups (i.e., Asian Americans, Native Americans) not previously studied in sufficient numbers to permit comorbidity analyses. Also for the first time, the authors examine specific and some rare psychiatric conditions that frequently co-occur with AUDs, exclude other psychiatric disorders due to substance use or other medical conditions, and control for the comorbidity of disorders with each other.

NESARC data can be used by researchers and health professionals to target preventive and treatment interventions for populations at greatest risk, Dr. Li noted. They also can be used by policy makers and providers to plan and allocate treatment resources, and by scientists to explore the common and independent biological and psychosocial factors that underlie AUDs and related psychiatric diagnoses.

Key to tackling malaria may lie in bed nets for adults and older children

Mon, 02 Jul 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Protecting older children and adults with insecticide-treated bed nets may be an effective way to combat malaria, a study has shown. The research, published today in the open access journal PLoS Medicine, suggests that protecting half of all older children and adults would also protect the wider community from malaria, which kills over one million people each year.

Current international guidelines recommend providing subsidised bed nets for young children and pregnant women in order to achieve over 80% coverage in these high-risk groups. However, this strategy appears to overlook the benefits of protecting the rest of the population.

Using recently-developed models of mosquito behaviour and mortality, researchers at the Ifakara Health Research and Development Centre in Tanzania, led by Dr Gerry Killeen, a Wellcome Trust researcher from the School of Biological and Biomedical Sciences, Durham University, have shown that if use of the nets can be achieved by 35-65% of older children and adults, this would substantially enhance the protection of the more vulnerable groups, too. Most human-to-mosquito transmission originates from adults and children over five years of age, who constitute the bulk of the population and are more attractive to mosquitoes.

Insecticide-treated nets can protect not only the individuals and households that use them, but also members of the surrounding community, says Dr Killeen. This is because they kill adult mosquitoes directly or force them to undertake longer, more hazardous foraging expeditions in search of blood to feed on and aquatic habitats in which to breed.

Dr Christian Lengeler, a co-author from the Swiss Tropical Institute, agrees: Nets have an altruistic value and this needs to be considered when planning programmes.

Malaria is caused by infection with a parasite carried in the salivary glands of the mosquito. The parasite is transmitted when a person is bitten by an infectious mosquito. After a brief sojourn in the liver, it grows and reproduces very rapidly in the blood, leading to symptoms including fever, anaemia and even death. The parasites can be retransmitted to another mosquito if it feeds on an infected person.

The researchers showed that use of the nets can greatly reduce the number of mosquitoes that survive repeated encounters with protected humans. Also, by preventing the mosquitoes feeding on humans, the nets can divert them to feed on other mammals which do not host the malaria parasite, reducing the number of humans bitten and of mosquitoes carrying the parasite.

Dr Killeen and colleagues acknowledge that the financial implications of promoting net use by all age groups across malaria-endemic Africa will be significant, in the order of the total investments in health care in Africa excluding HIV.

Fully subsidising enough nets to achieve 50% coverage would cost at least $1 billion, with ongoing recurrent costs of a similar magnitude, he says. While we need to maximize subsidies for expanded target groups, we also need to ensure those receiving little or no subsidy can buy this essential public health commodity if they wish to.

Dr Killeen is keen to stress his support for the existing personal protection targets for vulnerable groups specified by the Millennium Development Goals and Roll Back Malaria: The targets of the existing programmes are very worthy in themselves and we remain fully supportive of their continued prioritisation. We need to cover as many young children and pregnant women as possible without forgetting that even partial coverage of entire communities can provides greater and more equitable protection to everyone.

Co-author Patrick Kachur from the Centers for Disease Control and Prevention emphasizes that this is an achievable goal: A number of African countries are making progress towards the existing targets and should be supported to attain this more ambitious goal by any means necessary. If the full potential of insecticide-treated nets, including community-wide suppression of malaria transmission, can be realised across Africa, we could prevent hundreds of thousands of deaths each year.

The research was welcomed by Dr Alex Mwita, programme manager for the National Malaria Control Programme in Tanzania.

Malaria is still the commonest and most dangerous disease in tropical Africa today, says Dr Mwita. In Tanzania it kills over 80,000 children annually and is responsible for 36% of maternal mortality which at 578 per 100,000 live births is one the highest in the world. Economically, malaria contributes to individual, community and country poverty through lost labour days and in expenses incurred for treatment and prevention.

This paper is a welcome appeal to the world community to give a respite to the people of Africa, the majority of whom live in abject poverty. Free provision of at least three long lasting insecticide treated nets which last for five years to every household provides real chance for the people of Africa to loosen the tight grip of malaria shackles upon them.

Workers in no-smoking restaurants show lower carcinogen levels

Fri, 29 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Recent research on the dangers of secondhand smoke could help clear the air about the value of no-smoking laws governing bars and eateries.

A new study compares the level of a tobacco-specific carcinogen in nonsmokers who work in restaurants that allow smoking with that of employees in restaurants that ban it.

Restaurant workers exposed to tobacco smoke on the job were more likely to have a detectable level of NNK, a carcinogen implicated in the development of lung cancer, than those who worked in tobacco-free environments.

There are no studies showing any safe level of exposure to this potent lung carcinogen, said lead author Michael J. Stark, Ph.D. In addition to NNK, secondhand smoke contains more than 50 other carcinogens and a host of other toxic substances that cause lung cancer, various other cancers, heart disease and lung disease.

Stark is the principal investigator for the Multnomah County Health Department and Oregon Department of Human Services. The study appears online and in the August 2007 issue of the American Journal of Public Health.

