RxPG News : Epidemiology

Workplace safety program can reduce injuries if aggressively enforced, study finds

Fri, 27 Jan 2012 05:00:00 PST

( from http://www.rxpgnews.com ) A longstanding California occupational safety program requiring all businesses to eliminate workplace hazards can help prevent injuries to workers, but only if it is adequately enforced, according to a new study by the RAND Corporation.

The first-ever evaluation of the California Injury and Illness Prevention Program found evidence that the program reduces workplace injuries, but only at businesses that had been cited for not addressing the regulation's more-specific safety mandates.

We found the safety effects to be real, but not very large, said John Mendeloff, lead author of the study and a senior public policy researcher for RAND, a nonprofit research organization. We think that the most important reason for the limited impact of this program is that inspectors often did not go beyond a review of the employer's written document.

When California Division of Occupational Safety and Health inspectors did investigate further and found failures to comply with provisions to train workers, identify and abate hazards, and investigate injury causes, the average injury rates at targeted businesses declined more than 20 percent in the following two years, Mendeloff said.

However, these provisions were cited in only about 5 percent of Cal-OSHA inspections, RAND researchers found. In the other 20 percent of inspections where a violation of the rule was cited, it was only for the section requiring the employer have a written program. Such a violation carries an average penalty of $150.

The California Injury and Illness Prevention Program, which became effective in 1991, requires all employers to adopt certain procedures. These include communicating to employees about risks, carrying out regular workplace surveys and abating the hazards that are found, training employees about how to work safely, and investigating the causes of the injuries that occur. In contrast, almost all other safety standards address specific hazards -- for example, those dealing with protection against falls.

The program has been the most frequently violated Cal-OSHA standard in every year since 1991, being cited in about 25 percent of all inspections. The California program is also one possible model for federal OSHA's current rule-making effort to develop a safety and health program rule.

The RAND study notes that higher penalties for noncompliance with the program and more extensive activities to make employers aware of their obligations could enhance compliance. However, two other approaches could have a greater impact: having inspectors conduct more in-depth assessments of employer programs and having inspectors link the violations they find and the injuries that have occurred to the program by asking Why weren't these prevented by your Injury and Illness Prevention Program?

The study found that employers who were cited for violations of the Injury and Illness Prevention Program in one inspection usually came into compliance in future inspections. However, the overall percentage of inspections finding program violations did not change over time.

Moreover, the percentage of first-time inspections finding violations was the same in 2007 as it was in 1993. These findings indicate that information about the program requirements failed to reach many employers, they failed to be convinced to comply by the threat of penalties, or both.

The 20 percent reduction in injuries following citations for the specific requirements of the California Injury and Illness Prevention Program translates to about 1 injury per year at a workplace with 100 employees. Most estimates of the value of preventing a work injury are in the range of $15,000 to $50,000. The RAND study did not find evidence that the statewide workplace fatality rate had decreased after the introduction of the program standard.

The study of injury effects was carried out using several different injury data sets. In all cases, inspections were included in the data if before and after injury rates could be obtained for the inspected business. The study was limited to workplaces in the manufacturing, transportation, utilities, wholesale trade and health care sectors. It included inspections through 2006.

Psoriasis is associated with impaired HDL function, Penn study finds

Wed, 16 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Orlando - Collaborative research from Perelman School of Medicine at the University of Pennsylvania has shown that psoriasis patients have an increased risk of heart attack, stroke and cardiovascular death, especially if the psoriasis is moderate to severe. Now, Penn researchers have discovered the potential underlying mechanism by which the inflammatory skin disease impacts cardiovascular health. In two new studies presented at the 2011 American Heart Association Scientific Sessions, Penn researchers show that the systemic inflammatory impact of psoriasis may alter both the makeup of cholesterol particles and numbers, as well as impair the function of high density lipoprotein (HDL), the good cholesterol.

Anecdotally, many researchers have observed that HDL levels may be lower in states of inflammation, such as rheumatoid arthritis, psoriasis and even obesity, said lead study author Nehal Mehta, MD, MSCE, director of Inflammatory Risk in Preventive Cardiology at Penn. However, these new findings suggest that in addition to lower levels, chronic inflammation associated with conditions like psoriasis may change the composition and decrease the function of HDL as well.

In the current studies, researchers enrolled 78 patients with psoriasis and 84 control subjects. In the first study, the authors measured fasting lipid levels and examined the number and size of cholesterol particles using nuclear magnetic resonance (NMR) spectroscopy. This analysis revealed that patients with psoriasis had a higher number of smaller LDL particles, or bad cholesterol, which was independent of traditional risk factors and obesity. It was striking that the NMR profiles from patients with psoriasis resembled those seen in patients with diabetes, and that these patients with psoriasis had otherwise normal traditional lipid panels Dr. Mehta added.

In the second study, the researchers measured HDL efflux, which is the ability of a patient's HDL to remove cholesterol from cells involved in atherosclerosis. This process, known as 'reverse cholesterol transport', is why HDL may have protective properties. In a previous study, researchers at Penn have demonstrated that measuring HDL efflux capacity may be a more effective barometer of protection from heart disease than measuring HDL levels alone.

In this same group of patients who had normal cholesterol levels compared to controls, patients with psoriasis demonstrated dramatically reduced HDL efflux capacity compared to control patients. This negative association observed between psoriasis and HDL efflux persisted after adjusting for traditional lipid levels and other traditional risk factors, including body mass index (BMI).

Patients with psoriasis had an approximate 25 percent reduction in the HDL efflux capacity than the controls, despite their relatively normal overall lipid profiles which leads to the question of whether function is more important than concentration in chronic inflammatory states Dr. Mehta noted.

The new findings may provide a critical clue to the link between psoriasis and heart disease, but the researchers say larger studies are needed to validate their findings. Joel M. Gefland, MD, MSCE, assistant professor of Dermatology and Epidemiology, and a senior author on the studies, said We've been able to show that psoriasis is an important risk factor for vascular disease, and now we may finally be able to identify and ultimately treat the pathways by which psoriasis increases these risks.

Sugar-sweetened beverages may increase cardiovascular risk in women

Sun, 13 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Drinking two or more sugar-sweetened beverages a day may expand a woman's waistline and increase her risk of heart disease and diabetes, according to research presented at the American Heart Association's Scientific Sessions 2011.

In this study, researchers compared middle-aged and older women who drank two or more sugar-sweetened beverages a day, such as carbonated sodas or flavored waters with added sugar, to women who drank one or less daily. Women consuming two or more beverages per day were nearly four times as likely to develop high triglycerides, and were significantly more likely to increase their waist sizes and to develop impaired fasting glucose levels. The same associations were not observed in men.

Women who drank more than two sugar-sweetened drinks a day had increasing waist sizes, but weren't necessarily gaining weight, said Christina Shay, Ph.D., lead author of the study and assistant professor at the University of Oklahoma Health Sciences Center in Oklahoma City. These women also developed high triglycerides and women with normal blood glucose levels more frequently went from having a low risk to a high risk of developing diabetes over time.

The Multi-Ethnic Study of Atherosclerosis (MESA) included food frequency surveys in 4,166 African-American, Caucasian, Chinese-Americans and Hispanic adults 45 to 84 years old. At the beginning of the study the participants didn't have cardiovascular disease.

Researchers assessed risk factors in three follow-up exams spanning five years starting in 2002. Participants were monitored for weight gain, increases in waist circumference, low levels of high density lipoproteins (HDL good cholesterol), high levels of low density lipoproteins (LDL bad cholesterol), high triglycerides, impaired fasting glucose levels, and type 2 diabetes.

Most people assume that individuals who consume a lot of sugar-sweetened drinks have an increase in obesity, which in turn, increases their risk for heart disease and diabetes, said Shay, formerly of Northwestern University's Department of Preventive Medicine in Chicago, where the study was conducted. Although this does occur, this study showed that risk factors for heart disease and stroke developed even when the women didn't gain weight.

Women may have a greater chance for developing cardiovascular disease risk factors from sugar-sweetened drinks because they require fewer calories than men which makes each calorie count more towards cardiovascular risk in women, Shay said.

Researchers have yet to determine exactly how sugar-sweetened beverages influence cardiovascular risk factors such as high triglycerides in individuals who do not gain weight, Shay said, but further work is planned to try and figure that out.

NYUCN receives $7.56 million NIH grant to research heterosexuals at high risk of HIV infection

Fri, 28 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) New York University College of Nursing (NYUCN) received a five-year, $7.56 million grant from the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH) to evaluate the efficacy and cost-effectiveness of a peer-driven intervention to seek out heterosexuals at high risk for HIV in their communities, test them for HIV, and link them to care in a timely fashion if they are found to be HIV infected.

An estimated 25% of individuals currently living with HIV in the United States do not know they are infected. This undiagnosed HIV infection is particularly prevalent among populations that experience barriers to testing and care and that are therefore difficult to reach and engage. It is well documented that heterosexuals at high risk for HIV (HHR) are significantly less likely to test for HIV and more likely to be diagnosed with HIV late in the course of their HIV disease compared to their peers with traditional risk factors for HIV such as men who have sex with men and those who inject drugs. HHR also tend to experience serious delays in accessing care, placing them at grave risk for illness, loss of quality of life, and early mortality. People of color, particularly African Americans and Latinos, are vastly over-represented among the population of HHR.

The overall goal of this study is to develop a user-friendly, fairly brief, potent, and cost-effective method for reaching the population of HHR, and bringing those found to be infected with HIV into care in a timely fashion.

The problem of testing, treatment, and retention into care for HHR is challenging, because the population experiences a range of barriers to needed services. Among these are structural barriers, such as poor access to or difficulty accessing high-quality HIV testing and care; social barriers including social norms that do not encourage frequent use of health care generally, including of HIV testing; and numerous individual-level barriers such as mistrust of medical settings, fear of HIV testing, and not feeling at particularly high risk for HIV.

In fact, the prevalence of HIV infection among HHR in New York City has been found to be very high. Our research team, in collaboration with the New York City Department of Health and Mental Hygiene, has conducted surveillance with this population as part of the National HIV Behavioral Surveillance (NHBS) studies, led by Dr. Holly Hagan, a Professor at the College of Nursing. In the 2006-2007 study the NHBS found that over 7% of HHR in high-risk areas in New York City were infected with HIV, and only about 5% were aware of their diagnoses.

Even more striking, the NHBS study found that 11% of those in central Brooklyn were HIV-infected but did not know their status, said Dr. Marya Gwadz, a Senior Research Scientist at the College of Nursing, and the peer-driven intervention study's Principal Investigator. These findings inspired us to focus our efforts on this vulnerable population, and to concentrate on central Brooklyn, an area considered 'high risk' because of its elevated rates of poverty and a high HIV prevalence.

Gwadz and her research team, which includes Dr. Charles Cleland, Dr. Holly Hagan, Dr. Ann Kurth, and Dr. Noelle Leonard of the College of Nursing, and Dr. David Perlman of Beth Israel Medical Center, will build on the NHBS methodology, which uses a peer referral method called respondent driven sampling, to seek out and test HHR for HIV. Further, it will combine this recruitment method with peer education activities that can be conducted during the course of peer recruitment. These peer education activities are designed to increase an individual's motivation to join the study, be tested for HIV, and receive care in a timely fashion if HIV-infected. This is followed by patient navigation, an approach to support access to care, for those found to be HIV infected.

The peer-driven intervention is tailored specifically for African American and Latino HHR. We also designed it to be easy to use in the future in health departments and community-based organizations, by making use of computerized interactive components that don't require staff time to facilitate, peer-delivered components, which participants deliver independently, and patient navigation, a flexible and individualized approach to managing a complex health care system, said Dr. Gwadz. The project will enroll 3400 HHR in central Brooklyn over the course of five years.

The Department of Health has taken an active role in making sure all New Yorkers are offered HIV testing during medical encounters and then linked to care if they are found to be infected. Yet despite these efforts, the NHBS found that only a third of HHR had been tested in the past year. This suggests to us that in addition to the Department of Health initiatives we need active recruitment approaches to reach and engage people in their communities. Peer-driven interventions are powerful because they can simultaneously address both individual and social barriers, said Gwadz. Participants also like peer-driven interventions, because it provides them with a chance to give back to the community and help others access needed services.

The NHBS studies are the main surveillance efforts funded by the Centers for Disease Control and Prevention. These studies use both the peer referral method (respondent driven sampling), as well as individual recruitment of participants in select social venues at select times, called venue based sampling. While both of these recruitment methods have been effective in reaching vulnerable populations, no one has yet directly compared their effectiveness and relative costs for identifying undiagnosed HIV infection in HHR. One aim of this study is to answer this important research question and therefore provide guidance to the public health community on the costs and relative merits of each recruitment approach.

The study is designed to complement the vital local and national HIV prevention initiatives currently in place. We plan to contribute an efficient, innovative, and sustainable multi-level intervention to the HIV prevention portfolio at the end of the study, said Gwadz, as well as guidance on optimal approaches to reach HHR. Because the vast majority of HHR are African-American or Latino, we hope the study will ultimately play an important role in reducing racial/ethnic disparities in HIV/AIDS.

