RxPG News : Medicine

New genetic variants for COPD discovered in a groundbreaking study by SpiroMeta Consortium

Tue, 15 Dec 2009 04:59:12 PST

( from http://www.rxpgnews.com ) Scientists have discovered five genetic variants that are associated with the health of the human lung. The research by an international consortium of 96 scientists from 63 centres in Europe and Australia sheds new light on the molecular basis of lung diseases.

The research, part-funded by the Medical Research Council (MRC) and Asthma UK, is published today in Nature Genetics. It represents a significant advance because it is the first time that these five common genetic variations have been definitely linked with lung function.

The new findings provide hope for better treatment for lung diseases like Chronic Obstructive Pulmonary Disease (COPD) and asthma. In the past it has been difficult to develop new treatments because the molecular pathways that affect the health of the lung are not completely understood. It's hoped the new pathways discovered could in the future be targeted by drugs.

The ground-breaking research involved a genetic study of 2.5 million sites across the human genome involving samples from 20,000 people across the world. The consortium was led by Dr Martin Tobin from the University of Leicester and Professor Ian Hall from The University of Nottingham.

Lung function is commonly expressed using two measures recorded using a simple device called a spirometer. These measures are termed the FEV1 (or forced expiratory volume in 1 second) which is the volume of air that can be breathed out in 1 second, and the FVC (forced vital capacity) which is the total volume of air that can be breathed out. In chronic obstructive pulmonary disease (COPD), which encompasses chronic bronchitis and emphysema, narrowing of the airways causes a disproportionate reduction in FEV1. Cough, phlegm and shortness of breath are common symptoms of COPD. The simplest way to diagnose COPD is through spirometry, which is usually available in general practitioners' surgeries. Although there is no cure for COPD, stopping smoking and treatments can improve symptoms and reduce the impact of COPD on exercise and daily activities. Drug treatments include bronchodilators and, for exacerbations, may include short-term steroids. Patients with COPD are more susceptible to serious lung infections, so flu vaccination each winter is important.

The genetic determinants of COPD can be studied by investigating the genetic variants that affect the risk of developing COPD itself or by studying lung function itself, on which the diagnosis of COPD is based. Reduced lung function may also occur in patients with other airway diseases such as asthma.

Further research will be needed to study in detail the molecular alterations in the lung that result from the genetic variants identified, and to investigate whether these might be targeted by drugs. At this time there is no case for testing for common genetic variants that might predispose to COPD.

The scientists said: "This work is important because until now we have known very little about the genetic factors that determine an individual's lung function. By identifying the genes important in determining lung function, we can start to unravel the underlying mechanisms which control both lung development and lung damage. This will lead to a better understanding of diseases such as chronic obstructive pulmonary disease (COPD) and asthma. Crucially, it could open up new opportunities to manage and treat patients with lung conditions".

The authors added: "A large reduction in lung function occurs in chronic obstructive pulmonary disease (COPD), which affects around 1 in 10 adults above the age of 40 and is thought to be the fourth most common cause of death worldwide. Smoking is the major risk factor for development of COPD. Lung function and COPD cluster within families, indicating that variations in genes also predispose individuals to reduced lung function.

"The scientists of the SpiroMeta consortium compared genetic variants at each of 2.5 million sites across the human genome in over 20,000 individuals of European ancestry with their lung function measures. In five different locations in the human genome, genetic variants resulted in alterations in lung function. The scientists showed that these were real findings by checking the effects of the same variants in over 33,000 additional individuals. They also compared their results to those of a second consortium, CHARGE, which has published a paper in the same issue of the journal.

The scientists emphasise that they do not expect these findings to lead to immediately to genetic tests to predict who will develop lung disease. What is more important, they say, is that the findings will help understand the underlying causes of lung diseases and thus may indicate new ways of treating the condition.

"The research would not have been possible without the generous support of the participants of the contributing studies from the UK, Europe and Australia, to whom we offer our thanks."

Horse barn workers at high risk of respiratory symptoms

Sun, 22 Nov 2009 09:28:36 PST

( from http://www.rxpgnews.com ) The estimated 4.6 million Americans involved in the equine industry may be at risk of developing respiratory symptoms due to poor air quality in horse barns, according to a questionnaire study undertaken earlier this year by investigators at Tufts University’s Cummings School of Veterinary Medicine.

The study—which polled more than 80 New England horse barn workers—found that 50 percent of individuals working in barns complained of coughing, wheezing, or other ailments in the last year, compared to just 15 percent in the control group of 74 people. Moreover, increased exposure to barns yielded higher rates of self-reported respiratory symptoms, the study reports. The study was published in the journal Occupational Medicine and funded by the National Institutes of Health.

“It has long been known that lower respiratory illness is common in horses, and this is typically attributed to the amount of dust in barns,” said Melissa R. Mazan, DVM, associate professor of clinical sciences at the Cummings School and the study’s lead author. “Our hope was to see whether this poor air quality affects horse owners, and it appears that it might.”

For the study, Mazan and her colleagues at the Cummings School—including Jessica Svatek, Louise Maranda, and Andrew M. Hoffman—collaborated with researchers from the Harvard School of Public Health, the University of Connecticut, and the National Health and Environmental Effects Research Laboratory at the Environmental Protection Agency’s Research Triangle Park.

Although further study is necessary to determine the causes of respiratory distress, Dr. Mazan says, the results are striking—and may be similar among pig, dairy and chicken farmers, who work in environments similarly high in organic dust. A 2001 study of European animal farmers found similar results.

Investigation of exposure to the dust, lung function and horse dander allergies in the barn-exposed group will be necessary to determine how best to protect the health of this group, Dr. Mazan says.

Pulmonology research is one of four NIH-funded basic science divisions at the Cummings School, which also conducts research on infectious diseases, liver and hepatic illness, and reproduction and neurobiology, in addition to robust clinical, international, and sustainability research.

Depression as deadly as smoking

Tue, 17 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) A study by researchers at the University of Bergen, Norway, and the Institute of Psychiatry (IoP) at King's College London has found that depression is as much of a risk factor for mortality as smoking.

Utilising a unique link between a survey of over 60,000 people and a comprehensive mortality database, the researchers found that over the four years following the survey, the mortality risk was increased to a similar extent in people who were depressed as in people who were smokers.

Dr Robert Stewart, who led the research team at the IoP, explains the possible reasons that may underlie these surprising findings: 'Unlike smoking, we don't know how causal the association with depression is but it does suggest that more attention should be paid to this link because the association persisted after adjusting for many other factors.'

The study also shows that patients with depression face an overall increased risk of mortality, while a combination of depression and anxiety in patients lowers mortality compared with depression alone. Dr Stewart explains: 'One of the main messages from this research is that 'a little anxiety may be good for you'.

'It appears that we're talking about two risk groups here. People with very high levels of anxiety symptoms may be naturally more vulnerable due to stress, for example through the effects stress has on cardiovascular outcomes. On the other hand, people who score very low on anxiety measures, i.e. those who deny any symptoms at all, may be people who also tend not to seek help for physical conditions, or they may be people who tend to take risks. This would explain the higher mortality.'

In terms of the relationship between mortality and anxiety with depression as a risk factor, the research suggests that help-seeking behaviour may explain the pattern of outcomes. People with depression may not seek help or may fail to receive help when they do seek it, whereas the opposite may be true for people with anxiety.

Dr Stewart comments: 'It would certainly not surprise me at all to find that doctors are less likely to investigate physical symptoms in people with depression because they think that depression is the explanation, but may be more likely to investigate if someone is anxious because they think it will reassure them. These are conjectures but they would fit with the data.'

The researchers point out that the results should be considered in conjunction with other evidence suggesting a variety of adverse physical health outcomes and poor health associated with mental disorders such as depression and psychotic disorders.

In light of the findings, Dr Stewart makes suggestions on the focus of future developments in the treatment of depression and anxiety: 'The physical health of people with current or previous mental disorder needs a lot more attention than it gets at the moment.

'This applies to primary care, secondary mental health care and general hospital care in the sense that there should be more active screening for physical disorders and risk factors, such as blood pressure, cholesterol, adverse diet, smoking, lack of exercise, in people with mental disorders. This should be done in addition to more active treatment of disorders when present, and more effective general health promotion.'

Researchers focus on helping dying patients take care of unfinished business

Tue, 17 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) CLEVELAND--Hospice workers have watched patients emerge from comas and cling to life long enough to tell someone they love or forgive them.

This phenomenon of taking care of unfinished business has been observed, but researchers from the Frances Payne Bolton School of Nursing and the College of Arts and Sciences at Case Western Reserve University will begin groundbreaking studies to understand what drives the dying to live long enough to resolve these issues.

With the research data, they will design interventions to help patients in hospice care and families before and after the person passes.

Before now, end of life research primarily focused on making the patient comfortable by easing suffering or discomfort from the illness.

But, the approach of Barbara Daly and Mary Jo Prince-Paul from the School of Nursing and Julie Exline from Arts and Sciences is to relieve psychological distress by marshaling the patient's inner strengths and social connections.

These qualities include the resilient feelings of hope, optimism and connectedness that they mustered to make it through difficult and even life-threatening situations before their terminal illnesses. Marshaling these inner resources has been shown to improve the psychological outlook of healthy people, and the researchers want to find out the benefits for those severely ill.

In the past, researchers have shied away from approaching dying patients with questions, but among the goals of these projects is to give hospice patients options to participate in research. They also will organize a biomedical research group interested in palliative care that focuses on the patients' and family members' inner strength.

Daly, the Gertrude Perkins Oliva Professor of Oncology Nursing at Case Western Reserve and clinical ethics director at University Hospitals Case Medical Center, will establish the BEST Center (Building End-of-Life Science through Positive Human Strengths and Traits) to encourage research and recruit faculty in this area. The National Institute of Nursing Research funds the research.

Over the next year, three faculty members will receive support to concentrate 75 percent of their time on research. Each faculty member will receive $30,000 to launch a new project. As part of the hiring requirements, researchers must have a project ready to begin at their start date.

Approximately 20 faculty members across the Case Western Reserve campus work in the area of end-of-life issues. As one function of the BEST Center, the Palliative Care Education and Research Leadership (PEARL) group will meet regularly with the opportunity to collaborate and share ideas and findings.

Many people want the end-of-life experience to be meaningful, says Prince-Paul, assistant professor of nursing and hospice nurse at Hospice of the Western Reserve who has worked in hospice and palliative care for nearly 20 years.

With funding from the American Cancer Society, 163 patients ages 18 and older with an advanced cancer diagnosis will participate and test a new communication tool developed by Prince-Paul.

Patients will be interviewed three times over the course of a year or at the time they enter hospice care about what they feel is important. They will see how life goals and key communication expressions, such as love, gratitude, and forgiveness might change.

Prince-Paul explains, when people come face to face with death, hospice care workers have noticed that people want to clean up unfinished business.

At the end of life, people have limited ability and energy to communicate. We need to strategize and capitalize on the time they have to facilitate those things that matter most in their life, says Prince-Paul.

Families sometimes have unresolved issues to settle, too. Exline, a psychologist and associate professor of psychology, and Prince-Paul will lead the study of 200 family members who have someone near the end of life or have died.

Among those issues can be forgiveness. Exline, who has studied forgiving oneself, others and God over the past decade, will survey family members before and after the death of the loved one to see how hospice workers can help them as they undergo the emotional stress of caring for this seriously ill family member and then the challenges of bereavement.

With Fetzer Foundation support, Exline will lead the researchers in testing new survey tools to help determine how hospice workers can help family members.

The researchers will collaborate with healthcare workers from the Hospice of the Western Reserve, who will distribute questionnaires for those with a family member in hospice home care. Another group of family members will be interviewed during the bereavement period.

A primary caretaker in the family will answer questions that define some of the issues and emotions experienced at this time. The researchers will start by asking an open-ended question such as If you had an opportunity to say something to your family member, what would it be? Other detailed questions will follow.

The researchers will conduct another study during bereavement to assess if there are any unresolved issues with the deceased family member and if there is a continued bond with that family member.

Exline is interested in how people experience struggle and how forgiveness is part of that process.

Your own stem cells can treat heart disease

Tue, 17 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) CHICAGO --- The largest national stem cell study for heart disease showed the first evidence that transplanting a potent form of adult stem cells into the heart muscle of subjects with severe angina results in less pain and an improved ability to walk. The transplant subjects also experienced fewer deaths than those who didn't receive stem cells.

In the 12-month Phase II, double-blind trial, subjects' own purified stem cells, called CD34+ cells, were injected into their hearts in an effort to spur the growth of small blood vessels that make up the microcirculation of the heart muscle. Researchers believe the loss of these blood vessels contributes to the pain of chronic, severe angina.

This is the first study to show significant benefit in pain reduction and improved exercise capacity in this population with very advanced heart disease, said principal investigator Douglas Losordo, M.D., the Eileen M. Foell Professor of Heart Research at the Northwestern University Feinberg School of Medicine and a cardiologist and director of the program in cardiovascular regenerative medicine at Northwestern Memorial Hospital, the lead site of the study.

Losordo, also director of the Feinberg Cardiovascular Research Institute, said this study provides the first evidence that a person's own stem cells can be used as a treatment for their heart disease. He cautioned, however, that the findings of the 25-site trial with 167 subjects, require verification in a larger, Phase III study.

He presented his findings Nov. 17 at the American Heart Association Scientific Sessions 2009.

Out of the estimated 1 million people in the U.S. who suffer from chronic, severe angina -- chest pain due to blocked arteries -- about 300,000 cannot be helped by any traditional medical treatment such as angioplasty, bypass surgery or stents. This is called intractable or severe angina, the severity of which is designated by classes. The subjects in Losordo's study were class 3 or 4, meaning they had chest pain from normal to minimal activities, such as from brushing their teeth or even resting.

The stem cell transplant is the first therapy to produce an improvement in severe angina subjects' ability to walk on a treadmill. Twelve months after the procedure, the transplant subjects were able to double their improvement on a treadmill compared to the placebo group. It also took twice as long until they experienced angina pain on a treadmill compared to the placebo group, and, when they felt pain, it went away faster with rest. In addition, they had fewer overall episodes of chest pain in their daily lives.

In the trial, the CD34+ cells were injected into 10 locations in the heart muscle. A sophisticated electromechanical mapping technology identifies where the heart muscle is alive but not functioning, because it is not receiving enough blood supply.

Discoveries at NJIT including drug to stop brain injury receives $1.4M funding

Thu, 12 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) A drug to stop bleeding during a brain injury and a mattress that will prevent bedsores are among the scientific discoveries at NJIT that received earlier this week more than a million dollars in funding from the New Jersey Commission on Science and Technology. The discoveries are the work of five early stage companies based at NJIT's Enterprise Development Center (EDC), the state's oldest business incubator program.

EDC, which is home to 95 new companies, received a $300,000 grant from the Commission, the largest award given to any organization of this kind in New Jersey. The money will go toward maintaining and supplementing EDC's unique specialized training initiatives and other programs made available to tenant companies on a weekly basis.

We will receive this year a total of almost $1.4 million from the Commission to strengthen both our most promising companies as well as our actual programs which help companies succeed, said Judith Sheft, associate vice president, technology development.

Support from the Commission to these early stage companies in a variety of technology disciplines will help them accelerate their path to success and ultimately add to job growth in the state. A recent study from the Kauffman Foundation shows that newly created and young companies such as these are the primary drivers of job creation in the United States.

The following five companies received awards from the Commission.

Edge Therapeutics Inc., a recipient of $500,000, has three drugs to treat serious types of brain injury. The drugs are based on a patent-pending drug delivery platform technology that provides for targeted, site specific delivery to the brain of FDA-approved off-patent drugs.

Phoenix Labs, LLC, a recipient of $250,000, has developed and validated a patent-pending algorithm for precision-timing synchronization. Precision-timing synchronization is essential for the evolution of 3G and 4G wireless networks that will account for the most substantial growth in telecommunications industry revenue over the next decade.

Simphotek, Inc, a recipient of $250,000, is developing simulation software for biomedical, nanotechnology, renewable energy and photonic materials markets.

Healthy Functions received a $50,000 fellowship for the development of a mechanical pressure reduction mattress. This mattress will prevent pressure ulcers or bedsores on bedridden, comatose, paraplegic, and other patients who are neuro-muscularly disabled.

AcquiSci Inc received $21,936 fellowship to develop a systemic anti-inflammatory treatment of cardiovascular diseases with underlying inflammation.

American Academy of Nursing strengthened by induction of palliative care expert

Mon, 09 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Patricia Berry, PhD, APRN, FAAN, associate professor at the University of Utah College of Nursing was formally inducted into the American Academy of Nursing Saturday as one of the 2009 new Fellows. Berry was nominated for this honor by two current Academy Fellows and was selected by the Academy's 15-member Fellow Selection Committee for her outstanding achievements in the nursing profession. The induction of Berry and 97 other nurse leaders took place during the Academy's Annual Awards Ceremony in Atlanta, GA.

The American Academy of Nursing invites a select group of nursing leaders to become fellows of the academy, said University of Utah College of Nursing Dean and Louis H. Peery Presidential Endowed Chair, Maureen R. Keefe, RN, PhD, FAAN. This honor is indicative of Dr. Berry's numerous contributions to the field of nursing, particularly in the areas of end-of-life care and pain symptom management. According to Keefe, Berry joins a select group of College of Nursing faculty members who have received this distinguished honor.

The Academy is constituted to anticipate national and international trends in health care, and address resulting issues of health care knowledge and policy. Not only is the invitation to Fellowship recognition of one's accomplishments within the nursing profession, but it also affords the chance to work with other leaders in health care in addressing the issues of the day.

In addition to being a certified gerontological nurse practitioner and an advanced practice palliative care nurse, Berry is associate director, education and practice for the University of Utah's Hartford Center of Geriatric Nursing Excellence. With 32 years of experience in hospice and palliative care, Berry has contributed to critical policy, educational, and scientific initiatives to improve the management of pain and symptoms, especially for individuals with life-limiting illness and their families. She is a member of the national faculty for the Geriatric End of Life Nursing Education Consortium (ELNEC) and serves on the research committees of the National Hospice and Palliative Care Organization and the American Board of Nursing Specialties.

By sustaining her commitment to pain and symptom management, especially for older adults at the end of life, Dr. Berry will join other members of the Academy as an important force in disseminating nursing knowledge nationally and internationally, said Regina Fink, RN, PhD, FAAN, AOCN, a research nurse scientist with University of Colorado Hospital and one of Berry's nominators. Added Ginette Pepper, PhD, RN, FAAN, professor, Helen Lowe Bamberger Colby Endowed Chair in Gerontological Nursing, who joined with Fink in nominating Berry, One of the most expensive and agonizing aspects of our health care system is inappropriate care at the end of life. Dr. Berry's voice and expertise will help to further the mission of the Academy and assure the promotion of humane and effective health care.

Findings show nanomedicine promising for treating spinal cord injuries

Mon, 09 Nov 2009 04:59:12 PST

( from http://www.rxpgnews.com ) Researchers at Purdue University have discovered a new approach for repairing damaged nerve fibers in spinal cord injuries using nano-spheres that could be injected into the blood shortly after an accident.

The synthetic "copolymer micelles" are drug-delivery spheres about 60 nanometers in diameter, or roughly 100 times smaller than the diameter of a red blood cell.

Researchers have been studying how to deliver drugs for cancer treatment and other therapies using these spheres. Medications might be harbored in the cores and ferried to diseased or damaged tissue.

Purdue researchers have now shown that the micelles themselves repair damaged axons, fibers that transmit electrical impulses in the spinal cord.

"That was a very surprising discovery," said Ji-Xin Cheng, an associate professor in the Weldon School of Biomedical Engineering and Department of Chemistry. "Micelles have been used for 30 years as drug-delivery vehicles in research, but no one has ever used them directly as a medicine."

Findings are detailed in a research paper appearing Sunday (Nov. 8) in the journal Nature Nanotechnology.

A critical feature of micelles is that they combine two types of polymers, one being hydrophobic and the other hydrophilic, meaning they are either unable or able to mix with water. The hydrophobic core can be loaded with drugs to treat disease.

The micelles might be used instead of more conventional "membrane sealing agents," including polyethylene glycol, which makes up the outer shell of the micelles. Because of the nanoscale size and the polyethylene glycol shell of the micelles, they are not quickly filtered by the kidney or captured by the liver, enabling them to remain in the bloodstream long enough to circulate to damaged tissues.

In research led by biomedical engineering doctoral student Yunzhou Shi, the micelles also were shown to be non-toxic at the concentrations required.

"With the micelles, you need only about 1/100,000th the concentration of regular polyethylene glycol," Cheng said.

Ongoing research at Purdue has shown the benefits of polyethylene glycol, or PEG, to treat animals with spinal cord injuries. The work is led by Richard Borgens, director of the Center for Paralysis Research and the Mari Hulman George Professor of Neurology in the School of Veterinary Medicine.

Findings have shown that PEG specifically targets damaged cells and seals the injured area, reducing further damage. It also helps restore cell function.

The new findings were made possible by the interdisciplinary nature of the work, which involves Borgens and other Purdue researchers, Cheng said. The collaboration included Borgens; Riyi Shi, an associate professor of biomedical engineering and basic medical sciences; and Kinam Park, Showalter Distinguished Professor of Biomedical Engineering and a professor of pharmaceutics.

Findings showed that cores made of particular materials work better than others at restoring function to damaged axons, which are slender extensions of nerve cells.

The research also showed that without the micelles treatment about 18 percent of axons recover in a segment of damaged spinal cord tested in a "double sucrose gap recording chamber." The micelles treatment boosted the axon recovery to about 60 percent. The researchers used the chamber to study how well micelles repaired damaged nerve cells by measuring the "compound action potential," or the ability of a spinal cord to transmit signals.

The experiment mimics what happens during a traumatic spinal cord injury. Findings showed that micelles might be used to repair axon membranes damaged by compression injuries, a common type of spine injury.

The researchers also tracked dyed micelles in rats, demonstrating that the nanoparticles were successfully delivered to injury sites. Findings also showed micelles-treated animals recovered the coordinated control of all four limbs, whereas animals treated with conventional polyethylene glycol did not.

Carbon nanotubes can affect lung lining

Tue, 03 Nov 2009 23:05:36 PST

( from http://www.rxpgnews.com ) Carbon nanotubes which are used in everything from sports equipment to medical applications can affect the lining of the lungs, say researchers.

The long term effects, however, remain unclear.

The study was a collaboration between North Carolina State University -, The Hamner Institutes for Health Sciences, and the National Institute of Environmental Health Sciences.

Using mice in an animal model study, researchers set out to determine what happens when multi-walled carbon nanotubes are inhaled.

Specifically, researchers wanted to determine whether the nanotubes would be able to reach the pleura, which is the tissue that lines the outside of the lungs and is affected by exposure to certain types of asbestos fibres which cause cancer.

Researchers found that inhaled nanotubes do reach the pleura and cause health effects. Short-term studies described in the paper do not allow conclusions about long-term responses such as cancer.

The 'unique reaction' began within one day of inhalation of the nanotubes, when clusters of immune cells - began collecting on the surface of the pleura.

Localised fibrosis, or scarring on parts of the pleural surface that is also found with asbestos exposure, began two weeks after inhalation.

The study showed the immune response and fibrosis disappeared within three months of exposure. However, this study used only a single exposure to the nanotubes, says an NCSU release.

It remains unclear whether the pleura could recover from chronic, or repeated, exposures.

'More work needs to be done in that area and it is completely unknown at this point whether inhaled carbon nanotubes will prove to be carcinogenic in the lungs or in the pleural lining,' an NCSU release said.

These findings were published in Nature Nanotechnology.

Prostate cancer gives a new outlook on life

Mon, 05 Oct 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Men who have prostate cancer often feel quite healthy, but the diagnosis still gives them a whole new outlook on life. Once they have learned to live with their cancer, they choose to focus on valuable relationships and appreciate the little things in life, shows a dissertation thesis from the Sahlgrenska Academy at the University of Gothenburg, Sweden.

We need a better understanding of how men with prostate cancer experience their illness and how they choose to adapt their new circumstances, says district nurse Annikki Jonsson, who interviewed 37 men with prostate cancer for her thesis. We can then support them better and tailor their treatment to the phase they are in.

The results show that the men go through different phases of adjustment in succession after getting their diagnosis, and that their everyday lives are affected differently according to which phase they are in.

Those with less serious prostate cancer find themselves in an emotional vacuum immediately after receiving their diagnosis. During this phase, which normally lasts around a week, it is pointless for medical personnel to try to give men information about their illness.

But they do appreciate positive reception without pity during this initial phase. And, of course, if they do choose to get in touch and ask some questions, it's important to answer and tell where you can turn to with diffrent thoughts.

Once these men have negotiated this initial phase, they regain control over their lives and find their driving force for life. They begin actively seek out information about their illness.

Men who learn that they have an aggressive form of prostate cancer find that the disease is allways at present and they feel often a sense of emptiness during the initial period following the diagnosis. For these men, the disease is an existential threat.

They think a lot about how the future will be and how they will die.

The men I interviewed said that they lived life more intense, but that they had their ups and downs, says Jonsson. Sometimes they felt more alive, and in the next minute got a feeling that they risked losing control or being reminded of their changed masculinity.

The men were interviewed again two years after receiving their diagnosis. They told that they had realised that life is fragile, and they were aware that they did not know how long the life will be. They got more faith and trust in life and had discovered that they could preserve their autonomy and integrity despite their illness.

Life changes, and it's important to achieve some kind of balance, says Jonsson. The men focused their energy on the relationships which were valuable for them. They appreciated the little things in life in a different way nowadays and developed an inner strength to be true to themselves.

Weill Cornell Institute for Geriatric Psychiatry awarded $10 million grant

Thu, 24 Sep 2009 03:59:36 PST

( from http://www.rxpgnews.com ) WHITE PLAINS, NY (Sept. 24, 2009) -- The Weill Cornell Institute of Geriatric Psychiatry at NewYork-Presbyterian Hospital/Westchester Division announced today it has received the largest grant in its 20-year history. One of a handful awarded nationally, the new $10 million, five-year Center Grant from the National Institute of Mental Health (NIMH) will enable NewYork-Presbyterian/Weill Cornell investigators to advance their pioneering work in understanding the biological, medical, cognitive and psychosocial problems of depressed seniors. The grant is one of the largest ever given by NIMH to study geriatric depression.

The grant's principal investigator is Dr. George Alexopoulos, founder and director of the Weill Cornell Institute of Geriatric Psychiatry at NewYork-Presbyterian/Westchester, professor of psychiatry at Weill Cornell Medical College and director of the NIMH-supported Advanced Center for Interventions and Services Research (ACISR) in late-life depression. He is recognized as one of the world's leading geriatric psychiatry researchers in late-life depression and its treatment.

Dr. Alexopoulos, who has spent his career of more than 30 years investigating late-life depression, said, To receive a Center Grant by NIMH, a team must have a critical mass of competitively-funded research projects and demonstrate that the Center's new projects and structures will result in a scientific product that will be greater than the sum of its individual projects. As such, the Center Grant represents an endorsement by NIMH of the scope and importance of our team's work.

He added: This is an exciting time in the history of the Weill Cornell Institute of Geriatric Psychiatry. The 'Center Grant' is significant because it will enable our investigators to synthesize their findings in a meaningful way and develop new tools and practices needed to reduce the burden of depression and disability in elderly persons who have limited access to quality care.

As in the past, the Institute will seek individuals over the age of 60 from the community to participate in research studies.

Since its inception in 1994, the Weill Cornell Institute of Geriatric Psychiatry has consistently received support by NIMH. This is the fourth and largest Center Grant awarded to the Institute since its inception.

Dr. Alexopoulos noted that the Institute demonstrated in its grant application that we have the infrastructure and unique mix of innovative findings and synergies in place to take our research to the next level by developing new treatments and improving the care offered to elderly patients in the community.

The research efforts of Weill Cornell Institute's team of 13 NIMH-funded investigators, five at the full professor's level, have concentrated in three interrelated core areas:

University of Maryland Shock Trauma Center to participate in extremity research consortium

Fri, 11 Sep 2009 03:59:36 PST

( from http://www.rxpgnews.com ) The University of Maryland R Adams Cowley Shock Trauma Center in Baltimore, Md., will serve as one of 12 core clinical centers in a newly established Extremity Trauma Clinical Research Consortium funded by the U.S. Department of Defense.