Nonsmokers exposed to secondhand smoke have about a 20 percent increase in the risk of lung cancer and foodservice workers tend to have more exposure to indoor environmental tobacco smoke than workers do in any other occupation.

Clean indoor act laws already protect about 70 percent of workers from indoor environmental smoke. Yet, only 11 states have clean indoor air acts that ban smoking in all indoor workplaces. In states like Oregon, where the study took place, workplaces such as restaurants and bars have exemptions.

The researchers concluded that there is no justification for any clean air exemptions. Policymakers and the public need to protect the health of all nonsmoking workers by prohibiting smoking in all indoor workplaces, Stark said.

Restaurant patrons who smoke might be in denial about the dangers of secondhand smoke, said Bruce Leistikow, M.D., an epidemiologist with the department of public health sciences, University of California Davis Cancer Center. I think they underestimate the effects on themselves and thereby on others. The risks are so high that absent tobacco-industry lobbying and disinformation, secondhand smoke exposure would already be banned in all states.

According to Elaine Fraser, of the Department of Labor, Occupational Safety and Health Administration, there has been no successful national effort at banning smoking in the workplace but grassroots efforts, which research results strengthen, are slowly making a difference at the state and local levels.

Because of these efforts, the antismoking groups believe they are having a positive effect on changing the policies of the relatively small number of businesses that do not have a smoke-free work policy, OSHAs Fraser said.

Natural signal holds promise for psoriasis, age-related skin damage

Thu, 28 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The body may hold a secret to normalizing skin cell growth that is over zealous in psoriasis and non-melanoma skin cancers and too slow in aging and sun-damaged skin, researchers say.

Phosphatidylglycerol, a natural body lipid or fat, appears to signal cells to normalize growth and maturation or differentiation. When we apply it to skin cells, we see the normalization ability, says Dr. Wendy B. Bollag, cell physiologist at the Medical College of Georgia.

Her research, published online in The Journal of Investigative Dermatology, helps piece together the signaling pathway that prompts skin cells to stop multiplying and start differentiating.

Perhaps most importantly it shows that bypassing that pathway one researchers suspect becomes dysfunctional in diseases like psoriasis and giving the signal itself restores normal differentiation of skin cells or keratinocytes.

The findings prompted Dr. Bollag and John Edwards, CEO of Apeliotus Technologies of Atlanta, to seek National Institutes of Health funding for yearlong study in animal models of mild psoriasis to see if it works, with human trials as the goal. Proof of principle is the first phase. If in vivo data looks promising, well put together a study we can take into the clinic, says Dr. Bollag. She and Apeliotus received an NIH Small Business Technology Transfer grant, which supports small businesses collaborating with U.S. research institutions to develop technologies and methodologies with commercial potential.

A Georgia Research Alliance Industry Partnership Grant will allow parallel studies in animal models of chronological aging and photoaging from too much sun exposure, Dr. Bollag says.

MCG and Apeliotus will work with Avanti® Polar Lipids, Inc., of Alabaster, Ala., which has a chicken-egg derived phosphatidylglycerol used primarily for lipid research. Avanti is developing different phosphatidylglycerol ointments or salves for the new studies. Dr. Bollag notes that the lipid, already used as drug-delivery mechanism in humans, has been ingested at higher doses, so she believes lower doses applied externally will be safe.

Glycerol, a precursor of phosphatidylglycerol, also is available commercially and used in many skin care products because its long been known to help skin retain moisture, so it looks and feels better. We think that, yes, its a water attractor, but we think it also has this additional role as a precursor for an important lipid signal in the skin, says Dr. Bollag. Naturally occurring glycerol is an important precursor for many things such as fat, phospholipids, various sugars and metabolic pathways in the body. Glycerol levels go up when you exercise, because you are using fats as fuel.

Shes shown that the channel, aquaporin-3, delivers glycerol to phospholipase D, resulting in the skin cell differentiation signal, phosphatidylglycerol. This is serving as a signal, like an elevator operator who says, This way for normal keratinocyte differentiation, says Dr. Bollag. Thats good because without it, you get abnormal differentiation in skin diseases like psoriasis, non-melanoma skin cancer, some of the dermatitises; in a lot of these conditions, the cells proliferate too much and dont differentiate properly. We think maybe in psoriasis, the phospholipase D and aquaporin-3 become disconnected so now they cant produce phosphatidylglycerol. If you only put glycerol on it, it may not help.

But it looks as though the signal does.

Her newest research, done in mouse skin cells in culture, showed that aquaporin-3 manipulation impacted phosphatidylglycerol generation. The glycerol was coming through aquaporin. If we blocked it, we stopped glycerol from coming through and we also blocked phosphatidylglycerol. Then we started manipulating the various players. We did some over expression of aquaporin and showed it promoted differentiated status of the keratinocytes.

Then we wondered what would happen if we actually gave phosphatidylglycerol itself, so we bypassed the whole aquaporin-phospholipase D system and we saw some interesting results.

Phosphatidylglycerol inhibited growth of rapidly growing skin cells and increased growth in slow-growing cells. MCG has a patent pending on the ability of phosphatidylglycerol to normalize skin cell function.

The key is cells are supposed to proliferate in this one layer, she says of the basal layer, where a skin cell divides, with one staying to divide again and the other expressing different genes, proteins and functions as it moves toward the surface. Without phosphatidylglycerol, cells can proliferate too much and differentiate improperly, Dr. Bollag explains.

Right before cells reach the layer that we actually see, called the cornified layer, they spit out lipids they synthesize to make the water permeability barrier then they basically die. But they leave behind these hard shells that give skin its mechanical strength. When you get older, you dont turn it over as well, Dr. Bollag says, explaining why despite ongoing cell turnover old skin looks, well, old.