Postcode lotteries in preventative health care -- not necessarily all bad news

Tue, 27 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) There is much interest in the unequal health care caused by postcode lotteries. The area you live in can impact the treatment you receive for cancer treatment, surgery or GP care. Research published in BioMed Central's open access journal BMC Public Health shows that there are also geographic differences in the implementation of public health programs.

In 2009, the government introduced 'Health Checks' a national public health program with the aim of reducing the incidence of cardiovascular disease (CVD). This program is open to all 40-74 year olds with no prior history of CVD and aims to assess each person's risk of a cardiovascular event within the next 10 years and provide them with advice and medication if necessary.

Using an example of eight primary care trusts (PCTs) in North West London, researchers examined the amount of money each PCT spent on the program, how they recruited eligible people onto the program, what parameters they tested (including blood glucose levels, blood pressure, weight, alcohol intake, smoking and exercise) and what information and treatment was provided after the examination.

The results showed considerable variation across the PCTs including the amount of money spent per person. However, apart from one PCT, there was a general trend that PCTs responsible for more deprived areas, which traditionally have a higher burden of CVD, spent more per eligible person than PCTs responsible for more affluent areas.

For most PCTs, 'Health Checks' are carried out in GP practices. But flexibility in the scheme meant that the 'Health Checks' could also be carried out at local pharmacies, or at community events to include high-risk individuals who typically do not visit their GPs. This included football stadiums and job centers, to catch middle aged men in manual jobs, and people out of work.

Dr David McCoy from the Public Health Directorate said that, This study shows both good and bad in the way in the 'Health Checks' Program is implemented. Better coordination and sharing of information between PCTs could help iron out inequalities, reduce costs and PCTs would be able to learn from the experience of others.

Dr McCoy continued, A more serious problem we found was the lack of a common approach to evaluating the impact of 'Health Checks'. While we can count the number of health checks done, we currently don't know if this has a positive effect on unhealthy behavior or prevents CVD. Also there was no way of knowing whether uptake and impact of the program was the same for all sections of the population. The main point is to ensure that regardless of interpretation of guidelines, 'Health Checks' results in a real reduction in CVD risk.

Plant compound reduces breast cancer mortality

Tue, 13 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Phytoestrogens are plant compounds which, in the human body, can attach to the receptors for the female sexual hormone estrogen and which are taken in with our daily diet. A number of findings have attributed a cancer protective effect to these plant hormones. At DKFZ, a team headed by Prof. Dr. Jenny Chang-Claude summarized the results of several studies in a meta-analysis last year and showed that a diet rich in phytoestrogens lowers the risk of developing breast cancer after menopause. Now the Heidelberg researchers wanted to find out whether phytoestrogens also have an influence on the course of breast cancer. Prior investigations on this topic had provided contradictory results.

The most important type of phytoestrogens in our Western diet are lignans, which are contained in seeds, particularly flaxseeds, as well as in wheat and vegetables. In the bowel, these substances are turned into enterolactone, which is absorbed by the mucous tissue and which was determined by the Heidelberg researchers as a biomarker in the patients' blood.

From 2002 to 2005, the DKFZ researchers used the MARIE study to take blood samples of 1,140 women who had been diagnosed with postmenopausal breast cancer. After a mean observation time of six years, they related enterolactone levels to clinical disease progression.

The result: Compared to the study subjects with the lowest enterolactone levels, the women with the highest blood levels of this biomarker had an approximately 40 percent lower mortality risk. When the scientists additionally took account of the incidence of metastasis and secondary tumors, they obtained a similar result: Women with the highest enterolactone levels also had a lower risk for such an unfavorable disease progression.

We now have first clear evidence showing that lignans lower not only the risk of developing postmenopausal breast cancer, but also the mortality risk, says Jenny Chang-Claude. There had been prior studies to determine the lignan intake by means of dietary surveys. But the results of such surveys are often unreliable and, in addition, there are big differences in the way individuals actually process the plant substances into effective metabolic products. Therefore, the Heidelberg team chose the more reliable measurement of biomarkers.

However, Chang-Claude narrowed down the result: The result was significant only for the group of tumors that have no receptor for the estrogen hormone (ER-negative tumors). This gives reason to suspect that enterolactone protects from cancer not only by its hormone-like effect. Indeed, studies of cells and animals had already provided evidence suggesting that the substance also has an influence on cancer growth irrespective of estrogen. Thus, it promotes cell death and inhibits sprouting of new blood vessels.

In order to find out whether enterolactone also inhibits the aggressiveness of estrogen receptors in estrogen-positive tumors, we would need to expand this study to include much larger groups of women, said Jenny Chang-Claude. Moreover, the scientist firmly emphasized: By eating a diet that is rich in wholemeal products, seeds and vegetables, which is considered to be health-promoting anyway, everybody can take in enough lignans. At the present time, we can only discourage people from taking any food supplements.

Phytoestrogens have been the subject of intense scientific debates in past years. On the one hand, the results of several studies of cells as well as epidemiological findings suggest that they have a cancer protective effect. Another observation that may be interpreted in this direction is that Asian women are less frequently affected by breast cancer. Their soy-rich diet contains large amounts of another type of phytoestrogens, isoflavones. On the other hand, scientists fear that isoflavones might imitate the growth-promoting properties of real hormones and, thus, accelerate hormone-dependent tumors such as breast cancer and prostate cancer. It has not yet been finally determined whether lignans in the body imitate the hormone effect or, on the contrary, counteract it, says Jenny Chang-Claude. Our studies will help achieve more clarity in this important question, which also concerns our daily diet.

UofL's Ruth Carrico selected for National Nurse Fellowship

Tue, 16 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Ruth Carrico, Ph.D., R.N., F.S.H.E.A., C.I.C., an associate professor at the School of Public Health and Information Sciences, University of Louisville, has been named one of just 21 Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows for 2011. Carrico joins a select group of nurse leaders from across the country chosen to participate in this world-class, three-year leadership development program designed to enhance nurse leaders' effectiveness in improving the United States health care system.

With more than 30 years' experience in health care, Carrico has focused her nursing practice on infection prevention in the health care and public health sectors, and is board-certified in infection control. She has received training in health care epidemiology and public health at the Centers for Disease Control and Prevention (CDC) in conjunction with the Rollins School of Public Health at Emory University and the Society for Healthcare Epidemiology of America. Carrico has authored or co-authored six books, as well as numerous peer-reviewed manuscripts, abstracts, posters, e-learning modules, and book chapters.

Ruth is very deserving of this honor, said Richard Clover, M.D., dean, UofL School of Public Health and Information Sciences. She is a leader in the field of infection prevention and control and was recently appointed to the Healthcare Infection Control Practices Advisory Committee (HICPAC) to help advise the director of the Centers for Disease Control and Prevention and the secretary of the Department of Health and Human Services (HHS).

Begun by RWJF in 1998, the RWJF Executive Nurse Fellows (ENF) program strengthens the leadership capacity of nurses who aspire to shape health care locally and nationally. The program will provide Carrico and her colleagues with coaching, education and other support to strengthen their abilities to lead teams and organizations in improving health and health care. The ENF program is located at the Center for Creative Leadership (CCL), and co-directed by: Linda Cronenwett, Ph.D., R.N., F.A.A.N., the Beerstecher Blackwell Term Professor and former dean of the School of Nursing at the University of North Carolina at Chapel Hill; and David Altman, executive vice president of Research, Innovation and Product Development at CCL.

The Institute of Medicine report on the Future of Nursing, issued last fall, underscores the importance of nurse leadership as we work to improve the health and health care of all Americans, Cronenwett said. The RWJF Executive Nurse Fellows program is building and enhancing the leadership skills of extraordinary nurses around the country. Our alumni are a virtual 'who's who' of accomplished nurses, and we know that Ruth Carrico and the other members of this new cohort will join them in doing great things. The RWJF Executive Nurse Fellows program supports nurse leaders with potential to develop innovative ways to improve health care delivery.

I'm thrilled by the opportunity that the Executive Nurse Fellows program offers to build my advanced leadership skills, Carrico said. Nursing practice is critical to addressing the problem of health care-associated infections, so I hope to have the chance to consider educational curricula and possible improvement opportunities. Participation in the program represents a once in a lifetime opportunity for leadership development.

Executive Nurse Fellows hold senior leadership positions in health services, scientific and academic organizations, public health and community-based organizations or systems, and national professional, governmental and policy organizations. They continue in their current positions during their fellowships, and during the fellowship each develops, plans and implements a new initiative to improve health care delivery in her or his community. Carrico plans to focus her initiative on health care-associated infections.

National Institutes of Health renews successful infectious disease research study

Mon, 15 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The National Institute of General Medical Sciences, part of the National Institutes of Health, has renewed funding from its Models of Infectious Disease Agent Study for a research project at the Virginia Bioinformatics Institute at Virginia Tech, led by Stephen Eubank, professor.

Infectious diseases pose one of the most significant threats to public health worldwide. The Models of Infectious Disease Agent Study (MIDAS) is a multi-university research partnership with a mandate to develop computational models or simulations to assist policy makers, public health workers, and other researchers in making better-informed decisions about natural or intentionally caused emerging infectious diseases, and in planning for national emergencies or acts of bioterrorism.

The project, Synthetic Information Systems for Better Informing Public Health Policymakers, began in 2004 as a five-year project, received two additional years of funding in 2009 from the American Recovery and Reinvestment Act, and will now be supported with approximately $500,000 per year for an additional five years.

Dr. Eubank and his colleagues have done an outstanding job of advancing the goals of the MIDAS initiative by developing state of the art epidemiological models, said James Anderson, who helps manage the MIDAS program at the National Institutes of Health. These models helped policymakers evaluate efforts to mitigate the impact of disease outbreaks, such as the 2009 H1N1 flu pandemic. Dr. Madhav Marathe and Dr. Eubank aim to refine the current models in the next phase to produce software tools that will help public health officials detect and respond to disease outbreaks in distinct geographical regions and demographic populations.

The creation of network-based models of infectious disease can help guide the design of targeted intervention strategies to combat the spread of disease. Powerful computer simulations can provide important information before an outbreak actually happens, such as the potential benefits of isolating those infected with a virus and how to optimize the use of antiviral treatments.

To build a detailed model of a population, Eubank and Marathe, who are deputy directors of the Network Dynamics and Simulation Sciences Laboratory (NDSSL), and their colleagues typically start with census information, public surveys, and transportation data, which help provide a realistic picture of the daily activities of simulated people within a population and allow for detailed estimates of social contacts. These models are then combined with other models of people's behavior to demonstrate how social mixing patterns change under different interventions, such as the closing of schools or workplaces. Important information related to a specific infectious disease, such as H1N1 influenza for example, can be added, allowing researchers to pinpoint the best intervention strategies in a variety of situations.

In 2008, MIDAS researchers published a paper in the Proceedings of the National Academy of Sciences that concluded that a timely implementation of targeted household antiviral prevention measures and a reduction in contact between individuals could substantially lower the spread of the disease until a vaccine was available. Intervention methods used were antiviral treatment and household isolation of identified cases, disease prevention strategies and quarantine of household contacts, school closings, and reducing workplace and community contacts.

Past support from MIDAS has helped us scale our simulations from local to regional and national levels, to understand what details matter to the big picture, and to learn more about the important issues facing public health decision-makers, said Eubank We've also developed important collaborations with researchers at Northwestern University, the University of Utah, and Clemson University, who will participate in this project. We're thrilled to have the opportunity to carry this research through to the next stage: combining the best research from pure and applied mathematics, epidemiology, physical and social sciences, and computer science into tools that policymakers can and will use routinely to inform their response to infectious disease outbreaks. This is an example of how NDSSL applies advanced computing to bring scientific evidence to bear on understanding the many large, interdependent complex systems that are crucial to modern life.

In addition to Virginia Bioinformatics Institute, research groups from Harvard School of Public Health, the University of Pittsburgh, University of California at Irvine, University of Chicago and Argonne National Laboratory, University of Pennsylvania School of Veterinary Medicine,University of Washington and the Fred Hutchinson Cancer Research Center, Yale University, the University of Texas at Austin, and the Research Triangle Institute are members of the MIDAS team.

Good guy or bad guy? Diagnosing stomach disease in pet reptiles

Tue, 31 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Although known for over a century, cryptosporidiosis was believed to be an extremely rare condition and it only gained attention with the discovery that it can affect humans, especially immune-compromised individuals. It is caused by a single-cell parasite, one of a family known as cryptosporidia. Some cryptosporidia also infect reptiles, where after a sometimes lengthy incubation period they cause gastrointestinal problems even in otherwise healthy individuals. The condition is usually persistent and is presently impossible to cure. It is therefore important to minimize infections and in this regard reliable diagnostic procedures are essential.

Diagnosis is based on the detection of parasites in faeces but is complicated by the fact that snakes in particular excrete parasites that they swallow together with their prey, so the presence of cryptosporidia in faeces does not necessarily mean the animals are infected. For this reason it is essential to be able to distinguish between prey cryptosporidia and those that cause infection in the snake. Barbara Richter and colleagues at the Institute of Pathology and Forensic Veterinary Medicine in the University of Veterinary Medicine, Vienna now report a DNA-based procedure able to determine not only whether cryptosporidia are present but also whether they are of mammalian or snake origin.