The consortium will work closely with several major military treatment centers and the U.S. Army Institute of Surgical Research (USAISR) at Fort Sam Houston, Texas, to conduct multi-center clinical research studies relevant to the treatment and outcomes of severe orthopaedic trauma sustained on the battlefield. These studies will help establish treatment guidelines and facilitate the translation of new and emerging technologies into clinical practice.

This clinical research network offers us a unique opportunity to investigate treatments for a variety of injuries common in military and civilian patients, says Andrew N. Pollak, M.D., co-chair of the consortium and head of the division of orthopaedic traumatology at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center and associate professor of orthopaedics at the University of Maryland School of Medicine. We needed more funding to conduct definitive studies on severe wounds to the legs and arms. The results of this research will give us better insight into the best ways to treat severe, high-impact injuries to the limbs.

Dr. Pollak, who served as chair of the American Academy of Orthopaedic Surgeons' Extremity War Injury Project Team, will lead the orthopaedics studies at Shock Trauma as part of the new initiative. He has championed the need for increased funding for trauma research, citing the devastating extremity injuries suffered by U.S. soldiers in Iraq and Afghanistan. There is a profound need for targeted medical research to help military surgeons find new limb-sparing techniques to save injured extremities, avoid amputations and preserve and restore the function of injured extremities, he told the U.S. Senate Appropriations Subcommittee in 2007.

The Johns Hopkins Bloomberg School of Public Health will serve as the coordinating center for the consortium. The Orthopaedic Extremity Trauma Research Program (OETRP) of the Department of Defense has awarded the Bloomberg School of Public Health $18.4 million over five years to establish the consortium.

The need for such a consortium is evident, says Ellen MacKenzie, Ph.D., principal investigator and the Fred and Julie Soper Professor and Chair of the Bloomberg School's Department of Health Policy and Management. Eighty-two percent of all service members injured in Operation Iraqi Freedom and Operation Enduring Freedom sustain significant extremity trauma. Many sustain injuries to multiple limbs. The research to be conducted by the consortium will help us better understand what works and what doesn't in treating these injuries and ensure that our service members are provided with the best care possible.

E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine, says, The University of Maryland R Adams Cowley Shock Trauma Center is internationally recognized for its expertise in caring for the most critically injured patients and is a leader in trauma research. Our faculty members will play a very active role in this new consortium, working together with trauma specialists at other centers to develop innovative new therapies to treat traumatic limb injuries.

Initial funding of the consortium will help establish the research network and provide resources to address some of the critical needs in acute clinical care identified by the military. These include the reconstruction of significant bone defects and the management of musculoskeletal infections. Over time, the consortium will expand and leverage its expertise to address many other priority topics relevant to the long-term management of severe extremity trauma, including the prevention of osteomyelitis, chronic pain and disability.

An important feature of the consortium will be its ability to expand the number of clinical sites participating in any one study. More than 30 trauma centers across the country have pledged support for the consortium and are eager to participate in one or more of the studies.

We are thrilled to be partnering with the consortium and the incredible team of investigators they have assembled, says Joseph Wenke, Ph.D., of the USAISR. Together we will develop the infrastructure critically needed to address some of the most pressing issues in orthopaedic trauma care. Without a large, multi-center effort such as this, many of these issues would never be solved.

The other core clinical centers currently participating in the consortium are: Boston University Medical Center; The Florida Orthopaedic Institute; Carolinas Medical Center; Denver Health and Hospital Authority; OrthoIndy and the Indiana Orthopaedic Hospital; Orthopaedic Associates of Michigan; The Orthopaedic Trauma Institute at the University of California at San Francisco, San Francisco General Hospital; The University of Mississippi Medical Center; The University of Texas Southwestern Medical Center; The University of Washington Harborview Medical Center and Vanderbilt University Medical Center.

Piece from childhood virus may save soldiers' lives

Sun, 06 Sep 2009 03:58:48 PST

( from http://www.rxpgnews.com ) A harmless shard from the shell of a common childhood virus may halt a biological process that kills a significant percentage of battlefield casualties, heart attack victims and oxygen-deprived newborns, according to research presented Sunday, September 6, 2009, at the 12th European meeting on complement in human disease in Budapest, Hungary.

Introducing the virus's shell in vitro shuts down what's known as the complement response, a primordial part of the immune system that attacks and destroys the organs and vascular lining of people who have been deprived of oxygen for prolonged periods, according to researchers at Children's Hospital of The King's Daughters (CHKD) and Eastern Virginia Medical School (EVMS), in Norfolk, Va.

The complement response kicks in after the victim has been revived, in what is known as a reperfusion injury. It does its work slowly but unrelentingly, killing soldiers, infants or heart attack victims over the course of days.

To find a way to manipulate the complement system pharmacologically has been like a search for the Holy Grail, said one of the lead researchers, Dr. Kenji Cunnion, an infectious disease physician at CHKD and an associate professor of pediatrics at EVMS.

While Cunnion and Neel Krishna, Ph.D., a pediatric virologist at CHKD and assistant professor of microbiology at EVMS, focus on pediatric research, they see clear military applications.

The complement reaction is one of the major causes of death of the battlefield, said Krishna. By the time you get a victim to the hospital, it may be too late.

Dr. L.D. Britt, M.D., MPH, Brickhouse professor and chairman of surgery at EVMS, agrees.

Hemorrhagic shock is the leading cause of death in combat trauma and reperfusion injury plays a significant role both in increased mortality and increased brain damage, said Britt, senior consultant to the military on combat trauma. This research could help save the lives of soldiers, as well as the lives of other trauma victims who have been without oxygen for extended periods.

Britt has joined Cunnion in Krishna in seeking a grant from the Department of Defense to expedite research and development.

The complement system ranks as one of the oldest biological mechanisms in life's evolution and exists in almost identical form in everything from seagulls to starfish.

Essentially, the complement system recognizes and destroys potentially toxic substances that gain entry into an organism's bloodstream. When a starfish loses a limb, for instance, the complement system sends a contingent of killer cells to block and attack anything that tries to work its way inside.

In human evolution, complement provided an essential natural defense.

Up until 100 years ago, the vast majority of humans died from infectious diseases, said Cunnion. Nobody died of old age and almost nobody lived long enough to die of a heart attack.

Thanks to modern medicine, people now live long enough to die from trauma, such as car accidents, or from conditions, such as heart attack and stroke, that can leave cells throughout the body starved for oxygen. Cells deprived of oxygen often undergo biochemical changes, essentially marking themselves for death. When blood flow and oxygen are restored, these changes trigger the complement cascade. The marauding cells unleashed by complement cascade are indiscriminate, killing not only the cell with the biochemical marker but innocent bystander cells as well.

It's like throwing a grenade, said Krishna.

A patient, who has suffered survivable brain damage from oxygen deprivation, might die over several days as swaths of cells are destroyed by this seemingly unstoppable reaction. Animal research has shown that stopping this complement reaction significantly reduces brain damage.

The complement system is so complex that research scientists spend entire careers studying it, publishing in journals that specialize in this primordial defense mechanism.

In the case of Cunnion and Krishna, discovering how to shut down the complement system resulted from happenstance. As they worked in neighboring labs, they noticed a similarity in the structure of molecules Cunnion used in his experiments and the protein shell of the astrovirus Krishna studied. They wondered what would happen if they introduced the astrovirus shell into an assay routinely used in Cunnion's lab to assess complement activation.

It was kind of a shot in the dark, Krishna said. We didn't expect anything to happen.

The complement reaction completely stopped.

LLNL research reveals how blast waves may cause human brain injury even without direct head impacts

Wed, 26 Aug 2009 03:59:36 PST

( from http://www.rxpgnews.com ) LIVERMORE, Calif. - New research on the effects of blast waves could lead to an enhanced understanding of head injuries and improved military helmet design.

Using numerical hydrodynamic computer simulations, Lawrence Livermore scientists Willy Moss and Michael King, along with University of Rochester colleague Eric Blackman, have discovered that nonlethal blasts can induce enough skull flexure to generate potentially damaging loads in the brain, even without direct head impact.

Traumatic brain injury (TBI) results from mechanical loads in the brain, often without skull fracture, and causes complex, long-lasting symptoms. TBI in civilians is usually caused by direct head impacts resulting from motor vehicle and sports accidents. TBI also has emerged among military combat personnel exposed to blast waves. As modern body armor has substantially reduced soldier fatalities from explosive attacks, the lower mortality rates have revealed the high prevalence of TBI.

There has been extensive research on how head impacts, for example from automobile accidents, cause traumatic brain injury (TBI). But TBIs resulting from blast waves without head impacts have not been well understood.

To tackle this puzzle, the team used three-dimensional hydrodynamic simulations to prove that direct action of the blast wave on the head causes skull flexure, producing mechanical loads in brain tissue comparable to those in an injury-inducing impact, even at nonlethal blast pressures as low as 1 bar above atmospheric pressure.

In particular, the team showed that blast waves affect the brain very differently from direct impacts. The primary source of injury from direct impacts is the force resulting from the bulk acceleration of the head. In contrast, a blast wave squeezes the skull, creating pressures as large as an injury-inducing impact and pressure gradients in the brain that are much larger. This occurs even when the bulk head accelerations induced by a blast wave are much smaller than from a direct impact.

The blast wave sweeps over the skull like a rolling pin going over dough, said King, LLNL co-principal investigator.

Although the simulations show that the skull is deformed only about 50 microns (the width of a human hair), this is large enough to generate potentially damaging loads in the brain, according to Moss.

Because blast waves and direct impact affect the head in fundamentally different ways, armor systems that are designed to protect soldiers from impacts and projectiles may not be optimal for blast wave protection. The team studied how helmets and their suspension systems influence the blast-induced mechanical loads in the brain. They looked at two common systems: a nylon web system formerly used in the Personnel Armor Systems Ground Troops infantry helmet and viscoelastic foam pads like those in advanced combat helmets. Both helmets were modeled as hemi-ellipsoidal Kevlar shells.

In the first case, the 1.3 centimeter gap between the webbing and the shell allows the blast wave to wash under the helmet. In this case, the blast wave is focused by the shape of the helmet and the pressures under the helmet exceed those outside, so the helmet doesn't prevent the rippling deformation of the skull and pressure gradients in the brain.

In the second case, this under wash effect is mostly prevented by the presence of the foam pads, but under blast loading, the pads can become stiffer so that the blast wave-induced motion or deformation of the helmet is transferred to the skull. This can result in dangerous loads in the brain.

The possibility that blasts may contribute to traumatic brain injury has implications for injury diagnosis and improved armor design, Moss said.

Blackman added: By comparing the effect of blasts on the head with the effect of head impacts we'd be able to make some sense of the distinct mechanisms of injury, the damage a solider might incur, and how a helmet might be designed to minimize both.

Ellison Medical Foundation awards more than $1 million to mid-career scientists

Tue, 25 Aug 2009 03:59:36 PST

( from http://www.rxpgnews.com ) NEW YORK, August 25, 2009 -- Charleen T. Chu, MD, PhD, associate professor at the University of Pittsburgh and David M. Sabatini, MD, PhD, associate professor, Massachusetts Institute of Technology, received the 2009 Julie Martin Mid-Career Awards in Aging Research. Sponsored by The Ellison Medical Foundation, the grants provide funding of $550,000 to mid-career scientists whose research has great potential in advancing understanding of basic aging and its impact on age-related diseases. Through a partnership with the American Federation for Aging Research established in 2005, to date The Ellison Medical Foundation has disbursed $4.4 million to eight researchers.

In Parkinson's disease, dopaminergic neurons lose their ability to function and eventually die. Autophagy or self-eating is an important process by which damaged or unneeded structures in the cell are delivered to specialized compartments called lysosomes for digestion into building blocks that can be reused. The capacity for this recycling process, however, declines with age. Dr. Chu's research will develop methods to cause impairment of autophagy in adult mice to see if this factor contributes to the development of neurodegeneration on its own or in combination with genetic alterations that model familial parkinsonism. Dr. Chu's laboratory also studies the effects of overactivation of autophagy, which may also negatively alter neuritic and synaptic function. The ability to identify and correct age- or disease-related factors that disrupt the balance of autophagy could aid in the development of future therapies for neurological diseases.

The mammalian target of rapamycin (mTOR) signaling pathway is a key regulator of growth and metabolism in response to nutrients. mTOR signaling regulates protein synthesis, as well as cell size and proliferation, and has recently been linked to increased health and lifespan in a variety of organisms including yeast, worms, flies, and mice. Using mice with deletions of key mTOR genes, Dr. Sabatini seeks to learn more about the mechanisms underlying mTOR and its relationship to health and lifespan. The potential of such research is that one day this pathway may be able to be tweaked in people to provide some health benefits and protect against age-related diseases.

These grants address two pressing needs: to sustain the promising work of mid-career researchers and to encourage less conservative approaches to advance research on aging that may be deemed too risky for other sources of funding, said Stephanie Lederman, executive director, American Federation for Aging Research. We thank The Ellison Medical Foundation for their solid commitment to these scientists and the field.

One of the great opportunities in a scientist's career is the point where he/she has recently achieved tenure status and can begin to take greater risks with less concern about career security, said Richard L. Sprott, executive director, The Ellison Medical Foundation. We created this program in collaboration with AFAR in order to capitalize on the unique opportunities at this career stage by providing a funding source that encourages faster development of new ideas and approaches than is possible with more traditional funding.

Cardiac arrest resuscitation: Passive oxygen flow better than assisted ventilation

Tue, 11 Aug 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Arizona researchers have added another piece to the mounting body of evidence that suggests during resuscitation efforts to treat patients in cardiac arrest, passive ventilation significantly increases survival rates, compared to the widely practiced assisted ventilation.

The study, published in an online edition of Annals of Emergency Medicine, compared the numbers of patients who had suffered a cardiac arrest outside a hospital setting and were resuscitated in the field by Emergency Medical Services personnel. Rescuers used either bag-valve-mask ventilation, which forces air into the patient's lungs, or facemasks with a continuous flow of oxygen, which work in a similar fashion to those carried on airplanes in case the cabin pressure drops.

Among the 1,019 adult out-of-hospital cardiac arrest patients in the analysis, 459 received passive ventilation and 560 received bag-valve-mask ventilation. Neurologically normal survival after witnessed cardiac arrest with a shockable heart rhythm was higher for the passive oxygen flow method (38.2 percent) than bag-valve-mask ventilation (25.8 percent).

These results are strikingly similar to earlier observations from Wisconsin, where survival rates went up from 15 percent to 38 percent after paramedics abandoned the official guidelines for the modified protocol that we developed, says Gordon A. Ewy, MD, a co-author of the study and director of the Sarver Heart Center at The University of Arizona College of Medicine. The Sarver Heart Center's Resuscitation Research Group developed a modified protocol for treating out-of-hospital cardiac arrest called Cardiocerebral Resuscitation, as opposed to Cardiopulmonary Resuscitation, which should be reserved for respiratory arrest (such as near-drowning or drug overdose).

Under the new concept, first tested in Wisconsin, EMS personnel no longer intubated the patient for ventilation. Instead, they applied a facemask delivering a continuous, low-pressure flow of oxygen.

Our findings provide compelling evidence that positive pressure ventilation is not optimal in the initial management of out-of-hospital cardiac arrest, says lead author Bentley Bobrow, MD, emergency physician at Maricopa Medical Center in Phoenix and associate professor of emergency medicine at the UA College of Medicine. The work from our EMS providers in Arizona further questions the longstanding dogma of tracheal intubation and ventilation for cardiac arrest.

We are most pleased that while we are helping to advance the science of resuscitation, we are saving more victims of cardiac arrest in Arizona than ever before, adds Dr. Bobrow, who also is the medical director for the Arizona Department of Health Services Bureau of Emergency Medical Services.

This study reinforces our belief that survival of out-of-hospital cardiac arrest has more to do with circulating the blood through quality and uninterrupted chest compressions than with ventilation, Dr. Ewy adds.

Stories we tell about national trauma reflect our psychological well-being

Tue, 28 Jul 2009 03:59:36 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- A new study by psychologists at the University at Buffalo and the F. W. Olin College of Engineering finds that in the aftermath of national trauma, the ability to make sense out of what happened has implications for individual well-being and that the kinds of stories people tell about the incident predict very different psychological outcomes for them.

The study, The Political is Personal: Narrating 9/11 and Psychological Well-Being, is by Jonathan M. Adler, Ph.D., assistant professor of psychology at Olin, and Michael J. Poulin, Ph.D., assistant professor of psychology at UB.

Understanding the stories people tell about national events provides a unique opportunity to understand how individual well-being is linked to the state of the society, Poulin explains.

The study is published in the August issue of Journal of Personality. An online version of the study can be found online at the journal site: http://www3.interscience.wiley.com/cgi-bin/fulltext/122387789/HTMLSTART

Our findings suggest that different ways of writing about the events of 9/11 relate to different psychological outcomes, Poulin says, and that the different ways people describe traumatic national events -- even those they do not experience directly -- are linked to different levels of psychological adaptation.

To sum up, he says, we found that psychological well-being was associated with post-trauma stories that were high in closure, high in redemptive imagery and high in themes of national redemption. Psychological distress, on the other hand, was significantly related to accounts that were low in closure, high in contaminative imagery and high in themes of personal contamination.

The researchers looked at personal accounts about experiences of the terrorist attacks of 9/11 written by 395 adults from across the country, some of whom were more intimately connected to the events in question than were others. They then compared the narratives with various measures of their psychological well-being.

Accounts high in 'closure' are those that demonstrate an emotional conclusion or a coherent resolution of a difficult life event, Poulin says, and perhaps not surprisingly, participants who described the terrorist attacks with a sense that they were really over and no longer exerted an emotional influence had low levels of distress and high levels of well-being.

However, we also found that a high level of psychological well-being was significantly related to accounts that were high in references to national redemption and, among those more directly exposed to the attacks, high in redemptive imagery in general, he says.

He describes redemptive accounts as those that tell a story of something positive coming out of something negative. Adler notes that the theme of redemption has been characterized as a particularly American theme, observed in national rhetoric throughout history and in the personal stories of many well-known Americans.

On the opposite end of the spectrum, Adler and Poulin found that psychological distress was significantly related to accounts low in closure and high in contamination imagery or themes of personal contamination.

Contamination, Poulin says, is reflected in stories in which what was 'good' or 'acceptable' becomes contaminated, ruined, undermined, undone or spoiled. It is basically the opposite of redemption and may therefore be somewhat opposed to the themes of traditional American stories.

The study, funded by the National Science Foundation, is grounded in the theoretical tradition of the narrative study of lives. It involved a nationally representative sample of adults who wrote accounts about the 9/11 terrorist attacks approximately two months after they occurred.

The study participants were among more than 1,000 respondents who earlier had completed a two-month post-9/11 survey that included a number of open-ended questions related to their 9/11 experiences: their individual experiences on Sept. 11, 2001, how they made sense of the attacks and their aftermath, and whether they had been able to find positive consequences.

Those selected for the study were respondents who had contributed enough descriptive material to be coded for narrative themes of closure redemption and contamination.

The participants also completed a demographic survey, a mental-health questionnaire and answered questions about whether they had ever experienced any of 30 negative life events such as natural disaster or child abuse. They were assessed for their degree of exposure to the events of 9/11, and their levels of psychological well-being and distress were analyzed using well-known psychological scales.

Online obituaries are changing the way we publicly remember the dead and how newspapers cover deaths

Tue, 16 Jun 2009 03:59:36 PST

( from http://www.rxpgnews.com ) The ways we deal with death are finding a new life online, according to research being published by a Kansas State University journalism professor and her colleague.

You're accustomed to clipping an obituary from the newspaper and putting it in the family Bible, but with online obituary services you can e-mail them to anyone you know, said Bonnie Bressers, associate professor of journalism and mass communications at K-State.

She and Janice Hume at the University of Georgia, who is the principal researcher on the project, have studied the phenomenon of newspapers publishing obituaries online and what it means not only for mourners and the public memory of the dead but also the ethical implications for newspapers. They will present their work in August at the Association for Education in Journalism and Mass Communications conference in Boston.

Hume was a K-State journalism and mass communications faculty member from 1999-2001.

Hume and Bressers looked at obituaries in the largest circulation newspapers in each of nine geographic regions across the United States. All of these newspapers had a partnership with Legacy.com, an online obituary service. When readers click on a paid obituary from the newspaper's Web site, they're redirected to the Legacy site, which adds an online guestbook that allows visitors to post comments. The family can later e-mail the entire guestbook to other mourners.

The researchers found that although this capability has positive implications for a community of mourners, it poses a conundrum for newspapers. In part, this is because the Legacy pages recreate the look of the hosting newspaper.

To the user who isn't savvy, he or she would assume it's still the newspaper's site, Bressers said. In a hundred years, will readers distinguish the two? The ethical implications need to be considered.

Legacy vets comments for the subjective quality of appropriateness, which Bressers said makes it unlikely to read comments about a person that aren't a glowing -- and perhaps more accurate -- account of their character. At the same time, comments aren't edited for accuracy in the way a newspaper report would be.

If I were a newspaper, I'd also be concerned that outside companies like this are making money providing the kind of public access people want, Bressers said. Newspapers have long been the holders of public memory, remembering people and reflecting the values of the time. At one time, for example, an examination of newspaper obituaries would make it look like women and African-Americans didn't die. We see online obituaries opening up the possibility that more people won't be forgotten.

Bressers said that she and Hume also see how online obituaries are bringing mourners together in a way that would have been impossible before. Friends and family who wouldn't have been able to attend a funeral to sign a physical guest book can send their condolences from anywhere they have an Internet connection. The researchers found comments from friends and family members sharing stories -- often humorous ones -- that painted a clearer picture of what the deceased person was really like.

Bressers said they were struck by the remarkable connections not just between people who have died and their childhood friends and co-workers, but also between complete strangers. If the deceased was a veteran, strangers express gratitude for that person having served the country. Strangers who shared a medical condition with the deceased convey empathy with the family.

The messages that are perhaps more specific to online mourning are those speaking to the dead themselves. Hume and Bressers found such guestbook comments often make a request of the deceased, such as 'Say hi to Mom.'

Although comments can be left anonymously, mourners can leave an e-mail address with the contact me button, allowing the grieving to connect outside of the guestbook.

These obituaries go beyond what a reporter would write and what a family would pay for, Bressers said. Something may be lost in families not getting cards in the mail, but what is lost is outsized by allowing more people to participate in an online guestbook. The implications for community-building are immense.

Acute computer related injuries on the rise

Tue, 09 Jun 2009 06:00:57 PST

( from http://www.rxpgnews.com ) While back pain, blurred vision and mouse-related injuries are now well-documented hazards of long-term computer use, the number of acute injuries connected to computers is rising rapidly. According to a study published in the July 2009 issue of the American Journal of Preventive Medicine, researchers from the Center for Injury Research and Policy and The Research Institute at Nationwide Children's Hospital; and The Ohio State University College of Medicine, Columbus have found a more-than-sevenfold increase in computer-related injuries due to tripping over computer equipment, head injuries due to computer monitor falls and other physical incidents.

According to data from the National Electronic Injury Surveillance System database, over 78,000 cases of acute computer-related injuries were treated in U.S. emergency departments from 1994 through 2006. Approximately 93% of injuries occurred at home. The number of acute computer-related injuries increased by 732% over the 13-year study period, which is more than double the increase in household computer ownership (309%).

Injury mechanisms included hitting against or catching on computer equipment; tripping or falling over computer equipment; computer equipment falling on top of the patient; and the straining of muscles or joints. The computer part most often associated with injuries was the monitor. The percentage of monitor-related cases increased significantly, from 11.6% in 1994 to a peak of 37.1% in 2003. By 2006, it had decreased to 25.1%. The decrease since 2003 corresponds to the replacement of heavier cathode ray tube (CRT) monitors with smaller and easier-to-lift liquid crystal display (LCD) monitors.

Children aged <5 years had the highest injury rate of all age groups. The most common cause of injury was tripping or falling by patients aged <5 years (43.4%) and ≥60 years (37.7%) and hitting or getting caught on computer equipment for individuals of all other ages (36.9% of all cases). While injuries to the extremities were most common (57.4%), children aged <10 years most often had injuries to the head (75.8% for those aged <5 years and 61.8% for those aged 5𔃇 years).

According to Lara B. McKenzie, PhD, MA, Nationwide Children's Hospital Center for Injury Research and Policy, Columbus, "Future research on acute computer-related injuries is needed as this ubiquitous product becomes more intertwined in our everyday lives. More information is needed on the types of computers and equipment used, the layout of these systems, and the furniture utilized in order to develop household-safety practices in this area…Given the large increase in acute computer-related injuries over the study period, greater efforts are needed to prevent such injuries, especially among young children."

Common chemotherapy drug triggers fatal allergic reactions

Mon, 08 Jun 2009 03:59:36 PST

( from http://www.rxpgnews.com ) CHICAGO -- A chemotherapy drug that is supposed to help save cancer patients' lives, instead resulted in life-threatening and sometimes fatal allergic reactions.

A new study from the Research on Adverse Drug Events and Reports (RADAR) pharmacovigilance program at Northwestern University Feinberg School of Medicine identified 287 unique cases of hypersensitivity reactions submitted to the FDA's Adverse Event Report System between 1997 and 2007 with 109 (38 percent) deaths in patients who received Cremophor-based paclitaxel, a solvent-administered taxane chemotherapy.

Adverse event reports generally only represent from 1 to 10 percent of actual incidence, so the number of hypersensitivity reactions and deaths is likely significantly higher. The severe allergic reactions are believed to be caused by Cremophor, the chemical solvent - a derivative of castor oil -- that is used to dissolve some insoluble drugs before they can be injected into the blood stream.

Two patients who died from an allergic reaction had early-stage breast cancer, which had been surgically removed, and were being treated with Cremophor-containing paclitaxel to prevent the cancer from coming back. Both of these patients had received medications before the chemotherapy to reduce the risk of hypersensitivity reactions.

The study was led by Charles Bennett, M.D., RADAR program coordinator and a professor of hematology/oncology at Northwestern's Feinberg School, and Dennis Raisch, a professor of pharmacy at the University of New Mexico.

The deaths of women with early-stage breast cancer are particularly disturbing because without the adverse reaction, they could have likely had 40 years of life ahead of them, Bennett said.

RADAR investigators also found that 22 percent of all fatalities occurred in patients despite patients having received premedication to prevent hypersensitivity reactions, while another 15 percent of such patients experienced life-threatening respiratory arrest.

The report was presented at the 45th Annual Meeting of the American Society of Clinical Oncology held recently in Orlando, Fla.

Cremophor-containing paclitaxel has been associated with hypersensitivity reactions, with responses ranging from mild skin conditions to more severe effects, including anaphylaxis and cardiac collapse. Current U.S. product labeling for Cremophor containing paclitaxel includes a black-box warning alerting physicians and patients of potential toxicity and recommending the use of corticosteroids and other medications before chemotherapy administration to reduce the risk of hypersensitivity reactions.

The results of our review suggest that physicians should be vigilant in monitoring the safety of their patients undergoing chemotherapy treatment, said Bennett, who also is the A.C. Buehler Professor in Economics and Aging at the Feinberg School and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Patients receiving Cremophor-based paclitaxel should be given medications to prevent hypersensitivity reactions, but what is sobering, as the study has shown and as the black-box warning indicates, women suffer anaphylaxis despite receiving steroid premedication, Bennett said. Physicians should be diligent in reporting adverse events to regulatory agencies to better monitor the impact of Cremophor on patient safety. Physicians may also want to consider exploring other alternative chemotherapy options that do not include Cremophor.

In addition to the two women with early-stage breast cancer who died after treatment with the Cremophor-based paclitaxel, four other women with early-stage breast cancer experienced life-threatening anaphylaxis reactions. Each of them had received prior medications to prevent the reactions.

The fatal outcomes observed in patients with early-stage breast cancer were particularly striking as this is a patient population with a good prognosis that is generally treated with curative intent, said Raisch.

For the report, Bennett and Raisch reviewed adverse event reports submitted to regulatory agencies in the U.S., Europe and Japan. The most common cancer diagnosis for these patients with allergic reactions was lung cancer followed by breast cancer and ovarian cancer.

Comprehensive cardiogenetic testing for families of sudden unexplained death victims can save lives

Tue, 26 May 2009 03:59:36 PST

( from http://www.rxpgnews.com ) Vienna, Austria: Relatives of a young person who dies suddenly should always be referred for cardiological and genetic examination in order to identify if they too are at risk of sudden death, a scientist told the annual conference of the European Society of Human Genetics today (Tuesday 26 May). Dr. Christian van der Werf, a research fellow at the Department of Cardiogenetics, Academic Medical Centre, Amsterdam, The Netherlands said that, although his team's research showed that inherited heart disease was present in over 30% of the families of sudden unexplained death (SUD) victims, the majority of such relatives were currently not being referred for examination.