As its name implies, aquaporin also transports water, but interestingly, researchers have learned its a lot better at delivering glycerol. Phospholipids are the fats that comprise most of the plasma membranes that encase cells. Skin cells secrete extra lipids to help provide the water permeability barrier that keeps organs and fluids inside where they belong as well as the mechanical barrier that protects the body from invaders. That would just kill a normal cell, but the skin can survive that, she says, plopping her elbow down on a table. Temperature regulation and sensation are two other major skin functions.

Valley Foundation awards Parkinson's Institute $1M

Wed, 27 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The Parkinsons Institute, Americas only independent non-profit organization providing clinical research, basic research, clinical trials and comprehensive patient care for Parkinsons disease, today announced that the Valley Foundation has awarded a $1 million grant to support The Institutes STOP PD research program and to assist its relocation to a new facility.

Parkinsons disease is a chronic, degenerative neurological disorder currently afflicting over 1.5 million Americans. That number will increase as the population ages, so scientists and physicians at The Parkinsons Institute have initiated STOP PD, a drug discovery and development effort aimed at identifying compounds to halt and even reverse the progression of Parkinsons. The programs target is a protein called alpha-synuclein, which is known to abnormally aggregate within the brain cells of persons who develop Parkinsons. These protein deposits impair neuronal function and eventually lead to cell death.

In collaboration with Dr. Anthony Fink of the University of California, Santa Cruz, the program has already screened 4,000 known chemical compounds, identifying nearly 60 that inhibit alpha-synuclein aggregation in a laboratory setting. The promising compounds will next be tested in more sophisticated models of Parkinsons disease, with the goal of identifying candidates for eventual clinical trials in patients.

Current Parkinsons medications offer some symptomatic relief, but do nothing about the underlying disease, said J. William Langston, M.D., Founder, CEO, and Chief Scientific Officer. Effectively halting Parkinsons progression would literally be a new lease on life for many patients and their families.

On September 1, 2007 The Institute will relocate to a 60,000 square foot facility at 675 Almanor Avenue in Sunnyvale. The new site offers fifty percent more space than the current building, enabling a larger clinic with more examination and therapy rooms, more spacious and efficient laboratories, and a sizable conference room for scientific seminars, educational forums and community events.

As we approach our 20th anniversary, the Valley Foundations $1 million grant provides the vital lead gift for our planned $20 million multi-year campaign. We are tremendously gratified by their continuing strong support, added Dr. Langston. Our board of directors, staff, and supporters are all committed to accomplishing our relocation without major disruption in our research or patient care.

The Valley Foundation has great admiration for Dr. Langston, his entire team, and the important work they do, said Phillip R. Boyce, Chairman of the Valley Foundation board of trustees. We are proud to have supported The Parkinsons Institute since its inception, and believe this grant will help to take them to the next level.

Type 1 diabetes and heart disease -- Heavier may mean healthier

Sat, 23 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) CHICAGO, June 23 -- Researchers at the University of Pittsburgh Schools of the Health Sciences studying links between an early sign of heart disease called coronary artery calcification and body fat have found that, paradoxically, more fat may have some advantages, at least for people particularly women who have type 1 diabetes. Cardiovascular complications, including heart disease, are a leading cause of death for people with diabetes, who tend to suffer cardiovascular disease decades earlier than non-diabetics.

Gaining weight may reflect good or better treatment with insulin therapy, which may partly explain why participants who gained weight over time had lower mortality rates, said Trevor Orchard, M.D., professor of epidemiology at the University of Pittsburgh Graduate School of Public Health (GSPH), who is presenting the findings during the 67th annual meeting of the American Diabetes Association. Scientific sessions take place June 22-26 at the McCormick Place Convention Center, Chicago.

For this particular report, Dr. Orchard and his colleagues focused on 315 patients with type 1 diabetes participating in the Pittsburgh Epidemiology of Diabetes Complications Study, an 18-year prospective study of childhood onset type 1 diabetes, which began in 1986. As part of the study, the patients recently received a special computed tomography scan (CT) to assess coronary artery calcification.

The participants mean age was 42, and mean duration of diabetes was 34 years. In addition to the CT scan, patients were evaluated for fat underneath the skin and in the abdominal region, body mass index (BMI) and waist circumference. Although investigators noted a positive association for all measures of fatness and having any coronary artery calcification, in the two-thirds of patients who had calcification, the relationship reversed so that people with more fat had less severe calcification.

This association also varied by gender. Women with less fat under the skin had more evidence of coronary artery calcification than those with more fat. Thinner men also had more evidence of coronary artery calcification than men with a higher BMI.

What it comes down to is a kind of double-edged relationship, said Baqiyyah Conway, M.P.H., lead author of the abstract, adding that these associations of less severe artery calcification with greater fat persisted even when controlling for standard cardiovascular disease risk factors such as increased levels of LDL, or bad cholesterol, triglycerides, high blood pressure and lower levels of HDL, or good cholesterol. Controlling for kidney disease, another common complication of diabetes, weakened the association in men but not in women.

This is not a firm recommendation to people with type 1 diabetes to put on weight, but it does raise the possibility that weight recommendations in type 1 diabetes may be somewhat different than those for the general population, and emphasizes the complex relationship between body fat and cardiovascular risk in diabetes, said Dr. Orchard, who also is professor of medicine and pediatrics at the University of Pittsburgh School of Medicine.

High blood levels of urate linked to lower risk of Parkinson's disease

Thu, 21 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Boston, MA -- In a new, large-scale, prospective study exploring the link between levels of urate in the blood and risk of Parkinsons disease, researchers from the Harvard School of Public Health (HSPH) have found that high levels of urate are strongly associated with a reduced risk of the disease. The findings were published online on June 20, 2007 in The American Journal of Epidemiology and will appear in an upcoming print issue of the journal.