By means of the test, Richter was able to show that a particular type of cryptosporidium is present in about one in six samples from the popularly kept corn snake and in about one in twelve samples from the attractive leopard gecko, a lizard frequently found in reptile collections. These prevalence figures are far higher than previously suspected, showing the widespread nature of the disease. The corn snake in particular seems highly susceptible to infection. Worryingly, the new tool revealed that a large proportion of captive leopard geckos contain cryptosporidia of one form or another. It is possible that some of the infections do not inconvenience the host geckos but the animals nevertheless represent a source of infection for other reptiles that come into contact with them. Many reptile collections house a number of species together and there is therefore a significant risk of cross-species infection.

The new diagnostic procedure represents a precise method for the early diagnosis of cryptosporidiosis in lizards and snakes, before the animals show symptoms of disease. Nevertheless, Richter still raises a cautionary note. A further problem is that cryptosporidia are often present in faeces in very low numbers so it is easy to miss them in a single test. We are working to make our method more sensitive but it is very important to test the reptiles repeatedly. A negative result does not necessarily mean that the animal is really free of the parasite.

Heart failure treatment options have come a long way

Thu, 05 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) This year the Heart Failure Congress 2011, organised by the Heart Failure Association of the European Society of Cardiology (ESC), offers a strong scientific programme featuring 11 late breaking trials and clinical updates, over 1000 original abstracts (submitted by delegates from 61 countries), 14 industry sponsored satellites and mini satellites and over 70 separate sessions.

The presentations will demonstrate the fantastic improvements we've seen in both treatment options for heart failure and understanding of the mechanisms behind the disease. The field has come an awfully long way since the ESC first started holding dedicated heart failure meetings in 1995, said Professor Karl Swedberg, Scientific Chairperson of the Congress programme.

Highlights of the late breaking trials and clinical updates programme will include the SHIFT trial with ivadrabine, EMPHASIS-HF with eplerenone, an update on the MADIT CRT trial on how to predict optimal benefits from CRT, Northstar, and two telemonitoring trials - The TEHAF study and TIM-HF.

The Heart Failure Congress, which represents the largest meeting on heart failure in the world, offers the opportunity for everyone in the heart failure community to come together. It will help get delegates up to speed on the core topics and associated technologies that they need in their daily clinical practice, said Professor Piotr Ponikowski, President of the Heart Failure Association.

Delegates attending the Heart Failure meeting, which expects to attract around 2500 attendees, will include cardiologists, internists, general physicians, basic scientists, epidemiologists, nurses, and industry affiliates.

The overall theme of the congress will be co-morbidities, with sessions focusing on heart failure and diabetes, lung disease, renal impairment, hypertension, cancer, cardio-renal syndrome and anaemia. More and more patients with heart failure are suffering from co-morbidities. The problem heart failure clinicians face on a daily basis is how best to integrate the different medications and approaches to treatments, said Swedberg.

Other important topics that will be covered in depth are devices and technologies, including ICDs, CRT and LVAD, with sessions exploring how to apply the new findings in clinical practice.

One event likely to attract high attendance is an over view of the Surgical Treatment for Ischemic Heart Failure (STICH) trial, which will be presented by Christopher O'Connor (Durham, US) in a debate session at 14.15 on Monday in the Stockholm Lecture Room. The STICH trial, comparing CABG therapy and medical therapy in patients with left ventricular ejection fractions less than 35%, was first presented at the American College of Cardiology meeting in April. This session will provide a good opportunity for delegates to get to grips with how to interpret the results of this really important trial, with opportunities to ask the presenters questions, said Swedberg.

A highlight on Saturday will be the presidential debate that is being held as a joint session with the Heart Failure Society of America, to explore two controversial issues in heart failure treatment. One debate will feature whether ICDs are being over used in Europe, and the other will explore the controversy over whether heart rate reduction beyond beta blockers is effective in heart failure. Other joint sessions that will be held include Imaging heart failure, with the European Association of Echocardiography on Saturday, and the impact of new atrial fibrillation guidelines on heart failure management on Sunday with the European Heart Rhythm Association (EHRA).

For the first time the meeting will not offer a dedicated nursing tract. This was a conscious decision because we want to emphasize the team spirit that goes on in the management of heart failure patients. The work of physicians and nurses in heart failure should be properly integrated, explained Swedberg. Sessions that may be of particular interest to nurses will include palliative care for patients with end-stage heart failure, and how to talk to your patients.

In the opening ceremony a life time achievement award will be presented for the first time to Professor John Kjekshus, from the University of Oslo, Norway, who over the past 40 years has been involved in many trials in the development of treatments for heart failure, including the TIMOLOL trial, CONSENSUS trial, the 4 S trial, the MERIT trial and the CORONA trial.

To recognise the contribution of young researchers the Heart Failure Association Board are inviting delegates under 35 years to a special reception with faculty members that will be held on Monday evening. We want to emphasise the importance that we place on young researchers because they represent our new blood, said Ponikowski. The idea is to provide them with a clear picture of our aims, mission and on-going initiatives in the hope that we can inspire them to get more involved.

On Sunday a poster session providing updates from industry on the latest ongoing trials will be co chaired by John McMurray (Glasgow, GB) and Stefan Anker (Berlin, DE). The objective is to provide industry with an opportunity to present their ongoing trials and the audience to ask questions. It will be a real opportunity for delegates to get a feel for what's in the pipeline, said Ponikowski.

The city of Gothenburg provides an ideal venue for the congress. The many advantages include close proximity between hotels and the congress centre, together with many cultural and social attractions said Swedberg, adding that the closeness to the sea makes Gothenburg particularly special with a half-hour tram ride taking you straight into the southern archipelago.

Systematic effort helps hospital raise employee flu vaccination rates

Wed, 04 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A systematic effort to improve flu vaccination rates for healthcare workers has increased flu vaccinations rates from 59 percent to 77 percent at the University Health System (UHS) in San Antonio. A report detailing their interventions to increase vaccination was published in the June issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

UHS raised its healthcare worker vaccination rate from 59 percent in 2009 to 77 percent in 2010 through quality improvement tools including vaccine kits to individual units, Grand Round presentations, enhanced staff awareness and a dashboard of vaccination rates of each program was promoted on the staff intranet. The increase places the UHS well above national average for healthcare worker vaccination, which tends to hover below 50 percent.

The vaccination push was spearheaded by a quality improvement team with a goal of reaching a vaccination rate of 80 percent. The team developed a list of possible reasons for low immunization rates, and created a set of interventions to combat them.

Under the improvement program, a vaccination kit was provided to each hospital unit so workers could take it without leaving their work area. Multiple educational conferences on the importance of vaccination were held, and a flu information website and blog were added to the health system's website. Hospital newsletters featured articles about immunization, including photographs of hospital leaders being vaccinated. The vaccination campaign was also promoted on telephone hold messages and computer screen savers. To monitor progress, vaccination rates by unit were sent to unit directors weekly and were available to all employees on the website.

The quality improvement tools and techniques the team used led to a significant improvement of the vaccination rate, said Dr. Jose Cadena, a member of the team and an author of the journal report. Our methodology allowed us to adapt and modify interventions over time, adjusting to challenges and opportunities for improvement that emerged.

Making sure healthcare workers are vaccinated is a major public health initiative. Vaccination of healthcare workers helps save patients' lives and reduces the spread of influenza in healthcare settings. It also protects the individual worker from falling ill during influenza outbreaks and from missing work, which further impacts patient care.

Mathematical models have shown that [healthcare worker] influenza vaccination could lead to a 40 percent decreased risk of patients acquiring influenza in the healthcare setting, which makes influenza vaccination a patient safety issue, Dr. Cadena and his colleagues write.

While the vaccination effort was successful in raising immunization rates substantially, it still fell short of its 80 percent goal. Making vaccination a condition of employment, as recommended recently by several professional societies including the Society for Healthcare Epidemiology of America, may be required to achieve higher rates of vaccination, Dr. Cadena said.

HPV vaccine works for boys: Study shows first clear benefits

Fri, 04 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) The vaccine for human papillomavirus (HPV) can prevent 90 percent of genital warts in men when offered before exposure to the four HPV strains covered by the vaccine, according to a new multi-center study led by H. Lee Moffitt Cancer Center and UCSF.

The four-year, international clinical trial, which also found a nearly 66 percent effectiveness in the general population of young men regardless of prior exposure to these strains, provides the first reported results of using the HPV vaccine as a prophylactic in men.

Initial data from this study informed the Food and Drug Administration's decision to approve the vaccine for boys in 2009 to prevent warts, while results from a substudy led the FDA to expand approval late last year to prevent anal cancer. Findings can be found in the Feb. 3 issue of the New England Journal of Medicine, or online at www.nejm.org.

While the HPV vaccine was approved in 2006 for girls to prevent cervical cancer, the vaccine's benefit for young men was not initially addressed. Yet infection and diseases caused by HPV are common in men, the researchers said, including genital warts, which are one of the leading sexually transmitted diseases (STD) for which treatment is sought nationwide. The Centers for Disease Control and Prevention estimate that half of all sexually active Americans will get HPV at some point in their lives.

This is an exciting development in the STD world, said Joel Palefsky, MD, a UCSF professor of medicine who co-led the research along with epidemiologist Anna R. Giuliano, PhD, from the H. Lee Moffitt Cancer Center and Research Institute, in Tampa, FL. It shows that if we vaccinate males early enough, we should be able to prevent most cases of external genital warts in this population.

While warts are often considered an annoyance, rather than a life-threatening disease such as cervical cancer, Palefsky noted that warts are a common problem in young people and are often associated with depression, social stigma and loss of self-esteem. Complications of wart treatments are also quite common, he said.

The double-blind study included 4,065 healthy men aged 16-26 years, spanning 71 sites in 18 countries. Of those patients, 85 percent reported having exclusively female sexual partners, with the remainder self-identified as having sex with men.

The men were tested at the onset of the trial for previous exposure to each strain and were randomly selected to receive either a placebo or a vaccine that targeted HPV strains 6, 11, 16 and 18. Men with a history of anal or genital warts or lesions were excluded. Participants then received six follow-up examinations over the following three years to assess the vaccine's effectiveness.

In addition to preventing warts, the vaccine also effectively prevented HPV-persistent infection in 86 percent of the participants without previous exposure.

This is the first study to show that this vaccine works in boys, Giuliano said. As long as we have a poor record of vaccinations in girls, boys should also be vaccinated.

Vaccinating boys also should help prevent HPV transmission to women, as well as transmission from men to men, she said, and help reduce the incidence of the virus throughout the general population. This could be particularly significant, Palefsky added, since only 30 to 40 percent of teenage girls in the U.S. have received even one of the three recommended doses of the vaccine.

The authors noted that while they find it likely that the prevention of HPV infection and disease in men will have additional benefits, such as preventing anal, genital and throat cancers, these benefits need to be directly demonstrated through further clinical trials.

Scientists identify avoidable breast cancer risk factors

Tue, 18 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Many risk factors for breast cancer are well studied and documented. Thus, scientists are sure by now that early first menstrual period, late onset of menopause and a family history of breast cancer are associated with an increased breast cancer risk.

However, neither an individual woman nor medicine can influence whether family members develop breast cancer or at what age menopause starts - these are risk factors on which we have no influence. Scientists of the German Cancer Research Center in the team of Associate Professor (PD) Dr. Karen Steindorf and Professor Dr. Jenny Chang-Claude, jointly with Professor Dr. Dieter Flesch-Janys of Hamburg Eppendorf University Hospitals, have been searching for risk factors which can be influenced by changes in lifestyle and behavior.

58,000 women in Germany are diagnosed with breast cancer each year, says Jenny Chang-Claude.Therefore, a key question is whether there are behavioral changes that might help to lower the disease risk. Our study aims to determine the percentage of cases where these avoidable risk factors are responsible.

The researchers focused on aspects such as taking hormones for relief of menopausal symptoms (hormone replacement therapy), physical activity, overweight and alcohol consumption. All these lifestyle factors have been identified in prior studies as possible risk factors for the development of breast cancer.

In their current MARIE study, which is supported by Deutsche Krebshilfe (German Cancer Aid), the epidemiologists studied 6,386 female controls along with 3,074 patients who had been diagnosed with breast cancer after the onset of menopause. On the basis of these data, the scientists calculated the percentage of cancer cases that is attributable to a particular risk factor (or a particular combination of several risk factors).

Of the modifiable lifestyle factors, it is primarily hormone replacement therapy and a lack of physical activity which increase a woman's risk of developing breast cancer. Alcohol consumption and overweight were found to have less influence on breast cancer risk. Thus, 19.4 percent of invasive postmenopausal breast cancer are attributed to hormone replacement therapy; 12.8 percent to a lack of physical activity. Both factors together are responsible for 29.8 percent of breast cancer cases. When the investigators took a separate look at the group of patients whose tumors have receptors for sex hormones (hormone receptor-positive breast tumors), they determined an even higher value of 37.9 percent. The study leaders emphasize that these results reflect the situation in Germany with our typical lifestyle and may differ in countries with other lifestyles.