When an individual aged 1-50 years dies suddenly, autopsy reveals an inheritable heart disease in the majority of the victims. But in approximately 20% autopsy does not reveal the cause of death. We thought that cardiological and genetic examination of surviving first degree relatives of these SUD patients might reveal an inherited heart disease, said Dr. van der Werf.

In the largest such study to date, the team looked at the outcome of first degree relative screening in 127 families who had suffered an SUD and where either there had been no autopsy (53.8%), or the autopsy did not reveal a cause of death. The average age at death of the SUD victims was only 29.8 years old.

The initial examination of the relatives consisted of taking personal and family medical history and a resting ECG. A second cardiac autopsy of the SUD victim was undertaken if tissue had been stored and was available. Additional cardiological examinations of the relatives were performed where necessary. Genetic analysis of the associated candidate gene(s) was performed in material obtained from the deceased person or in those relatives who showed clinical abnormalities.

The researchers found inherited heart disease in 36, or 32% of the families. These results meant that doctors were able to treat affected relatives and try to prevent their succumbing to sudden cardiac death. The scale of heart disease that we found in such families underlines the necessity for general practitioners to refer first degree relatives of SUD victims to a specialised cardiogenetics department as soon as possible, said Dr. van der Werf. Currently we estimate that only 10% of SUD families are being examined for inherited heart conditions.

The study is the second report from the registry of families who attended the Amsterdam centre's cardiogenetics department because of unexplained sudden death of a relative aged 1-50 years. The scientists intend to continue to report the yield of family screening in an increasing number of families.

At present we are conducting a study to stimulate general practitioners and other involved physicians to request autopsy and DNA-storage for SUD patients and to refer relatives to a cardiogenetics department after a case of sudden death at young age. We hope this will lead to identification of more families at risk of sudden cardiac death, in which preventive measures then can be taken said Dr. van der Werf.

Relatives of young sudden death victims are often referred to cardiologists for cardiological examination. We believe relatives should instead be referred to cardiogenetics departments, where clinical geneticists, cardiologists and psychosocial workers cooperate. These professionals specialise in inherited heart diseases and their clinical and psychosocial implications, and can provide a better quality of care. Additionally, cardiologists should receive more education in inherited heart diseases. By taking these measures we can save lives and avoid further distress for families who have already suffered enough, he said.

Pirfenidone could be new agent for treatment of Idiopathic pulmonary fibrosis.

Sun, 17 May 2009 10:58:43 PST

( from http://www.rxpgnews.com ) A large, well-controlled, multi-national clinical trial program has demonstrated the effectiveness and safety of what may become the first FDA-approved medicine for idiopathic pulmonary fibrosis, or IPF.

In a Phase III clinical study program called "CAPACITY," investigators discovered that the oral anti-fibrotic and anti-inflammatory agent, pirfenidone, could slow the deterioration of lung capacity in patients suffering from IPF.

The researchers presented their findings on Sunday, May 17, at the American Thoracic Society's 105th International Conference in San Diego.

The CAPACITY trial consisted of two multi-national, randomized, double-blind, placebo-controlled Phase III trials (CAPACITY 1 and CAPACITY 2) designed to evaluate the safety and efficacy of pirfenidone in IPF patients with mild to moderate impairment in lung function. The primary endpoint of change in percent predicted forced vital capacity (FVC) at week 72 was met with statistical significance in CAPACITY 2 (p=0.001), along with the secondary endpoints of categorical change in FVC and progression-free survival (PFS), defined as time to either death, a 10-percent decrease in FVC or a 15-percent decrease in DLCO (diffusing capacity of the lung for carbon monoxide). The primary endpoint was not met in CAPACITY 1 (p=0.501), but evidence of a pirfenidone treatment effect on the primary endpoint was observed at several periods in that trial. Importantly, greater than 80 percent of patients in the trials completed treatment and greater than 90 percent completed the study.

An exploratory analysis of pooled data from both trials revealed that treatment with pirfenidone resulted in a 30-percent relative reduction in the percentage of patients who experienced an absolute decline in percent predicted FVC of at least 10 percent. This magnitude of decline is considered clinically meaningful, as a 10-percent decline in percent predicted FVC has been shown in multiple studies to be an independent predictor of mortality in patients with IPF. Exploratory analyses of pooled data from the two CAPACITY studies also demonstrated a statistically significant treatment effect on the primary endpoint of change in percent-predicted FVC at week 72, progression-free survival time and change in six-minute walk test distance.

"While it was disappointing that the primary endpoint was not met in CAPACITY 1, important consistencies between the two CAPACITY studies were observed in the overall treatment effect of pirfenidone," said Paul Noble, M.D., co-chair of the CAPACITY program and professor of medicine and chief of Pulmonary, Allergy and Critical Care Medicine at Duke University Medical Center. "The treatment effect observed in the CAPACITY studies was generally consistent with that observed in the Phase III study in IPF patients conducted by Shionogi in Japan. Collectively, these three studies give us a very good sense of the impact that pirfenidone has on the progression of IPF over at least one year."

According to the National Heart, Lung, and Blood Institute, about 200,000 Americans have idiopathic pulmonary fibrosis, a condition that scars tissue deep in the lungs. Most patients are diagnosed with the disease in their 50s and 60s, and many people live only three to five years after being diagnosed. There are no approved medications in the United States or Europe to treat the disease. Pirfenidone is approved in Japan for the treatment of IPF.

A total of 779 patients were enrolled in the CAPACITY trials at 110 sites in 11 countries. The mean age of participants was 66. To be eligible for the study, patients had to have a definitive diagnosis made by high-resolution CT scan or by biopsy, and a FVC ≥ 50 percent of predicted values and a DLCO ≥ 35 percent of predicted value.

Dr. Roland du Bois, M.D., professor of medicine at National Jewish Health, in Denver, Colo., and CAPACITY co-chair, concurred that these studies were very encouraging for IPF sufferers and added that "the safety and tolerability of pirfenidone was reassuring. The principal side effects experienced by patients in the studies were gastrointestinal discomfort and photo-sensitivity, both of which were manageable in the majority of patients."

The CAPACITY trials follow a Phase III clinical study conducted in Japan that was reported at the American Thoracic Society's 2008 International Conference in Toronto. That trial, which demonstrated the ability of pirfenidone to reduce the decline of lung capacity and improve progression-free survival, served as the basis for the Japanese regulatory authorities' approval of the medicine for the treatment of IPF in Japan.

Dr. du Bois concluded, "When taken in the context of the urgent unmet medical need for new medicines to treat IPF patients, the collective efficacy and safety data from the two CAPACITY studies, corroborated by a similar study in Japan, make a case for the use of pirfenidone in this disease setting."

InterMune, Inc., the developer of the medication, is preparing a New Drug Application (NDA) for pirfenidone for the treatment of IPF, which it expects to submit to the FDA in the summer of 2009, to be followed by a Marketing Authorization Application (MAA), which will be submitted to the European Medicines Agency (EMEA) around the end of 2009. Meanwhile, all patients in the study have been offered pirfenidone as part of an open-label, long-term safety study called RECAP.

Injectable Testosterone Undecanoate In Tea-seed Oil Found an an Effective Male Contraceptive

Mon, 11 May 2009 13:37:27 PST

( from http://www.rxpgnews.com ) Injectable testosterone could be the way to male contraception, that is effective, reversible, and minus serious short-term side-effects, according to a new study.

'For couples who can not, or prefer not to, use only female-oriented contraception, options have been limited to vasectomy, condom and withdrawal,' said Yi-Qun Gu, National Research Institute for Family Planning - in Beijing.

'Our study shows a male hormonal contraceptive regimen may be a potential, novel and workable alternative,' he added.

Gu said this study is the largest multi-centre, male hormonal contraceptive efficacy clinical trial of an androgen preparation in the world.

Participants included 1,045 healthy fertile Chinese men aged between 20-45 years. Each participant had fathered at least one child within the two years before the study and had a normal medical history.

Their female partners were between 18 and 38 years of age and had normal reproductive function.

Males were injected monthly with 500 mg of a formulation of testosterone undecanoate - in tea seed oil for 30 months. Results showed a cumulative contraceptive failure - rate of 1.1 per 100 men in the 24-month efficacy phase.

No serious adverse events were reported and reproductive function returned to the normal fertile reference range in all but two participants, said a NRIFP release.

'Despite the present encouraging results, the long-term safety of this hormonal male contraceptive regimen requires more extensive testing with a focus on cardiovascular, prostate and behavioural safety,' said Gu.

NC State develops new test method to measure stored heat in firefighter suits

Tue, 14 Apr 2009 03:59:36 PST

( from http://www.rxpgnews.com ) For decades, researchers have evaluated the thermal performance of protective clothing worn by firefighters. A particular area of current interest is how to address the burns received by firefighters when they are not directly in contact with fire - called stored heat burns. Researchers at North Carolina State University have developed a testing apparatus and measurement protocol that allow firefighter suits to be evaluated for their ability to prevent and minimize stored heat burns.

You can compare the burn to when you sit close to a fireplace, and then press down on your jeans and you can feel the heat, says Dr. Roger Barker, professor of textile engineering chemistry and science, and director of the Textile Protection and Comfort Center (T-PACC). Firefighters are getting burns without ever coming in direct contact with the flames. It is a serious issue.

Barker and his colleagues were contacted to develop and evaluate this new test method for stored heat measurement in a two-phase study. During the first phase, sponsored by the National Institute for Occupational Safety and Health, Barker and his team developed a laboratory testing apparatus to conduct the stored energy test which measures transferred and discharged heat in turnout suit materials. The second phase, sponsored by the National Fire Protection Research Foundation, involved using that apparatus to test a variety of firefighter suits and develop a database that will facilitate a new national standard that firefighter suits are measured against and certified.

All firefighter turnout suits are made of three layers - an outer shell, moisture barrier and thermal liner. There are many different combinations of fabrics and barriers used, and reinforcements and reflective trim are attached to the outer shell. Regardless of the combination of materials used, suits must go through a battery of tests to meet the standard set by the National Fire Protection Association, or NFPA.

One of the major objectives of our study was to better understand the role moisture - mostly the sweat from firefighters - plays in transferred and stored heat burns, Barker says. When moisture accumulates in the turnout suit materials, it has a big effect on the thermal properties of those materials and changes its heat capacity and thermal conductivity. These changes affect its thermal protective insulation and ability to store thermal energy.

The stored energy test protocol we developed includes having suit test materials pre-conditioned with moisture - similar to the sweat of a firefighter - in order to determine the effect on transferred and stored heat, Barker adds.

Throughout the development process, various stakeholders - including firefighters, suit manufacturers and members of the NFPA - provided feedback and input to NC State's researchers in order to develop a protocol that met the needs of the firefighters, while understanding the challenges and limitations of the manufacturing process. The NFPA is currently reviewing the protocol supplied by NC State's College of Textiles, and will consider adopting this test method as part of the requirements that manufacturers will need their suits to meet in order to have their suits certified as complying with the NFPA standard.

We know there is no lab test that measures with absolute accuracy what a firefighter encounters, because every fire is a different set of conditions and thermal threats, Barker says. However, we now have a better understanding of the general causes and mechanisms behind transferred and stored heat, and a test method to measure these effects. This research and recommended testing protocol is a major development that could significantly improve the health and safety for firefighters everywhere.

Milkshakes are medicine for anorexic teens in family-based outpatient therapy

Thu, 02 Apr 2009 03:59:36 PST

( from http://www.rxpgnews.com ) NEW YORK (April 2, 2009) -- Getting your teenager to drink a chocolate milkshake isn't something most parents need to worry about. But this is just the approach used in one treatment for anorexia nervosa. Known as Behavioral Family Therapy, or the Maudsley Approach, parents are called up on to supervise the eating habits of their anorexic child, feeding them high-calorie meals like milkshakes and macaroni and cheese until they regain a healthy weight.

For the first time, the Maudsley Approach is being compared with a more established treatment known as Family Systems Therapy as part of an ongoing National Institutes of Health (NIH)-funded treatment study at NewYork-Presbyterian Hospital/Westchester Division and five other centers nationally. Both are outpatient therapies for adolescents, aged 12 to 18.

Anorexia is a life-threatening condition. Treating it early is very important since it is during the teenage years that this disorder usually takes hold, says Dr. Katherine Halmi, founder of the Eating Disorders Program at NewYork-Presbyterian Hospital/Westchester Division and professor of psychiatry at Weill Cornell Medical College. Traditionally, patients with anorexia have been treated in a hospital setting or through one-on-one outpatient therapy. While inpatient treatment is still appropriate in acute cases, we have increasingly seen the value of family-oriented outpatient therapy for adolescents.

The current study is designed to compare two different therapeutic approaches that involve the family -- one is a behavioral therapy initially focused on weight gain, and the other examines various underlying issues in the family dynamic.

In the Maudsley Approach, named after the hospital in London where it was developed in the 1980s, the anorexic teenager attends therapy sessions together with their parents and siblings. Parents work with the Maudsley therapist to develop ways in which they can monitor their child's intake, choosing the amounts and types of foods necessary for them to regain to a healthy weight. Siblings are encouraged to act as a support system for their sister or brother. Once patients achieve a healthy weight, they graduate toward taking more responsibility for their intake. At this point, family and developmental issues relevant to the patient maintaining a healthy weight are addressed.

In Family Systems Therapy, families also attend regular therapy sessions, but discussions do not necessarily focus on eating. Instead, family members are free to broadly explore and challenge any problematic communication patterns or stressors within the family unit.

In Maudsley, food is medicine that restores the body and mind. When the body is starving, the mind also weakens, becoming more susceptible to anorexia's rigid, often obsessive logic. Supervised feeding helps to break this vicious cycle. With the anorexia in charge, the adolescent really cannot regain the weight on his or her own. Nutritional rehabilitation gives the brain the nutrition it needs to re-establish healthy eating habits, says Dr. Dara Bellace, a clinical psychologist at NewYork-Presbyterian Hospital/Westchester Division and an instructor of psychology in psychiatry at Weill Cornell Medical College.

This approach does not blame parents, but rather calls on their ability to nurse their child back to health. It requires a strong commitment to be with them for every meal -- something that can mean rearranging schedules and taking a tag-team approach to sharing the responsibility, adds Dr. Bellace. The adolescent must also dedicate themselves to the therapy, understanding that, until they regain the weight, their parents will be feeding them much as they did when they were younger, deciding what and how much they eat and making sure they finish.

Previous research has shown the Maudsley Approach successfully prevented hospitalization and helped adolescents recover their normal weights, with at least 75 percent of patients maintaining their recovery after five years.

A total of 240 adolescents aged 12 to 18 are being recruited for the study at six centers: NewYork-Presbyterian/Westchester; Stanford University in Palo Alto, Calif.; Sheppard Pratt in Baltimore, Md.; University of California at San Diego; University of Toronto; and Washington University in St. Louis. Those eligible must be medically stable individuals ages 12 to 18 with a body weight between 75 percent and 87 percent of its healthy range. Families are randomized to receive either the Maudsley Approach or Family Systems Therapy. In each family treatment, they attend 16 one-hour sessions over the course of nine months. Sessions are held weekly for the first seven to eight weeks, bimonthly for the next six sessions, and monthly for the remaining sessions.

Anorexia nervosa is an eating disorder characterized by extreme low body weight and body image distortion with an obsessive fear of gaining weight. The condition largely affects adolescent females, who make up more than 40 percent of all cases. As much as 3 percent of American girls and women are anorexic. Contributing causes may include genetics, personality type, hormones, stress and societal pressures.

Anorexia carries the highest mortality rate of any psychiatric condition. Previous research by Dr. Halmi found that 7 percent of affected women died within 10 years. In a Swedish study that followed patients for 30 years, 18 percent to 20 percent of the women died. Even when anorexia is not fatal, it can cause long-term complications, including damage to the heart and bones.

Codeine use and accident risk

Tue, 24 Mar 2009 03:59:36 PST

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

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

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

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

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

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

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

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

New surgical option for wrist arthritis

Fri, 13 Feb 2009 04:59:36 PST

( from http://www.rxpgnews.com ) NEW YORK (Feb. 13, 2009) -- Breaking a fall, such as a tumble on the sidewalk, with your hands and wrists is everyone's natural reflex. But, if you fall hard enough, you'll often fracture your radius bone, or even one of the smaller wrist bones and wrist ligaments. Left untreated, these injuries could lead to disabling wrist arthritis.

For patients who develop wrist arthritis, a new surgical option known as OCRPRC (OsteoChondral Resurfacing in Proximal Row Carpectomy) is available at NewYork-Presbyterian Hospital/Columbia University Medical Center, where it is offered by one of the orthopedic surgeons who originally developed and described the technique -- Dr. Peter Tang. His research shows that the procedure reduces pain and improves hand function.

I often see patients who had a wrist injury in the past who either did not seek medical attention or whose original injury was not diagnosed. As with most things in medicine, the earlier a diagnosis is made, the better the outcome. So if you continue to have pain after a month, you should make an appointment to see a hand surgeon for an evaluation, says Dr. Tang, who is an orthopedic hand surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of orthopedic surgery at Columbia University College of Physicians and Surgeons.

Because the biomechanics of the wrist is both delicate and complex, an alteration in the normal anatomy can lead to arthritis. Once disabling arthritis develops, surgery cannot simply fix the injured structure, but rather must remove the arthritis and improve wrist function. The two most common operations for wrist arthritis are a partial fusion of the small wrist bones (intercarpal fusion) and excision of the first row of carpal bones (proximal row carpectomy, or PRC). There are various reasons to choose one operation over the other, but PRC has a quicker recovery, may be better for older patients, gives equal grip strength to intercarpal fusion, and usually results in more wrist motion.

Once the three carpal bones are removed during the PRC procedure, the capitate bone becomes the point where the wrist articulates with the arm; as such, it is important that the arthritis has not progressed to the capitate bone.

For these patients whose arthritis has progressed, Dr. Tang has adapted a cartilage-grafting technique that is used effectively in sports medicine treatments for cartilage disorders in the knee, ankle and elbow. The results are promising, according to his study in the Journal of Hand Surgery, with improvement in grip strength and decrease in pain levels.

The goal of this new procedure is to give the best possible outcome by improving the cartilage status of the capitate bone. Another plus is that we do not have to take the graft from another part of the body. Even though we take out the three carpal bones for arthritis, there is usually one area of the bones where we can find undamaged cartilage for grafting, says Dr. Tang.

The study followed eight patients who underwent osteochondral resurfacing over 18 months. Preoperatively, seven patients described their pain as moderate to severe, while postoperatively, seven patients described their pain as mild to no pain, and one patient described the pain as moderate. Preoperative grip strength increased from 62 percent of their healthy side to postoperatively, 71 percent. Preoperative Mayo wrist score improved from a score of 51, which rates as poor, to a postoperative score of 68, which rates as fair.

Smokers putting their loved ones at risk of heart attacks

Wed, 11 Feb 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Researchers at University College London and St George's, University of London measured recent exposure to tobacco smoke in non-smoking middle-aged men taking part in the British Regional Heart Study by measuring the levels of cotinine - a compound carried in the blood - at two time points 20 years apart. A blood cotinine level above 0.7ng/mL is associated with a 40% increase in the risk of a heart attack (2), and other studies have suggested that even a level of 0.2ng/mL may increase the risk (3). The researchers found that while in 1978-80, 73% of men had a cotinine level above 0.7ng/mL, by 1998-2000 that proportion had fallen to 17%.

However, despite the number of non-smoking men at risk having fallen, half of those who still had a high cotinine level (above 0.7 ng/ml) in 1998-2000 lived with a partner who smoked. Non-smoking men who had a partner who smoked had average cotinine levels of 1.39ng/mL, almost twice the level associated with an increased risk of a heart attack. Their cotinine levels were nearly eight times higher than the cotinine levels of men whose partner did not smoke.

During the period the study looked at, national data shows that the prevalence of smoking amongst adults across the UK declined from 40% to 27% and the number of cigarettes consumed by smokers fell from 114 to 97 per week. Restrictions on smoking in public spaces and workplaces were also introduced, although the study period was before the national legislative bans on smoking in public places introduced between 2006 and 2007.

Dr Barbara Jefferis, from University College London who led the research, said: The decline in smoking together with restrictions on smoking in public places has created an environment where people are exposed to far less tobacco smoke. This has resulted in the dramatic fall in the number of non-smokers at an increased risk of a heart attack.

However, we can clearly see that living with someone who smokes puts you at a heightened risk. If we are going to reduce people's exposure to tobacco smoke further then we will need to focus efforts on reducing smoking in the home.

Professor Peter Weissberg, Medical Director at the BHF, said: This research shows that a great deal of progress has been made in reducing exposure to potentially damaging environmental tobacco smoke over the past 20 years. Importantly, it also shows that people are now more at risk of exposure in their own homes than in public places.

We cannot stop people smoking in their own home, but we would urge smokers to think of the risk they're exposing their non smoking friends and relatives to when they have a cigarette in the house.

The BHF are calling for a proper plan to reduce the harm from smoking including measures in the NHS Bill that will put an end to point of sale displays and prohibit cigarette vending machines, which are disproportionately used by underage smokers.

Unexplained chest pain can be due to stress

Mon, 09 Feb 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Each year, many people seek emergency treatment for unexplained chest pains. A thesis from the Sahlgrenska Academy, University of Gothenburg, Sweden, indicates several common factors among those affected, including stress at work, anxiety, depression and a sedentary lifestyle.

Chest pain is a common reason for patients to seek emergency treatment. A considerable number of patients are diagnosed with unexplained chest pain, which means that the pain cannot be linked to biomedical factors such as heart disease, or some other illness. The patient group is significant in size, with just over 20,000 patients seeking hospital treatment in 2006, and so far researchers have been unable to identify specific causes for unexplained chest pain.

Many suffer from recurring bouts of pain over several years, while the healthcare services are unable to find out what's causing it, says Registered nurse Annika Janson Fagring, the author of the thesis.

In her thesis, Annika Janson Fagring describes and analyses symptoms among patients with unexplained chest pain. The results show that most of them are middle-aged, and that over a third of those affected were born outside Sweden. The chest pain had a negative impact on the patients' daily life in the form of tiredness, anxiety and fear of death.

The main difference between women and men with unexplained chest pain is that men were more likely to perceive their lives and jobs as being stressful, while women tended more to suffer from symptoms of depressions and anxiety, says Annika Janson Fagring.

The patients, both men and women, experienced more symptoms of depression and anxiety, and work-related stress when compared with a reference group of people who were not suffering from heart disease. The male patients were more physically active in their spare time than the female patients, but compared with the reference group, both the men and the women with unexplained chest pain led a more sedentary lifestyle.

The thesis also looks at the development of symptoms and the prognosis for patients with unexplained chest pain over a period of time, compared with patients suffering from angina and patients who had suffered a heart attack. A register study revealed that from 1987 up until 2000, the number of patients with diagnosed unexplained chest pain increased, and then levelled out. The number of patients with angina increased up until 1994 and has since fallen, while the number of patients who have suffered heart attacks has fallen throughout the whole period examined.

There were fewer deaths among patients with unexplained chest pain a year after they became ill, compared with patients that became ill with angina or suffered heart attacks. Deaths among men a year after falling ill with unexplained chest pain were a third higher compared with men in the rest of the population, while women did not display any increased risk of death.

Annika Janson Fagring says that the thesis shows that it is important to improve knowledge and understanding of the symptoms experienced by patients with unexplained chest pain, in order to be able to offer more individualised care.

Computerized writing aids make writing easier for persons with aphasia

Tue, 03 Feb 2009 04:59:36 PST

( from http://www.rxpgnews.com ) It is possible to improve writing skills for those with aphasia with the aid of computerised writing aids. This is the conclusion of a doctoral thesis from the Sahlgrenska Academy at the University of Gothenburg, Sweden.

Aphasia affects the ability to understand and use spoken language, and the ability to read and write. Persons with aphasia were trained in the use of computerised writing aids in the study on which speech and language pathologist Ingrid Behrns' doctoral thesis is based. The subjects were aided by a computer-based spell-checker and a program for word prediction, similar to that used when writing SMS messages on mobile telephones.

The thesis shows that writing ability improved in several ways with the aid of these programs.

A fairly high reading and writing ability is necessary in order to benefit from the most common spell-checkers. So we used two writing aids that have been specially developed for persons with dyslexia, instead. These programs were also useful for persons who have writing problems arising from aphasia, says Ingrid Behrns.

The programs are easy to use and cheap to purchase, and may be beneficial for many people who have aphasia. The greatest benefit for those who were members of the group receiving writing training was that it became easier to make corrections in what they had written. They also wrote longer sentences with fewer spelling errors.

But is important to remember that time must be invested in learning how to use the computer programs. It was particularly encouraging to find that it is possible to improve writing ability even though several years have passed since the participants developed aphasia, says Ingrid Behrns.

Previous research into writing ability and aphasia has focussed on the spelling of single words, but the work presented in the thesis investigated not only the completed text but also revisions that were made when writing a story. This makes it possible to see the aspects of the writing process for which the writer has had to use most energy. The thesis also shows that persons with aphasia can write stories with high coherence and a good overall structure, despite their language difficulties. The results also show that it is sometimes easier for persons with aphasia to express themselves in writing rather than in spoken language.

The good results from the writing training are very encouraging since the ability to express oneself in writing opens many possibilities for communication using the Internet, says Ingrid Behrns.

APHASIA: Aphasia is a collective term for language difficulties that can arise after a stroke, for example, or from head injuries such as may be suffered in a traffic accident. Older persons are affected more often than younger, but aphasia can affect persons of any age. A person with aphasia has difficulty understanding, speaking, reading and writing, while their intellectual abilities are not impaired in any way. Approximately 12,000 Swedes are affected by aphasia each year.

Fainting, stomach upsets and heart conditions most common in-flight medical conditions

Sat, 24 Jan 2009 16:25:54 PST

( from http://www.rxpgnews.com ) Fainting is the most common in-flight medical emergency. Research recently published in BioMed Central's open access journal Critical Care details the number, type and frequency of medical emergencies on board two airlines.

Michael Sand led a team of researchers from the University of Bochum, Germany, and the University of California Los Angeles (UCLA), who analysed 10,189 different emergencies. He said, "Although in-flight medical emergencies are rare in general, they can have a significant effect on other passengers and crew, potentially with operational implications for the flight. The breakdown of the various medical emergencies encountered in our study showed that fainting was by far the most frequent medical condition, followed by stomach upsets, and heart conditions".

In all, the authors found 5307 cases of fainting (53.5%), 926 cases of gastrointestinal problems (8.9%) and 509 cases related to a cardiac condition (4.9%). The highly publicized problem of thrombosis accounted for a very small number of cases, although they do occur most often after a flight, rather than during. According to the authors, "Surgical illnesses accounted for a minor percentage of all on-board emergencies. There were 47 cases of thrombosis (0.5%), 27 appendicitis cases (0.25%) and just one case of gastrointestinal bleeding (less than 0.1 %). There were two births and 52 deaths".

The authors highlight that there are major problems with record keeping about in-flight emergencies. Out of 32 airlines approached to take part, 27 did not have the data available, one had data that was unsuitable and two refused to take part due to company policy. Sand said, "Standardization of in-flight medical emergency reporting is necessary for further larger studies to be conducted, as the current quality of data is poor".

The limited scope of the data available makes it difficult to make strong recommendations based on the information, but the authors do note that not all of the airlines had defibrillators as part of their medical flight kits. Sand said, "Considering the fact that cardiac conditions were the third most common condition seen in this study, patients with cardiac irregularities may profit from an on-board automatic external defibrillator. The same is true for patients with a suspected myocardial infarction."

Researcher wins $1.2 million grant for gene regulation work

Fri, 09 Jan 2009 04:59:36 PST

( from http://www.rxpgnews.com ) TALLAHASSEE, Fla. -- A unique discovery in a Florida State University College of Medicine laboratory is the basis for research with the potential to one day help scientists learn how to stop cancer and other diseases in the tissue where they are forming.

Jamila Horabin, associate professor of biomedical sciences at the College of Medicine, has received a four-year, $1.2 million grant from the National Institutes of Health to pursue her work. Horabin recently discovered a direct link between RNA silencing and the genetic master switch controlling the sex determination process in fruit flies.