Urate is a normal component of blood, and although high levels can lead to gout, urate might also have beneficial effects because it is a potent antioxidant. Parkinsons disease is a chronic, progressive nerve disorder associated with destruction of brain cells producing dopamine, a neurotransmitter essential to the normal functioning of the central nervous system.

This is the strongest evidence to date that urate may protect against Parkinsons disease, said lead author Marc Weisskopf, Assistant Professor of Environmental and Occupational Epidemiology at HSPH.

The researchers used the HSPH-based Health Professionals Follow-up Study, a population of male health professionals established in 1986, as the source for their data. The study cohort included more than 18,000 men without Parkinsons disease who had provided blood samples between 1993 and 1995 and whose subsequent health status was followed.

The researchers found that men in the top quartile of blood urate concentration had 55 percent lower risk of developing Parkinsons disease than men in the bottom quartile. This difference was not explained by differences in age or other risk factors for Parkinsons disease. The results of two previous studies had suggested a possible inverse relation between blood urate and risk of Parkinsons disease, but it is only when the previous data were combined with those of this new study that the evidence became compelling.

The authors hypothesize that urates antioxidant properties may help dampen the effects of oxidative stress, which appears to contribute to the progressive loss of the dopamine-producing brain cells that occurs in individuals with Parkinsons disease. If so, elevating blood urate could be helpful for patients with Parkinsons disease, said Alberto Ascherio, Associate Professor of Nutrition and Epidemiology at HSPH and senior author of the study. To follow-up on this clue, Ascherio, along with co-author Michael Schwarzschild, a movement disorder specialist at Massachusetts General Hospital, and colleagues at the Parkinson Study Group, a collaborative group of Parkinsons disease researchers from the U.S. and Canada, accessed the databases of two large, randomized studies conducted among patients with early Parkinsons disease. The preliminary results, presented in abstract form at recent meetings, showed a slower progression of the disease among individuals with high blood urate.

It is still uncertain whether urate exerts a neuroprotective effect, but approaches to elevating urate levels are nonetheless worth considering as a potential neuroprotective strategy, said Ascherio, who is now collaborating with Schwarzschild and others in the design of a clinical trial in individuals with Parkinsons disease to examine this possibility. But elevating blood urate increases the risk of kidney stones and may have adverse cardiovascular effects and should only be attempted in the context of a closely monitored randomized trial until beneficial effects are proven, he added.

Pregnancy nausea/vomiting may indicate lower risk of breast cancer

Thu, 21 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- It may not seem so at the time, but women who suffer through morning sickness during their pregnancies actually may be fortunate.

Those women may have a 30 percent lower risk of developing breast cancer later in life than mothers-to-be who experience nine nausea-free months, a new study by epidemiologists at the University at Buffalo suggests.

Although the exact mechanism responsible for causing nausea and vomiting during pregnancy has yet to be pinpointed, it likely is a result of changing levels of ovarian and placental hormone production, which may include higher circulating levels of a hormone called human chorionic gonadotropin, said David Jaworowicz, Jr., first author on the study.

In vitro studies have shown that this hormone possesses several activities that have potential protective effects against cancer cells, said Jaworowicz, a doctoral candidate in the Department of Social Preventive Medicine in UBs School of Public Health and Health Professions.

Jaworowiczs research, which was presented today at the Society for Epidemiologic Researchs annual meeting in Boston, Mass., found no association of other pregnancy-related medical conditions -- pregnancy-induced hypertension, preeclampsia, gestational diabetes or weight gain -- and breast-cancer risk.

The study was based on data from participants in the Western New York Exposure and Breast Cancer Study, a population-based case-control study of breast cancer conducted in women 35-79 from two Western New York counties between 1996 and 2001.

The analysis compared extensive data on pregnancy-related conditions from 1,001 women with primary breast cancer and 1,917 women without breast cancer matched to cases by age and race who served as controls.

Pregnancy is a time when the breast undergoes a variety of cellular and anatomical changes, said Jaworowicz. During this period, the breast tissue is exposed to varying levels of a number of hormones, which may affect the physiology of the breast.

We were interested in the association between pregnancy-related events and characteristics, including pregnancy-induced hypertension, preeclampsia/eclampsia, gestational diabetes, high weight gain during pregnancy, and nausea and vomiting, because these markers may serve as proxies for underlying hormonal changes and altered hormone levels in blood and tissue.

Jaworowicz noted that the presence or absence of these pregnancy-related conditions may indicate a different course or extent of hormone-regulated breast tissue proliferation and differentiation during pregnancy, but also may indicate distinct hormonal profiles that persist following pregnancy.

Although pregnancy conditions other than nausea and vomiting were not associated statistically with breast cancer risk, these were only preliminary findings, he added, based mainly upon whether women ever experienced these conditions vs. never during any of their pregnancies.

More nuanced experiences regarding these pregnancy-related characteristics will be the focus of future analyses, he said.

Evidence from the current analysis did suggest that the lower risk of developing breast cancer observed with nausea and vomiting was stronger as the symptoms became more severe, or persisted longer into pregnancy. A modest trend toward increased cancer risk was observed in premenopausal women who gained more than 40 pounds during pregnancy, compared to those who gained less than 23 pounds, said Jaworowicz, but the trend didnt reach statistical significance.

Pregnancy is a time of drastic physiological changes, including rapid development and alterations in the breast tissue, he noted. The rapidly changing anatomy of the breast makes it more susceptible to errors in DNA replication and/or repair, which may translate into breast cancer.