Non-modifiable factors such as family history or age at first and last menstrual period account for 37.2 percent in total of all malignant postmenopausal breast cancers. That means that two factors which each woman has in her own hands are responsible for a similar number of postmenopausal breast cancer cases as the non-modifiable factors, Karen Steindorf says. If behavioral changes in these two areas could be brought about, almost 30 percent of breast cancers after menopause could be prevented. Therefore, the DKFZ researchers recommend women to take more exercise and to refrain from hormone replacement therapy, unless it is absolutely necessary.

Consortium studying mathematical modeling of influenza infection

Thu, 16 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Mount Sinai School of Medicine today announced that the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), has renewed funding of the Program for Research on Immune Modeling and Experimentation (PRIME). This program seeks to develop easy-to-use, predictive mathematical models to better understand patterns of infection among individuals affected by the H1N1 and 1918 influenza viruses and other related viruses.

The renewed contract provides an additional $17.2 million over five years to the initiative, following an initial contract of $16.8 million, bringing the total funding for PRIME to $34 million. Mount Sinai is the primary research site for PRIME, leading five other institutions and organizations around the world.

As part of PRIME, researchers at Mount Sinai School of Medicine use data-based models to simulate the response of human dendritic cells, a type of immune cell, to influenza viruses. The PRIME team will test and refine a cutting-edge informatics platform that replaces paper recordkeeping and transmits results to a centralized database sponsored by NIAID. This database will help scientists more effectively design their experiments and make better use of available data. Under the renewed contract, Mount Sinai researchers will perform large-scale experiments to validate mathematical models and test their predictions, with the goal of helping scientists better understand the immune response to these viruses.

The number of factors contributing to human response to a virus is overwhelming, far too many for scientists to test through traditional experiments, said Stuart C. Sealfon, MD, Glickenhaus Professor and Chair of the Department of Neurology, Director of the Center for Genomics, Proteomics and Bioinformatics, Director of the Center for Translational Systems Biology, Professor of Neurobiology, and Professor of Pharmacology and Systems Therapeutics at Mount Sinai School of Medicine. Using a computational approach, we can better understand what makes these viruses tick, allowing scientists to refer to a centralized database to better direct their experiments.

During the first five years of the contract, the PRIME team made several advances in working with immunologists on using these tools. With the renewal, the research team will facilitate the use of computational approaches by experimentalists to elucidate the molecular mechanism of action of virus infection.

The PRIME team is at the forefront of a major transition in medical research to leverage the power of computational biology to help design experiments, said Dr. Sealfon. This approach can make these experiments much more efficient and accelerate scientific discovery, which is especially critical in studying severe pandemics.

Widespread vitamin D deficiency a concern in Asia

Mon, 13 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Bone health experts attending the 1st Asia-Pacific Osteoporosis Meeting in Singapore this week have flagged vitamin D deficiency as a major concern in the region, particularly in South Asia where the problem is especially severe and widespread across the entire population.

Dr. Nikhil Tandon, Professor of Endocrinology and Metabolism at the All India Institute of Medical Sciences of New Delhi, India highlighted the results of various studies which show severe deficiency across India and Pakistan in all age groups, as well as insufficiency in populations of South-East and East Asia. A lack of exposure to sunshine, genetic traits and dietary habits are all factors which influence vitamin D levels. In certain regions, vitamin D deficiency can also be attributed to skin pigmentation and traditional clothing, as well as air pollution and limited outdoor activity in urban populations, he stated.

Vitamin D is primarily made in the skin when it is exposed to sunlight, with limited amounts obtained from food sources. However, in people with low sunlight exposure vitamin D is principally obtained from nutritional or supplemental sources. In the elderly, vitamin D deficiency is linked to reduced physical performance and increased risk of fall-related fractures. In children, severe vitamin D deficiency results in inadequate mineralization of bone, leading to growth retardation and bone deformities known as rickets. As well, there is evidence that children born to mothers who are vitamin D deficient during pregnancy may have reduced bone mass, which could in turn be a risk factor for osteoporosis later in life.

At a Vitamin D Roundtable held in conjunction with the meeting, nutrition and bone health experts discussed the importance of encouraging further studies on vitamin D status and risk factors in countries where data are scarce. The group is developing interactive vitamin D maps based on published data of 25(OH)D serum levels, the biomarker used to measure vitamin D status in the blood. Chair of the Roundtable, Professor Robert Josse, Professor in the Departments of Medicine and Nutritional Sciences at the University of Toronto, Canada commented, The maps will track vitamin D levels by region and different population groups, giving a valuable overview of the prevalence of vitamin D deficiency around the world. The global maps are innovative tools that will help identify problem areas, encourage awareness and stimulate research studies. By facilitating global comparisons, the maps should provide an incentive for health authorities to implement strategies to improve vitamin D status in the population.

Laboratory studies show promise for new multiple sclerosis treatment

Thu, 18 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Successfully treating and reversing the effects of multiple sclerosis, or MS, may one day be possible using a drug originally developed to treat chronic pain, according to Distinguished Professor Linda Watkins of the University of Colorado at Boulder.

Watkins and her colleagues in CU-Boulder's department of psychology and neuroscience discovered that a single injection of a compound called ATL313 -- an anti-inflammatory drug being developed to treat chronic pain -- stopped the progression of MS-caused paralysis in rats for weeks at a time.

Lisa Loram, a senior research associate who spearheaded the project in Watkins' laboratory, presented the findings at the Society for Neuroscience's annual meeting held in San Diego this week.

MS is an inflammatory disease where the body's immune system attacks a protective sheath called myelin that encompasses nerves in the spinal cord and brain. As the disease progresses, the myelin develops lesions, or scars, that cause permanent neurological problems.

What happens now with MS drugs is they slow or stop the progression of MS, but they don't treat it, Watkins said. They don't take people back to normal because the lesions caused by MS don't heal.

Watkins, Loram and their colleagues hope to use spinal cord and brain-imaging technology to extend their studies to determine if lesions are being healed in rats that received an ATL313 injection.

If we have a drug that is able to heal these lesions, this treatment could be a major breakthrough in how we treat the symptoms of MS in the future, she said.

The new findings were quite a surprise to Watkins. The team had originally wanted to look at the drug's potential in treating pain associated with MS, because about 70 to 80 percent of MS patients suffer from chronic pain that is not treatable.

What we had originally thought about this class of compounds is that they would calm down glial cells in the spinal cord because their pro-inflammatory activation is what causes pain, she said.

Under normal circumstances glial cells are thought to be like housekeepers in the nervous system, Watkins said, essentially cleaning up debris and providing support for neurons. Recent work by Watkins and others has shown that glial cells in the central nervous system also act as key players in pain enhancement by exciting neurons that transmit pain signals.

What's become evident is that glial cells have a Dr. Jekyll and Mr. Hyde personality, Watkins said. Under normal circumstances they do all these really good things for the neurons, but when they shift into the Mr. Hyde formation they release a whole host of chemicals that cause problems like neuropathic pain and other chronic pain conditions.

They discovered that ATL313 appears to reset the glial cells from an angry activated state to a calm anti-inflammatory state that may heal MS lesions.

Doubled risk of anxiety for 18 month-old children with congenital heart defects

Wed, 17 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Research from the Norwegian Institute of Public Health (NIPH) shows that children with severe congenital heart defects have twice the risk of anxiety at 18 months of age compared to healthy children. Children with mild and moderate heart defects, on the other hand, did not show an increased risk of anxiety.

- These findings suggest that children with severe forms of congenital heart defects are prone to emotional problems at a very young age. The increased risk of anxiety could be related to the number of medical procedures and hospital admissions that characterise the first years of life for these children, said PhD student Kim Stene-Larsen at the NIPH.

Part of the HEARTKIDS project

The NIPH is collaborating with the Department of Paediatric Cardiology at Oslo University Hospital on a major research project, HEARTKIDS.

In this follow-up study the researchers examined whether children with congenital heart defects had an increased risk of internalising problems such as anxiety or sleep problems at 18 months of age.

Out of 198 eighteen month old children with a congenital heart defect who were studied, 58 had a severe heart defect. Analysis showed that the children with a severe heart defect had a doubled risk of anxiety compared to healthy children.

In addition to the severity of the heart defect, maternal anxiety and depression explained some of the anxiety in these children. Children with mild or moderate heart defects, however, showed no signs of anxiety or other internalising problems.

The HEARTKIDS project is a sub-study of the Norwegian Mother and Child Cohort Study (MoBa). The project is funded by the Norwegian Research Council. This longitudinal study aims to explore the psychological and developmental consequences of congenital heart defects in infants and toddlers. Through a merge of the MoBa and the Oslo University Hospital's nationwide register of congenital heart defects, which provides accurate diagnostic information about heart defects, it is possible to compare children with varying severity of heart defects with healthy children.

Previous findings from the HEARTKIDS project have shown that 6-month-old children with moderate or severe congenital heart defects show a higher risk of emotional reactivity (irritability, frequent and powerful crying).

Need for more knowledge about children with congenital heart defects

Approximately one percent of all newborn children have a congenital heart defect. The severity of the heart defects varies widely from minor defects to complex conditions that require a series of operations throughout the child's first year.

Several studies have shown that children with congenital heart defects down to 3 years of age are more prone to emotional problems like anxiety and depression. However, there is little knowledge about the emotional problems in infancy and early childhood, which is the phase of life where most of the medical treatment is carried out. The HEARTKIDS project is focusing on the phase from birth to child age 3 years of age.

Vitamin D deficit doubles risk of stroke in whites, but not in blacks

Sun, 14 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Low levels of vitamin D, the essential nutrient obtained from milk, fortified cereals and exposure to sunlight, doubles the risk of stroke in whites, but not in blacks, according to a new report by researchers at Johns Hopkins.

Stroke is the nation's third leading cause of death, killing more than 140,000 Americans annually and temporarily or permanently disabling over half a million when there is a loss of blood flow to the brain.

Researchers say their findings, to be presented Nov. 15 at the American Heart Association's (AHA) annual Scientific Sessions in Chicago, back up evidence from earlier work at Johns Hopkins linking vitamin D deficiency to higher rates of death, heart disease and peripheral artery disease in adults.

The Hopkins team says its results fail to explain why African Americans, who are more likely to be vitamin D deficient due to their darker skin pigmentation's ability to block the sun's rays, also suffer from higher rates of stroke. Of the 176 study participants known to have died from stroke within a 14-year period, 116 were white and 60 were black. Still, African Americans had a 65 percent greater likelihood of suffering such a severe bleeding in or interruption of blood flow to the brain than whites, when age, other risk factors for stroke, and vitamin D deficiency were factored into their analysis.

Higher numbers for hypertension and diabetes definitely explain some of the excess risk for stroke in blacks compared to whites, but not this much risk, says study co-lead investigator and preventive cardiologist Erin Michos, M.D., M.H.S., an assistant professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. Something else is surely behind this problem. However, don't blame vitamin D deficits for the higher number of strokes in blacks.

Nearly 8,000 initially healthy men and women of both races were involved in the latest analysis, part of a larger, ongoing national health survey, in which the researchers compared the risk of death from stroke between those with the lowest blood levels of vitamin D to those with higher amounts. Among them, 6.6 percent of whites and 32.3 percent of blacks had severely low blood levels of vitamin D, which the experts say is less than 15 nanograms per milliliter.

It may be that blacks have adapted over the generations to vitamin D deficiency, so we are not going to see any compounding effects with stroke, says Michos, who notes that African Americans have adapted elsewhere to low levels of the bone-strengthening vitamin, with fewer incidents of bone fracture and greater overall bone density than seen in Caucasians.

In blacks, we may not need to raise vitamin D levels to the same level as in whites to minimize their risk of stroke says Michos, who emphasizes that clinical trials are needed to verify that supplements actually do prevent heart attacks and stroke. In her practice, she says, she monitors her patients' levels of the key nutrient as part of routine blood work while also testing for other known risk factors for heart disease and stroke, including blood pressure, glucose and lipid levels.

Michos cautions that the number of fatal strokes recorded in blacks may not have been statistically sufficient to find a relationship with vitamin D deficits. And she points out that the study only assessed information on deaths from stroke, not the more common brain incidents of stroke, which are usually non-fatal, or even mini-strokes, whose symptoms typically dissipate in a day or so. She says the team's next steps will be to evaluate cognitive brain function as well as non-fatal and transient strokes and any possible tie-ins to nutrient deficiency.

Besides helping to keep bones healthy, vitamin D plays an essential role in preventing abnormal cell growth, and in bolstering the body's immune system. The hormone-like nutrient also controls blood levels of calcium and phosphorus, essential chemicals in the body. Shortages of vitamin D have also been tied to increased rates of breast cancer and depression in the elderly.

Michos recommends that people maintain good vitamin D levels by eating diets rich in such fish as salmon and tuna, consuming vitamin-D fortified dairy products, and taking vitamin D supplements. She also promotes brief exposure daily to the sun's vitamin D-producing ultraviolet light. And to those concerned about the cancer risks linked to too much time spent in the sun, she says as little as 10 to 15 minutes of daily exposure is enough during the summer months.