With that knowledge, she is now seeking to fully understand how a cellular process in gene regulation called the RNA-induced silencing complex (RISC) might interfere with or silence the genes assumed to be at work in nearly all forms of disease and cancer. With a greater understanding of the process, her hope is that scientists will one day be able to switch off the gene activity causing cancerous tumors and cardiovascular disease.

We want to know how RNA silencing affects fundamental gene expression, Horabin said. Many genes are regulated by this process, and it will have far-reaching impact if we understand how it works, which is really the hope and dream of a basic scientist.

Myra Hurt, associate dean for research and graduate programs at the College of Medicine, said Horabin's work has great potential for finding a new way of fighting disease.

There are a number of genes involved with tumor development and metastasis, for example, Hurt said. Imagine if you could target those genes and silence them in the tissue where they are. Here is one more layer of gene regulation that we really didn't know about until fairly recently, and now if we can understand it maybe we can use this technology to target genes involved in disease conditions very specifically and silence them.

The fruit fly offers numerous advantages for such research. Its genome has been fully mapped, so every gene is known and can be studied for cause and effect relationships in the laboratory. Additionally, the fruit fly reaches full maturity in a matter of days, is plentiful, inexpensive and, most importantly, shares remarkable similarities to humans at the level where gene activity is regulated.

Sometimes you find that the fly gene that you are working with is similar to a human gene that is involved in directing a disease, Horabin said. So if the fly gene is being regulated in a particular way, then odds are the human gene is being regulated the very same way.

Study to explore ethical challenges health professionals face while caring for children with LTNMDs

Wed, 07 Jan 2009 04:59:36 PST

( from http://www.rxpgnews.com ) (Baltimore) The Greenwall Foundation recently awarded two core faculty members of the Johns Hopkins Berman Institute of Bioethics a grant that will allow Drs. Gail Geller and Cynda Hylton Rushton to explore the ethical challenges health professionals face while caring for children and families affected by life-threatening neuromuscular diseases (LTNMD).

The concept for this latest LTNMD study grew out of the work of the international HeartSongs Project funded by the Stavros Niarchos Foundation. The goal of the HeartSongs Project is to develop a worldwide network of professionals from a range of disciplines, parents and affected children who share a common vision of comprehensive care for children with LTNMD. In addition to the United States, countries involved in the HeartSongs project include the United Kingdom, Canada, Australia, France, Denmark and Greece. The Project aims to integrate the principles of pediatric palliative care (PPC) into the care of individuals living with LTNMDs. PPC can be described as a holistic, interdisciplinary model of care that incorporates emotional, spiritual, developmental, and physical dimensions. The HeartSongs' International Consortium will develop recommendations regarding promising practices in comprehensive and integrated care. The two-year project, co-directed by Geller and Rushton, opened with a summit in England this past April and will culminate in a second summit to be held in Greece in March 2009. Hopes for a HeartSongs II call for expanding the project to include more European countries as well as countries in South America, Africa, Asia and the Middle East.

The HeartSongs Project is named in honor of the young American poet Mattie J.T. Stepanek who lived with a rare form of muscular dystrophy. Mattie's messages of love, hope and peace have stirred the hearts and souls of millions worldwide. The author of 7 books, Mattie shared hope through his 'Heartsongs' poetry, and collaborated with Former President Jimmy Carter on an essay book, Just Peace. (http://www.mattieonline.com/) Mattie died in 2004 just before his fourteenth birthday. According to Dr. Rushton, Mattie's legacy for a better world for all children has inspired our work to improve the lives of children, like Mattie, who live with LTNMDs.

Geller and Rushton's earlier research, also funded by the Stavros Niarchos Foundation, revealed that many parents of children living with LTNMD often do not take advantage of Advanced Care Planning (ACP) as early as experts recommend. Because the life expectancy of LTNMDs is uncertain and unpredictable, Drs. Geller and Rushton claim that ACP, and palliative care more broadly, should not be restricted solely to children who are considered close to death.

Geller and Rushton's newest Greenwall Foundation funded study will focus on the attitudes and behaviors of health professionals who care for patients living with Duchnne Muscular Dystrophy (DMD) and Spinal Muscular Atrophy (SMA Type 1), the two most common pediatric LTNMDs worldwide. Although both diseases are life threatening, says Dr. Geller, each has a unique life expectancy and disease trajectory thereby creating distinct ethical challenges for the children, their families and the health care team. Dr. Rushton says, based on a review of the literature and our own prior work, there is a need to more fully understand the nature, prevalence, and consequences of ethical challenges experienced by Neuromuscular Disease specialists who care for these children, adolescents and their families. These findings will fill an important gap that will inform the development of targeted interventions to support patient/family centered care of children with LTNMD's and their families.

Rushton and Geller say results of the national survey of health care practitioners will be presented to a focus group of regional Muscular Dystrophy Association-clinic directors and pediatric palliative care specialists to develop clinical and policy recommendations for enhancing ethically appropriate care for children with LTNMD.

Persistent Sexual Arousal Syndrome Renamed As Restless Genital Syndrome

Sun, 28 Dec 2008 13:02:44 PST

( from http://www.rxpgnews.com ) Restless legs and overactive bladder could trigger imminent orgasms in women, according to a study.

Neuropsychiatrist Marcel Waldinger and his colleagues of Utrecht University and The Hague's HagaHospital studied 18 Dutch women with Persistent Sexual Arousal Syndrome -.

Their findings were recently published in the Journal of Sexual Medicine.

Women affected by this rare and mysterious syndrome experience persistent genital sensations as if they are continuously on the verge of an orgasm.

All participants received in depth interviews and various medical examinations such as MRI-scans of the brain and pelvis. The study showed that most women in this research also had restless legs, symptoms of an overactive bladder and pelvic varicosis.

'These results are a very important breakthrough in the research of this syndrome and show that this is a real physical disorder,' Waldinger emphasised.

In 2001, PSAS was mentioned for the first time in medical literature. Only 22 case reports have been described so far. A key feature of the syndrome is that sexual contact does not lead to diminishment but to aggravation of the symptoms. The complaints may lead to desperate and depressive feelings.

The majority of women in the study, the largest on PSAS so far, reported that their complaints were accompanied by restless legs and frequent urge to void.

Some of them reported to have restless legs symptoms long before their genital complaints. MRI-scan and ECHO-Doppler investigations of the pelvis and genitals also demonstrated a high prevalence of pelvic varicosis.

Notably, varicosis and restless legs are associated. The researchers are currently continuing their research on restless legs and bladder functioning in women with PSAS, said a Utrecht University release.

According to Waldinger, PSAS is a genital form of restless legs. Based on scientific observations, he postulated the view that the weird genital sensations are equivalent to the sensations belonging to the Restless Legs Syndrome.

'In order to emphasise this equivalence, we decided to change PSAS into Restless Genital Syndrome -', Waldinger explained.

Both theories about human cellular aging supported by new research

Tue, 16 Dec 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Aging yeast cells accumulate damage over time, but they do so by following a pattern laid down earlier in their life by diet as well as the genes that control metabolism and the dynamics of cell structures such as mitochondria, the power plants of cells.

These research findings, presented at the American Society for Cell Biology (ASCB) 48th Annual Meeting, Dec. 13-17, 2008 in San Francisco, support the theories that old age is the final stage of a developmental program AND the result of a lifelong accumulation of unrepaired cellular and molecular damage.

The diet plus metabolic genes pattern is a modular longevity network, says Vladimir Titorenko of Concordia University in Montreal, who studies baker's yeast, Saccharomyces cerevisiae, as a simpler model for the complex mechanisms of human cellular aging.

Through the yeast model, Titorenko and colleagues identified five groups of novel anti-aging small molecules that significantly delayed aging.

The scientists first identified a mechanism closely linking life span to the dynamics of such lipids as cholesterol, triglycerides and fatty acids: When fatty acids build up, yeast cells explode from within, scattering their contents and spreading inflammation to neighboring cells.

In addition to cell death, the accumulation of fatty acids sets off chemical reactions that ultimately produce a lipid called diacylglycerol, which impairs many of the yeast's stress response-related defenses.

Knowing the link between life span and lipid dynamics, the scientists next evaluated aging effects of both calorie-rich and low-calorie diets.

The calorie-rich diet suppressed the oxidation of fatty acids in peroxisomes, structures in cells that use enzymes to neutralize toxic peroxides.

These fatty acids are constantly synthesized in the endoplasmic reticulum (ER), the cell's protein manufacturing factory. Without peroxisome processing, fatty acids end up deposited within lipid bodies.

Low-calorie diets, which have been shown to increase lifespan and delay age-related disorders in nonhuman primates and other organisms, altered the way fats were processed in the yeast cells.

The researchers assessed calorie restriction along with a number of known mutations that extend yeast lifespan against a variety of age-related changes in fat metabolism and lipid transport.

To determine whether the diet-aging mechanism could be manipulated by a therapeutic drug, Titorenko and his colleagues developed a life-span assay for a high-throughput screening of multi-compound chemical libraries.

The assay identified five groups of novel anti-aging small molecules that significantly delayed yeast aging by remodeling lipid dynamics in the ER, peroxisomes and lipid bodies or by activating stress response-related processes in mitochondria.

These small molecules can be used as research tools to investigate the mechanisms of longevity, says Titorenko, and as possible pharmaceutical agents for age-related disorders that affect lipid metabolism such as heart disease, chronic inflammation, and Type 2 diabetes.

Bittersweet milestones

Mon, 24 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) For many of the elderly, the golden years are anything but. Faced with health problems, financial issues and the death of a spouse or loved one, many adults 65 years and older suffer from depression. While research is emerging to help this group understand and treat the problem, another group - centenarians - has been left largely in the dark.

Centenarians are still rare, and depression hasn't been studied thoroughly in this group, said Adam Davey, a developmental psychologist in the College of Health Professions at Temple University. We've found that it's a very under diagnosed condition among people over 100 years old, yet it's one of the most easily treated forms of mental illness.

According to the U.S. Bureau of the Census, more than 60,000 people in the U.S. are 100 years old or over, and as baby boomers start to hit their 100-year mark, that number is expected to more than quadruple to 274,000. As a result of this new boom, a group of researchers have been studying this group more and more to learn about successful late-life aging.

In a study presented at the Gerontological Society of America's annual meeting on Nov. 24, lead author Davey and colleagues from institutions across the country looked at indicators of depression among respondents enrolled in the Georgia Centenarian Study, a three-phased project to study quality of life for those over age 100.

Based on responses given in the survey by a sample of 244 centenarians, researchers found that more than 25 percent showed clinically relevant levels of depressive symptoms, yet only 8 percent reported having a current diagnosis of depression.

Davey notes that further study will need to pinpoint the reason for these high levels, but his research suggests a number of factors, including poor nutritional status, urinary incontinence, limited physical activity and past history of anxiety.

People who suffer from depression tend to have a high risk of mortality, so it's puzzling to see higher numbers among the oldest old, he said.

In an earlier phase of the Georgia Centenarian Study, researchers found that centenarians living in a community setting were found to have higher levels of depression than their younger counterparts. Davey noted that since caregivers play a large role in the lives of many centenarians, it is important for doctors, nurses and even family members to focus on the larger picture to ensure a better quality of life.

Funerary monument reveals Iron Age belief that the soul lived in the stone

Tue, 18 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Archaeologists in southeastern Turkey have discovered an Iron Age chiseled stone slab that provides the first written evidence in the region that people believed the soul was separate from the body.

University of Chicago researchers will describe the discovery, a testimony created by an Iron Age official that includes an incised image of the man, on Nov. 22-23 at conferences of biblical and Middle Eastern archaeological scholars in Boston.

The Neubauer Expedition of the Oriental Institute at the University of Chicago found the 800-pound basalt stele, 3 feet tall and 2 feet wide, at Zincirli (pronounced Zin-jeer-lee), the site of the ancient city of Sam'al. Once the capital of a prosperous kingdom, it is now one of the most important Iron Age sites under excavation.

The stele is the first of its kind to be found intact in its original location, enabling scholars to learn about funerary customs and life in the eighth century B.C. At the time, vast empires emerged in the ancient Middle East, and cultures such as the Israelites and Phoenicians became part of a vibrant mix.

The man featured on the stele was probably cremated, a practice that Jewish and other cultures shun because of a belief in the unity of body and soul. According to the inscription, the soul of the deceased resided in the stele.

The stele is in almost pristine condition. It is unique in its combination of pictorial and textual features and thus provides an important addition to our knowledge of ancient language and culture, said David Schloen, Associate Professor at the Oriental Institute and Director of the University's Neubauer Expedition to Zincirli.

Schloen will present the Kuttamuwa stele to a scholarly audience at the meeting of the American Schools of Oriental Research on Nov. 22 in Boston, the major annual conference for Middle Eastern archaeology. Dennis Pardee, Professor of Near Eastern Languages and Civilization at the University of Chicago, will present his translation of the stele's 13-line inscription the following day at the annual meeting of the Society of Biblical Literature, also in Boston, in a session on Paleographical Studies in the Near East.

German archaeologists first excavated the 100-acre site in the 1890s and unearthed massive city walls, gates and palaces. A number of royal inscriptions and other finds are now on display in museums in Istanbul and Berlin. Schloen and his team from the University of Chicago have excavated Zincirli for two months annually since 2006.

Zincirli is a remarkable site, said Gil Stein, Director of the Oriental Institute. Because no other cities were built on top of it, we have excellent Iron Age materials right under the surface. It is rare also in having written evidence together with artistic and archaeological evidence from the Iron Age. Having all of that information helps an archaeologist study the ethnicity of the inhabitants, trade and migration, as well as the relationships of the groups who lived there.

Stroke patients soon may have fun, high-tech tool

Mon, 10 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) The University of Central Florida will immerse stroke survivors in a virtual world full of flying insects to help expand their range of movement.

Researchers in UCF's Media Convergence Lab (MCL) are teaming up with the California-based Virtual Reality Medical Center (VRMC) to create the program and software that can track patients' progress.

VRMC obtained a contract last year from the National Science Foundation to develop the virtual program, and the company teamed up with the UCF researchers for preliminary work. The research team since has landed a $199,000 contract to create a fully functional virtual game.

Although the game could change slightly, the design will require patients to put on goggles while sitting at a table. A few bugs would fly around nearby. The patients' mission is to smash all of the virtual insects. Each time they succeed, they would earn a point. As patients improve their range of motion, more bugs would appear at greater distances, forcing patients to work harder and increase their range of motion. Think of a 21st-century version of the childhood game Whack-a-Mole.

It has to be fun so patients will actually do their physical therapy exercises, said Eileen Smith, associate director of UCF's Media Convergence Lab at the Institute of Simulation and Training.

One of the sad things about stroke is that it is very isolating, she said. If we can make the game fun for everyone, maybe grandchildren will jump in while grandma is doing her exercises. Then it won't just be a physical therapy session; it will be family time. It will help patients re-engage.

Smith is collaborating with the project's lead researcher, Charles Hughes, director of the Media Convergence Lab and a professor in UCF's School of Electrical Engineering and Computer Science. During their preliminary work, they found that UCF could produce a viable and reproducible program with software to track patients' progress.

Funding for the second phase also will include $99,000 from the Florida High Tech Corridor.

We're ecstatic, Smith said. It's our lab's first phase II contract, and it is exactly the kind of thing we want. It goes with our lab's philosophy. We don't want to create cool widgets. We want to create things people can actually use to better their lives.

Smith and her team are working with a doctor and a physical therapist along with VRMC to create the prototype. UCF will deliver it to VRMC by the end of 2009 and provide a license to VRMC to enable commercialization.

VRMC plans to introduce the program to physical therapy clinics. Eventually, Mark Wiederhold, VRMC's president, said the company would market the product as a take-home program that patients could run on their computers or hand-held devices.

Wiederhold is a physician who has authored more than 200 journal articles. He said he partnered with UCF because it is a leader in simulation technology.

UCF is in a leadership position in this area of research, Wiederhold said. They are a very important team member on this project. UCF has a collaborating spirit. . . They get it.

That's part of the reason Wiederhold will be opening a new office in Lake Nona's Medical City. VRMC, which already has an office in Orlando, then will be close to UCF's new College of Medicine, with which Wiederhold is collaborating on other projects.

HIV drug maraviroc effective for drug-resistant patients

Wed, 01 Oct 2008 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Oct. 2, 2008) -- As many as one quarter of HIV patients have drug resistance, limiting their treatment options and raising their risk for AIDS and death. Now, maraviroc, the first of a new class of HIV drugs called CCR5 receptor antagonists, has been shown to be effective over 48 weeks for drug-resistant patients with R5 HIV-1, a variation of the virus found in more than half of HIV-infected patients.

Results of the two Phase 3 multicenter MOTIVATE (Maraviroc Plus Optimized Therapy in Viremic Antiretroviral Treatment Experienced Patients) studies led by NewYork-Presbyterian Hospital/Weill Cornell Medical Center's Dr. Roy Gulick and published in the October 2 issue of the New England Journal of Medicine (NEJM) find that the drug, taken with an optimized standard HIV drug regimen, resulted in significantly greater suppression of the virus at 48 weeks, with concurrent increases in immune system T-cell counts, when compared with placebo. Rates of side effects were not different between the maraviroc and placebo groups.

Preliminary results of these studies led to FDA approval of maraviroc in August 2007.

Because it is from a new class of HIV medications known as HIV entry inhibitors, people living with HIV generally will not have resistance to maraviroc because they have not been exposed to any drugs from the class previously. Unlike earlier HIV drugs that target the virus, maraviroc acts on the human T-cell, binding to it in such a way that prevents HIV from binding and subsequently infecting the T-cell.

It is now possible to expect that a majority of treatment-experienced patients who experience failure on their current HIV drugs will regain control of their HIV infection with maraviroc combined with other newer antiretroviral drugs. This is an important step forward, says study principal investigator Dr. Roy Gulick, who is professor of medicine and director of the Cornell HIV Clinical Trials Unit of the Division of International Medicine and Infectious Diseases at Weill Cornell Medical College, and a practicing physician at NewYork-Presbyterian Hospital in New York City. Suppressing virus levels and increasing immune system T-cells with HIV treatment regimens helps HIV-infected people live longer, healthier lives.

The double-blind study followed 1,049 of patients with advanced HIV and resistance to three antiretroviral drug classes. Patients were randomized to receive maraviroc once-daily, twice-daily or placebo. Safety and efficacy were assessed at 48 weeks. The MOTIVATE studies comprised two identical arms: MOTIVATE1 was conducted in Canada and the U.S., while MOTIVATE2 was conducted in Australia, Europe and the U.S.

15 years later: Landmark hearing study follows up on farm youth

Fri, 12 Sep 2008 03:59:37 PST

( from http://www.rxpgnews.com ) (MARSHFIELD, Wis.) A landmark study conducted by Marshfield Clinic Research Foundation (MCRF) 15 years ago found that an educational intervention improved hearing protection use among farm youth.

Now, the National Institute for Occupational Safety and Health (NIOSH) has awarded a $954,000 grant to MCRF to study the same group of Wisconsin youth to see whether the increase in hearing protection use continued into adulthood and whether it helped preserve hearing.

The new three-year study, under principal investigator Barbara Marlenga, Ph.D., a research scientist with the National Farm Medicine Center, MCRF, will evaluate whether the hearing conservation program conducted with farm youth from 1992-96 had long-term benefits to safeguard hearing. Although that hearing conservation program was conducted with farm youth, the impact of this new study goes beyond agriculture.

Noise-induced hearing loss is a big problem, Marlenga said. Ten million people in the United States, including children and youth, have hearing loss from exposure to loud noises. More than 30 million workers are estimated to be exposed to hazardous noise levels on the job.

The key to success of this study is the ability to find the youth from the original research study. To qualify for the new grant, Marlenga and colleagues conducted a search for the earlier participants, who are now young adults. She sent a letter to a small number of the original 689 people, then called and asked if they would be willing to participate in the follow-up study. More than 90 percent of those she reached said they would participate in a follow-up study.

Being able to demonstrate that we could find these students again was crucial to our receiving the grant, Marlenga said. This is a one-of-a-kind opportunity to see if early intervention to prevent noise-induced hearing loss can be sustained over time, Marlenga said.

The original study, conducted through the National Farm Medicine Center, MCRF, evaluated hearing of 689 farm youth in junior and senior high school. Half the participants received ear muffs and ear plugs as well as training and reminders about using hearing protection over a four-year period while in school. At the end of the study, the youth who received the intervention reported using hearing protection more consistently than those who did not, although at that time hearing test results were not different between the two groups.

After 15 years, we expect that noise-induced hearing loss would start to appear, Marlenga said.

For the new study, participants will again have their hearing tested and will be asked about work and home noise exposure. They will also be asked about hearing protection and whether they are required to use it where they work.

MEMS sensor for remote monitoring of asthmatic patients

Sun, 24 Aug 2008 10:26:01 PST

( from http://www.rxpgnews.com ) An inexpensive web-enabled device for measuring lung function in patients with asthma and other disorders is being developed by researchers at Texas Instruments, in Bangalore, India, and co-workers. Writing in the International Journal of Biomedical Engineering and Technology, the team explains how the devise could allow physicians to monitor their patients remotely and quickly instigate medical attention in an emergency.

Spirometers are commonly used to measure lung capacity and the response of breathing during therapy. However, the widespread application of spirometers is limited in the developing world and in remote regions because of the high instrument cost of the instrument and a lack of specialist healthcare workers trained in its use.

Texas Instruments researcher N.C.S. Ramachandran is an expert in high-speed and low-power digital design and is working with professor of electrical engineering Vivek Agarwal of the Indian Institute of Technology, Bombay, India, on the development of an inexpensive and easy to operate spirometer that can be quickly hooked up to an internet connection through built-in web and data encryption software.

Simply monitoring cough and wheezing in asthma sufferers does not always provide an accurate assessment of the severity of their symptoms. Breathing tests carried out using a spirometer, on the other hand, are much more accurate and can provide a clear indication of whether or not medication is being effective.

The team has developed the device as a low-cost, portable spirometer built around a pressure sensor for detecting airflow. The sensor is fabricated using technology similar to that for manufacturing computer chips and is based on microelectromechanical system (MEMS). The MEMS spirometer can measures the flow and volume of air moving in and out of the patient's lungs.

The use of mass production techniques for making the MEMS sensor, means the device can be inexpensive (a few dollars per unit), small, and so portable. Embedding of the necessary electronics and software to allow it to connect to a computer and the Web make it ideal for remote monitoring by a patient's healthcare worker. "Not only can the remotely located patient consult a specialist," the researchers say, "the specialist too can instruct the patient for specific test procedures and treatment."

Survivors of 1918 flu pandemic protected with a lifetime immunity to virus

Sun, 17 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) New research has discovered that infection and natural exposure to the 1918 influenza virus made survivors immune to the disease for the remaining of their lives. Antibodies produced by cells isolated from these survivors served as an effective therapy to protect mice from the highly lethal 1918 infection. The study entitled Neutralizing antibodies derived from the B cells of 1918 influenza pandemic survivors, was released for advanced online publication by the journal Nature. Researchers at Mount Sinai School of Medicine's Department of Microbiology contributed to the research findings. An estimated 50 million people were killed by the 1918 flu pandemic worldwide.

Ninety years after survivors encountered the 1918 pandemic influenza virus, we collected antibody-producing B cells from them, and successfully isolated B cells that produce antibodies that block the viral infection, said contributing author Dr. Christopher Basler, PhD, Associate Professor of Microbiology at Mount Sinai School of Medicine. The antibodies produced by these cells demonstrated remarkable power to block 1918 flu virus infection in mice, proving that, even nine decades after infection with this virus, survivors retain protection from it.

The fact that you can isolate these anti-1918 memory B cells so long after infection will hopefully provide the impetus to further study the mechanisms behind long lived immunity, said Dr. Osvaldo Martinez, post-doctoral fellow at Mount Sinai School of Medicine.

For this study, 32 individuals who were born before 1918 and lived through the influenza pandemic were recruited by Dr. Eric Altschuler at the University of Medicine and Dentistry of New Jersey to donate blood which was tested by Dr. Basler's lab for the presence of antibodies that recognize the 1918 virus. Dr. James Crowe and colleagues at Vanderbilt University produced antibodies from these individuals' blood cells and provided these to Dr. Basler's lab where the potent neutralizing activity against 1918 virus was demonstrated. Antibodies were also provided to Dr. Terrence Tumpey at the CDC to test in mice the strength of the antibodies derived from the 1918 survivors.

Our findings show that survivors of the pandemic have highly effective, virus neutralizing antibodies to this powerful virus, and humans can sustain circulating B memory cells to viruses for up to 9 decades after exposure, said Dr. Tshidi Tsibane, post-doctoral fellow, Department of Microbiology, Mount Sinai School of Medicine. These findings could serve as potential therapy for another 1918-like virus.

Vanderbilt University, Mount Sinai School of Medicine, University of Medicine and Dentistry of New Jersey, Centers for Disease Control and Prevention and The Scripps Research Institute collaborated on this research study.

About The Mount Sinai Medical Center The Mount Sinai Medical Center encompasses The Mount Sinai Hospital and Mount Sinai School of Medicine. The Mount Sinai Hospital is one of the nation's oldest, largest and most-respected voluntary hospitals. Founded in 1852, Mount Sinai today is a 1,171-bed tertiary-care teaching facility that is internationally acclaimed for excellence in clinical care. Last year, nearly 50,000 people were treated at Mount Sinai as inpatients, and there were nearly 450,000 outpatient visits to the Medical Center.

Mount Sinai School of Medicine is internationally recognized as a leader in groundbreaking clinical and basic-science research, as well as having an innovative approach to medical education. With a faculty of more than 3,400 in 38 clinical and basic science departments and centers, Mount Sinai ranks among the top 20 medical schools in receipt of National Institute of Health (NIH) grants.

Birth during a recession raises risk of fatal cardiovascular disease at advanced age

Mon, 11 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) People who suffer from cardiovascular diseases at advanced ages may have reason to suspect that the cause of their illness lies far away ... around the date of their birth. A team of European researchers reports that if economic conditions at the time of birth were bad, then this leads to a higher risk of cardiovascular mortality much later in life.

A recent study published by the Institute for the Study of Labor (IZA) in Bonn, Germany, finds that individuals born in a recession on average live 15 months shorter than those born under better conditions, and that this difference can be mostly attributed to cardiovascular health risks. Extrapolating this, early-life differences in economic household conditions go some way towards explaining why some individuals are hit by cardiovascular diseases at high ages and others are not.

What is surprising is that such effects may pop up seventy or eighty years after birth, said co-author Gerard van den Berg, who is Economics Professor at VU University Amsterdam and Program Director at IZA. In the intervening years, nothing extraordinary may happen in terms of health, but then suddenly the dead hand of the past can reach out and create fatal cardiovascular problems. The authors do not find such long-run effects on cancer in general, although certain types of cancer have been linked to low birth weight, which is another marker of early-life conditions.

The researchers use data on individuals born around 1900. Such old cohorts are necessary to study long-run effects on mortality. Moreover, in order to observe the death cause as well, the researchers had to resort to twins from Denmark, for whom death causes have been systematically collected for many years. The twin data come with an added bonus. They make it possible to check whether a twin pair's health outcomes are more similar later in life if they were born under adverse conditions than if they were born under good conditions. It turns out that, indeed, they are more similar later in life if the starting position was bad. Conversely, if an individual is born under better conditions, then individual-specific factors dominate more. In short, individual-specific qualities come more to fruition if the starting position in life is better.

As to the explanation of why bad economic conditions lead to long-run damage to the cardiovascular system, Van den Berg points to analyses his team carried out for specific parts of Denmark. These analyses suggest that long-run effects are particularly triggered by the combination of suboptimal nutrition and a suboptimal health infrastructure early in life. Low household income is less harmful for the baby's future if the environment has good health care and hygiene facilities. On top of this, it cannot be ruled out that stress is a major factor. Parents who are stressed due to economic hardship may produce offspring with features that make them more susceptible to cardiovascular diseases at advanced ages.

One may wonder whether the results are of significance for present-day birth conditions. Of course, we need another eighty years to know this for sure. But there are signs that long-run effects are as important as ever. For example, birth weight studies among recent cohorts show effects on health and adult height that are as strong as ever. And with the advent of the fast food society, nutritional habits among segments of society may not be as good as they used to be.

From this point of view, it may be worthwhile to screen young individuals born under adverse conditions for cardiovascular markers and predictors, and to expose those who have unfavorable test values to preventive interventions. Moreover, the results support investments in nutritional quality and health infrastructure in countries with a high degree of deprivation, as a means to reduce the cardiovascular mortality rate in future years.