Associated with these changes are the fluctuating hormonal profiles that must be kept in a delicate balance. If the correct ratios and relative amounts between these hormones are not maintained within a normal range, certain pregnancy-related outcomes may emerge, such as high blood pressure, glucose intolerance and gestational diabetes, eclamptic conditions with seizures and/or toxemia, or extremely severe nausea.

These pregnancy-related factors may serve as indicators of underlying biological conditions that may influence a womans lifetime risk for breast cancer.

By recognizing that pregnancy-associated medical outcomes may provide easily accessible signals about core changes in the female physiology, future studies should continue to investigate and dissect the intricate relationship that may exist between readily observational perinatal factors, physiological characteristics and cancer risk, Jaworowicz said.

Subsequent analyses are planned to investigate the potential association between pregnancy characteristics and genetic polymorphisms of particular enzymes responsible for estrogen metabolism.

This will help us to elucidate the potential link between pregnancy-associated conditions, hormonal exposures and breast cancer risk.

Award winning book co-edited by Rutgers College of Nursing Dean updated with new information

Wed, 20 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) (NEWARK, N.J., June, 20, 2007) -- The award winning book, Emerging Infectious Diseases: Trends and Issues, co-edited by Felissa R. Lashley, Rutgers College of Nursing dean and professor, and Jerry D. Durham, chancellor and professor of nursing at Allen College, Waterloo, Iowa, has been published in a second edition that provides new and updated information on emerging, re-emerging and antibiotic-resistant infectious diseases that continue to increase at an alarming rate around the world.

Written for a wide range of health professionals, particularly nurses, this second edition, published by Springer Publishing Co., provides a comprehensive overview of these diseases, their epidemiology, clinical manifestations, prevention and treatment. Contributed by a multidisciplinary team of nurses, physicians, public health, and infectious disease specialists, the book includes material on the most recent and important new emerging infectious diseases.

Each chapter is illustrated with clinical case examples to demonstrate the pitfalls in differential diagnosis and explain proper management and treatment. The book includes appendices that provide critical reference information for each of the bacterial, viral, fungal, and parasitic diseases.

This book provides readers the knowledge to better understand the factors contributing to the emergence and reemergence of infectious diseases and microbial resistance in a broad context, said Lashley, who is also the interim director of the Nursing Center for Bioterrorism and Emerging Infectious Diseases Preparedness at Rutgers, The State University of New Jersey. We live in a global community in which the health of developed and developing nations is intertwined. In this worldwide community, infectious diseases can spread rapidly around the world, making international surveillance and control of emerging infections vital to world health.

The first edition of this book won the Book of the Year award from the American Journal of Nursing (AJN), which was also a Choice awardee.

Lashleys other books have also received AJN Book of the Year awards, including the first and second editions of her book, Clinical Genetics in Nursing Practice, The Person with AIDS: Nursing Perspectives, and Women, Children and HIV/AIDS. Her book, Tuberculosis: A Sourcebook for Nursing Practice, received a Book of the Year award from The Nurse Practitioner.

She has created a Web page for nurses to share biopreparedness and emerging infectious diseases information and initiated an annual interdisciplinary conference on emerging infectious diseases.

Lashley is certified as a PhD medical geneticist by the American Board of Medical Genetics, the first nurse to be so certified, and is a founding fellow of the American College of Medical Genetics. She is a fellow of the American Academy of Nursing where she co-chairs the expert panel on emerging infections.

Lashley received the 2000 Research Recognition Award for Outstanding Research from the Association of Nurses in AIDS Care. In 2003 she received the Distinguished Alumni Award from Illinois State University, and in 2005 she was initiated into their Hall of Fame. She has been selected as a Women of Excellence by the New Jersey Women in AIDS Network. In 1999, she received the Distinguished Nurse Research Award from the Illinois Nurses Association. She also received the SAGE award for mentoring nurse leaders in 2001 from the Illinois Leadership Institute.

Gum disease in postmenopausal women linked to oral bone loss

Fri, 15 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- A study conducted in a large sample of postmenopausal women by University at Buffalo epidemiologists has provided new information on the prevalence of certain gum-disease-causing oral bacteria in this population and the association of the bacteria with oral bone loss.

Results showed that women infected with four bacteria known to cause periodontal disease were more likely to have more severe oral bone loss than those without these oral pathogens.

Two widely recognized periodontal pathogens, called P. gingivalis and T. forsythensis, were found to infect 15.1 percent and 37.9 percent of the women, respectively. Two additional oral bacteria suspected to be pathogenic, P. intermedia and C. rectus, were found in 43.4 percent and 17.4 percent of women.

This is one of the first studies in community-dwelling postmenopausal women that assessed bacteria presence and associated it with oral bone loss, while controlling for other factors, such as age, smoking status and income, said Jean Wactawski-Wende, Ph.D., associate professor of social and preventive medicine, UB School of Public Health and Health Professions, and senior author on the study

Results appear in the June 2007 issue of the Journal of Periodontology.

The study involved 1,256 postmenopausal women who were part of a larger population-based investigation of risk factors for osteoporosis and oral bone loss in postmenopausal women, which is an offshoot of the observational portion of the national Womens Health Initiative (WHI).

Participants in this study completed questionnaires, had physical measurements taken, had bone-density testing and an oral health examination. The oral health examination had several components, including microbiological sampling of subgingival plaque and oral X-rays.

Investigators used a measure called alveolar crestal height to determine the amount of oral bone loss. Alveolar bone surrounds the teeth and holds them in place in the upper and lower jaw. The lower the crest, or top of the bone, the more bone has been lost. Loss of alveolar crest bone eventually can lead to tooth loss.