If vitamin supplements are used, Michos says that daily doses between 1,000 and 2,000 international units are generally safe and beneficial for most people, but that people with the severe vitamin D deficits may need higher doses under close supervision by their physician to avoid possible risk of toxicity.

The U.S. Institute of Medicine (IOM) previously suggested that an adequate daily intake of vitamin D is between 200 and 600 international units. However, Michos argues that this may be woefully inadequate for most people to raise their vitamin D blood levels to a healthy 30 nanograms per milliliter. The IOM has set up an expert panel to review its vitamin D guidelines, with new recommendations expected by the end of the year. Previous results from the same nationwide survey showed that 41 percent of men and 53 percent of women have unhealthy amounts of vitamin D, with nutrient levels below 28 nanograms per milliliter.

Contact among age groups key to understanding whooping cough spread and control

Thu, 11 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---Strategies for preventing the spread of whooping cough---on the rise in the United States and several other countries in recent years---should take into account how often people in different age groups interact, research at the University of Michigan suggests.

The findings appear in the Nov. 12 issue of the journal Science.

Thanks to widespread childhood vaccination, whooping cough (pertussis) once seemed to be under control. But the illness, which in infants causes violent, gasping coughing spells, has made a comeback in some developed countries since the 1980s, becoming a major public health concern. In addition, there's been a shift in who's getting sick, with fewer cases seen in preschool children and more in teenagers, but the reasons for the changing patterns have been unclear.

A variety of explanations have been proposed---genetic changes in the bacterium that causes the disease or the wearing off of immunity in people who were vaccinated years ago, for example.

But by combining two independent sets of data from previous studies, epidemiologists Pejman Rohani, Xue Zhong and Aaron King found that age-specific contact patterns alone can explain the observed shifts in prevalence and age-specific incidence.

One set of data came from an unplanned natural experiment. In Sweden, where infants had been routinely vaccinated for nearly 30 years, concerns about vaccine safety and efficacy led to a halt in pertussis vaccination in 1979. Immunization resumed in 1996 using a different vaccine. During the hiatus and after vaccination resumed, the Swedish Institute for Infectious Disease Control collected data on whooping cough incidence by age group.

The second data set was from a 2008 study in which more than 7,000 people from eight European countries kept track of all the contacts they had with other people during one day, recording the age and sex of the person they interacted with, where the interaction took place and the duration and type of contact (such as conversation or physical contact). A key finding of that study was that children interacted far more frequently with other children than with adults.

The U-M researchers developed a simple mathematical model of whooping cough transmission that incorporated the contact data and then compared the model's predictions with the actual incidence data. The model accurately predicted the declines in whooping cough cases seen in Swedish infants, toddlers and adults and the upturn in cases among teenagers with the resumption of vaccination.

The results cast doubt on the prevalent notion that infected adults, in whom the illness often goes undiagnosed, act as a reservoir for the disease and are a major source of transmission to younger folk. In many countries, concerns about this possibility have prompted adult booster vaccination programs.

But the U-M study shows that, overall, the role of adults in transmission is minimal, and that blanket booster-vaccination of adults is unlikely to be an efficient strategy for controlling the disease, said King, an assistant professor of ecology and evolutionary biology with a joint appointment in mathematics.

The researchers stressed that because the study used incidence data from Sweden, one can only speculate on how its results apply to the United States, where infant vaccination compliance rates are lower and the population is much more diverse. We need similar analyses for the United States, said Rohani, a professor of ecology and evolutionary biology with a joint appointment in the Center for the Study of Complex Systems.

The study makes two robust conclusions, said King. The first point is that we see strong evidence for the efficacy of vaccination directed at children when compliance is high. The second is that better knowledge of actual contact patterns among age groups is crucial for the design of more effective and economical vaccination strategies.

Study identifies factors that increase risk of falls among orthopedic inpatients

Mon, 08 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Patients who undergo total hip replacements are more at risk for having a serious fall while recovering in the hospital than patients undergoing other orthopedic procedures, according to a recent study. The study, which will be presented at the American College of Rheumatology's annual meeting, Nov. 7-11, in Atlanta, also identified other factors involved in patient falls that could help hospitals devise strategies to reduce these accidents.

Patients undergoing total hip replacements (THR) appear more likely to have more serious falls than other orthopedic patients, and serious falls happen earlier than most falls, two days postoperatively rather than four when most falls occurred, said Lisa Mandl, M.D., a rheumatologist at Hospital for Special Surgery in New York. THR patients should be monitored closely, especially during the first three postoperative days. This study identified a window in which we might need to be more careful than we thought.

While studies have examined rates and characteristics of falls in general hospitals that see critically ill patients, there is sparse research on falls in patients staying overnight for elective orthopedic procedures. To fill the knowledge gap, investigators in the Quality Research Center at Hospital for Special Surgery (HSS) conducted a retrospective review of all patients who had fallen in their hospital from 2000-2009. At HSS, almost all admissions are for elective orthopedic procedures, with a small number due to non-critical rheumatic disease patients. Falls in patients 18 years or older were identified from the hospital's falls reporting database and discharge records. The fall rate was 0.9 % of admissions and 2.0 falls per 1,000 inpatient days.

By sifting through records, the investigators tried to characterize the types of falls and identify factors that predicted whether a patient would fall. No association was found between falling and body mass index, age, gender, location in the hospital, day of the week, or time of day. The study showed that 13.1% of first falls resulted in injuries, of which 3.3% were serious, defined as transfer to a higher level of care, dislocation, fracture, intra-cranial bleed, or the need for an operation. Patients with serious falls were more likely to fall earlier in their stay, (post-operative day 2.3 vs. 4.1; P= 0.003) and have had a THR (P=0.001).

Among patients who fell, 38.2% had a total knee replacement (TKR), 18.5% had a spine procedure such as a spine straightening, 14.7% had a THR, 11.5% had a lower extremity procedure such as foot or ankle surgery, and 8.9% were admitted for another procedure or medical reason. Of the 842 falls that were characterized as first falls during the admission, 45.1% involved using the bathroom.

Before this study, we suspected that people fell on their way to the bathroom and that total knee replacement patients comprised a large percentage of falls and we confirmed this, said Dr. Mandl, who is also assistant research professor of medicine and public health at Weill Cornell Medical School. Now we know that patients who have total hip replacements are more likely to have serious falls.

17.5% of first falls were in patients with a known history of previous falls. Twenty-six falls were second or third falls in the same patient during the same admission. We know that a previous fall puts you at risk for a future fall and even though we knew these people were high risk, they still fell. We weren't able to stop it. That tells us that whatever we are doing now is not really good enough, said Dr. Mandl. We need to be more vigilant about people who are high risk.

Dr. Mandl said that clinicians should remind patients that it is okay to ask for help. These are people who normally don't call someone to help them go to the bathroom, so they feel stupid, Dr. Mandl said. We have to make sure that people know it is appropriate that they call people.

According to Dr. Mandl, the number of falls will likely increase in future years because the number of TKRs and THRs is projected to skyrocket. More hips and knees will need to be replaced due to the aging population and increased obesity rates.

Huge 'biobank' for research into major diseases to be set up by Qatar and Imperial College London

Thu, 28 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A biobank of samples and clinical measurements from tens of thousands of people is to be established in Qatar to help scientists understand the causes of major diseases and develop new treatments, it is announced today.

The Qatar Biobank is being established by Qatar Foundation for Education, Science, and Community Development (QF) and Qatar's Supreme Council of Health, with the assistance of experts from Imperial College London. The project was announced at the Royal Society today in the presence of Her Highness Sheikha Mozah bint Nasser Al-Missned, during the Qatari state visit to the UK.

The biobank will collect a wealth of medical data from up to 100,000 volunteers and store samples of their blood and urine in a high-tech storage facility over many years. This will allow scientists to look at diseases already present in the population as well as following up the participants to see who develops disease in the future. Researchers will compare data, including genetic information and data on environmental exposures and lifestyles, from participants who develop illnesses with data from those who remain healthy. In this way, they aim to identify early markers that can indicate when someone is likely to develop a particular disease, so that people will be able to receive early treatment or take measures to prevent a disease developing.

The Qatar Biobank will be the first very large population-based study involving the collection of biological samples in an Arabic country. It will provide scientists with an invaluable resource for improving the prevention, diagnosis and treatment of a wide range of chronic diseases, such as diabetes and heart disease, which are placing increasing demands on Qatar's free public health service.

The initiative builds on other large national and international biobanking projects such as the UK Biobank, set up in 2006, which is the most advanced project of its type in the world.

Public health experts from Imperial College London are playing a crucial role in the design and implementation of the project.

Professor Elio Riboli, Director of the School of Public Health at Imperial College London, said: At the very beginning of the study, healthy participants will be examined using top-level technology, such as MRI scans, so that later we can pick out aspects of the imaging data that may look today normal but might actually be predictive of diseases. The results will be invaluable not only for the Qatar population but for medical science in general.

Qatar is an extremely interesting population from a medical point of view. It's a population in rapid transition towards more Western lifestyles. Qatar is home to residents from different regions of the world, which means we can look at disease risk factors in multiethnic populations in detail and on a very large scale.

Professor Paul Elliott, Head of the Department of Epidemiology and Biostatistics at Imperial College London, said: This is a fantastic opportunity to set up a world-leading project, following up the health of a population over many years, and really try and understand the causes of disease, both genetic and environmental.

Doctors at University of Colorado School of Medicine to train African doctors in AIDS care

Thu, 07 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The HIV epidemic continues to grow, especially in Africa where it has orphaned millions of children and decimated entire communities. In this environment, funding to train African health care providers is critical.

The U.S. Department of Health and Human Services is partnering with the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) to invest $130 million over five years to transform African medical education and dramatically increase the number of practicing health care workers. The University of Colorado School of Medicine will receive $1.9 million in federal grant funding to support this work. Faculty from the University of Colorado will travel to Zimbabwe to train medical students about HIV under funding from this NIH grant.

The Medical Education Partnership Initiative (MEPI) will award grants directly to African institutions in a dozen countries; the African institutions will work in partnership with U.S. medical schools and universities. The initiative will form a network of approximately 30 regional partners, country health and education ministries, and more than 20 U.S. collaborators. University of Colorado School of Medicine will collaborate with the University of Zimbabwe College of Health Sciences in one of the programmatic awards announced today. The Colorado-Zimbabwe collaboration, called the Novel Education Clinical Trainees and Researchers (NECTAR), will improve medical student HIV education in Zimbabwe. Dr. Thomas Campbell, MD, Professor of Medicine, is the Principal Investigator for the University of Colorado. Drs. Eva Aagaard, Director of the Academy of Medical Educators, Lucy Bradley-Springer, Director of the Mountain Plains AIDS Education and Training Center, Suzanne Brandenburg, Director of the Internal Medicine Residency Program, and Nancy Madinger, Director of the Infectious Diseases Fellowship Program at the University of Colorado School of Medicine will work with Dr. Campbell to administer and implement the program. Bonnie Walters, Executive Director of the Evaluation Center in the School of Education and Human Development, and her colleagues will monitor the impact of NECTAR on medical education in Zimbabwe.

The University of Colorado is widely recognized for the outstanding teachers and clinicians among our faculty, said Campbell. It is very exciting that we will now have this opportunity to share our teaching skills with our Zimbabwean colleagues to help them improve medical education in Zimbabwe. As NECTAR is implemented, interested UC faculty from diverse areas of medicine will have opportunities to participate in activities at the University of Zimbabwe including lecturing, bedside teaching and clinical and research mentorship.

We must dramatically transform African medical education to increase the number of qualified care providers available and develop the scientific expertise needed for research and innovation, said Ambassador Eric Goosby, U.S. Global AIDS Coordinator at the State Department. By engaging country health and education ministries, MEPI will strengthen national plans to improve medical instruction and bolster the overall health care delivery systems. As we transition PEPFAR-supported HIV efforts from an emergency response to a more sustainable effort, we need to develop the expertise necessary for evidence-based decision making on the local level. This expertise will empower countries to lead health programs and fulfill their responsibility for the health of their people.

Eleven programmatic awards, largely funded by PEPFAR, will expand and enhance medical education and research training in the field of HIV. Eight smaller, non-HIV awards, funded by the NIH Director's Common Fund, with additional support from several NIH institutes, will help develop expertise in topics such as maternal and child health, cardiovascular diseases, cancer, mental health, surgery and emergency medicine. Through NECTAR, UC Faculty will support PEPFAR goals to train and retain 140,000 new health care workers and improve the capacity of partner countries to deliver primary health care.

HRSA's decades of experience working in HIV/AIDS through the Ryan White HIV/AIDS Program have highlighted the critical need for enhanced medical education and training to provide quality care to people affected by HIV/AIDS in rural and underserved communities. We are proud to collaborate with PEPFAR and NIH to advance medical education in Africa through this initiative, as well as continue supporting the on-going care and treatment and health system strengthening activities, said Mary K. Wakefield, Ph.D., R.N., HRSA administrator.