Explosions and blast related injuries

Tue, 05 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) There has been a rise in global terrorism against nonmilitary targets. Recent events in Oklahoma City, New York City, Madrid, London, and Mumbai have demonstrated that mass casualties are more likely from explosive devices than from biological, chemical, radioactive, or nuclear weapons. Editors Nabil M. Elsayed, James L. Atkins and Nikolai Gorbunov have assembled an impressive list of international experts in the mechanisms and treatment of blast related injuries in this timely book.

This authoritative text begins with a section on the epidemiology of blast and explosion injuries which details issues of triage, morbidity and mortality, as well as clinical experiences treating casualties at combat support hospitals. The next section covers the pathology and pathophysiology of blast injuries on the lungs and nervous system as well as quaternary blast effects resulting in burns. In a section devoted to primary research on the mechanisms of primary blast injuries, there are chapters devoted to computational modeling of lung blast injuries and the biochemical mechanisms primary blast injuries to include the role of free radicals and oxidative stress and the inflammatory response in primary blast injuries. The final section of the book relates global experiences of blast injuries and their mass casualty management.

Other than the physicians who have treated trauma victims in settings such as Iraq and Afghanistan, few physicians in the United States have been trained in the care of the injured blast victim or have taken care of patients who have sustained injuries from explosions. The assessment of acute injuries from blast is still poorly understood and no reliable prognosticators of blast injuries currently exist. While this text is not meant to serve as a text for the treatment of blast-related injuries, it is meant to provide a better understanding of explosion blast injury mechanism which will in turn help in the design of better protective armor and improve medical care.

Co-Editor Colonel (retired) James L. Atkins, M.D., PhD stated he was thrilled we were able to assemble such a qualified international group of contributors for the book. This shows this is a worldwide problem, not just a military problem Dr. Atkins also added that These threats are constantly changing and it is important that medical professional recognize the patterns of blast related injuries and the inflammatory response precipitated by blast injuries that may take up to 48 hours to manifest. He hopes this book helps clinicians and researchers understand what is already known about blast injuries and that in turns helps to guide the treatment of mass casualties resulting in blast related injuries.

Sleep apnea linked to increased risk of death

Fri, 01 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Sleep-disordered breathing (also known as sleep apnea) is associated with an increased risk of death, according to new results from the Wisconsin Sleep Cohort, an 18-year observational study supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Researchers found that adults (ages 30 to 60) with sleep-disordered breathing at the start of the study were two to three times more likely to die from any cause compared to those who did not have sleep-disordered breathing. The risk of death was linked to the severity of sleep-disordered breathing and was not attributable to age, gender, body mass index (an indicator of overweight or obesity), or cardiovascular health status.

Sleep-Disordered Breathing and Mortality: Eighteen-Year Follow-Up of the Wisconsin Sleep Cohort, is published August 1 in the journal Sleep.

Researchers followed 1522 generally healthy men and women for an average of 13.8 years after testing them for sleep-disordered breathing using a standard overnight sleep test. Participants with severe sleep-disordered breathing were three times more likely to die during the study than those without breathing problems during sleep. Those who were not treated were at even greater risk. Participants with untreated severe sleep-disordered breathing were four times more likely to die from any cause and five times more likely to die from cardiovascular conditions.

The Wisconsin Sleep Cohort is the most comprehensive assessment yet of mortality risks associated with sleep-disordered breathing and the first to study a randomly selected population of adults in the United States. The findings suggest that the treatment of severe sleep-disordered breathing may be protective, especially against cardiovascular deaths. Further studies are needed to determine whether the findings are applicable across the United States, and how treatment may improve survival, quality of life, and the overall health status of affected individuals.

Michael J. Twery, PhD, director of the NHLBI National Center on Sleep Disorders Research, is available to comment on these findings, as well as on associated health risks of sleep-disordered breathing, and the importance of diagnosing and treating the condition.

An estimated 12-18 million Americans have moderate to severe sleep-disordered breathing. Periodically during sleep, the upper airway becomes narrowed or blocked, and air has trouble reaching the lungs; in some cases, breathing stops completely (called apnea) for seconds to minutes at a time. The frequent pauses in breathing disrupt sleep and prevent adequate amounts of oxygen from entering the bloodstream. Interruptions in breathing are potentially serious medical conditions and should be evaluated by a physician to determine whether treatment is needed.

Because affected individuals are asleep and typically unaware of the breathing problems, and the condition cannot be diagnosed during routine physician office visits, most people with sleep-disordered breathing are undiagnosed.

New male circumcision device for HIV prevention studied by NewYork-Presbyterian/Weill Cornell

Fri, 01 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (July 31, 2008) -- With the recent endorsement by the World Health Organization (WHO) and scientists worldwide of adult male circumcision as an important strategy for HIV prevention, there is increased urgency to develop safe and cost-effective circumcision services. This is especially the case in Africa where HIV/AIDS continues to spread at an epidemic rate.

Studying this method are Dr. Marc Goldstein and physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, who are evaluating an innovative circumcision device developed in China and will initiate a study of the device in Africa in the coming months.

The device, named the ShangRing after its inventor, Mr. Jian-Zhong Shang, consists of two concentric plastic rings that sandwich the foreskin, allowing it to be cut away without suturing and with minimal bleeding. Performed in a clinic under local anesthesia, the procedure takes less than five minutes, compared with approximately 20 to 30 minutes for a traditional free hands circumcision that requires suturing. The patient returns in one week for device removal.

Circumcision with this technique promises to be faster, safer and more acceptable to patients than conventional surgical circumcision methods, says Dr. Goldstein, the study's principal investigator. He is urologist and specialist in reproductive medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology at Weill Cornell Medical College, and senior scientist at The Population Council, Center for Biomedical Research, located on the campus of The Rockefeller University.

The hope is that with these advantages, circumcision will become more commonplace (currently only between 15 and 50 percent of sub-Saharan males are circumcised). Its advantages include reduced risk of a variety of sexually transmitted diseases (STDs), notably HIV.

Circumcision is the only new HIV prevention method to demonstrate consistent efficacy in randomized controlled trials, notes co-principal investigator Dr. Philip S. Li, associate research professor of urology and reproductive medicine and director of microsurgical research and training at the Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical College.

Three randomized controlled trials in Kenya, Uganda and South Africa reported a protective effect (up to 60 percent) of circumcision against HIV infection. The World Health Organization, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and other global reproductive health organizations such as EngenderHealth have recognized circumcision as an important method to reduce HIV infection.

The ShangRing has been used to circumcise several thousand Chinese men since 2005. Preliminary reports of 1,200 patients indicate good results with minimal complications. The ShangRing, with 15 patents pending in 85 countries, is currently available only in China. FDA evaluation is under way.

The beauty of this device is its simple, innovative design, says Dr. Howard Kim, a fellow in male reproductive medicine and microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and member of the Weill Cornell team that traveled to China to learn this new technique. Although many male circumcision devices are available, they have not gained widespread acceptance due to high complication rates or difficulties with surgical technique.

Even non-physician health care providers will be able to learn this procedure to safely perform circumcisions in resource-poor regions, adds Dr. Richard Lee, a chief resident in urology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and another member of the China team.

The NewYork-Presbyterian/Weill Cornell team, in collaboration with the nonprofits EngenderHealth and The Population Council, are planning a small pilot study in Nyanza, Kenya, to test efficacy, safety and acceptability of the technique. Local health providers who perform circumcisions in a clinical setting will be recruited and trained in the procedure by the NewYork-Presbyterian/Weill Cornell team. The pilot study is expected to be followed by a multicenter clinical trial that will compare the ShangRing technique to traditional circumcision methods.

Male circumcision has been performed as far back as ancient Egypt, and the practice has continued through the ensuing centuries for religious, cultural and sociopolitical reasons. Performing circumcision for potential health benefits gained momentum in the 19th century with the advent of anesthesia and the initial epidemiological studies demonstrating lower rates of venereal diseases in circumcised men. Recent studies have shown that circumcised men are at significantly lower risk of urinary tract infections and sexually transmitted infections such as syphilis and chancroid. Additional studies point to lower risk of invasive penile carcinoma, gonorrhea and chlamydia (in female partners).

FDA approves NeuRx diaphragm pacing system for use in spinal cord- injured patients

Wed, 18 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) The U.S. Food and Drug Administration (FDA) has approved the NeuRx Diaphragm Pacing System (DPS) for spinal cord-injured patients who are dependent on ventilators for breathing. The light-weight, battery-powered electronic DPS allows patients to breathe and speak more naturally, while eliminating the need for a power source and concern over power outages.

The system was developed over the course of 20 years through a joint research effort of physicians and engineers, primarily at University Hospitals Case Medical Center, Case Western Reserve University and Louis Stokes Cleveland Veterans Affairs Medical Center, all located in Cleveland. NeuRx DPS is manufactured commercially by Synapse Biomedical, Inc., based in Oberlin, Ohio.

DPS gained national attention in 2003 when University Hospitals Case Medical Center (UHCMC) surgeon Raymond Onders, M.D., implanted the system in actor Christopher Reeve. Dr. Onders is the director of minimally invasive surgery at UHCMC.

This is a major step in improving the quality of life for patients who have spinal cord injuries and cannot breathe without the help of a ventilator, said Dr. Onders. Based on testimonials that I've received from patients who have been in the clinical trials, DPS provides patients with a freedom of mobility that they never imagined. They've sent photographs or videos themselves parachuting from planes, sailing solo, or enjoying rides at amusement parks with their families; activities impossible to do with a ventilator.

NeuRx DPS is a technology providing electrical stimulation to muscle and nerves running through the diaphragm, the major muscle involved in breathing. When stimulated by NeuRx DPS, the diaphragm contracts, allowing patients to breathe more naturally than having air forced into their lungs as a mechanical ventilator does.

FDA approval is based on 50 patients implanted with the system at hospitals in the United States and Canada, including UHCMC; Shepherd Center in Atlanta; Methodist Neurological Institute in Houston; and Vancouver General Hospital. Dr. Onders, a founder and shareholder of Synapse, trained all of the implanting surgeons. Dr. Onders will continue to oversee initial surgeries as regional trauma centers are certified to offer the system.

According to information from Synapse, in the DPS clinical trial, more than 50 percent of spinal cord-injured patients were able to completely eliminate their need fro mechanical ventilation.

The system is implanted through minimally invasive laparoscopic surgery. Patients and caregivers who want to find a doctor who can evaluate their case for possible treatment should visit

US could face shortage of 44,000 primary care physicians by 2025

Tue, 17 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) COLUMBIA, Mo.- By 2025, the wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn't increase soon, according to a new University of Missouri study. Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians.

Today, generalist physicians are a third of the U.S. physician workforce and are responsible for more than half of all patient visits at doctors' offices.

Concern about the supply of generalists is not new, said Colwill, who also is a member of the National Academy of Sciences Institute of Medicine. It has been with us since the 1960s and was gradually improving. However, during the past decade, the number of generalist graduates has fallen by 22 percent and declines continue as medical school graduates enter other specialties. At the same time, the U.S. population is increasing by about one percent each year, and the baby boomer generation will significantly increase the number of Americans older than 65 by 2025.

In the study, which was published in a recent edition of Health Affairs, Colwill and co-researchers, James Cultice from the U.S. Health Resources and Services Administration and Robin Kruse from the University of Missouri, used data from the National Ambulatory Medical Care Survey to estimate the future demand for generalist care. The Census Bureau predicts that the number of adults will increase 21 percent by 2025, and the number of Americans older than 65 will rise by 73 percent.

Typically, older adults seek care from generalists nearly three times each year, double the rate of adults younger than 65. Because of this, Colwill and his researchers expect the number of doctor visits to increase by 29 percent by 2025. At the same time, they project that the supply of general internists and family physicians will increase less than 5 percent.

As patient numbers rise, these practitioners will be doing more 'urgent care' and will have less time for preventive services, coordinating care with other specialists, and getting to the depth of their patients' problems, Colwill said. This will increase the load on other, already overloaded specialists and lead to even more referrals and increased costs of care. We need to change the incentives by making primary care practice more manageable and income comparable with that in other specialties.

Colwill strongly endorsed development of new models of primary care called medical homes where teams of physicians, nurse practitioners, physician assistants and others provide comprehensive primary care services that also focus on management of patients with chronic illnesses. These models promote more access through expanded hours and use of telephone, e-mail and electronic medical records. If appropriately reimbursed, these models should increase quality, reduce overall costs and improve both patient and physician satisfaction.

At the same time, numbers of graduates must be increased, Colwill said. Students' interest in generalist careers can be enhanced if medical schools renew their commitment to the education of generalists as they have done earlier. Further, incentives such as forgiveness of loans for primary care practice would tip the scales for many medical students and residents as they select a specialty and type of practice.

The Association of American Medical Colleges recommends that medical schools increase their enrollment by 30 percent, but have not indicated specific specialty areas for the increase. Colwill said this enrollment increase could result in more specialists, but little increase in primary care physicians if the incentive for becoming generalists is not examined soon.

'Cancer was one of the best things to happen to me... but I worry about the future'

Tue, 10 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) London, UK: For Dan Savage, surviving testicular cancer has been a spur to him making the most of his life and taking more adventurous decisions, and he says, that in retrospect, it was probably one of the best things that has happened to him. But as he approaches the end of his fifth year in remission from the disease, when he will be signed off as cured by the medical profession, he worries that from now on he will have no regular medical checks that might pick up early signs of the cancer returning. It will be down to him to contact the cancer clinic if he is worried about any new symptoms.

Dan, aged 25, is now an award-winning artist. He has set up his own studio in York (UK) and specialises in creating glass artwork for architectural spaces. He is also an ambassador for Teenage Cancer Trust and will be speaking at the charity's Fifth International Conference on Teenage and Young Adult Cancer Medicine on Tuesday.

Dan was 20 and studying art at Lancaster University when he discovered a lump the size of half a pea in his right testicle. After having surgery at Lancaster he was transferred to St James's hospital in Leeds for chemotherapy.

The chemotherapy was largely precautionary. The outward appearance of the tumour suggested it had been caught early, but when they dissected it, they found it was quite developed, just on the brink of spreading and they didn't want to take that risk. Also they found that I had the most aggressive form of testicular cancer, teratoma, says Dan.

Dan feels he got off fairly lightly, although the chemotherapy made him very sick and he lost his hair. Looking back now, he says: Having cancer, for me, was one of the best things to happen. It gave me a real drive to succeed and make the most of my life. I know, from speaking to other cancer survivors, that many of them agree. I have gained more confidence. Starting up my own business isn't necessarily what I would have done prior to having cancer. Cancer didn't stop his studies: he went back to university, completed his degree and went on to do a Masters degree in Glass. He has also married his long-term girlfriend.

Dan has not suffered any particular problems following his treatment, although he finds he is more susceptible to common colds and other illnesses that are going around.

I'm much more aware now of my own body and if anything is slightly out of kilter, I'm probably a lot more paranoid about it, he says. On a day-to-day basis I'm fairly relaxed, but if I have an ache or pain I start to worry.

One thing I am getting a bit worried about is that I'm coming up to five years in remission, and will be signed off by the doctors in June. Thereafter it's up to me. People say I'm cured but I don't see it like that. Something could crop up. It worries me that I won't have any more medical checks. I know that if I find anything that's odd I can go straight back to the clinic rather than the GP, which is good because the GP route was a bit of a nightmare. So that is reassuring. But I get reassurance from having regular checks, from having a blood test and even if I don't hear anything after the blood test has been taken, I still know someone has seen it and it's OK. I would prefer to keep the checks going for longer.

Before his chemotherapy the doctors talked to him about fertility and he had sperm samples frozen. The samples were good quality, but, as he was young, fit and healthy (apart from the cancer), he knows he has a good chance of his fertility returning to normal levels, although he hasn't re-visited the fertility clinic to check yet.

Dan says he has become very health conscious in terms of fitness levels and diet. I drink a lot of green tea!

For heart failure patients, certain findings on ECG predicts risk of rehospitalization and death

Tue, 10 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Among patients hospitalized with heart failure, having a longer than normal QRS duration (a measurement of the electrical conducting time of the heart on an electrocardiogram (ECG)] appears to predict a high risk of death or rehospitalization within a few months after discharge, according to a study in the June 11 issue of JAMA.

An ECG is routinely obtained on all patients admitted with heart failure. Hospitalization for heart failure is a major public health problem in the developed world, with the United States and Europe each reporting more than 1 million heart failure hospitalizations per year. The frequency and the predictive value of a prolonged QRS duration during an admission for heart failure has not been well studied. Establishing the prognostic value of a prolonged QRS duration during hospitalization for heart failure may aid in tailoring therapy to improve postdischarge morbidity and mortality, according to background information.

Mihai Gheorghiade, M.D., and Norman C. Wang, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, and investigators with the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial, investigated the relationship of QRS duration and changes during the course of hospitalization to outcomes such as death and hospitalization for heart failure. The study included 4,133 patients hospitalized for heart failure and having a left ventricular ejection fraction (LVEF; a measure of how well the left ventricle of the heart pumps with each contraction) of 40 percent or less. After excluding 1,029 patients with a pacemaker, implantable cardioverter-defibrillator, or both at enrollment and 142 patients without a reported baseline QRS duration, 2,962 patients were included in this analysis: 1,641 had a normal QRS duration (less than 120 ms) and 1,321 had a prolonged QRS duration (120 ms or greater). Median (midpoint) follow-up time was 9.9 months.

There were 678 total deaths (307 of 1,641 patients [18.7 percent] with a normal baseline QRS duration and 371 of 1,321 [28.1 percent] with a prolonged baseline QRS duration). The most common cause of death was heart failure followed by sudden cardiac death. The composite of cardiovascular death or hospitalization for heart failure was more frequent in patients with a prolonged baseline QRS duration at 3 months after enrollment (21.1 percent vs. 14.6 percent) and at the end of the follow-up period of 9.9 months (41.6 percent vs. 32.4 percent). After adjusting for multiple variables, compared with normal baseline QRS duration, prolonged QRS duration was associated with a 24 percent increased risk of death and a 28 percent increased risk for the composite of cardiovascular death or hospitalization for heart failure.

In this analysis, a prolonged QRS duration was present in 45 percent of patients admitted with heart failure and reduced LVEF, did not appear to significantly change during hospitalization, and was independently associated with high postdischarge mortality and readmission rate. This high morbidity and mortality was observed even though patients were well-treated with standard medical therapy that included beta-blockers and angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blockers [ARBs], the authors write.

Measurement of the QRS duration on an ECG has significant advantages as a tool in the clinical setting. It is relatively inexpensive, simple to perform, and yields an instant result. The measurement is objective and does not require specialized training to interpret. In addition, the QRS duration is stable in the majority of patients during the course of their hospitalization. Perhaps most important, a prolonged QRS duration becomes a potential target for intervention [with existing therapy], which may improve postdischarge mortality and morbidity.

Cartilage regeneration '20,000 Leagues Under the Sea'

Wed, 04 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) HOUSTON, June 4, 2008 -- Bioengineers at Rice University have discovered that intense pressure -- similar to what someone would experience more than a half-mile beneath the ocean's surface -- stimulates cartilage cells to grow new tissue with nearly all of the properties of natural cartilage. The new method, which requires no stem cells, may eventually provide relief for thousands of arthritis sufferers.

This tissue-engineering method holds promise not only for cartilage but also for tissues to repair bladders, blood vessels, kidneys, heart valves, bones and more, said lead researcher Kyriacos Athanasiou, Rice's Karl F. Hasselmann Professor of Bioengineering.

The findings appear this week in the journal PLoS ONE. They are the latest from the emerging field of tissue engineering, a new discipline that aims to capitalize on the body's innate healing abilities to develop new ways of growing tissues that can be used to surgically repair wounds without risk of rejection.

Cartilage, a tissue in the human body that cannot heal itself, has long been a target of tissue engineers. Cartilage is the skeleton's shock absorber, and its stiffness, strength and other mechanical properties derive not from living cartilage cells but from the densely woven matrix of collagen and proteoglycan that surrounds them. This extracellular matrix, or ECM, is produced during cartilage development in children, but cannot be repaired following injury in adulthood.

Injured cartilage often serves as the focal point for arthritis formation, so tissue engineers have long sought a means of growing new cartilage that can be transplanted into adults to repair damaged joints before arthritis can develop. Unfortunately, cartilage is difficult to engineer, in part because there are no natural healing processes to mimic.

Athanasiou's Musculoskeletal Bioengineering Laboratory has focused on cartilage for more than 10 years, and he said the new process is the first he has studied that produces cartilage that's almost identical to the body's own tissue.

The combination of hydrostatic pressure and growth factors used in this process result in an engineered cartilage ECM with properties nearly identical to that of native cartilage, he said. This research appears very promising for treating arthritis, as cartilage can now be produced in our lab that is almost identical in composition to native tissue.

So far, the process has been tried only with cells from cows and has yet to be tested in live animals. Athanasiou cautions that it will be several years before the process will be ready for clinical testing in humans.

The new findings are based on three years of data collected by graduate student Benjamin Elder, who is simultaneously earning a doctorate in bioengineering at Rice and a medical degree at Baylor College of Medicine under Rice and Baylor's Medical Scientist Training Program.

In the study, Elder took small samples of cartilage from calves' knees, dissolved the ECM and isolated the living cartilage cells, or chondrocytes. The calf chondrocytes were used to create tissue-engineered cartilage. The engineered cartilage was placed into a chemical bath of growth factors and sealed inside soft plastic containers that were placed inside a chamber connected to a hydraulic press. For one hour per day, the bags were squeezed at intense pressures.

Our knees are filled with fluid, and when we walk or run the hydrostatic pressure on the cartilage cells in the knee approaches the pressures we used in our experiments, Elder said. But in daily activities, these pressures are fleeting, just a second or so at a time.

Most of the prevailing strategies in tissue engineering attempt to reproduce the conditions that cells experience in the body. Athanasiou said the unconventional approach of using unnaturally high-pressure stemmed from insights gained during years of previous experiments.

Elder said, By combining high pressure and growth factors, we were able to more than triple the biomechanical properties of the cartilage. We're not sure why they reinforce one another, but we do not get the same results when we apply them independently.

Elder, who earned both a bachelor's and master's degree from Yale in four years, has a 4.2 grade point average at Rice and is on track to earn his bioengineering doctorate in just three years. He's already finished two years of medical school and will resume his medical studies in the fall.

Ben's an exceptional student and he embodies the future of this field, Athanasiou said. He plans to pursue a career in neurosurgery, where he will be able to conduct future work in tissue engineering and translate it from the laboratory bench to the patient's bedside.

Agent in red wine found to keep hearts young

Tue, 03 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) MADISON - How, scientists wonder, do the French get away with a clean bill of heart health despite a diet loaded with saturated fats?

The answer to the so-called French paradox may be found in red wine. More specifically, it may reside in small doses of resveratrol, a natural constituent of grapes, pomegranates, red wine and other foods, according to a new study by an international team of researchers.

Writing this week (June 3) in the online, open-access journal Public Library of Science One, the researchers report that low doses of resveratrol in the diet of middle-aged mice has a widespread influence on the genetic levers of aging and may confer special protection on the heart.

Specifically, the researchers found that low doses of resveratrol mimic the effects of what is known as caloric restriction - diets with 20-30 percent fewer calories than a typical diet - that in numerous studies has been shown to extend lifespan and blunt the effects of aging.

This brings down the dose of resveratrol toward the consumption reality mode, says senior author Richard Weindruch, a University of Wisconsin-Madison professor of medicine and a researcher at the William S. Middleton Memorial Veterans Hospital. At the same time, it plugs into the biology of caloric restriction.

Previous research has shown that resveratrol in high doses extends lifespan in invertebrates and prevents early mortality in mice given a high-fat diet. The new study, conducted by researchers from academia and industry, extends those findings, showing that resveratrol in low doses and beginning in middle age can elicit many of the same benefits as a reduced-calorie diet.

Resveratrol is active in much lower doses than previously thought and mimics a significant fraction of the profile of caloric restriction at the gene expression level, says Tomas Prolla, a UW-Madison professor of genetics and a senior author of the new report.

The group explored the influence of the agent on heart, muscle and brain by looking for changes in gene expression in those tissues. As animals age, gene expression in the different tissues of the body changes as genes are switched on and off.

In the new study - which compared the genetic crosstalk of animals on a restricted diet with those fed small doses of resveratrol - the similarities were remarkable, explains lead author Jamie Barger of Madison-based LifeGen Technologies. In the heart, for example, there are at least 1,029 genes whose functions change with age, and the organ's function is known to diminish with age. In animals on a restricted diet, 90 percent of those heart genes experienced altered gene expression profiles, while low doses of resveratrol thwarted age-related change in 92 percent. The new findings, say the study's authors, were associated with prevention of the decline in heart function associated with aging.

In short, a glass of wine or food or supplements that contain even small doses of resveratrol are likely to represent a robust intervention in the retardation of cardiac aging, the authors note.

That finding may also explain the remarkable heart health of people who live in some regions of France where diets are soaked in saturated fats but the incidence of heart disease, a major cause of mortality in the United States, is low. In France, meals are traditionally complemented with a glass of red wine.

The new resveratrol study is also important because it suggests that caloric restriction, which has been widely studied in animals from spiders to humans, and resveratrol may govern the same master genetic pathways related to aging.

There must be a few master biochemical pathways activated in response to caloric restriction, which in turn activate many other pathways, explains Prolla. And resveratrol seems to activate some of these master pathways as well.

The new findings, according to Weindruch and Prolla, provide strong evidence that resveratrol can improve quality of life through its influence on the different parameters of aging such as cardiac function. However, whether the agent can extend lifespan in ways similar to caloric restriction will require further study, according to the new report's authors.

Exposure therapy may help prevent post-traumatic stress disorder

Mon, 02 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Exposure-based therapy, in which recent trauma survivors are instructed to relive the troubling event, may be effective in preventing the progression from acute stress disorder to post-traumatic stress disorder, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Individuals who develop acute stress disorder during or soon after a traumatic event are likely to subsequently develop post-traumatic stress disorder (PTSD), according to background information in the article. PTSD is associated with other mental and physical illnesses, a reduced quality of life and increased health care costs. Both exposure therapy and cognitive restructuring, which focuses on changing maladaptive thoughts and responses to a traumatic event, have been used as early interventions to prevent PTSD in those with acute stress disorder. However, there is evidence that some clinicians do not use exposure therapy because it causes distress for recent trauma survivors.

Richard A. Bryant, Ph.D., of the University of New South Wales, Sydney, Australia, and colleagues conducted a randomized controlled trial involving 90 patients who developed acute stress disorder following a non-sexual assault or motor vehicle crash between March 2002 and June 2006. Thirty participants each were randomly assigned to five weekly 90-minute sessions of exposure therapy or cognitive restructuring, while the remaining 30 were put on a waitlist for treatment. All the patients were assessed at the beginning of the study, after six weeks and six months following treatment.

Sixty-three participants completed the study. After completing treatment, fewer patients in the exposure therapy group (10, or 33 percent) met criteria for PTSD than patients in the cognitive restructuring group (19, or 63 percent) or the wait-list group (23, or 77 percent). At the six-month follow-up, fewer patients in the exposure therapy group (11, or 37 percent) met criteria for PTSD than patients in the cognitive restructuring group (19, or 63 percent), and 14 patients (47 percent) in the exposure group vs. four patients (13 percent) in the cognitive restructuring group achieved full remission.

Despite some concerns that patients may not be able to manage the distress elicited by prolonged exposure, there was no difference in drop-out rates for the prolonged exposure and cognitive restructuring groups (17 percent vs. 23 percent), the authors write. In addition, distress ratings were more significantly reduced in the exposure therapy group than the cognitive restructuring group after three sessions.

Exposure therapy may be more effective than cognitive restructuring because it eases the anxiety associated with the traumatic memory and corrects the belief that the memory must be avoided, in addition to encouraging self-control by managing the exposure exercise, the authors note. The current findings suggest that direct activation of trauma memories is particularly useful for prevention of PTSD symptoms in patients with acute stress disorder, they conclude. Exposure should be used in early intervention for people who are at high risk for developing PTSD.

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

Mon, 12 May 2008 03:59:37 PST

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

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

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

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

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

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

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

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

National scientific meeting on child mental health at Kentucky

Tue, 06 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) As the nation observes National Children's Mental Health Awareness Day on Thursday, the University of Kentucky Center for the Study of Violence Against Children (CSVAC) will host national experts at the scientific meeting From Neuroscience to Social Practice: Translational Research on Violence Against Children. The two-day event, being held May 7-8 in Lexington, Ky., includes the unveiling of research findings on violence against children that will be published in an upcoming issue of the Journal of Loss and Trauma.