The association between bacterial infection and oral bone loss turned out to be strongest in overweight women, compared to normal weight or obese women.

We expected to see an increased risk for oral bone loss with increasing body mass index (BMI, a factor representing the relationship of weight to height), commented Renee Brennan, Ph.D., research assistant professor of social and preventive medicine and first author on the study.

However, the greatest risk was seen in overweight women. This was supported by a three-fold increase in these women. Other factors that we could not assess may be at play in the obese women. We need to explore further the impact of weight and BMI on the associations of oral bacteria and oral bone loss.

Blood levels of inflammation markers, which would provide a clear picture of overall risk werent available at the time, but the researchers now are planning to investigate this association.

In addition to substantiating the relationship between certain known and suspected oral pathogens and oral bone loss, results confirmed that the three control bacteria included in the study, which have not been associated with periodontal disease, also were not associated with oral bone loss.

On the contrary, the two control bacteria -- S. sanguis and Capnocytophaga sp. -- were associated with healthier oral bone.

Brennan said the findings will help develop a more complete understanding of the mechanisms involved in periodontal disease.

American College of Preventive Medicine applauds IOM report on training public health physicians

Wed, 13 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Washington, D.C. The American College of Preventive Medicine (ACPM) today applauded the recent release of the Institute of Medicine report, Training Physicians for Public Health Careers, praising the report as a major milestone for preventive medicine and public health from one of the most prestigious voices in medicine. The report calls on Congress to stem the tide of Americas eroding preventive medicine and public health workforce.

The report reflects an in-depth examination by the Committee on Training Physicians for Public Health Careers of the role and need for public health physicians, what these physicians need to know, how to ensure an adequate supply of these physicians, and how to fund the training of these physicians.

The report recommends a doubling of the estimated 10,000 public health physicians currently in practice and specifically calls for expansion and addition of Public Health/General Preventive Medicine residency programs to graduate a minimum 400 additional residents each year. The report also recommends that Congress fund a comprehensive enumeration of the public health workforce in order to project needs for public health physicians and public health education programs.

Noting that Reliable financial support of physician education and training in public health is lacking, the IOM Committee recommends the U.S. Congress fund a comprehensive educational strategy to assure an adequate number of public health physicians. Such a strategy should include funding for residency training in preventive medicine that parallels funding streams for graduate medical education in other medical disciplines, as well as reinstatement and growth of funding health professions training programs under Title VII of the Public Health Service Act.

ACPM President Michael D. Parkinson, MD, MPH, FACPM, praised the committee for its breakthrough work, long overdue, bringing together many important pieces to a very complex puzzle. Dr. Parkinson added, Making the blue ribbon case for seeing preventive medicine residency training as an underutilized yet valued national resource in need of new emphasis and federal support has been convincingly made.

Preventive medicine physicians have unique expertise in assessing and responding to the health needs of the population, including the threats of infectious and chronic diseases, occupational and environmental health issues, and behavioral and socioeconomic determinants of community health. Preventive medicine residency training programs thus address a critical need for leadership at the local, state, and national levels across a wide spectrum of issues threatening the health of our nation.

Congress has already taken the first step toward addressing some of the IOM recommendations with the recent introduction of the Preventive Medicine and Public Health Training Act, S. 1120, by Senators Tom Harkin (D-IA), Johnny Isakson (R-GA), Joseph Lieberman (I-CT), and Jeff Bingaman (D-NM). This bill works to address the present inequity in funding by calling on the Centers for Disease Control and Prevention (CDC) to establish a competitive grant program that would provide federal support directly to preventive medicine residency training programs. The legislation further stipulates that preventive medicine residents should also rotate through community health centers to provide additional clinical and population-based services to underserved communities.

The decline in the number of preventive medicine specialists is a direct function of inadequate and shrinking funding sources available to offset residency training costs. During a time of growing public health threats from emerging infectious diseases, bioterrorism, and natural disasters, the IOM should be lauded for their attempts to strengthen our nations public health infrastructure and to reverse this troubling trend, said Dr. Parkinson.

Targeted HIV testing more effective than CDC mass testing proposal

Mon, 11 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) A targeted campaign of testing and counseling aimed at those who are at high risk for HIV would be more effective than the mass patient screening proposed by the Centers for Disease Control and Prevention (CDC), according to an analysis by David Holtgrave, PhD, an expert on HIV prevention at the Johns Hopkins Bloomberg School of Public Health. Holtgrave determined that the CDCs testing strategy is likely to cost $864 million for one year. For the same price, a targeted testing and counseling approach would identify more than three times as many people with HIV and could prevent four times as many new HIV infections compared to the CDCs testing strategy. Holtgraves study is the first to examine the cost-effectiveness of the CDCs testing plan and is published in the June 2007 edition of the journal PLoS Medicine.

The CDC estimates that 25 percent of Americans with HIV do not know they are HIV positive. Because they are unaware, they do not seek treatment and are at greater risk of spreading HIV to others. To identify more Americans with HIV, the CDC has recommended that doctors in the United States test all patients aged 13 to 64 for HIV at every health care visit, unless the patient opts out, or specifically declines to be tested. In order to meet the demands of more testing, doctors can forgo the HIV risk reduction counseling that usually accompanies HIV testing.

While the CDCs recommended opt-out testing offers some public health benefit, the data shows there would be substantially more benefit from a more targeted program that includes rather than discards risk reduction counselingincluding more diagnosed infections and more transmissions prevented, said Holtgrave, who is professor and chair of the Bloomberg Schools Department of Health, Behavior and Society.