High death and disability rates due to fractures in Russia, Central Asia and Eastern Europe

Mon, 27 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Preliminary findings from an upcoming new report by the International Osteoporosis Foundation (IOF) show alarming projections and reveal the poor state of post-fracture care in the Russian Federation and many other countries in the region. The findings were announced today at a press conference in St. Petersburg at the IOF Summit of Eastern European and Central Asian Osteoporosis Patient Societies.

Osteoporosis, a disease of the bone which leaves people at increased risk of fracture, is most common in the older population. Population projections for most countries in the region predict that by 2050 there will be a decrease of the total population, but a significant increase (up to 56%) in the percentage of people aged 50 and over. As a result, in the Russia Federation alone the number of people with osteoporosis is expected to increase by a third by 2050.

Despite the major public health burden of osteoporosis-related fractures, the disease suffers from severe under recognition - mainly due to the lack of solid epidemiological and economic data which would help convince health authorities of the urgency of osteoporosis prevention. There are no formal hip or fragility fracture registries in most countries within the region and data on vertebral fractures, the most common osteoporotic fracture, are completely lacking. IOF President John Kanis stated, It is clear from the key findings that governments need to support wide scale epidemiological studies to collect data on the incidence of osteoporotic fractures.

DXA technology, diagnostic equipment which provides the most accurate method of diagnosis, is usually only accessible in main cities - yet in about one-third of the countries, more than 40% of the population lives in a rural area. In most countries, drug treatment for those at high risk of fracture is not, or is only partially, reimbursed - effectively making treatment unaffordable for the majority of citizens.

Low levels of calcium and vitamin D intake impact negatively on bone health. The average daily calcium intake in nearly all countries outlined in the report falls far below the FAO/WHO recommendations. In addition the majority of populations in the region suffer from severe vitamin D insufficiency. This not only affects fracture rates, but also causes rickets. In recent years the incidence of rickets (pediatric vitamin D deficiency) among Russian infants has ranged from 54% to 66% in some regions.

Although older people who sustain a hip fracture are at increased risk of death and suffer long term disability throughout the world, the report indicates that this problem is far more severe in the Russia Federation and in many other countries of the region. Professor Olga Lesnyak, Vice-President of the Russian Association on Osteoporosis and author of the report, called for action, There is an urgent need for health care providers to improve post hip fracture surgical care, she said. While in Western Europe most hip fracture patients receive operative treatment (the optimal standard of care), in the Russian Federation there is an extremely low rate of surgical treatment. Consequently there is high mortality rate after a hip fracture, reaching up to 45-52% during the first year after fracture in some Russian cities. Of the surviving hip fracture patients, 33% remain bed-ridden and 42% are capable of only very limited activities. Only 9% are able to return to the same level of daily activity as they had before their fracture.

IOF Chief Operating Officer Judy Stenmark stated, Wider and more equitable access to diagnostic tests and appropriate medication are required to stem the growing tide of fractures in the region.

NIH to launch Gulf oil spill health study

Tue, 07 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The National Institutes of Health will launch a multi-year study this fall to look at the potential health effects from the oil spill in the Gulf region. The Gulf Worker Study, announced by NIH Director Francis S. Collins, M.D., Ph.D., in June, is in response to the largest oil spill in U.S. history, caused by the explosion of the Deepwater Horizon offshore drilling oil rig in the Gulf of Mexico. Dr. Collins pledged $10 million in NIH funding for the study's initial phases.

To help expedite the launch of the study, BP will contribute an additional $10 million to NIH for this and other important health research. The BP funding will come through the Gulf of Mexico Research Initiative (GRI). The GRI is a ten-year, $500 million independent research program established by BP to better understand and mitigate the environmental and potential health effects of the Gulf spill. The NIH will have full autonomy regarding the distribution of the $10 million, with input from external scientific experts in environmental health and who are familiar with the Gulf region.

It was clear to us that we need to begin immediately studying the health of the workers most directly involved in responding to this crisis, said Collins. The donation from BP will help speed our work with CDC, EPA, and other federal agencies, academia, as well as state and local partners to carry out this important study. Collins asked the National Institute of Environmental Health Sciences (NIEHS), part of the NIH, to lead the research project.

The study will focus on workers' exposure to oil and dispersant products, and potential health consequences such as respiratory, neurobehavioral, carcinogenic, and immunological conditions. The study is also expected to evaluate mental health concerns and other oil spill-related stressors such as job loss, family disruption, and financial uncertainties.

Clean-up workers are likely to be the most heavily exposed of all population groups in the Gulf Coast region, said Dale Sandler, Ph.D., chief of the Epidemiology Branch at NIEHS and lead researcher on the study. We plan to enroll workers with varying levels of exposure. For example, we hope to recruit workers involved in oil burning, skimming and booming, equipment decontamination, wildlife cleanup, and also those with lower exposure such as shoreline clean-up workers. We'll also recruit some people who completed the worker safety training, but did not have the opportunity to do any clean-up work. They will be our study controls.

Sandler added, What we learn from this study may help us prepare for future incidents that put clean-up workers at risk.

The current focus of NIEHS is to ensure that the Gulf communities most affected by the oil spill have a say in the study's design and implementation, as well as input into future research directions. The NIEHS is hosting webinars and other community engagement activities to obtain input.

Community involvement and participation is critical to the success of this study, said Linda Birnbaum, Ph.D., director of NIEHS and the National Toxicology Program.

NIH and the Department of Health and Human Services have had a continuous presence in the Gulf since the explosion occurred. The NIEHS Worker Education and Training Program (WETP) used its 24 years of experience preparing people for hazardous conditions to contribute to training more than 100,000 workers in the Gulf so they could safely clean up the oil spill. The WETP also distributed thousands of pocket-sized training booklets in English, Spanish, and Vietnamese, so workers have the information they need to protect themselves. The WETP materials are available at

Telltale signs of bioterror

Mon, 16 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) HOUSTON -- (Aug. 16, 2010) -- Researchers at Rice University have won federal support to develop a genomic test that can quickly determine whether a disease outbreak is caused by a natural pathogen or one that was grown in a lab by terrorists.

The three-year grant -- Rice's first from the Defense Threat Reduction Agency -- is designed to provide homeland security and public health officials with the tools they need to quickly determine how to respond to an outbreak.

In a natural outbreak, there are classic rules of epidemiology that describe how particular types of diseases will spread, said principal investigator Yousif Shamoo, associate professor of biochemistry and cell biology and director of Rice's Institute for Biosciences and Bioengineering. In a man-made outbreak, you may be faced with an actor who is continuously spreading the disease, or you might have a person who's engineered strains knowing public health strategy.

The project's goal is to find telltale signs that an organism has become accustomed to living in a biology lab. Shamoo said that's possible because of the way bacteria evolve -- they can progress through hundreds of generations in just a few weeks and rapidly adapt to new conditions giving telltale signs of their domestication in a lab.

Living out in the wild is a pretty rough existence, Shamoo said. By comparison, life in the laboratory is very posh. You live in very nice conditions on agar plates eating this very rich media. And it's the same diet every day. Our expectation is that organisms will lose certain genes that allow them to get nutrition from the soil or the gut or wherever they came from, simply because they won't need them anymore.

Shamoo's lab specializes in studying how the process of evolution plays out at the molecular level. His group also studies how bacteria evolve to become drug resistant. He said the same forces that allow drug-resistant strains of a organism to outcompete their nondrug resistant cousins in a hospital will also allow his team to discern between pathogens whose origins are in nature or the lab.

There's a cost to the organism to maintain its genes, Shamoo said. If genes are no longer necessary, that presents an advantage for new strains that put more energy into dividing and growing, rather than maintaining unnecessary functions. Those strains will outcompete the wild-type, which will disappear from the lab within just a few generations.

For the DTRA project, Shamoo and his students will gather wild strains of two common bacteria -- Enterococcus faecalis and Escherichia coli -- and domesticate each of them in the lab. Genomic snapshots will be taken throughout the process, and they'll be analyzed for telltale patterns.

You don't want to get into the business of trying to catalog the specific changes that take place for thousands of different organisms, Shamoo said. The idea is to look for commonalities. Is there a common set of responses to domestication that you would likely see for any organism that's adapting from living in the wild to living in the laboratory?

While E. faecalis and E. coli are each common, well-studied bacteria, they also come from opposite ends of their species' genetic spectrum. Due to fundamental differences in the chemical and physical properties of their cell walls, for example, they fall into very different classifications: E. faecalis is Gram-positive, and E. coli is Gram-negative.

The upshot is that if genetic patterns associated with domestication can be found in each of these, those same patterns are likely to be found in other bacteria, Shamoo said.

There's nothing to stop us from going further with this, Shamoo said. If we find something after three years, and we want to expand the pool to include soil bacteria, or other types, we can do that and see if the patterns repeat.

UC Davis receives $1 million NIH grant to improve health in No. Calif. Native American communities

Mon, 09 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) (SACRAMENTO, Calif.) -- UC Davis School of Medicine researchers will train Native American communities in Northern California to develop and implement culturally appropriate interventions to improve their health by decreasing obesity and type-2 diabetes, through a $1 million research grant from the National Institute of Diabetes and Kidney Diseases of the National Institutes of Health.

The communities include the Round Valley Indian Tribes of Covelo, Calif., Mendocino County, and communities served by Northern Valley Indian Health, Inc., which include Glenn County and portions of Butte, Tehama and Colusa counties.

This will be a unique situation in which university health researchers will collaborate with community members to teach them how to perform research on their own communities, to ensure that the research is culturally appropriate, acceptable and helpful, said Dennis Styne, study principal investigator and the Yocha Dehe Endowed Chair in Pediatric Endocrinology.

Community members will collect data about their community's health habits to, for example, learn what kinds of healthy foods and exercise resources are most helpful, and select and design the most effective interventions, Styne said.

Over one-third of all American Indian adults nationwide are obese, compared with about 22 percent of non-Hispanic whites. Among the Native American communities participating in the study, nearly 68 percent of adults are obese and 24 percent of children between 2 and 5 years old have body mass indexes in the 95th percentile for their ages.

Obesity is associated with type-2 diabetes, which can result in heart and kidney disease, nerve damage and blindness and lead to premature death. The condition has been described as a disease of disparity, disproportionately affecting low-income and ethnic minority populations. American Indians are 2.6 times as likely to be diagnosed with diabetes as non-Hispanic whites. Nationwide, the number of Native Americans diagnosed with diabetes doubled between 1991 and 2001. In the Round Valley and Northern Valley Native American communities, 11 percent are affected by type-2 diabetes.

The Native American community is disproportionately affected by diabetes and heart disease, hypertension, lipid problems and other diseases of disparity, Styne said. They are aware of the importance of the conditions and are committed to working to turn the tide.

Styne said that the two-year research initiative will train community members as research associates in the use of community-based and community-governed participatory research techniques, to ensure engagement in improving their health. The UC Davis researchers will work collaboratively with two established community-health centers that serve the Native American communities, the Round Valley Indian Health Center and Northern Valley Indian Health, Inc., with the full support of their boards of directors.

Partners at Round Valley will include Edward Whipple, outreach prevention coordinator at Round Valley Unified School District, fitness and health instructor at Mendocino Community College and an enrolled member of the Round Valley tribe; and Diann Simmons, a consultant with the Round Valley Sustainability Program. At Northern Valley Indian Health, UC Davis will partner with Vicki Shively, a nurse and member of the Choctaw Nation who has served for seven years as the center's community health director.

The study's co-investigators will be: Valarie Blue Bird Jernigan, training director of community-based participatory research for the project and a member of the Choctow Nation who is a senior research fellow at the University of Washington and a visiting assistant researcher at UC Davis; Diana Cassady, associate professor of public health sciences, who will collaborate on evaluation of the FitKid and FitTeen programs in Round Valley schools; and Karen Jetter, assistant research economist at the Agricultural Issues Center at UC Davis, who will direct training in socioeconomic survey methods.

USC wins $56.8M NIH award for clinical and translational research

Thu, 15 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The University of Southern California (USC) has received a prestigious $56.8 million Clinical and Translational Science Award from the National Institutes of Health (NIH) to support and promote scientific discoveries and their application in real-life settings to health and health care. The CTSA will have an important focus on health issues of people living in densely populated urban environments.

The award, which will be distributed over the next five years, was given to the USC-based Los Angeles Basin Clinical and Translational Science Institute (CTSI). CTSI was established in 2006 to connect basic scientists to clinical and community researchers and practitioners with a goal of accelerating the translation of laboratory discoveries into practice. Principal investigator is Thomas A. Buchanan, M.D., director of the Los Angeles Basin CTSI, and associate dean for clinical research at the Keck School of Medicine of USC.

We congratulate principal investigator Dr. Tom Buchanan and the highly interdisciplinary USC team for winning this award, said Carmen A. Puliafito, M.D., M.B.A., dean of the Keck School of Medicine. An extraordinarily strong grant application resulted in USC receiving the first Clinical and Translational Science Award in Los Angeles. The application received a score of 12 on a scale of 10 to 90 (10 is a perfect score).