The scientific meeting is expected to draw a national audience of researchers, clinicians and policymakers, including state officials from the Commonwealth. Hosted by CSVAC, the event is dedicated to the enhancement of the health and well-being of children and their families through research, service and dissemination of information about child abuse and trauma.

The two-day program will include three major research presentations: Relational Poverty and Vulnerability to Developmental Trauma: A Neurodevelopmental Perspective presented by Dr. Bruce Perry, senior fellow of The ChildTrauma Academy in Houston; The Importance of Early Experience: Clinical, Research and Policy Perspectives presented by Dr. Charlie Zeanah Jr., executive director of the Institute of Infant and Early Childhood Mental Health at Tulane University in New Orleans; and The Effects of Psychotherapy on the Adult Brain: Do they Apply to Children presented by Dr. Jerald Kay, chairman of the Department of Psychiatry at Wright State University in Dayton, Ohio.

All three research presentations will be followed by formal discussion sessions on the presenter's findings and how it will translate into practice at various levels.

Perry's research, Relational Poverty and Vulnerability to Developmental Trauma is developing ways to assess the health of a child's brain at an early developmental age. Secondly his research is looking at a variety of interventions, including creative and artistic forms of play, which target the areas in the brain that need the most attention.

Robert Walker, a researcher and assistant professor in behavioral science at UK's Center on Drug and Alcohol Research with conjoint appointments in the College of Social Work and Department of Psychiatry, describes Perry as moving toward the translation of neuroscience into clinical practice. Perry is encouraging the use of clinical practices that build on what is known about the environment/brain interactions in child development. His treatment approaches take into account the neurodevelopmental effects of abuse and severe neglect when working with children who have been maltreated.

He is starting the dialogue on how we bring brain science into behavioral interventions -- one of the primary missions of CSVAC, said Walker.

The Importance of Early Experience is Zeanah's research on data from clinical, research and policy perspectives as it pertains specifically to the importance of early experiences. His findings argue in the clinical arena a liberal approach must hold sway, as specific treatment plans must be proposed and implemented for the patient as problems arise, while conclusions derived from research are inherently conservative and policy decisions tend to fall between the extremes due to funding priorities and the need for reasonable evidence before definitive answers are known.

The two-day scientific meeting will conclude with Kay's presentation on The Effects of Psychotherapy on the Adult Brain and its corresponding discussion sessions. Kay's research evaluates the challenges of translating of neurobiological findings to following psychotherapy in adulthood into practice in treatment of children. This research focusing on children comes on the heels of a newfound greater appreciation of the psychobiology of attachment and its disorders in adults, as well as an increasing sophistication in the study of gene-environment interaction.

CSVAC houses the Child and Adolescent Trauma Treatment Institute and is a member of the National Child Traumatic Stress Network. The center is dedicated to the enhancement of the health and well-being of children and their families through research, clinical services and dissemination of information about child abuse and trauma. It is also home to UK's Comprehensive Assessment and Training Services project, a statewide translational research center within CSVAC that focuses on testing and refining best practices technologies in a living laboratory setting, then disseminating these practices to build community capacity to identify, assess and treat traumatized children and their families.

Harmful blood glucose levels linked to defective gene

Thu, 01 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) A genetic mutation that can raise the amount of glucose in a person's blood to harmful levels is identified today in a study in the journal Science.

High levels of blood glucose increase the risk of cardiovascular disease and early death, even in healthy people who do not have diabetes and whose blood glucose levels are at the higher end of the range considered 'normal' by doctors. One in five people in the UK has a high blood glucose level.

The study, by researchers from Imperial College London, the French National Research Institute and McGill University in Canada, reveals an association between high levels of blood glucose and a mutation in a gene known as G6PC2 or IGRP.

The research shows that the mutated IGRP gene blocks the action of a sensor called glucokinase. By stopping glucokinase from doing its job, the gene prevents the body from keeping tight control over its levels of blood glucose. Glucokinase works by signalling to cells known as beta cells which then secrete insulin to keep blood glucose levels under control.

The researchers hope their findings could enable a therapy to be developed to stop the defective IGRP gene from blocking the glucokinase sensor. This would restore control of glucose levels in the blood and help prevent these levels from becoming too high.

The researchers believe that the mutation in the IGRP gene could cause an increase of around five percent in the level of glucose in the blood. This small percentage increase would be enough to raise a person's risk of health problems because levels of blood glucose are so tightly controlled.

Epidemiological studies have shown that 80 percent of the risk of cardiovascular disease is related to a blood glucose level just above the average. High blood glucose levels are linked to obesity, poor nutrition and lack of exercise.

Professor Philippe Froguel, leading author of the research from the French National Research Institute and the Department of Genomic Medicine at Imperial College London, said: Having a high level of blood glucose is a bit like having high cholesterol or high blood pressure in that the higher the level, the greater your risk of serious health problems. Our study helps unravel the genetic reasons why some people have higher levels of glucose in their blood than others.

At present, doctors advise people with high blood glucose levels to lose weight and exercise. We hope that ultimately our research will mean we can develop new treatments to stop people from developing high blood glucose levels, which would enable them to live longer and healthier lives, added Professor Froguel.

The scientists reached their conclusions after comparing the genetic makeup of 654 non diabetic people with differing levels of blood glucose, from the low to the high end of the 'normal' range. The researchers looked at mutations in the building blocks, called nucleotides, which make up DNA.

There are mutations, known as single-nucleotide polymorphisms, in around one in every 600 nucleotides. The scientists examined over 392,000 of these mutations to find the ones specific to high blood glucose levels. The researchers confirmed their findings by analysing the genetic makeup of a further 8000 individuals with blood glucose levels within the non diabetic range, to verify that the same genetic mutations were visible in these individuals.

Today's study follows on from a study published in February 2007 by the same team, where they identified the most important genes associated with a risk of developing type-2 diabetes.

Zebrafish may help solve ringing in vets' ears

Wed, 30 Apr 2008 03:59:37 PST

( from http://www.rxpgnews.com ) CHICAGO -- Ernest Moore, an audiologist and cell biologist at Northwestern University, developed tinnitus -- a chronic ringing and whooshing sound in his ears -- twenty years ago after serving in the U.S. Army reserves medical corps. His hearing was damaged by the crack of too many M16 rifles and artillery explosions. He suspects his hearing also suffered from hunting opossum with rifles as a kid on his grandmother's farm in Tennessee.

Ever since his ears began ringing, Moore has been researching a cure. He's at the forefront of just a small band of such scientists in the country. There's a lot riding on his work.

Half of the soldiers returning from Iraq and Afghanistan exposed to explosive devices suffer from tinnitus. The major cause is exposure to loud noises, which can damage and destroy hair cells of the inner ear. It's the number one war-related disability.

Nearly 400,000 troops collected disability for service-related tinnitus in 2006, which cost $539 million in 2006. The number climbs nearly 20 percent each year. It could hit $1 billion by 2011, according to the American Tinnitus Association.

An additional 12 million Americans have tinnitus severe enough to seek medical attention. In about two million of those cases, patients are so debilitated they can't function normally.

Despite the widespread suffering, there has only been a paltry $3 million allotted for public and private research. As a tinnitus researcher, Moore feels like a cross between Rodney Dangerfield and Sisyphus.

It's been tough to snare research money from the small purse and hard to garner respect for tinnitus. Ears don't bleed from tinnitus, Moore explained. It's a hidden problem. It's not obvious and dramatic like a heart attack or cancer -- although it torments its sufferers. Only one out of ten grant proposals he submits each year have been funded.

The research itself is challenging because Moore can't ask mice and rats if their ears are ringing. Now, he's working with zebrafish (yes, they do have ears, which are remarkably similar to humans' ears.) He's been able to cause ringing in their ears -- he thinks -- by exposing them to certain drugs and tracking their erratic swimming on video. Moore then looks at the cells in their ears to see if the electrical firing has increased, an early sign of damage and tinnitus. His early findings show an increased firing.

Then Moore attempts to block this effect with drugs to return the cells to their normal activity. In preliminary research, it appears the drugs he has tested do slow down the increased electrical firing or tinnitus-like behavior of the hair cells in the ear.

Moore is beginning to meet with doctors to discuss launching a clinical trial to test these drugs for patients with tinnitus.

If these drugs are found to be safe -- and some are already on the market for other uses -- and if they are found to have efficacy in humans, then they might be used to treat an individual's tinnitus, Moore said.

If the hair cell is not totally damaged -- just beginning to break down, and you administer these drugs, you might be able to prevent it from further damage and interfere with the cells' ability to generate tinnitus, he explained.

Tinnitus finally will begin to get some respect in April when The Department of Defense 2008 Appropriations Bill will open up $50 million in new research funding for tinnitus related to service in the armed forces. Ernest Moore has applied to launch the clinical trial with the drugs he has used with the zebrafish.

Study shows false memories complicate end-of-life treatment decisions

Fri, 25 Apr 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Irvine, Calif., April 25, 2008 -- Advance directives, or living wills, may not effectively honor end-of-life wishes because life-sustaining treatment preferences often change without people being aware of the changes, according to a new study co-authored by UC Irvine researchers Peter Ditto and Elizabeth Loftus.

False memories can play a significant role in the discrepancy between an individual's true preferences for end-of-life treatment and what is instructed in their living will. Life-sustaining treatment preferences often change as people age or experience new health problems, and advance directive forms typically remind people of their right to update their directives if their wishes change. This assumes that people recognize when their wishes about end-of-life treatment have changed, and remember that their current wishes are different from those documented in their living will.

Living wills are a noble idea and can often be very helpful in decisions that must be made near the end of life. But the notion that you can just fill out a document and all your troubles will be solved, a notion that is frequently reinforced in the popular media, is seriously misguided, said Peter Ditto, professor of psychology and social behavior at UCI.

In research reported in the current issue of the American Psychological Association journal Health Psychology, a sample of 401 adults older than 65 were interviewed about which life-sustaining treatments they would want if they were seriously ill. They were interviewed again 12 months later to test their recall of earlier decisions. About one-third of participants changed their wishes regarding medical treatment such as CPR and tube feeding over the course of the year, and in 75 percent of these cases, participants falsely remembered that their original views on the issues matched their new ones.

Interviewers also talked to individuals empowered to make medical decisions if the study subjects were no longer able. These potential surrogate decision makers were even less sensitive to changes in their loved one's wishes, showing false memories in 86 percent of cases.

On a policy level, these results suggest that living wills should have an 'expiration date.' People can't be counted upon to update their directives as their wishes change because they often have no awareness that their wishes have changed, Ditto said. On a more personal level, our research stresses the importance of maintaining an ongoing dialogue among individuals, their families and their physicians about end-of-life treatment options, he continued.

Scientists identify new longevity genes

Wed, 12 Mar 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Scientists at the University of Washington and other institutions have identified 25 genes regulating lifespan in two organisms separated by about 1.5 billion years in evolutionary change. At least 15 of those genes have very similar versions in humans, suggesting that scientists may be able to target those genes to help slow down the aging process and treat age-related conditions. The study will be published online by the journal Genome Research on March 13.

The two organisms used in this study, the single-celled budding yeast and the roundworm C. elegans, are commonly used models for aging research. Finding genes that are conserved between the two organisms is significant, researchers say, because the two species are so far apart on the evolutionary scale -- even farther apart than the tiny worms and humans. That, combined with the presence of similar human genes, is an indication that these genes could regulate human longevity as well.

Now that we know what many of these genes actually are, we have potential targets to go after in humans, said Brian Kennedy, UW associate professor of biochemistry and one of the senior authors of the study. We hope that in the future we could affect those targets and improve not just lifespan, but also the 'health span' or the period of a person's life when they can be healthy and not suffer from age-related illnesses.

Several of the genes that the scientists identified as being involved in aging are also connected to a key nutrient response pathway known as known as the Target of Rapamycin, or TOR. That finding gives more evidence to the theory that calorie intake and nutrient response affect lifespan by altering TOR activity. Previous studies have found that drastically restricting the caloric intake of organisms, an approach known as dietary restriction, can prolong their lifespan and reduce the incidence of age-related diseases. TOR inhibitors are being tested clinically in people for anti-cancer properties, and this work suggests they may also be useful against a variety of age-associated diseases.

What we'd like to eventually do is be able to mimic the effects of dietary restriction with a drug, explained Matt Kaeberlein, another senior author on the paper and a UW assistant professor of pathology. Most people don't want to cut their diet that drastically, just so they may live a little longer. But someday in the future, we may be able to accomplish the same thing with a pill.

These findings also give new insight into the genetic basis of aging, the scientists said, and provide some of the first quantitative evidence that genes regulating aging have been conserved during the process of evolution. Earlier evolutionary theories suggested that aging was not genetically controlled, since an organism does not get any advantage in natural selection by having a very long lifespan that goes far past their reproductive age.

To find these lifespan-controlling genes, the scientists took a genomic approach to comprehensively examine genes that affect aging in yeast and worms. Based on published reports, they first identified 276 genes in C. elegans that affected aging, and then searched for similar genetic sequences in the yeast genome. Of the 25 aging-related genes they found in both worms and yeast, only three had been previously thought to be conserved across many organisms.

Clinical depression raises risk of death for heart attack patients years after attack

Mon, 03 Mar 2008 04:59:37 PST

( from http://www.rxpgnews.com ) March 3, 2008 -- Depressed heart attack patients have a higher risk for sudden death in the months following a heart attack. Now a team led by researchers from Washington University School of Medicine in St. Louis has found that the risk continues for many years.

There's a two- to four-fold increase in a person's risk of dying following a heart attack if they also happen to be depressed, says Robert. M. Carney, Ph.D., lead author of the new study and professor of psychiatry at Washington University. Previously we thought the impact of depression was strongest for the first three to six months following a heart attack and then gradually dropped off within a couple of years. Instead, we found that the effect lasts for at least five years.

Carney, with colleagues from Duke University Medical Center, Harvard University, Yale University, the National Heart, Lung and Blood Institute (NIH) and the Mayo Clinic, followed more than 750 heart attack patients for five years. The findings will appear in an upcoming issue of the Journal of Affective Disorders and are currently available online.

Patients followed in the study had participated in the NIH-funded project Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD). A little less than half were diagnosed with depression.

In the five years following a heart attack, 106 patients died. Of those, 62 had been diagnosed with depression, while 44 had not. In gauging the effects of depression, the investigators also considered other risks including age, smoking, hypertension, gender and diabetes.

Some of those factors, like younger age and female gender, lower mortality risk. Smoking and diabetes tend to raise the risk of dying. Carney says his team used statistical methods to evaluate the ways in which the various factors influenced mortality risk. Then they removed the influence of all other factors from the risk equation in order to consider the statistical impact of depression itself.

We found that after adjusting for those risk factors, depression continues to play a statistically significant role, he says.

One possible explanation for depression's lingering influence on mortality is its recurring nature. Because the disorder can come and go over many years, it also may continue to increase the risk of death for many years.

People typically are depressed for a while, then they'll either get better with treatment or it may subside on its own, Carney says. But depression can always recur, and we think that because it is a recurring problem, whatever depression is doing to mortality risk after a heart attack, it continues doing for quite a long time.

Past studies have differed over how much depression affects survival following a heart attack. But Carney believes these new findings are more reliable because all of the patients in this study were personally interviewed to determine their depression status, whereas other studies have relied on self-reporting.

New algorithm based on procalcitonin for sepsis

Sat, 01 Mar 2008 04:07:23 PST

( from http://www.rxpgnews.com ) Using a blood test and a decision algorithm, rather than standard hospital protocols, to determine the appropriate length of antibiotic therapy in patients with severe sepsis or septic shock can reduce duration of treatments, shorten ICU stays, and lower hospital costs— all without adverse effects on patients, according to new research.

“We have shown that it is possible to customize antibiotic treatment duration in patients with septicemia based on a reliable and robust blood test,” says Jérôme Pugin, M.D., of the Intensive Care Unit at the University Hospital in Geneva, Switzerland.

The findings appear in the first issue for March of the American Journal of Respiratory and Clinical Care Medicine, published by the American Thoracic Society.

The researchers randomized 79 patients to receive a treatment course of antibiotics either according standard treatment protocols administered by the treating physicians, or according to the decision algorithm based on measured blood levels of procalcitonin (PCT), a marker for severe bacterial infection in patients with suspected sepsis. For patients randomized to the PCT-based treatment there were predetermined “stopping rules” based on circulating PCT levels at which point investigators encouraged treating physicians to discontinue antibiotic therapy, although the treating physician retained the ultimate decision-making power.

In the analysis that included all 79 patients, the median treatment time for the PCT group was 3.5 fewer days than that of the control group, although the difference was not significant. However, once the investigators controlled for early drop-outs, previously undiagnosed infections, and patients whose physicians declined to stop antibiotic treatment when the algorithm would have dictated it, they found that patients treated by the PCT algorithm had a significantly shorter treatment time at 6 days, than patients treated according to standard protocols, who averaged 12.5 days on antibiotics.

“Our study is the first randomized clinical trial in which a surrogate biochemical parameter was used to reduce the duration of antibiotic therapy in a population of critically ill patients admitted to the ICU for severe sepsis and septic shock,” wrote Dr. Pugin. “Despite the relatively short duration of treatment in bacteremic patients assigned to the PCT group, no case of recurrence of infection was observed in these patients.”

Following the PCT algorithm had another benefit: patients randomized to the PCT treatment had significantly shorter stays in the ICU than control patients—an average of three days versus five.

Customizing treatment does more than simply save hospitals money and patients precious days in the ICU, says Dr. Pugin. Overuse of antibiotics can result in antibiotic resistance. “Given the diversity of the types of infections, bacterial strains and levels of host immune defense, every infected patient should benefit from a personalized treatment, and particularly, a personalized treatment duration,” he said.

The investigators hope that customized treatments will continue to improve care for sepsis patients around the world. “We have now implemented this new algorithm based on procalcitonin guidance in our ICU for patients presenting with severe sepsis and septic shock, and are following the outcome of those patients,” said Dr. Pugin. “Currently, three large multi-center trials are ongoing in France, Denmark and Germany, with a design similar to that of our study. Results from these studies will be important to determine whether such a protocol of procalcitonin guidance is definitely safe and can be generalized worldwide.”

Obese children have respiratory problems during surgery

Fri, 22 Feb 2008 07:39:02 PST

( from http://www.rxpgnews.com ) Add this to the growing list of health challenges faced by obese children: A new study from the University of Michigan Health System finds that obese children are much more likely than normal-weight children to have problems with airway obstruction and other breathing-related functions during surgery.

Obese children were found to have a higher rate of difficult mask ventilation, airway obstruction, major oxygen desaturation (a decrease in oxygen in the patient’s blood), and other airway problems. The study appears in the March issue of the journal Anesthesiology.

“To our knowledge, this is the first study of its kind,” says lead author Alan R. Tait, Ph.D., professor in the Department of Anesthesiology at the U-M Health System. This large-scale prospective study examines the effect of overweight and obesity on the outcomes of operations in children undergoing elective non-cardiac surgery.

“Based on current trends, it is likely that anesthesiologists will continue to care for an increasing number of children who are overweight or obese,” Tait says, “so it is vital that we are aware of the higher risk they face in the operating room.”

Researchers studied the experiences of 2,025 children who were having elective surgery. Of those, 1,380 were normal weight, 351 were overweight and 294 were obese. Children ranged in age from 2 to 18 years old.

In addition to the problems the obese patients experienced during surgery, they also had a higher rate of illnesses and conditions including asthma, hypertension, sleep apnea and Type II diabetes. These conditions all can contribute to problems during surgery, Tait notes.

By the numbers:

An estimated 15 to 17 percent of children and adolescents in the United States are considered obese.

Major airway obstructions occurred in 19 percent of obese children, compared with 11 percent of normal-weight children.

Nearly 9 percent of obese children experienced difficult mask ventilation, compared with 2 percent of normal-weight children.

17 percent of obese children in the study experienced major oxygen desaturation (decreased oxygen in the blood), compared with 9 percent of normal-weight children.

28 percent of obese children had asthma, compared with 16 percent of normal-weight children.

It should be noted however, that despite the increased risk of adverse events among children who are obese, none resulted in significant illness.

Study suggests new therapy for lung disease patients

Fri, 08 Feb 2008 04:09:37 PST

( from http://www.rxpgnews.com ) CHICAGO -- A new study by researchers at Northwestern University's Feinberg School of Medicine may change current thinking about how best to treat patients in respiratory distress in hospital intensive care units.

It has been commonly believed that high levels of carbon dioxide (CO2) or hypercapnia in the blood and lungs of patients with acute lung disease may be beneficial to them. Now, for the first time, scientists have shown how elevated levels of CO2 actually have the opposite effect.

The excessive CO2 impairs the functioning of the lungs. Jacob Sznajder, M.D., chief of pulmonary and critical care at the Feinberg School, and his research team found that high levels of CO2 make it harder for the lungs to clear fluid.

New York Methodist Hospital to study airway bypass treatment for emphysema

Wed, 06 Feb 2008 00:04:37 PST

( from http://www.rxpgnews.com ) Brooklyn, NY, February 4, 2007 -- New York Methodist Hospital today announced the start of the EASE (Exhale Airway Stents for Emphysema) Trial, an international, multi-center clinical trial to explore an investigational treatment that may offer a significant new, minimally-invasive option for those suffering with advanced widespread emphysema. The study focuses on a procedure called airway bypass that involves creating pathways in the lung for trapped air to escape and in turn, relieve emphysema symptoms including shortness of breath.

Emphysema is a chronic, progressive, and irreversible lung disease characterized by the destruction of lung tissue. The loss of the lungs' natural elasticity and the collapse of airways in the lung combine to make exhalation ineffective, leaving the emphysema sufferer with hyperinflation because they can't get air out of their lungs. With hyperinflation, breathing becomes inefficient and the patient is always short of breath. Even the most nominal physical activities become difficult for emphysema patients and many become dependent on oxygen therapy.

We are excited to be part of this study because currently there are limited treatment options for the emphysema patients. Patients are often in poor physical condition, struggling with each breath, states Arthur Sung, MD, Director of Interventional Pulmonology and the principal investigator of the study at NYM's Institute for Asthma and Other Lung Diseases. By creating new pathways for airflow with the airway bypass procedure, we hope to reduce hyperinflation and improve lung function. If patients can breathe easier it is likely to improve their quality of life.

Naked mole-rats bear chili pepper heat

Mon, 28 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Pity the tiny naked mole-rat. The buck-toothed, sausage-like rodent lives by the hundreds in packed, oxygen-starved burrows some six feet under ground. It is even cold-blooded -- which, as far as we know, is unique among mammals.

You can feel their pain. But, they can't feel ours.

Evolution has benefited naked mole-rats by ridding them of a body chemical called Substance P, a neurotransmitter released by pain fibers that send signals to the central nervous system in mammals after making contact with things that cause long-lasting, achy pain.

A better understanding of how Substance P works in the strange rodents may lead to new analgesic drugs for people with chronic pain who do not respond well to current medication, according to Thomas Park, associate professor of biological sciences at the University of Illinois at Chicago, and Gary Lewin of the Max-Delbrück Center for Molecular Medicine in Berlin, principal authors of a study appearing Jan. 29 in the free-access journal PLoS Biology.

Park, Lewin and their laboratory teams in Chicago and Berlin used a modified herpes cold sore virus to carry genes for Substance P to the rodents' nerve fibers.

We were able to rescue their ability to feel pain, said Park. His research group restored Substance P and the naked mole-rats' ability to sense the burning sensation other mammals feel when subjected to capsaicin, the active ingredient in chili peppers.

The restored sensitivity was limited to just one rear foot of each tested rodent. They'd pull their foot back and lick it, in response to the stimulus, said Park. Other feet were impervious to the sting of capsaicin.

Capsaicin is very specific for exciting the fibers that normally have Substance P, said Park. They're not the fibers that respond to a pin prick or pinch, but the ones that respond after an injury or burn and produce longer-lasting pain.

But the researchers found that mole-rats remained completely insensitive to acids, indicating a fundamental difference in how their nerves respond to this stimulus.

Acid acts on the capsaicin receptor and on another family of receptors called acid-sensitive ion channels, Park said. Acid is not as specific as capsaicin. The mole-rat is the only animal that shows completely no response to acid.

Park said the research adds to knowledge about the neurotransmitter Substance P.

This is important specifically to the long-term, secondary-order inflammatory pain. It's the pain that can last for hours or days when you pull a muscle or have a surgical procedure, he said.

Park said naked mole-rats provide a new model system that is different from all other animals he has studied.

We're learning which nerve fibers are important for which kinds of pain, so we'll be able to develop new strategies and targets.

Naked mole-rats, native to east-central Africa, developed a protective reaction to acids through evolution. Living in tight underground quarters, the mole-rats exhale high levels of carbon dioxide, which becomes acid when it touches skin and mucous tissue in the nose, eyes and mouth. But the mole-rats have evolved to become desensitized to the stinging pain of acid.

The UIC biologist plans to study other animals, both closely related and unrelated -- such as Alaskan marmots that burrow in high CO2 environments -- to examine how they have evolved similar strategies to cope with acid-rich living conditions.

Pollution shrinks fetus size: Brisbane study finds

Sun, 06 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Exposure to air pollution significantly reduces foetus size during pregnancy, according to a new study by Brisbane scientists.

Queensland University of Technology senior research fellow Dr Adrian Barnett said the study compared the foetus sizes of more than 15,000 ultrasound scans in Brisbane to air pollution levels within a 14km radius of the city.

The study found that mothers with a higher exposure to air pollution had foetuses that were, on average, smaller in terms of abdominal circumference, head circumference and femur length, Dr Barnett said.

The 10-year study, which was undertaken by Dr Barnett, Dr Craig Hansen (US Environmental Protection Agency) and Dr Gary Pritchard (PacUser), has been published in the international journal Environmental Health Perspectives.

Dr Barnett, who is based at QUT's Institute of Health and Biomedical Innovation, said the study looked at foetuses between 13 and 26 weeks duration.

To our knowledge this is the first study of its kind as it uses ultrasound measurement as a direct estimate of growth, rather than using birth weight as a delayed measure of growth, Dr Barnett said.

When analysing scans from women at different distances to monitoring sites, we found that there was a negative relationship between pollutants such as sulphur dioxide found in diesel emissions, and ultrasound measurement.

If the pollution levels were high the size of the foetus decreased significantly.

Dr Barnett said with research showing that bigger babies were healthier in childhood and adulthood, foetus size during pregnancy was important.

Birth weight is a major predictor of later health, for example, bigger babies have been shown to have higher IQs in childhood and lower risk of cardiovascular disease in adulthood, he said.

While some people may think there is no air pollution in Brisbane because the air looks so clean, you have to remember that most air pollutants are not visible to the naked eye, people do have a very outdoor lifestyle, and homes are designed to maximise airflow.

So although the actual levels of pollution are low our exposure to whatever is out there is relatively high.

This is particularly a problem for people who live near major roads.

Dr Barnett said it was wise for pregnant women to try to reduce their exposure to air pollution, most of which in Brisbane was caused by vehicles.

While we need to get more data from individual mothers before we can be more certain about the effects of air pollution on fetal development, we would recommend that where possible pregnant women reduce their exposure to air pollution.

New drug targets may fight tuberculosis and other bacterial infections in novel way

Thu, 27 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Dec. 27, 2007) -- Over the course of the 20th Century, doctors waged war against infectious bacterial illness with the best new weapon they had: antibiotics.

But the emergence of dangerous, multi-drug resistant strains of tuberculosis and other killer infections means that in the 21st century antibiotics are losing ground against bacterial disease.

Now, researchers from Weill Cornell Medical College in New York City say exciting new molecular targets -- so-called virulence factors that bacteria use to thrive once they are in the host -- present an alternative, potent means of stopping TB, leprosy and other bacterial illness.

We have developed the first inhibitor of a key small molecule from Mycobacterium tuberculosis and Mycobacterium leprae (which causes leprosy) utilized to subvert human host's defenses and damage and invade human host's cells during infection, explains study senior author Dr. Luis Quadri, Associate Professor of Microbiology and Immunology at Weill Cornell.

With this work, we now have proof of principle for the inhibition of this virulence factor in bacteria cultured in the lab. Our next step is to explore whether this inhibitor can stop these pathogens from multiplying in a mouse host, curtailing infection, Dr. Quadri says.