Using standard methods of cost-effectiveness analysis, Holtgrave estimates that CDCs recommended opt-out testing program would cost $864 million. For the same cost, a program of targeted counseling and testing would diagnose 188,170 new HIV infections, compared with 56,940 that would be detected through CDCs testing plan, assuming 1 percent of the population tested is HIV positive. Additionally, targeted counseling and testing would prevent an estimated 14,553 new HIV infections at a cost of $59,383 per infection prevented, compared to 3,644 from opt-out testing at a cost of $237,149 per infection prevented. Further, Holtgrave says that targeted testing and counseling perform better than opt-out testing in several key outcomes even when the rate of HIV infection in the community is 0.3 percent.

It is important that everyone living with HIV knows their serostatus so that they might access life-saving HIV treatment. The question now is to determine the most effective testing strategies for identifying people with HIV. Our work sought to answer that question, said Holtgrave.

University of Manchester researchers reveal clues to new genes behind rheumatoid arthritis

Thu, 07 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Researchers at the University of Manchester have identified evidence of several new genes behind the chronic inflammatory disease rheumatoid arthritis (RA), which affects 387,000 people in the UK.

Professor Jane Worthington and her team at the University's arthritis research campaign (arc) Epidemiology Unit made their findings as part of the largest ever study of the genetics behind common diseases.

The £9M Wellcome Trust Case Control Consortium (WTCCC), which today publishes its results in the journals Nature and Nature Genetics, has given a major boost to the understanding of genetics of seven common diseases, including RA. As well as providing insights into what leads some people to develop the diseases and offering new avenues for treatments, the success of the approach heralds exciting advances in the study of the genetics of disease. It has identified a wealth of genes implicated in coronary heart disease, type 1 and type 2 diabetes, Crohn's disease, bipolar disorder and hypertension, as well as RA. Some of these genes are novel whilst others were known about and have been confirmed by the current study.

Professor Worthington and her team have implicated several genes in the development of RA for the first time. Previously two genes were known to explain 50% of genetically determined susceptibility. Now the team have replicated their results for one of the new genes and are working to validate others.

RA is a chronic inflammatory disease that can affect nearly all joints in the body, particularly the hands and feet. Complications such as lung disease can occur. In addition, patients with RA are more likely to die from cardiovascular disease and some cancers. Some people respond well to treatment, but most suffer a lifetime of disability.

The team will now carry out further work to validate the findings and understand how the variation within key genes influences the development of RA, the course of the disease and the response to treatment.

Dr Anne Barton, a clinician on the team, said: These are exciting results as RA is a complex, heterogeneous disease with some people suffering inflammation of the hands and feet which comes and goes whilst others develop a progressive form which can quite rapidly result in marked disability. We believe the genes we have found may determine who develops RA or how the severe the disease becomes.

We also hope that this study may help us to discover why 40-50% of people do not respond to therapy. This therapy is expensive - £8,000 per patient per year for the newest biologic agents that block the inflammatory mediator TNF - and this work could show whether someone would respond well or not in advance, rather than by costly trial and error.

Professor Worthington said: The WTCCC has been a fantastic example of collaborative effort in the UK. It has taken us to the place we are now, more rapidly and efficiently than if we had tried to undertake this study on our own.

We had 2,000 DNA samples from patients with RA. By contacting other RA clinicians and researchers in the UK, we now have a further 5,000 samples to take this work forward.

We are also indebted to the arthritis research campaign (arc), which provided the funding to collect the samples used. This was a huge investment, collecting samples from RA patients over two decades, but it was the sample collection which made it a high quality study.

Professor Peter Donnelly, Chair of the WTCCC, based at the University of Oxford, said: Many of the most common diseases are very complex, involving both 'nature' and 'nurture', genes interacting with our environment and lifestyles. By identifying the genes underlying these conditions, our study should enable scientists to understand better how disease occurs, which people are most at risk and, in time, to produce more effective, more personalised treatments.

The £9 million WTCCC has been one of the UK's largest and most successful academic collaborations to date, involving 50 leading research groups and over 200 scientists in the field of human genetics from dozens of institutions. For these papers, part of a number of studies due to be published over the next year, the researchers analysed 17,000 DNA samples taken from people in the UK - two thousand patients for each disease and three thousand control samples - to identify common genetic variations for seven major diseases.

Although the human genome is made up of more than three billion sub-units of DNA, called nucleotides (or bases), most of these show little in the way of differences between individuals. The International HapMap Consortium and related efforts demonstrated that a substantial part of the variation in DNA sequence between individuals is due to single-nucleotide polymorphisms (differences), also known as SNPs. There are approximately 8 million common SNPs in European populations. Fortunately, because SNPs that lie close together on chromosomes often tell quite similar stories, researchers in the WTCCC were able to explore this variation through analysing a subset of these SNPs (in fact approximately 500,000).

Human genetics has a chequered history of irreproducible results, but this landmark collaboration of scientists in Britain has shown conclusively that the new approach of analysing a large subset of genetic variants in large samples of patients and healthy individuals works, says Professor Donnelly. We are now able to effectively scan most of the common variation in the human genome to look for variants associated with diseases. This approach will undoubtedly herald major advances in how we understand and tackle disease in the future.

The findings have been welcomed by Dr Mark Walport, Director of the Wellcome Trust, the UK's largest medical research charity. The Wellcome Trust not only funded the WTCCC, but also co-funded the Human Genome Project and HapMap.

Just a few years ago it would have been thought wildly optimistic that it would be possible in the near future to study a thousand genetic variants in each of a thousand people, says Dr Mark Walport, Director of the Wellcome Trust, the UK's largest medical research charity, which funded the study. What has been achieved in this research is the analysis of half a million genetic variants in each of seventeen thousand individuals, with the discovery of more than ten genes that predispose to common diseases.