Faculty from eight USC schools and Childrens Hospital Los Angeles will partner with Kaiser Permanente Southern California, the Los Angeles County departments of Health Services and Mental Health, the Community Clinic Association of Los Angeles County, and more than 30 community health organizations in greater Los Angeles to address the specific needs of the urban and diverse patient populations found in USC's backyard of downtown Los Angeles.

We positioned our CTSI as not only an institute focused on health research, but also as a partnership among some of the largest providers of health care in Los Angeles. We are working collaboratively with others on campus and off campus, using L.A. as a real world laboratory to address issues that are important to the community here, Buchanan said.

With this award, USC joins a consortium of 55 health research centers in 28 states and the District of Columbia that are developing new ways to advance medical research in many disease areas and conditions, including cancer, mental illness, neurological disorders, cardiovascular disease, diabetes and obesity.

The selected research institutions work together as a national consortium to improve the way biomedical research is conducted across the country. The consortium, funded through the Clinical and Translational Science Awards (CTSA), shares a common vision to reduce the time it takes for laboratory discoveries to become treatments for patients, and to engage communities in clinical research efforts. It also is fulfilling the critical need to train a new generation of clinical researchers. The CTSA program is led by the National Center for Research Resources, part of National Institutes of Health.

USC competed for the award against 38 other institutions, including three major academic institutions in Southern California. Nine institutions received grant awards this year, and the NIH has stated that it plans to implement a maximum of 60 Clinical and Translational Science Awards overall.

While USC's Los Angeles Basin CTSI has already been successful at launching community research and interdisciplinary projects on a small scale, large-scale funding from the new NIH award will open the doors to development of a premier clinical and translational institute with the potential for a very large impact on health research and health care.

The Los Angeles Basin CTSI has four main goals for the CTSA. The first is to create an integrated academic environment that promotes and supports clinical and translational research. The second is to develop new interdisciplinary teams and projects to address top research priorities and health issues of people living in urban environments. The third is to train a new generation of investigators for clinical and translational science. The fourth goal is to share research findings locally, through the CTSI partnership, and nationally, through the consortium of institutions with CTSAs, to foster better health.

The CTSI has secured participation of eight schools at USC, including Medicine, Cinematic Arts, Dentistry, Education, Engineering, Law, Pharmacy and Social Work.

Some interdisciplinary projects are currently under way. For example, leveraging talent from health sciences, engineering, cinema and informatics, faculty members recently developed an interactive computer game that helps autistic children better interact on an emotional level, one of the deficits of those with the disorder.

Obesity remains an economic issue, Seattle obesity study finds

Mon, 24 May 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Ensuring access to healthy, affordable foods is a top priority in tackling the obesity epidemic in the United States. Over the course of the last six months, the Institute of Medicine, United States Department of Agriculture, The White House and First Lady Michelle Obama have taken an interest in improving access to affordable and nutritious foods.

Here in Seattle, Adam Drewnowski, UW professor of epidemiology, and his team are tackling the same issue. Remember the fat zip codes that predicted obesity rates from a few years ago? Drewnowski and his team were the brains behind that, as well as last summer's study which showed that grocery prices in Seattle varied greatly between one supermarket chain and another.

Now, researchers at the UW Center for Public Health Nutrition, UW Urban Form Lab and the Nutritional Sciences Program in the School of Public Health are asking: Who buys what foods, why, where, and for how much?

The answers might surprise you. Most studies have used distance to the nearest supermarket as the best predictor of whether people have good diets and better health. But Drewnowski and team say that's not true. Six out of seven people shopped for food outside their immediate neighborhood, he said The closest supermarket for most people was less than a mile away, but people chose the market that was more than three miles away. Driving further to save money on groceries is common. For that reason, physical proximity to a supermarket may not, by itself, assure a healthy diet. Money does matter, Drewnowski said.

Areas where access to healthy affordable foods is scarce have become known as food deserts. Seattle, however, is well-supplied with supermarkets, grocery stores, farmers markets and other vendors, said Drewnowski. We do not see evidence of significant food deserts, he said. In comparison with other areas in the state, public transportation is also prevalent and accessible, so people can take a bus to a supermarket or grocery store with relative ease.

Researchers combined a telephone survey, modeled on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factors Surveillance System, with new geo-coding techniques and methods of spatial analysis for the new study.

Economic access has also become a primary research focus in public health nutrition, including the work by Drewnowski and team. Supermarket chains have specific demographics--consumers differ by age, education, income, health, and even obesity rates. The county-wide obesity rate in 2007 was 19.8 percent, but our research found that the obesity rate was only four percent among Whole Foods and PCC shoppers, said Drewnowski. Consumers who shop at most area supermarket chains have obesity rates at 25 percent and higher. Clearly, not all supermarkets are the same and economic access is determined by price.

UW researchers recently discussed the Seattle Obesity Study results at Shopping for Health conference, which brought together public health agencies, academicians, supermarket representatives and policymakers from Seattle, King County and Washington state. Additional findings include:

Health impacts of mobile phone use to be explored in huge new study

Thu, 22 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A new decades-long study launches today to investigate whether there is a link between the use of mobile phones and long-term health problems such as cancer.

The cohort study on mobile communications (COSMOS) forms part of the Mobile Telecommunications and Health Research (MTHR) Programme. The international study will run for 20-30 years and will follow the health of at least 250,000 participants aged 18-69 in five European countries. The UK arm of COSMOS is being led by a research team from Imperial College London.

There are currently over six billion mobile phone devices in use worldwide, with over 70 million in use in the UK, which has a population of 61 million people.

Studies of short term use of mobile phones and health have been reassuring, other than well known associations with risk of motor accidents. However, there are still some uncertainties about the health effects of mobile phone use, since some diseases take many years to develop and so far few people have been using mobile phones for that period of time.

Dr Mireille Toledano, co-Principal Investigator of the study from the School of Public Health at Imperial College London, said: For the benefit of current users and for future generations, it is important for us to carry out long term health monitoring of a large group of mobile phone users so that we can identify if there are any possible health effects from this new and widespread technology that has become so central to our everyday lives.

Professor Paul Elliott, Principal Investigator of the study from the School of Public Health at Imperial College London, said: Scientists have been looking at the effects of mobile phones on health for several years and so far, reviews of the research have been reassuring with respect to mobile phone use and health problems in the short term. However, as mobile phones have only been in widespread use for a relatively short time, we haven't been able to carry out long-term studies until now.

COSMOS aims to fill in important gaps in our knowledge of mobile phones and health. By looking at large numbers of people across Europe over a long period of time, we should be able to build up a valuable picture of whether or not there is any link between mobile phone use and health problems over the long term, added Professor Elliott.

Through four major mobile phone operators, the COSMOS project team from Imperial College London is inviting 2.4 million mobile phone users in the UK to take part in the study.

We can only do this study and find out whether mobile phones are affecting our health in the long term with the help of the public willing to take part. Through contributing a small amount of time to this study, participants will make a big difference to our understanding of mobile phones and health. Anyone who wants to find out more and get in touch with us can visit our website at www.ukcosmos.org, said Dr Toledano.

Participants who agree to take part in the study will complete an on-line questionnaire about their mobile phone use, health and lifestyle. The researchers will monitor participants' mobile phone use and any health problems they might develop, e.g., cancers and neurological diseases such as Alzheimer's disease, for at least the next 20 years. They will also analyse whether any changes in the frequency of symptoms, such as headaches and sleep disorders, are related to mobile phone usage.

Over the past decade, mobile phones have become a normal part of everyday life for the majority of people in Britain. The COSMOS study is the largest research study worldwide investigating mobile phone use and health and is a very important step towards finding out whether there are health implications of using a mobile phone over a long period of time, said Dr Toledano.

Professor Lawrie Challis from the MTHR Programme Management Committee said We still cannot rule out the possibility that mobile phone use causes cancer. The balance of present evidence does not suggest it does but we need to be sure. The best way of doing this is through a large cohort study such as COSMOS and I am very pleased that the UK is to play an important part in this international endeavour

The study follows on from successful pilot studies carried out between 2004-2008 during the first phase of the MTHR Programme.

Visualization of geographic patterns may predict spread of disease

Thu, 15 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Washington, D.C. -- Disease statistics buried within patient records or detailed in newspaper clippings can be sorted and organized to depict geographic patterns, allowing the discovery of trends that were previously overlooked, according to a Penn State geographer.

The use of interactive maps and graphs, combined with word search interfaces, can lead to greater insight into complex events like the spread of Swine flu, said Frank Hardisty, research associate, Penn State GeoVISTA Center.

The GeoViz Toolkit is a user-friendly application that combines text mining with geographical mapping. It allows users to search publically available data to identify and visualize data patterns for their own interests or concerns.

The flexible software package allows someone with no programming experience to navigate the application, while also providing different components and analytical tools for experienced analysts.

Potential applications range from research in public health -- infectious disease dynamics, cancer etiology, surveillance and control -- through analysis of socioeconomic and demographic data, to exploration of patterns of incidents related to terrorism or crime, said Hardisty.

Many sources for disease and crime statistics -- newspaper articles for example -- are in a semi-structured format that do not clearly present the data in a table or graph, but rather bury it within the text of the document.

To obtain high-quality, relevant information from these documents, researchers use text analytics or 'text mining, allowing them to retrieve only applicable information, like the date and description of a disease-related death, from the flood of information usually included in a newspaper clipping.

An example would be searching a database of H1N1 flu reports for 'child' or 'children' and seeing if there is spatial clustering in the relative frequency of those reports, Hardisty told attendees today (April 15) at the 2010 Association of American Geographers Annual Meeting in Washington, D.C.

H1N1 data, provided by RhizaLabs, was used in a GeoViz query. Reports containing child or similar terms were mapped, with areas containing a high frequency of children cases highlighted. In general, areas with low population density exhibited a higher proportion of cases containing the search term.

The hypothesis that this evokes is that rural states have proportionally more transmissions via children, while more densely populated places are more likely to experience other vectors of transmission, said Hardisty.

The GeoViz application allows users to easily manipulate the software to change time and location, as well as how the data is viewed. The user can thus visualize the pattern of how the disease spreads and determine how quickly it progresses from one area to the next.

Visual geographic analysis can identify locations that are more or less susceptible to certain disease, crime, or weather patterns and researchers might link these occurrences with a cause or trigger. Using the GeoViz Toolkit could contribute to how people respond to or prevent these incidents.

First, GeoViz methods can help first responders gain better situational awareness. Second, a better retroactive understanding of clustered patterns like disease incidence and public security incidents will lead to the development of effective control measures, concluded Hardisty.

Survival in metastatic breast cancer patients is improving: targeted therapies have contributed

Fri, 26 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: Trends indicate that survival is improving in patients with metastatic breast cancer, especially in those patients whose tumours are described as being HER2 (human epidermal growth factor receptor-2) positive, a surgical oncologist will say today (Friday 26 March) at the seventh European Breast Cancer Conference (EBCC7).

Dr Marie Sundquist, from the Department of Surgery, County Hospital, Kalmar, Sweden, will say that the median survival times for five-year intervals of 557 metastatic breast cancer patients in Kalmar, Sweden, increased steadily, from 10 months for the 1985 to 1990 period, to 22 months for the 2000 to 2004 period.

She will be reporting the findings of a retrospective analysis of follow-up data of breast cancer patients who were diagnosed in hospitals in Kalmar County since 1985. A strength of our work is that we have studied a consecutive population in a defined geographical area for a continuous period of 25 years, Dr Sundquist will tell the conference.

Dr Sundquist will tell delegates that for 288 patients with grade III tumours, the most aggressive type of breast cancer, the median survival time increased from 10 months for the 1985 to1990 period to 17 months for the 2000 to 2004 period. The increased use of the chemotherapy drugs called anthracyclines and taxanes led to the improved survival outcomes in this group of patients with the aggressive form of metastatic breast cancer, she said.

Some breast cancer cells have receptors, which allow certain types of hormones or proteins to attach to the cancer cell. Breast cancer hormone-receptor status can affect the individual patient's treatment options as well as overall prognosis. Analysis of the data by HER2 positive status revealed that HER2 positive patients with metastatic breast cancer had improved survival rates. Prior to the year 2000, 40 HER2 positive patients had a median survival of 14 months compared to 21 months for 40 HER2 positive patients diagnosed with breast cancer from the year 2000 onwards.

Dr Sundquist said: There is no doubt that trastuzumab (Herceptin), which targets the HER2 gene, is the most important reason for the improved survival in this group of patients, and use of the chemotherapy drugs known as anthracyclines also contributed.

In the group of HER2 positive patients that had the most aggressive type of breast cancer (grade III), 45% of those patients that received trastuzumab had survived more than three years and 30% more than five years, Dr Sundquist added.

Patients whose breast tumours have spread outside of the breast and armpit areas are essentially incurable. However, some patients live even decades with a good quality of life despite an initially widespread tumour burden, while others fail to respond to any therapy. To explore and try to understand these mechanisms would make it easier to tailor the treatment for each individual patient, Dr Sundquist will say.