The findings -- published online today in Chemistry and Biology and appearing in the journal's Jan. 26 print edition -- highlight what Dr. Quadri has called a paradigm shift in infectious disease research.

We are moving beyond antimicrobials such as antibiotics, which kill the bacterium directly, to anti-infectives, that may have no effect against the pathogen in the test tube but which do compromise its ability to infect and spread in the host, he explains. We believe that the expansion of the drug armamentarium to include such anti-infective drugs could help the fight against multi-drug resistant infection that has become such a challenge today.

According to World Health Organization data, TB remains one of the world's top-ten leading causes of death, killing nearly two million people each year. Multi-drug resistant strains of M. tuberculosis -- as well as even more dangerous, extensive-drug-resistant (XDR) strains of the bug -- are emerging each year.

Obviously, we are going to require more than the traditional antimicrobial approach to turn this situation around, Dr. Quadri says.

In this study, Dr. Quadri, along with co-lead researchers Drs. Julian Ferraras and Karen Stirrett, focused on particular small-molecule virulence factors called phenolic glycolipids (PGLs).

Various strains of M. tuberculosis use PGLs to weaken our body defenses whereas M. leprae uses PGLs to damage and invade our nerve cells during infection.

Therefore, we hypothesize that drugs blocking PGL synthesis would reduce the adaptive fitness of PGL-producing M. tuberculosis strains in the human host by eliminating PGL-dependent immunomodulatory effects. These drugs may also diminish the ability of M. leprae to invade nerve cells and produce nerve function impairment, Dr. Quadri explains.

In complex work in the laboratory, the researchers investigated and then elucidated a crucial, early step in PGL biosynthesis. They also pinpointed a key enzyme, called FadD22, that is essential to that stage of the process.

Based on that, we collaborated with Dr. Derek Tan's lab at Memorial Sloan-Kettering Cancer Center to synthesize a molecule that targets FadD22 and successfully inhibits that early step in PGL production, Dr. Quadri said.

Follow-up work using both enzyme assays and M. tuberculosis assays confirmed that the new inhibitor does block the production of PGLs. Although it was technically not possible to test the inhibitor in M. leprae, that pathogen is very closely related to M. tuberculosis, so the researchers believe their agent would inhibit production of PGLs there, as well.

Work is already underway to come up with other, even more potent PGL biosynthesis inhibitors, Dr. Quadri says, with an eye to testing the best candidates in an animal model.

We are not saying that anti-infectives will ever replace antibiotics, but with pathogens as deadly as M. tuberculosis or as debilitating as M. leprae, you'd ideally like to have as many pharmaceutical weapons in your armamentarium as you can, to use either alone or in combination, Dr. Quadri says.

The new discoveries are highly encouraging, he adds.

I believe that drugs targeting virulence factors are just one component of the paradigm shift in the antimicrobial drug discovery for the 21st century -- one that will offer patients more options in the fight against truly global killers, he says.

Short sleep times in patients with chronic medical diagnoses associated with obesity

Sun, 16 Dec 2007 10:09:03 PST

( from http://www.rxpgnews.com ) A study published in the December 15 issue of the Journal of Clinical Sleep Medicine (JCSM) demonstrates an association between short sleep times and obesity in patients with chronic medical problems.

The study surveyed 200 patients attending internal medicine clinics to determine their sleep habits, lifestyle characteristics, and medical diagnoses.

According to the results, subjects with short sleep times (less than seven hours) had a significantly increased likelihood of obesity defined by a body mass index greater than 30 kg/meters2 when compared to the reference group of eight to nine hours. There was a U-shaped relationship between obesity and sleep time in women indicating that women who had both short and long sleep times were more likely to be obese. This relationship was not present in men. Other factors predicting obesity in these clinic patients included young age (18 to 49 years), not smoking, drinking alcohol, hypertension, diabetes, and sleep apnea.

“Our study demonstrates that short sleep times have an association with obesity in adults with chronic medical problems and that chronic disease and attendant therapies and/or changes in physical activities do not obscure this relationship,” said Kenneth Nugent, MD, of Texas Tech University, lead author of the study. “This study suggests that adults should sleep eight to nine hours per night to maintain optimal weight. Whether or not manipulating sleep time in adults will prevent additional weight gain or facilitate weight loss is unclear. This question will require therapeutic trials in which sleep hygiene is addressed during weight loss studies.”

A strong relationship exists between weight and obstructive sleep apnea (OSA), in that your neck gets thicker as you gain weight. This increases the level of fat in the back of the throat, narrowing the airway. With more fat in the throat, your airway is more likely to be blocked.

People with OSA are often obese and have a neck size of more than 17 inches. Many people with OSA also have high blood pressure.

It is estimated that four percent of men and two percent of women have OSA, and millions more remain undiagnosed.

First introduced as a treatment option for OSA in 1981, continuous positive airway pressure (CPAP) is the most common and effective treatment for OSA. CPAP provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing the pauses in breathing that characterize sleep apnea and restoring normal oxygen levels.

New UIC center to study end-of-life transition

Thu, 13 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) The University of Illinois at Chicago College of Nursing has received a federal grant to create a center to study people as they transition to the end of life.

The UIC Center for End-of-Life Transition Research will advance the science of care for people of all ages facing death -- infants, children, adults and older adults. It is funded through a $2.4 million grant from the National Institute of Nursing Research, one of the National Institutes of Health.

The American health care system often fails in providing appropriate care to people facing the end-of-life transition, said center director Diana Wilkie, professor and Harriet Werley Endowed Chair for Nursing Research. More than half of the people dying of cancer do so with their pain unrelieved and their expressed wishes about life-sustaining treatments not honored.

Research also suggests that parents of children who died felt that their children suffered greatly during the last month of life, said Karen Kavanaugh, professor of maternal-child nursing and co-director of the center.

The new center, Kavanaugh said, will conduct research to foster patient-centered, family-focused, respectful death and planning for end-of-life care that is consistent with the patients' and families' values and priorities.

The new center is a landmark opportunity to make important advances for palliative and end-of-life care, Kavanaugh said.

Four studies led by an interdisciplinary team from various colleges throughout UIC will be conducted during the five-year project.

One project will predict end-of-life in patients with advanced heart failure. Despite recent advances in drug and device therapy, the long-term prognosis of patients with advanced heart failure remains poor, says Catherine Ryan, research assistant professor of nursing and an expert in critical care, who will conduct the study.

More than 5 million people live with advanced heart failure, and accurately predicting the end of the illness trajectory for people with this disease will be extremely beneficial to direct care, Ryan said. Such knowledge, she said, could reduce the annual cost of care for these patients -- a cost estimated for 2007 to be $33.2 billion.

Another study will focus on oral health problems in terminally ill cancer patients in hospice care. Dr. Dena Fischer, assistant professor of oral medicine and diagnostic sciences in the UIC College of Dentistry, will direct the study.

Oral health problems are common for patients in the end of life, though such problems have gone largely unrecognized and may contribute to symptom burden during end-of-life transition, Fischer said. Our study will be taken from the perspectives of the patient, primary caregiver and oral health professional to determine the primary caregiver's knowledge about oral health problems and treatment.

A third study will utilize a suicide prevention online video to learn how it can raise suicide awareness among Asian American and Caucasian college students in Chicago. Students will complete computerized questionnaires about their cultural orientation and attitudes about suicide after watching the video. The study will be directed by Aruna Jha, research assistant professor of nursing, who has a background in social work.

Jha said Asian Americans have recently emerged as the group with the fastest increase in rates of suicide deaths for men and women aged 20 to 24. Their rates are now equal to other races in suicide attempts among high school students, and one and a half times the likelihood of whites for serious suicidal intent among college students. This gap is particularly disturbing given the availability of a well-accepted suicide awareness videotape.

Teresa Savage, research assistant professor of nursing, will conduct a fourth project, which will address end-of-life issues for patients with intellectual or developmental disabilities.

There are more than 4 million people in the United States who have an intellectual or developmental disability, Savage said. They are a disenfranchised group in the health care system, and many of these individuals are left out of decision-making regarding their own health care, especially at the end of their life.

Savage and her research team will conduct focus groups with developmentally disabled patients, support staff caregivers and family caregivers to learn about their perceptions of end-of-life care.

Other College of Nursing faculty with leadership roles in the new center are Sandy Burgener, associate professor of medical-surgical nursing; Laura Szalacha, research assistant professor of public health, mental health, and administrative nursing; Marquis Foreman, professor of medical-surgical nursing; and Gail Keenan, associate professor of public health, mental health and administrative nursing. An interdisciplinary group of UIC faculty from the health sciences and computer sciences will also participate in the new center.

Dr. Nicholas Schiff receives research award for Innovation in Neuroscience

Thu, 13 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Dec. 13, 2007) -- A leading authority on neurological disorders of consciousness, Dr. Nicholas Schiff of NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City has received a prestigious Research Award for Innovation in Neuroscience from the Society for Neuroscience, the world's largest organization of physicians and scientists who study the brain and nervous system.

The award -- for imaginative, innovative research that will advance novel ideas and have the potential to lead to significant breakthroughs in the understanding of the brain and nervous system and related diseases, -- was presented at the Society's recent annual meeting in San Diego.

Dr. Schiff was the lead author of a breakthrough study in the Aug. 2 journal Nature, reporting that a 38-year-old man who spent more than five years in a minimally conscious state as a result of a severe head injury is now communicating regularly with family members and recovering his ability to move after having his brain stimulated with pulses of electric current. The findings provide the first rigorous evidence that any procedure can initiate and sustain recovery in such a severely disabled person, years after the injury occurred.

Study investigators included NewYork-Presbyterian/Weill Cornell's Dr. Joseph Fins and physician-scientists at the JFK Johnson Rehabilitation Institute (Edison, N.J.) and the Cleveland Clinic Foundation.

Dr. Schiff is associate professor of neurology and neuroscience at Weill Cornell Medical College and associate attending neurologist at NewYork-Presbyterian/Weill Cornell. He is an inventor at Cornell University of some of the technology used in the study described in Nature and is a paid consultant and advisor to IntElect Medical Inc., to which the technology has been licensed by Cornell University and in which Cornell University has an equity interest. A Conflict Management Plan relating to IntElect and its relationship with Dr. Schiff and Cornell University is in place.

A diplomate of the American Board of Psychiatry and Neurology, he received his medical degree from Cornell University Medical College (now Weill Cornell Medical College). He completed his residency in neurology at The New York Hospital (now NewYork-Presbyterian/Weill Cornell), where he trained with Drs. Fred Plum and Jerome Posner and developed his subspecialty interest in the field of impaired consciousness. He is a co-author of the fourth edition of Dr. Plum and Posner's classic textbook The Diagnosis of Stupor and Coma. Dr. Schiff is an elected member of the American Neurological Association. His long-range goals are to develop strategies and improved diagnostics to treat of chronic cognitive disabilities resulting from brain injuries.

Exercise testing may help predict seriousness of mitral regurgitation

Tue, 11 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Dec. 11, 2007) -- In as many as one in five people over age 55, when the heart contracts to send blood around the body, some degree of backward leakage occurs across the mitral valve, a condition known as mitral regurgitation (MR). When sufficiently severe, MR causes buildup of blood in the lungs, leading to difficulty in breathing (dyspnea, or shortness of breath), a serious condition called congestive heart failure. MR also can cause heart rhythm irregularities (arrhythmias) such as atrial fibrillation, which can lead to strokes and other problems, and ventricular tachycardia, which can cause sudden death.

A new study finds that monitoring the capacity of these patients to exercise on a treadmill -- an evaluation called exercise tolerance testing (ETT) -- may be useful in predicting the condition's progression and whether the patient will need surgery. Led by NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the research is published in the American Journal of Cardiology.

Mitral regurgitation can be very benign, going unnoticed for many years, or can be severe, impeding the heart's proper function and leading to complications, even death. There are few accurate ways to predict the seriousness of a single case, and these methods require fairly sophisticated and expensive imaging. Our study shows that exercise tolerance testing, a simple procedure often performed in doctors' offices, is an excellent tool for predicting if the patient is deteriorating and needs surgery, says Dr. Jeffrey S. Borer, a study co-author ; director of the Howard Gilman Institute for Valvular Heart Diseases at NewYork-Presbyterian/Weill Cornell; and the Gladys and Roland Harriman Professor of Cardiovascular Medicine and professor of cardiovascular medicine in cardiothoracic surgery at Weill Cornell Medical College.

We found that exercise testing is a simple and relatively inexpensive way to predict outcomes. Patients with mitral regurgitation who perform well on the treadmill will likely remain healthy and not have to undergo further testing for a number of years. This gives these patients peace of mind, says principal investigator Dr. Phyllis G. Supino, associate research professor of public health in medicine and associate research professor of public health at Weill Cornell Medical College.

Developed in its most simple form in the 1920s, exercise tolerance testing (ETT) is used commonly to assess the progression of coronary artery disease and the severity of aortic stenosis.

In mitral regurgitation, the mitral valve does not close completely, as it should, when the heart contracts, allowing blood to flow backward instead of forward, limiting blood flow to the body. Symptoms include shortness of breath, fatigue, cough, heart palpitations, swollen feet or ankles, and excessive urination. A characteristic heart murmur can be heard with a stethoscope.

In the current study, researchers followed 38 patients with chronic severe nonischemic MR (that is, MR not due to a prior heart attack) for an average of seven years. All underwent ETT at study entry. Patients who could continue exercising for 15 minutes or longer (of a maximum total of 18 minutes) had a fivefold lower annual risk of developing heart failure or other evidence of severe heart dysfunction necessitating surgery, compared to patients who were unable to exercise for that length of time.

In patients with chronic severe nonischemic MR, progression to surgical indications generally is rapid. There are two surgical options for the treatment of MR: mitral valve replacement and mitral valve repair.

Aging with GRACE: Improving health care for older adults

Tue, 11 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) INDIANAPOLIS - Most older adults obtain their health care in the offices of busy primary care physicians or, in the case of those without physicians, in even busier hospital emergency departments. In either location, seniors often don't receive the recommended care for preventive services, chronic disease management and geriatric syndromes. A study published in the December 12 issue of the Journal of the American Medical Association reports on GRACE, the largest randomized clinical trial of a health system and home-based geriatrics care concept designed to improve health care for community-dwelling low-income older adults.

GRACE, developed by researchers from the Indiana University School of Medicine, the Indiana University Center for Aging Research and the Regenstrief Institute Inc., was designed to involve seniors and their primary care physicians in a program to optimize health and functional status, and decrease high-cost emergency department visits and hospital admissions. The JAMA study reports GRACE's success in both improving quality of care and health-related quality of life measures while reducing emergency department use. Hospital admissions also were reduced in the second year of the program in a group at high risk for hospital admission.

GRACE, short for Geriatric Resources for Assessment and Care of Elders, is geriatrics care specifically targeting medically vulnerable individuals. The key to GRACE is two teams. The support team, consisting of a nurse practitioner and a social worker, meet with each patient at home to conduct an initial comprehensive geriatric assessment from the medicine cabinet to the kitchen cabinet. Based on the support team's findings, a larger interdisciplinary team (including a geriatrician, pharmacist, physical therapist, mental health social worker, and community-based services liaison) develops an individualized care plan.

Then the ball is back in the support team's court. The nurse practitioner and the social worker meet with the patient's primary care doctor to come up with a health-care plan consistent with the patient's goals, for example maintaining the ability to participate in prized social and religious activities. The support team then works with the patient to implement the plan which contains strategies for medical issues of concern as well as elements related to maintaining quality of life. With the assistance of an electronic medical record and tracking system, the GRACE support team provides ongoing comprehensive care management.

Rather than concentrating on individual diseases, we focused on the many issues faced by aging low-income adults -- access to needed services, medications, mobility, depression, transportation, diet, as well as other health issues of aging, said study leader Steven R. Counsell, M.D., Mary Elizabeth Mitchell Professor of Geriatrics at the IU School of Medicine, IU Center for Aging Research center scientist, and affiliated scientist at the Regenstrief Institute. Using a model for geriatrics care based on our prior work, we were able to deliver care which was very popular with patients and their doctors, improved health outcomes, and helped keep seniors from having to use the emergency department.

Screening for abdominal aortic aneurysms in women may save lives

Fri, 09 Nov 2007 04:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Nov. 9, 2007) -- In 9 out of 10 cases, a burst abdominal aortic artery is quickly fatal for its most common victim: elderly males. A new study -- the largest yet performed -- now confirms that women over 65 with a history of smoking or heart disease are also at high risk for an abdominal aortic aneurysm (AAA) -- supporting the notion that they should also receive ultrasound screening to help spot and correct the dangerous condition.

The findings, reported in the Journal of Vascular Surgery, challenge current recommendations on AAA screening issued by the United States Preventive Services Task Force. Those guidelines recommend that screening only be performed -- and reimbursed by Medicare -- for men aged 65 to 75 who have ever smoked.

The Task Force ruled against screening for older women, citing a lack of evidence to support the cost-effectiveness of such a move.

That left us scratching our heads, says the study's senior author, Dr. K. Craig Kent, chief of vascular surgery at NewYork-Presbyterian Hospital, the Greenberg-Starr Professor of Surgery at Weill Cornell Medical College and professor of surgery at Columbia University College of Physicians and Surgeons. We know that AAA kills up to 30,000 Americans each year, with the ratio of males to females at about 4 to 1. But that still means that thousands of American women will die from this type of event each year. We wanted to discover whether certain subgroups of women might be at especially heightened risk and therefore benefit from screening.

An AAA occurs when a bubble-like swelling occurs in a portion of the aorta, the major artery that carries blood from the heart through the abdomen to the lower body. As this 'bubble' swells over time, the artery wall can thin out and rupture.

Ruptures can occur suddenly and typically prove fatal. In fact, 85 percent of people who suffer a ruptured AAA die before making it to the hospital, and only half of the 15 percent who do receive hospital care survive the attack.

That's why detecting these aneurysms early and monitoring or repairing them is crucial, Dr. Kent says.

But right now, doctors are actually being advised against providing their female patients with the 10-minute ultrasound test that could spot the problem. The noninvasive test itself is relatively inexpensive (about $40) and is often bundled with other diagnostic screens.

In the new study, Dr. Kent and colleagues recruited 17,540 patients from 100 hospitals and clinics spread across the United States. Overall, the cohort included 10,012 women over the age of 65 (average age 69.6 years) and 7,528 men over the age of 60 (average age 70).

Patients were questioned as to their demographics, history of smoking and medical histories. They also underwent conventional AAA ultrasound screening.

Overall, AAA showed up in 291 (3.9%) of the men and 74 (0.7%) of the women -- similar to the usual rate. But certain subgroups of women fared much worse. For example, women over age 65 were more than four times as likely to have this type of aneurysm than women younger than 65, and that risk grew by 10 percent with every added year of age.

Women with a history of smoking, or a history of heart disease (i.e., a prior heart attack or coronary bypass) faced triple the risk of AAA, the researchers found.

Any combination of the above risk factors boosted a woman's odds of AAA by up to six-fold, the team found.

The bottom line, in terms of the cost-effectiveness of screening older women, is that these tests are probably not useful for the general population, but are certainly warranted for women over 65 with risk factors such as smoking and a history of heart disease, Dr. Kent says. In fact, having just one of those risk factors alone may also indicate a need for screening, based on a discussion between the patient and her doctor.

We hope that this data provides the evidence that the Task Force and others in the field have needed to push for screening of AAA in at-risk females, Dr. Kent says. Women can also benefit greatly from this data, as they decide with their doctors whether or not testing is right for them.

Patients enrolled in the study were screened through the Stroke and Aneurysm Vascular Evaluation (SAVE) Program, which is sponsored and funded by medical device maker Medtronic Inc., of Minneapolis, and conducted by Life Line Screening, Cleveland.

Triage study challenges notions of emergency medical response to disaster

Thu, 01 Nov 2007 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (Oct. 31, 2007) -- In the face of terrorism and catastrophic natural disasters, modern regional trauma systems that improve survival for critically injured patients are more vital than ever.

Yet many fundamental assumptions underlying these systems -- such as the notion that it is imperative to send the sickest patients to the hospital first -- have rarely been subjected to rigorous scientific scrutiny. Now, for the first time, researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have created a computer simulation model of trauma system response to mass casualty incidents involving dozens or hundreds of injured victims. The study shows that the best response depends more on the capability of regional hospitals to treat critically injured victims than on the ability to accurately identify those victims in the field.

There's been the notion gleaned from prior studies that 'overtriage' -- letting some people into emergency care who might not actually need it -- usually ends up costing lives, with deaths rising as overtriage rates increase. But our new model demonstrates that overtriage alone is unlikely to be the culprit, says lead researcher Dr. Nathaniel Hupert, assistant professor of public health and medicine at Weill Cornell Medical College and assistant attending physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Instead, levels of overtriage can be beneficial, harmless or detrimental, depending on complex factors included in the researchers' model, he says. Those factors include the capacity of medical facilities to deal with the wounded and the time it takes to process and care for patients.

No triage system is 100-percent accurate, so the key issue to define from an outcomes perspective is, 'How good is good-enough' Dr. Hupert says. Our study suggests that pre-disaster planning can begin to address this question systematically, using modeling that takes into account local resources and response times, as well as specific types of mass casualty events.

The study is published in a special October supplement on mass casualty incidents of the journal Disaster Medicine and Public Health Preparedness, which focuses on the Virginia Tech shooting.

According to Dr. Hupert, experts in the field of traumatology and disaster preparedness have tended to rely on historical or anecdotal evidence to describe the downside of overtriage. A number of studies released over the past decade have bolstered the notion that overtriage stretches limited medical resources during mass casualty events and ends up costing lives, Dr. Hupert says. This was thought to happen in a linear fashion: More overtriage, more unnecessary deaths.

Overtriage can be valuable, however, because it helps ensure that critically injured people who do require speedy, lifesaving care aren't missed. In fact, guidelines from the American College of Surgeons support a limited amount of overtriage in emergency care.

To determine how much overtriage matters to patient outcomes, Dr. Hupert, along with engineers Eric Hollingsworth and Dr. Wei Xiong, Instructor in the Department of Public Health, created a discrete event simulation model representing the size and type of mass casualty event, the accuracy of field triage, and the treatment capability of the regional hospital trauma system. The model included a number of key variables that had never been brought together in one unified framework.

We included the ability of responders to triage patients, either in the field or at the site of care; the capacity of local centers to care for incoming wounded and then recycle resources to care for new patients; the time needed to process and treat patients; and the window of time in which it was assumed critically injured patients might die, Hollingsworth explains.

The team found that, contrary to prior reports, the relationship between overtriage and critical patient mortality is not linear, and is highly dependent on whether there is a surplus or shortage of trauma bays in regional emergency departments.

In some cases -- for example, when the risk of death over the short term is high but you have a really large capacity to care for the injured -- we can now show how overtriage may actually be a good thing, because you get more people into emergency care than you would otherwise, Dr. Hupert says. On the other hand, if you have a more limited capacity, overtriage can be much less valuable, and perhaps harmful.

The model also addresses another relative unknown in mass casualty response: the impact of large numbers of walk-in patients on outcomes of those most critically injured. As with overtriage, the model suggests that the walking wounded can have a variable impact on the relationship between resources and mortality. By giving planners the ability to quantify these effects, however, the model advances the current state of disaster response logistics.

The bottom line, according to the researchers, is that the best triage strategy during a mass casualty event is probably one that takes into account a variety of local and regional factors, which means that use of the model should spur regional collaboration and information sharing. We hope that this type of modeling study will be used to help disaster response teams plan effective strategies to deal with mass casualty events occurring in their own specific regions, Dr. Hupert says. We can never predict when or where disaster will strike, but with models like these we can hope to be more prepared.

Now that they have a better understanding of the relationship between triage and outcomes, the researchers are continuing to build the model. In our current work, we are incorporating details such as the spectrum of likely injuries from a particular event, the diagnostic tests needed to sort out critical from noncritical patients, and transportation times from the site of injury to the care center, Dr. Xiong says.

This work and other projects that Dr. Hupert and his team are conducting clearly demonstrate the value of combining methods from public health and operations research. Insights are provided that can directly lead to ways to improve the effectiveness and efficiency of our health-care system, says Dr. Alvin Mushlin, professor and chairman of the Department of Public Health and Professor of Medicine at Weill Cornell Medical College, and Public Health Physician-in-Chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Imaging shows structural changes in mild traumatic brain injury

Thu, 25 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Researchers report that diffusion tensor imaging can identify structural changes in the white matter of the brain that correlates to cognitive deficits even in patients with mild traumatic brain injury.

The study is published in the October issue of the journal Brain.

We studied patients with all severities of traumatic brain injury -- mild to severe -- and found that abnormalities in white matter existed on the spectrum, said Dr. Marilyn Kraus, associate professor of psychiatry and neurology at the University of Illinois at Chicago College of Medicine and lead author of the study. Even in patients with mild TBI -- those identified as having minimal or no loss of consciousness -- there were structural deficits.

Diffusion tensor imaging uses magnetic resonance imaging technology to examine the integrity of white matter that is especially vulnerable to traumatic brain injury. This imaging modality allows researchers to quantify and qualify structural changes in white matter, particularly in chronic TBI patients.

Thirty-seven TBI patients (20 mild and 17 moderate to severe) and 18 healthy volunteers underwent diffusion tensor imaging and neuropsychological testing to evaluate memory, attention, and executive function. All subjects were at least six months post-injury, and the majority were high-functioning people who were employed or in school at the time of evaluation.

The researchers found that structural changes in the white matter correlate to observable cognitive deficits related to thinking, memory and attention. Patients with more severe injuries had greater white matter abnormalities, representing a permanent change in the brain.

We know that discreet brain areas are important for specific types of functioning, such as thinking, memory, cognition and motor skills, said Kraus. But what's also very important is that the white matter serves as the connection between these significant areas of the brain.

In some ways, the brain is similar to a computer, said Deborah Little, director of MRI research in the department of neurology and rehabilitation medicine at UIC and co-author of the study. You have the CPU and the memory, but they are worthless unless they are connected to each other. The white matter of the brain has the same function as the cables of the computer.

When white matter is damaged, areas of the brain may appear healthy but they are actually unplugged and cannot function.

This study validates that getting smacked in the head is not a good thing, despite the fact that some clinicians still believe a patient can recover fully after a concussion, said Little.

A significant percentage of patients in the study had no self-reported cognitive deficits, yet they did have permanent damage that was apparent to researchers.

TBI has been a long-standing public health problem and a significant source of disability, but the recent increase in veterans returning from war and athletes who have experienced multiple concussions has generated greater public attention to TBI.

Very often in TBI there are forces being applied to the brain that stress the tracts of white matter -- pulling them, yanking them -- and the white matter becomes damaged, Kraus said.

Patients who have a contusion, or bruising of the brain, can also suffer from subtle and diffuse damage to the white matter. The researchers believe that not only the focal lesion but the damage to the white matter is very important.

In the study, the researchers were also able to determine axonal damage (tearing of the axons that allow one neuron to communicate with another) in white matter versus abnormalities in the myelin (the protective sheath that, if damaged, can disrupt signals between the brain and other parts of the body.) If an axon is severed, the damage generally cannot be repaired.

We found that the milder injuries had less myelin damage, and the more severe injuries had both axonal and myelin damage, said Kraus.

This research helps us to understand how early on, particularly in milder injuries, there may be some ability for myelin to repair, Little said. When athletes, for example, are sustaining head injuries over and over -- without being told to sit out -- it may have a huge impact on their recovery. This could affect decisions clinicians make about when someone with a mild injury should return to the battlefield or playing field.

An eye for an eye: using stem cells to treat damaged eyes and a rare skin disorder

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Doctors and scientists in Italy have shown how stem cells can be used to treat damaged eyes and, in combination with gene therapy, a rare and debilitating skin disease.

Professor Michele De Luca of the University of Modena and Reggio Emilia described the work to an international meeting of stem cell scientists in Milan (30 Sep � 2 Oct, �Challenges in Stem Cell Differentiation and Transplantation�) organised by the European Science Foundation�s EuroSTELLS stem cell programme in conjunction with the National Research Council of Italy.

Stem cell therapy involves the use of stem cells � �blank� cells (�toti- or �pluripotent�) that have not differentiated into specialised cells � to generate new tissues or organs. While widespread stem cell therapy lies some way in the future, Professor De Luca pointed out that it has been used already for many years in the treatment of burns. Many tissues of the body are continuously regenerated by their own population of stem cells. In the skin, such cells are called holoclones and for decades doctors have taken small samples of these cells from burns patients and cultured the cells into new skin that can be grafted onto the wound.