This research shows that it is possible to analyse human variation in health and disease on an enormous scale. It shows the importance of studies such as the UK Biobank, which is seeking half a million volunteers aged between 40 and 69, with the aim of understanding the links between health, the environment and genetic variation. New preventive strategies and new treatments depend on a detailed understanding of the genetic, behavioural and environmental factors that conspire to cause disease.

Meningitis: effectiveness of preventive vaccination demonstrated

Tue, 05 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Meningitis epidemics caused by the pathogen Nesseiria meningitis (or meningococcus) provoke high mortality in children and young people under 20 years of age in sub-Saharan Africa. They rage during periods of drought from January to April, in the area known as the Meningitis Belt (see Map)

Two types of vaccine are currently on the market: the polysaccharide vaccine and the conjugated vaccine. The polysaccharide form, elaborated from a sugar present at the surface of the meningococcus provides only partial, temporary immunity in very young children (2).

The conjugated vaccine, however, is based on a combination between this same sugar and an antigenic protein and renders an effective durable immunity. It could therefore be used in a routine preventive vaccination campaign. But it is costly. Its high price, at 11 to 22 euros per dose, means it remains inaccessible for African countries. These have available only the polysaccharide vaccine, less expensive at 0.3 to 0.5 euro, but which, because of its low immunity capacity, is generally kept only for emergency vaccinations, when epidemics occur.

IRD researchers have been running a follow-up study of the people of the Niakhar region (located 150 km from Dakar, in Senegal) for more than 40 years. They looked into the question of the ability of the polysaccharide vaccine to prevent the occurrence of meningitis cases during epidemics in the course of subsequent years. To do that, they made use of results of two vaccination campaigns conducted with this vaccine by the Senegalese health services. One of these was run in 1996 in 8 of the 30 villages that make up the Niakhar region, the other in 1999, in the whole of the study area, hit be a series of epidemics between 1998 and 2000.

Using quarterly censuses carried out since 1983, the researchers collected then analysed data on childrens state of health and vaccine status. They could therefore make comparisons between the different villages regarding the number of cases of meningitis that broke out, in particular in the years that followed the 1996 vaccination campaign (3).

Their investigation revealed that in the villages vaccinated at that date, two to three times fewer subjects were recorded as suffering from the disease. The polysaccharide vaccine could help avoid up to 72% of cases in subsequent epidemics.

These results speak in favour of adopting a strategy of routine vaccination using this vaccine whenever no other vaccine is available in order to prevent meningococcus meningitis epidemics in this region of Africa. However, a conjugated vaccine which should be sold at less than 1$ (0.80 euro) per dose, is under development. Thanks to the full, durable immunity it confers right from early childhood, it is an ideal tool for a preventive vaccination strategy. Clinical trials initiated in 2006, notably in Niakhar, are continuing for a further 2 years in order to make sure that no undesirable side-effects occur after administration.

Gene variations point to why lung cancer drugs work better in Japanese vs. US patients

Sat, 02 Jun 2007 03:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich. Last year, a groundbreaking international project found that a group of Japanese patients with advanced non-small cell lung cancer survived longer and had a higher rate of side effects than U.S. patients with the same diagnosis,.when both groups were given two well-known drugs for the disease.

Now, a follow-up study suggests the reasons appear to lie in subtle variations in certain genes that govern how the body metabolizes chemotherapy drugs. David Gandara, M.D., a University of California, Davis researcher who led the recent Southwest Oncology Group study, will present the results Saturday, June 2, at the American Society of Clinical Oncology annual meeting.

The discovery that Japanese and U.S. patients, matched in age, gender and other respects, had differences in key metabolism-related genes is the latest result from a seven-year collaboration between the Southwest Oncology Group and two clinical trials groups in Japan. Gandara, who leads lung cancer trial efforts for the Southwest Oncology Group, is director of clinical research at the University of California, Davis, Cancer Center. The Southwest Oncology Group (SWOG) is the largest federally funded U.S. cancer trials network.

The recent SWOG study breaks new ground by exploring the possible role of ethnic patterns in the emerging science of pharmacogenomics, which promises to tailor drug regimens to a patients genetic profile. Nobody else in the world has ever done this, with a common arm looking at genetic differences among ethnic groups, Gandara says.

Researchers looked at DNA from 156 patients who received the chemotherapy drugs paclitaxel and carboplatin in a SWOG clinical trial and one conducted by the Japan Multicenter Trial Organization. In the trials, half the Japanese patients survived one year, while slightly more than one-third of U.S. patients did. The Japanese patients as a group survived longer despite the fact that a significant number of them had to be given a lower dose of paclitaxel and for a shorter time than the U.S. patients because of toxicity. The U.S. group was predominantly Caucasian; 2 percent were Asian-Americans.

To find clues to the differences, the scientists examined six genes in DNA samples from the patients. They found differences in four. In patients with certain variations in the CYP3A4 gene, it took 2.75 times longer for their lung cancer to progress than in patients without the variations. A variation in another gene, ERCC2, appeared to interfere with how well patients responded to treatment.

The differences in outcomes corresponded with the patients genetic makeup, rather than their ethnicity per se, since. some individuals in each group possessed genetic variations not typical of their group. Thus, the study suggests therapies in the future need to be tailored to each individual based on analysis of his or her genetic makeup, not simply ethnicity.

The relatively small number of patients makes the results of the study far from conclusive: Gandara calls the study hypothesis-generating. Next, he and other SWOG scientists are seeking funding to learn what genes may explain why Japanese and U.S. patients respond differently to EGFR inhibitors such as erlotinib, a relatively new targeted therapy that is another important class of drugs for lung cancer.