A new era of breast cancer treatment started with the gene-targeted therapy of trastuzumab. Since then, a number of similar targeted therapies including antibodies or inhibitors of specific genes have been developed. This will open new avenues in the treatment of all metastatic breast cancers and also of primary breast cancer.

These new targeted therapies will, at least in the beginning after their development, be very costly for healthcare systems. On the other hand they will make it possible for many women to lead almost normal lives, work and contribute to society for an increased number of years, she concluded.

The researchers intend to follow up their work by performing genetic analyses of the tumours with different responsiveness to specific treatments. Health care systems will need to provide tools for the routine clinical assessment of a number of genes related to treatment response, she added.

'Rare' cancers in the spotlight at major European conference

Wed, 24 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) More should be done across Europe to ensure that people with rare forms of cancer are not denied access to the best possible treatment, say the organizers of a major European cancer conference to be held in Milan on 9 and 10 March 2010.

People with rare diseases have the same right to receive proper treatment as all other patients, said Dr. Paolo G. Casali, Head of the Sarcoma Medical Treatment Unit at the Milan Istituto Nazionale Tumori and co-chair of the ESMO Conference on Sarcoma and GIST. Yet the sad reality is that access to treatments for rare cancers varies across Europe. And patients with these tumors do not always receive the best possible care.

Focusing on these forms of cancer can have wider benefits, Dr. Casali added. Many rare cancers are exceptionally rich of targets for the new molecularly targeted therapies. Sarcomas are an obvious case: they are relatively rare, they can be split into 50-plus subgroups, they have plenty of targets, they are serving as an advanced model for medical oncologists. This Conference highlights all this.

The ESMO Conference on Sarcoma and GIST is part of the European Society for Medical Oncology's strong commitment to cover the newest therapies and address issues related to rare cancers. The conference will present the latest developments in the diagnosis and treatment of a group of rare cancers that affect the body's connective tissues.

Known as soft tissue sarcomas, these tumors can be found in muscle, blood vessels, deep skin tissues, nerves and the tissues around joints. GIST, or gastrointestinal stromal tumour, is a type of sarcoma that originates from the wall of the gastrointestinal tract. Around 50 different kinds of soft-tissue sarcomas have been identified. Altogether, connective tissue cancers affect about 25,000 people in Europe each year.

Therapies in sarcomas present many real challenges, said Dr.Paolo Dei Tos Director of the Pathology Unit of the Regional Hospital of Treviso, Italy co-chair of the meeting. We know that the best treatment results come when we can combine information from biology, pathology and the clinic. The goal of this conference is to improve treatment across Europe by providing a comprehensive overview of the current medical therapy of these diseases.

Around 200 specialists in sarcoma and GIST are expected to attend this niche conference, which is organized by the European Society for Medical Oncology (ESMO) in cooperation with the Milan Istituto Nazionale Tumori, and with the support of Conticanet, a EU-funded project for clinical research on connective tissue cancers in Europe.

If we are going to make progress against these diseases in Europe then we need to make a concerted effort to understand them better, said Conticanet's coordinator, Dr. Jean-Yves Blay, who is one co-chair of the conference.

The conference will have a particular focus on the molecular and pathological bases of soft tissue sarcomas and GIST, aiming to give a perspective on the state of the art in medical treatment and what new approaches are coming. Some of the most respected and pioneering experts dealing with these rare cancers will be among the speakers.

Sarcomas being rare cancers make this meeting a significant expression of ESMO's efforts on rare diseases, said Dr. Casali. When all the 'rare' tumors are considered as a group, they represent one-fourth of all cancer cases.

Computer models suggest vaccination or culling best to prevent foot-and-mouth disease

Tue, 19 Jan 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Combining technology and animal health, a group of Kansas State University researchers is developing a more effective way to predict the spread of foot-and-mouth disease and the impact of preventative measures.

The researchers are finding that if a foot-and-mouth disease outbreak is not in the epidemic stage, preemptive vaccination is a minimally expensive way to halt the disease's spread across a network of animals. But if there's a high probability of infection, computer models show that culling strategies are better.

We are trying to do predictive as well as preventative modeling using a network-based approach, said Sohini Roy Chowdhury, a master's student in electrical engineering. First we track how the infection is spreading in space and time. Then we try to mitigate that with certain strategies. The novel contribution of this project is that we considered networks in countries like Turkey, Iran and Thailand that don't have a highly built database.

Roy Chowdhury is working with Caterina Scoglio, associate professor of electrical and computer engineering, and William Hsu, associate professor of computing and information sciences. They presented the work in December 2009 at the Second International Conference on Infectious Diseases Dynamics in Athens, Greece.

The researchers used mathematical equations to predict how foot-and-mouth disease spreads over a network of infected herds. In the network, the nodes are places like stockyards and grazing lands where animals are held. They are connected in various ways, such as by animals' grazing movements and by how people and vehicles move among the herds. Hsu said the researchers' goal is to increase the accuracy of models that predict disease spread in these networks over space and time.

In the experiments, the researchers ran up to a week of predictive modeling on a real network and saw how well it matched data from the actual episode. Roy Chowdhury said they also used artificial intelligence-based modules to cross compare the model's accuracy.

The researchers also tested such mitigation strategies as vaccination, culling and isolation to see how they affected the network. In real-world outbreaks of foot-and-mouth disease, culling often is presumed to be the best strategy, but Scoglio said their research could shed more light on the effectiveness of this practice.

It is the hope to properly contain a disease like foot-and-mouth disease that is so infectious while minimizing the economic losses, Scoglio said.

Hsu said this study also could benefit relief workers sent to help contain foot-and-mouth disease. The K-State network models improve upon existing ones, he said, because they consider such factors as wind, animal grazing and human movements between regions, as well as the number of meat markets in an area.

Scoglio's research group has studied disease outbreaks using computer models of networks before, but this project is different in that it considers a specific disease, she said.

Hsu contributed his research in data mining, which seeks to scour news stories and other online public sources and extract information that could offer clues about disease outbreaks. For this project, Hsu's system crawled and analyzed Web articles from news agencies like the BBC and CNN, as well as such sources as disease control fact sheets from universities.

Just as Google indexes sites based on authoritativeness and looks for hub sites, we also look to start our crawls of the Web from sites like the World Health Organization and the Centers for Disease Control and Prevention, Hsu said.

At the conference in Athens, Roy Chowdhury also presented a poster on preliminary work the group has done on H1N1 infections. Using temporal models, they generated predictions on when infections would peak and the rate at which they would drop off after that peak. Roy Chowdhury used data from the Centers for Disease Control and Prevention. The group plans to extend this analysis of the H1N1 epidemic using network-based models.

Math goes viral

Fri, 11 Dec 2009 05:00:00 PST

( from http://www.rxpgnews.com ) At least a dozen Alberta high-school calculus classrooms were exposed to the West Nile virus recently.

Luckily, however, it wasn't literally the illness. University of Alberta education professor Stephen Norris and mathematics professor Gerda de Vries used the virus as a theoretical tool when they designed materials for use in an advanced high-school math course. The materials allow students to use mathematical concepts learned in their curriculum to determine the disease's reproductive number, which determines the likelihood of a disease spreading.

The approach is a marriage of science and math, subjects the researchers say seem to exist in separate worlds at a secondary-school level, but that when brought together can effectively bring real-world scenarios into the classroom to enhance learning and understanding.

Not to mention answering that ages old high-school student question: why do I need to know this?

This piece was designed to satisfy an optional unit in Math 31 (Calculus), for which there are no materials, so we said, 'let's fill the gap,' said Norris. These materials show a real application of mathematics in the biology curriculum for high-school students.

Norris and de Vries chose a published academic math paper on the transmission of the West Nile virus and modified it -keeping the science intact, but making it readable and practical for high-school calculus students.

The information and equations in the original paper dealing with disease transmission were then used as the basis for calculus math problems to be solved by the students. Students were presented with a variety of materials that covered topics and concepts such as rate of change, exponential growth-decay models, and models for the carriers of the virus, including mosquitoes and infectious and susceptible birds. The students' mathematical skills were then put to use in determining the spread of the disease using various parameters, which included variables such as biting rate and the probability of infection.

Norris underlines that the project challenged the students to see and understand science in a different fashion from what they learn inside the science curricula. He points out that high-school classroom scientific experiments are proven science and have been around for at least 300 years, in many cases. For the students to discover that real scientists often work with some assumptions that they know to be false in order to reach their conclusions was certainly an eye-opening realization for them, he says.

There's no way out of the fact that the knowledge you gain from science is imperfect; it's tentative and subject to change, said Norris. I think that's what struck the students between the eyes.

Both researchers agree that this form of collaborative, interdisciplinary learning can take place across all subject areas. De Vries and Norris are currently working on another project that focuses on population genetics that will fit into Grade 12 biology and math courses.

It's mathematics in the real world. Kids are always asking, 'why am I learning this,' she said. All of a sudden the mathematics that kids have learned comes together in a project like this.

Common pain relief medication may encourage cancer growth

Wed, 18 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Although morphine has been the gold-standard treatment for postoperative and chronic cancer pain for two centuries, a growing body of evidence is showing that opiate-based painkillers can stimulate the growth and spread of cancer cells. Two new studies advance that argument and demonstrate how shielding lung cancer cells from opiates reduces cell proliferation, invasion and migration in both cell-culture and mouse models.

The reports--to be presented November 18, 2009, at Molecular Targets and Cancer Therapeutics, a joint meeting in Boston of the American Association for Cancer Research, the National Cancer Institute, and the European Organization for Research and Treatment of Cancer--highlight the mu opiate receptor, where morphine works, as a potential therapeutic target.

If confirmed clinically, this could change how we do surgical anesthesia for our cancer patients, said Patrick A. Singleton, PhD, assistant professor of medicine at the University of Chicago Medical Center and principal author of both studies. It also suggests potential new applications for this novel class of drugs which should be explored.

The proposition that opiates influence cancer recurrence, prompted by several unrelated clinical and laboratory studies, has gradually gained support. It started with a 2002 palliative-care trial in which patients who received spinal rather than systemic pain relief survived longer. Soon after that, Singleton's colleague, anesthesiologist Jonathan Moss, noticed that several cancer patients receiving a selective opiate blocker in a compassionate-use protocol lived longer than expected. Two recent retrospective studies found that breast and prostate cancer patients who received regional rather than general anesthesia had fewer recurrences. In February, 2009, the Anesthesia Patient Safety Foundation highlighted the issue.

Moss's palliative-care patients were taking methylnaltrexone (MNTX), developed in the 1980s for opiate-induced constipation by the late University of Chicago pharmacologist Leon Goldberg. Goldberg modified an established drug that blocks morphine so that it could no longer cross the protective barrier that surrounds the brain. So MNTX blocks morphine's peripheral side effects but does not interfere with its effect on pain, which is centered in the brain. It won FDA approval in 2008.

These were patients with advanced cancer and a life expectancy of one to two months, Moss recalled, yet several lived for another five or six. It made us wonder whether this was just a consequence of better GI function or could there possibly be an effect on the tumors.

So Singleton, Moss and colleagues, including Joe G.N. Garcia, MD, professor of medicine at the University of Chicago, began a series of studies looking at the many peripheral effects of opiates and the potential benefits of blocking those effects.

In laboratory studies, morphine can directly boost tumor-cell proliferation and inhibit the immune response. The researchers found that opiates also promote angiogenesis, the growth of new blood vessels, and decrease barrier function--effects that may exacerbate diseases involving vascular leakiness including acute lung injury in experimental models. In a surgical setting, decreased barrier function may make it easier for tumors to invade tissue and spread to distant sites. Increased angiogenesis helps cancers thrive in a new site.

In the studies to be presented Nov. 18, Singleton and colleagues focus on the mu opiate receptor as a regulator of tumor growth and metastasis and examine the ability of methylnaltrexone to attenuate these effects.

Using two different models of non-small cell lung cancer, the research teams showed that MNTX inhibited the tumor-promoting effects of opiates. In one study, using bronchioloalveolar carcinoma cells, MNTX blocked oncogenic signaling and prevented tumor-cell proliferation and migration.

In the other study, using Lewis lung carcinoma cells, mice without the mu opiate receptor did not develop the tumors that normal mice did when injected with cancer cells. The researchers further showed that MNTX reduced proliferation of cancer cells by 90 percent in normal mice. It also prevented invasion in cell culture and tumor growth and metastasis in mice.

The opioid receptor promotes Lewis lung cancer tumor growth, angiogenesis and metastasis, the authors conclude in a summary of the second study. Methylnaltrexone attenuates these oncogenic effects.

In conjunction with previous studies on opiate-induced angiogenesis by our laboratory and others, these experimental data suggest a plausible explanation for the epidemiologic observations, notes Moss, professor of anesthesiology and critical care at the University of Chicago. If these laboratory studies are confirmed clinically, the selection of anesthetic technique used during the operative procedure and the possible use of opiate antagonists in the perioperative period may be important.

UC Davis leads attack on deadly new diseases

Fri, 23 Oct 2009 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 PST

New supplement may help slow sight loss in elderly

Fri, 19 Jun 2009 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 05:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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 04:00:00 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.