Professor De Luca�s team showed that cells of the transparent outer covering of the eye, the cornea, are constantly being replaced by new cells deriving from an area surrounding the cornea called the limbus. The cells differentiate into corneal epithelium and migrate to the cornea.

�If the cornea is damaged severely by a chemical burn or infection, for example, it can become opaque and necessitates a transplant,� Professor De Luca told the meeting. �However, a transplant will only be successful if the patient�s limbus has remained intact so that it can continue to replenish the new cornea.�

For many years doctors did not understand why some transplants failed � because they did not appreciate the requirement for the limbus.

In cases where the limbus is destroyed there has been little hope to restore the patient�s sight. Professor De Luca�s team decided to take a leaf from the way that burns are treated and grow a new cornea from limbar stem cells taken from the healthy eye.

By removing a small sample of these cells it was possible to culture a new cornea and graft it on to the damaged eye. The team showed that of 240 patients who were operated on in this way, the cornea regenerated successfully in 70% of cases.

The researchers then turned their attention to a rare but debilitating genetic disease of the skin resulting in a syndrome known as Epidermolysis Bullosa, in which the skin is highly fragile and prone to blistering due to faulty proteins that effectively anchor the surface layers of skin to the body.

In one form of the disease there is a mutation in one of these anchoring proteins called laminin 5. The Italian researchers obtained consent to carry out a small-scale trial of a novel gene therapy using skin holoclones on one patient, a 37-year-old male, on small part of his body .

�Because the patient�s body was so badly affected it was difficult to isolate any stem cells from his skin,� Professor De Luca told the conference. �Most people have between seven and ten per cent of holoclones. Our man had none. Eventually we found a few in the palms of his hand and cultured them from a biopsy.�

The team then used gene therapy to insert the correct laminin gene into the growing cells and grafted the new tissue onto the patient�s body. The graft was successful and after several months the skin remained to all intents normal, without the blistering and flaking.

�This demonstrates that it is possible to use stem cells in gene therapy for genetic skin disorders,� Professor De Luca said.

From terror to joy: faced with death, our minds turn to happier thoughts

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Philosophers and scientists have long been interested in how the mind processes the inevitability of death, both cognitively and emotionally. One would expect, for example, that reminders of our mortality--say the sudden death of a loved one--would throw us into a state of disabling fear of the unknown. But that doesn't happen. If the prospect of death is so incomprehensible, why are we not trembling in a constant state of terror over this fact?

Psychologists have some ideas about how we cope with existential dread. One emerging idea--terror management theory --holds that the brain is hard-wired to keep us from being paralyzed by fear. According to this theory the brain allows us to think about dying, even to change the way we live our lives, but not cower in the corner, paralyzed by fear. The automatic, unconscious part of our brain in effect protects the conscious mind.

But how does this work? Psychologists Nathan DeWall of the University of Kentucky and Roy Baumeister of Florida State University ran three experiments to study existential dread in the laboratory. They prompted volunteers to think about what happens physically as they die and to imagine what it is like to be dead. It's the experimental equivalent of losing a loved one and ruminating about dying as a result.

Once the volunteers were preoccupied with thoughts of death and dying, they completed a series of word tests, which have been designed to tap into unconscious emotions. For example, volunteers might be asked to complete the word stem jo_ to make a word. They could make a neutral word like job or jog, or they might instead opt for the emotional word joy. Or, in a similar test, they might see the word puppy flashed on a screen, and they would instantaneously have to choose either beetle or parade as the best match. Beetle is closer to puppy in meaning, but parade is closer to puppy in emotional content. The idea is that the results represent the unconscious mind at work.

The results, as reported in the November issue of Psychological Science, a journal of the Association for Psychological Science, are intriguing. The volunteers who were preoccupied with thoughts of death were not at all morose if you tapped into their emotional brains. Indeed, the opposite: they were much more likely than control subjects to summon up positive emotional associations rather than neutral or negative ones. What this suggests, the psychologists say, is that the brain is involuntarily searching out and activating pleasant, positive information from the memory banks in order to help the brain cope with an incomprehensible threat.

Kaiser Permanente study shows electronic medical records and outreach improve osteoporosis care

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) October 22, 2007 (Oakland, CA) �Electronic medical records and outreach programs of e-mail messages, letters and phone calls to patients and their primary care providers after a bone fracture can dramatically improve the diagnosis and management of the patients� osteoporosis, according to a Kaiser Permanente study in the September issue of the Journal of the American Geriatrics Society. This is the largest study to show that electronic medical records improve the continuity of care for osteoporosis.

�Often when a patient sustains a fracture, there is a disconnect between the treating orthopedist and the patient�s primary care physician. With Kaiser Permanente�s computerized database and integrated care delivery system, we can closely monitor and follow patients with fractures and prevent that disconnect,� said Adrianne Feldstein, MD, MS, an investigator at the Kaiser Permanente Center for Health Research (CHR) in Portland and the lead author of the study. �This intervention has broad applicability to a large group of health care providers � from local health departments to HMOs to PPOs � with access to electronic billing or clinical data. Armed with that data, these health organizations can make sure their patients with fractures get appropriate bone density screening follow up.�

This study of 3,588 women shows that an outreach program targeted to patients with a previous fracture meant there was an improvement from 13.4 percent to 44 percent of patients being evaluated and/or treated for osteoporosis. Osteoporosis management is the receipt of a bone mineral density (BMD) measurement or osteoporosis medication in the six months after a fracture. If widely implemented, this approach could substantially improve the secondary prevention of osteoporosis, according to the study authors.

Osteoporosis, a bone disease that leads to increased risk of fracture, is a prevalent condition in older adults, and affects about 20 percent of women 65 and older. Medication can reduce fracture risk in people with osteoporosis significantly, yet many patients, even those who already sustained a previous fracture, do not receive the necessary BMD screening and subsequent treatment. It is estimated that in 2005 there were 2 million fractures at a cost of $17 billion in the United States; by 2025, this number is expected to increase by 50 percent as the population ages.

�Osteoporosis now causes more deaths annually than breast cancer and ovarian cancer combined, said Dr. Feldstein �This study shows that we can cost-effectively improve management with interventions as simple as e-mails, letters and phone calls. That in turn should reduce fractures and mortality, and improve quality of life.�

Researchers at the Kaiser Permanente Center for Health Research used the organization�s integrated databases to analyze medical records of 3,588 women aged 67 and older who sustained qualifying clinical fractures. The women were members of the health plan in Oregon and had not received a BMD measurement or osteoporosis treatment in the 12 months before the fracture.

The goal of the study was to evaluate the effect of the interventions on the National Center for Quality Improvement, Health Employer Data and Information Set (HEDIS) measure that evaluates the proportion of women age 67 and older who sustained a qualifying clinical fracture and had not received a BMD measurement or osteoporosis treatment in the 12 months before the fracture and who received either of these six months after the fracture.

The study was conducted in two phases: In Phase 1, primary care physicians with eligible patients were sent an electronic medical record (EMR) in-basket message that contained patient-specific clinical guideline advice consistent with national guidelines, as well as offered outreach to the patient. If the PCP elected, patients were then contacted via an introductory letter and phone call by outreach staff, who completed a patient record review, counseled the patients regarding risk of osteoporosis and future fractures, and ordered laboratory testing, medication, or a BMD measurement. During Phase 2 clinicians and staff were eligible for a financial incentive for quality improvement based on the osteoporosis HEDIS measure.

�Although the financial incentive helped staff define what the organizational priority was, being a team player is what drove behavior,� said Dr. Feldstein. �The increase in performance resulted from re-engineering the patient�s care and ensuring continuity of care from orthopedist and primary care physician.�

MacArthur commits $11 million to further UCSF work in maternal safety

Fri, 19 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The John D. and Catherine T. MacArthur Foundation has promised $10.75 million to extend a ground-breaking UCSF project to help combat maternal mortality in Nigeria and India � two countries that comprise one-third of all maternal deaths worldwide.

MacArthur Foundation President Jonathan Fanton announced the grant today in London at the Women Deliver conference.

The funding will go to the nongovernmental organization Pathfinder International, which will use the grant to implement a spectrum of interventions developed and tested by UCSF researchers to treat women suffering from post-partum hemorrhaging. UCSF will continue to advise the group on the roll-out, including development of a plan for monitoring and evaluating the project�s outcomes.

The centerpiece of the program is the non-pneumatic anti-shock garment, or NASG, a low-cost and reusable body suit made of lightweight neoprene that was originally designed for battlefield use. When the suit's five Velcro closures are tightened around the patient's body, the compression stops blood from flowing to the lower extremities and forces it back to the heart, lungs, and brain to counteract shock.

The suit has now been shown to effectively stem hemorrhaging after childbirth, according to Suellen Miller, CNM, PhD, who proposed the garment�s use as a maternal life-saver and pilot-tested the project in Egypt over the past four years with Egyptian colleagues Mohammed Mourad Yousiff, MD, from El Galaa Maternity Hospital, in Cairo; and Mohamed Fathalla, MD, from the Assiut Teaching Hospital, in Assiut.

�It is tremendously gratifying to see this work being expanded by Pathfinder,� said Miller, an associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Services and director of the Safe Motherhood Programs of the UCSF Women�s Global Health Imperative.

�Hundreds of thousands of new mothers die needlessly every year due to hemorrhaging, simply because they don�t have access to a hospital,� she said. �This simple garment appears extremely promising in pilot studies and could potentially have a huge impact on the lives of both the women and their families.�

In the pilot study, 158 obstetrical hemorrhage patients underwent standard hemorrhage treatment and 206 patients with obstetrical hemorrhaging underwent standard treatment plus the anti-shock garment.

Study results showed a 50 percent decrease in blood loss among women treated with the garment, which is statistically significant, Miller said. Pilot results, which were published in the April 2006 issue of the �British Journal of Obstetrics and Gynecology,� showed a 69 percent decrease in death and severe illness.

�In our research, women who appeared clinically dead, with no blood pressure and no palpable pulse, were resuscitated and kept alive for up to two days until they could be transported to a hospital,� said Miller.

The World Health Organization estimates that 529,000 women died in pregnancy or childbirth in the year 2000. More than 99 percent of these deaths occurred in developing countries, where Miller said the majority of women give birth at home, with poorly trained or untrained attendants. Of the risks, postpartum hemorrhage is the most common cause of maternal mortality, accounting for approximately 25-30 percent of all maternal deaths.

Pathfinder will use the MacArthur grant to introduce a package of low-tech interventions at several hundred health facilities in seven Indian states and eight states in Nigeria. Those interventions, called the Continuum of Care for PPH (post partum hemorrhage), were developed by Miller and Stacie Geller, PhD, an associate professor at the University of Illinois College of Medicine.

The package of interventions includes the anti-shock garment, a uterus-contracting drug to prevent bleeding, a calibrated blood collection drape to diagnose postpartum hemorrhage, and a community-developed communication and transportation plan to get patients to a health facility for assessment and emergency obstetrical treatment.

�It is important to address postpartum hemorrhage wherever there is the potential for it to occur, from the community up through the health system,� said Dan Pellegrom, president of Pathfinder International. �Prevention and management starts in homes and communities, so it is important to cultivate informed and engaged communities that are aware of the danger signs of hemorrhaging and can transport women to skilled service providers.�

The current funding builds upon nearly $2 million in previous MacArthur grants to UCSF for preliminary pilot studies of the anti-shock garment in Egypt, Mexico and Nigeria. Fanton, from MacArthur, said the introduction of the garment on a large-scale could help save hundreds of thousands of lives and help strengthen national health care systems.

�No other major cause of maternal death can be prevented as easily as postpartum hemorrhage,� Fanton said. �Our hope is that the anti-shock garment will eventually become part of a standard package of care for postpartum hemorrhage in developing countries.�

Miller and her team will continue a rigorous NIH funded randomized cluster trial of the garment in Zambia and Zimbabwe.

Septic survival

Wed, 17 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) While survival rates for sepsis have increased over the past two decades, children under four and those in adolescence remain highly susceptible to the condition. Researchers in The Netherlands have now demonstrated that age and to a lesser extent, gender, are critical factors in whether or not a child sufferer will develop a more severe disease state and survive or not. These findings could help to improve the treatment of sepsis and improve survival rates further still.

Writing in the online open access journal Critical Care, Jan Hazelzet and colleagues at the Erasmus MC-Sophia Paediatric Intensive Care Unit (PICU) in Rotterdam describe their study of almost 300 children admitted with sepsis and purpura (red patches caused by bleeding under the skin) between 1988 and 2006. The researchers recorded the age, gender, ethnic origin, severity of condition, therapy, and survival of the patients. They then pooled the data and analyzed the outcomes retrospectively.

The results showed that the fatality rate from sepsis and purpura was 15.7%. However, during the study period, they observed a marked improvement in the numbers of children surviving sepsis. Nevertheless, they found that younger children were affected more severely and fatality rate was higher (4.3 times) for those under the age of three years. They found no difference in fatality rates between boys and girls, but boys were admitted to the PICU for longer periods and had more severe symptoms. The team found that the course of sepsis and purpura was not related to a child's ethnic origin.

In almost all cases, the infection that led to sepsis was Neisseria meningitidis, the bacterium commonly known as meningococcus. The team also reports how the drugs used to treat sepsis changed during the course of the study. There has been a marked reduction in the use of dopamine and a concomitant increase in the use of dobutamine, norepinephrine and corticosteroids to treat sepsis. The finding of the important influence of young age and to a lesser extent gender can lead to a better understanding of the disease, which in turn can lead to better therapy, says Jan Hazelzet.

Sepsis is a serious medical condition triggered by infection, which leads to body-wide inflammation, fever, increased pulse and breathing, and potentially organ failure and death. Each year, more than 750,000 people in the USA will develop severe sepsis, and more than 215,000 will die from the condition. In the UK, sepsis kills around 30,000 people annually.

Study shows reducing class size may be more cost-effective than most medical interventions

Tue, 16 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) October 16, 2007 -- Reducing the number of students per classroom in U.S. primary schools may be more cost-effective than most public health and medical interventions, according to a study by researchers at Columbia University Mailman School of Public Health and the Virginia Commonwealth University. The study indicates that class-size reductions would generate more quality-adjusted life-year gains per dollar invested than the majority of medical interventions. The findings will be published in the November issue of the American Journal of Public Health.

The researchers estimated the health and economic effects of reducing class sizes from 22�25 students to 13�17 students in kindergarten through grade 3 nationwide, based on an intervention tested in Project STAR (Student Teacher Achievement Ratio), a large multi-school randomized trial that began in 1985. Project STAR is considered the highest quality long-term experiment to date in the field of education.

The study shows that a student graduating from high school after attending smaller-sized classes gains an average of 1.7 quality-adjusted life-years and generates a net $168,431 in lifetime revenue. �Higher earnings and better job quality enhance access to health insurance coverage, reduce exposure to hazardous work conditions, and provide individuals and families with the necessary resources to move out of unfavorable neighborhoods and to purchase goods and services,� says Peter A. Muennig, MD, MPH, assistant professor of Health Policy and Management at the Mailman School. �Regardless of class size, the net effect of graduating from high school is roughly equivalent to taking 20 years of bad health off of your life.

When targeted to low-income students, the estimated savings would increase to $196,000 per additional graduate. �This is because low-income students seem to benefit more from the additional attention afforded by small classes,� noted Dr. Muennig. �Because we focused on a relatively expensive intervention and examined outcomes over a range of values, our results should provide a conservative framework for evaluating this and other interventions as long-term data on educational interventions become more plentiful,� he commented.

The performance of students in the U.S. has been declining relative to the performance of students in other countries. With health costs soaring and student performance falling, the United States is in jeopardy of losing its economic dominance.

The findings not only raise issues of whether investments in social determinants of health can be more cost-effective than investments in conventional medical care, �but more intriguing still, also bring up the idea that each dollar invested in education could also potentially produce other long-term returns,� observes Dr. Muennig. He notes that further analysis will refine models and produce more-precise estimates, but �these findings do point to the importance of looking more broadly at the options available for improving health outcomes�including those outside the boundaries of clinical medicine.�

Severely mentally ill at high risk for cardiovascular disease

Tue, 16 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) St. Louis, Oct. 15, 2007 � A psychiatrist at Washington University School of Medicine in St. Louis writes in the Journal of the American Medical Association (JAMA) that although mortality from cardiovascular disease has declined in the United States over the past several decades, patients with severe psychiatric illness are not enjoying the benefits of that progress.

In a commentary article in the Oct. 17 issue of JAMA, John W. Newcomer, M.D., professor of psychiatry, of psychology and of medicine and medical director of the Center for Clinical Studies at Washington University, reports that those with illnesses such as schizophrenia, bipolar disorder and major depression lose 25 to 30 years of life expectancy compared to the general population. And although suicide does claim the lives of many psychiatric patients, most of those premature deaths are due to cardiovascular disease.

This is really a double hit, Newcomer says. Not only are these patients dealing with the serious burden that accompanies their psychiatric disorder, but they also have an increased risk and an increased burden from major medical conditions like diabetes, heart disease and stroke. Ultimately, it is the unrecognized risk factors and the under-diagnosed and under-treated conditions that significantly shorten the lifespan.

Newcomer says several factors conspire to elevate risk including reduced access to appropriate medical care. Major mental disorders significantly impair a person's ability to work and learn, so patients tend to have lower incomes and poorer dietary habits, often relying instead on fast food. In addition, patients with serious psychiatric illness are much more likely to smoke � between 50 percent and 80 percent smoke cigarettes � and although the severely mentally ill make up only between 5 percent and 10 percent of the population, they consume a disproportionate amount of all cigarettes smoked in the United States. Many psychiatric medications also tend to contribute to weight gain, in part by making people less active and sometimes by stimulating appetite, and weight gain can be a prominent side effect of some antipsychotic drugs in particular.

All of this adds up, Newcomer says. They are more likely to eat more high-fat food and to burn fewer calories, so it's not surprising that this population also tends to have higher rates of overweight and obesity.

But that's not the whole story. Newcomer also reports that patients with severe mental illness are significantly less likely to receive therapies of proven benefit for problems with cholesterol, diabetes, hypertension or heart disease. Those who have survived a heart attack are less likely to receive appropriate medications, cardiac catheterization procedures or bypass surgery than heart-attack patients without mental illness.

Regarding preventive care, Newcomer cites data from a national study of 1,500 patients with chronic schizophrenia. They participated in the National Institute of Mental Health-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. The CATIE study found that 88 percent of patients entering the study with high cholesterol did not take lipid-lowering drugs. Another 30 percent with diabetes at the start of the study received no anti-diabetes medications, and 62 percent of those with high blood pressure were not taking any antihypertensive medication.

Those with severe psychiatric illness also are less likely to be screened for high cholesterol, high blood pressure or diabetes despite the evidence of increased risk in general and specific evidence that some antipsychotic drugs can have adverse effects on body weight, glucose metabolism and lipid levels.

A solution, Newcomer argues, will emerge only if psychiatrists and primary-care providers can work together.

This requires coordination, he says. And coordination between psychiatric professionals and primary-care providers is not easy when they often are physically located in different places. There are transportation issues and scheduling issues. For healthy people, the need to make an extra appointment lowers the probability that it will actually happen, and research further indicates that when patients with severe mental disorders have to go across the hall, it reduces the probability they will get care. If they have to cross the street, the probability gets even lower. If it's across town � well, without case managers and others working closely with these patients, in general those follow-ups won't happen.

Newcomer says another problem is that lifestyle interventions that encourage healthy eating, smoking cessation and exercise can be difficult enough in the general population, but they are even more difficult when patients with schizophrenia or other mental disorders are involved. He says such behavioral interventions have been shown to work even in those with severe psychiatric illness, but achieving success requires extra commitment and resources from the health-care community.

Getting psychiatrists to change their routine is important. Newcomer says that to lower risk of cardiovascular complications, psychiatrists may need to regularly weigh their patients, take blood pressure and screen appropriately for blood glucose, cholesterol and triglycerides.

We're not saying psychiatrists should start prescribing lipid-lowering agents or diabetes drugs, but they are on the 'front lines,' seeing psychiatric patients much more than primary-care providers, Newcomer says. It's important that psychiatrists begin to employ some of these basic screening techniques.

He also says that it's vital that patients with severe mental disorders receive needed psychiatric medications, even though some of those drugs may contribute to weight gain, abnormal lipid levels and risk for cardiovascular disease and diabetes.

If you have a serious psychiatric condition like schizophrenia, you really need to take medication, Newcomer says. Clearly we don't want people to stop taking their medicine, but in some cases, there may be alternative drugs that have fewer effects on risk for obesity or diabetes. Combinations of diet, exercise and selected medication are being studied to lower these risks without losing the benefits that antipsychotic drugs provide for these patients with severe psychiatric illness.

And Newcomer believes if such strategies can be developed and implemented, it is possible to quickly lower rates of cardiovascular disease and increase life expectancy in this population.

I think there's some 'low-hanging fruit' here, he says. Just getting psychiatrists engaged in this type of general health monitoring should help. Most of these patients already are seeing a physician, and if that physician and medical team can screen for cardiovascular risk factors, we may be able to intervene and find ways to lower that risk significantly.

UCSD findings could lead to new therapy for spinal cord injury-induced spasticity and rigidity

Tue, 16 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Research led by scientists at the University of California, San Diego (UCSD) School of Medicine has identified a target with potential as an effective new therapy for chronic spasticity and rigidity, a painful condition that often results from spinal cord injury.

In work with rats, Martin Marsala, M.D., a professor in the Department of Anesthesiology at the University of California, San Diego (UCSD) School of Medicine, demonstrated that an AMPA receptor antagonist called NGX424 (tezampanel), being developed by TorreyPines Therapeutics, Inc., of La Jolla, California, is highly potent in suppressing spasticity and rigidity. The study will be published in the October 17 issue of the Journal of Neuroscience.

Paraplegia from spinal cord ischemia is a serious complication that occurs in 20 to 40 percent of patients undergoing a surgical process called aortic cross-clamping. When the surgeon works on the aorta to correct a potentially lethal aneurysm, this large vessel carrying all of the blood flow from the heart must be temporarily blocked. If clamping occurs for more than 30 minutes, the procedure can result in the loss of specialized spinal cord neurons called spinal inhibitory neurons. Loss of these neurons can lead to irreversible spasticity and rigidity, or loss of muscle control, in the lower limbs.

�This exaggerated muscle tone, or uncontrolled spasms, is a serious complication of either ischemic or traumatic injury to the spinal cord -- such as injuries resulting from a diving or car accident,� said Marsala. Several other conditions can lead to spasticity/rigidity, including brain trauma, multiple sclerosis, cerebral palsy or Parkinson�s disease � all of which lead to increased peripheral muscle tone.

The most effective treatment for the spastic muscle condition � which results in pain and tremendous spasms, even in those patients who have partial motor recovery � has been a drug called Baclofen, a GABA-B receptor agonist that is delivered either systemically or spinally to patients. However, according to Marsala, patients taking this drug often develop tolerance and need increased dosage to achieve the same effect.

�A new therapy to control spasticity is very important,� said lead author Michael P. Hefferan, Ph.D., of UCSD�s Department of Anesthesiology. �This AMPA receptor blockade offers a novel means of reducing the spasticity and rigidity in muscles because it works through a totally different receptor system than current drugs being used.�

Spinal spasticity is the result of increased spinal neuronal excitability. The NGX424 compound � which is delivered via intrathecal catheters that inject the drug into the fluid surrounding the spinal cord � suppresses the AMPA-mediated neuronal excitation, relieving otherwise increased muscle tone.

The authors also demonstrated that intrathecal delivery of GluR1 antisense (a treatment that blocks expression of one of the subunits in the AMPA receptor complex) provides a similar antispasticity effect. This further demonstrates a role for AMPA receptors in spasticity and rigidity, and indicates that blockade of this subunit by NGX424 likely plays a key role in the observed antispasticity effect.

Marsala added that additional large animal safety testing will be required before the researchers can consider clinical trials in humans. However, the rat data from this study indicates no toxicity using infused NGX424. Subcutaneous delivery of the drug is currently being evaluated for treating migraines.

AFAR/Ellison Medical Foundation increase commitment to scientists studying aging

Fri, 12 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) New York, October 11, 2007 - At a time when established scientists are leaving academia because of a lack of funding for biomedical research and a potential new generation of scientists are considering whether to even enter a field with a competitive funding environment, the Ellison Medical Foundation in partnership with the American Federation for Aging Research (AFAR), has increased funding for two critical grant programs: the new Ellison Medical Foundation/AFAR Postdoctoral Fellows in Aging Research Program and the Julie Martin Mid-Career Awards in Aging Research.

The Ellison Medical Foundation has awarded AFAR more than $2.8 million to support 45 postdoctoral fellows (both MDs and PhDs at any level of postdoctoral training) over the next three years in the fundamental mechanisms of aging. With this new commitment, the Ellison Medical Foundation/AFAR partnership has increased five-fold the number of researchers it will support.

�We are grateful to the ongoing and continued support of the Ellison Medical Foundation in expanding the postdoctoral fellowship program, said Stephanie Lederman, Executive Director of the American Federation for Aging Research. �There are so many promising scientists yet we are only able to fund eight percent of the applicants who seek grants. There�s a potential to lose a tremendous brain trust of future leaders in aging research. The Ellison Medical Foundation has taken a lead role in helping the next generation of researchers establish careers and an aging society will benefit,� she added.

�The potential for dramatic discoveries in biological and biomedical science applied to aging is greater now than at any other time in history,� said Richard L. Sprott, PhD, Executive Director of the Ellison Medical Foundation. �In the face of this opportunity we currently see declining federal support for scientists. Those just beginning their careers are especially vulnerable as support dries up. Our hope is that this decline is temporary, yet even a temporary reduction in support for scientists just beginning their careers, or those deciding whether to stay in science or build a career elsewhere, could result in the loss of most of a whole generation of scientists. Our partnership with AFAR is an important part of our overall strategy to help sustain as many developing investigators of aging as can survive the current funding shortage. Partnership with AFAR helps both organizations maximize the impact of funding by maximizing the quality of the review process using AFAR reviewers and minimizing the administrative burdens by combining our programs into a single, highly effective program,� Dr. Sprott added.

Strong link between air pollution and acute bronchitis diagnoses in preschool-aged children

Thu, 11 Oct 2007 15:05:42 PST

( from http://www.rxpgnews.com ) In one of the first studies to examine air pollution in relation to infant and early childhood health, a UC Davis researcher has discovered a strong link between exposure to components of air pollution and acute bronchitis diagnoses in preschool-aged children. Those components – polycyclic aromatic hydrocarbons, or PAHs – contribute to air pollution from a variety of sources, including coal burning, vehicle exhaust, wood-burning stoves, tobacco smoke and grilling food.

Led by UC Davis environmental epidemiologist Irva Hertz-Picciotto, the Czech Early Childhood Health Study involved 1,133 children from birth to 4.5 years of age born in two districts of the Czech Republic between 1994 and 1998. One of those districts, Teplice (pronounced Tuh-PLEET-zuh), is known for its high levels of air pollution. The other, Prachatice (pronounced prah-kuh-TEET-zuh), has much lower levels of air pollution.

Hertz-Picciotto and colleagues compared information on medical diagnoses of lower respiratory illnesses such as bronchitis, croup, pneumonia and asthma with detailed data on air quality. The findings revealed a significant increase in diagnoses of acute bronchitis when children aged 2 to 4.5 were exposed to medium-to-high levels of PAHs for 30 consecutive days.

“This is the first large-scale, comprehensive study looking at early childhood respiratory infections and the constituents of today’s air pollution,” said Hertz-Picciotto, a UC Davis professor of epidemiology and lead author of the study. “We found that polycyclic aromatic hydrocarbons have a significant effect on the lung health of children in the study, in particular in increases in acute bronchitis diagnoses for toddlers and preschoolers. We saw the biggest impact on children old enough to play outside, while infants were affected but not quite as much.”

Scientists classify the components of air pollution as either particles or a variety of chemical compounds. Whereas a number of studies have examined particles, sulfur dioxide and ozone, very little research in human populations have addressed PAHs, which result from the incomplete combustion of carbon-containing fuels such as wood, coal, diesel or tobacco. Current environmental regulations in both the United States and Europe focus on controlling particulate emissions.

“Our work strongly suggests that regulators consider efforts to curb PAHs as well. Reducing particles may also reduce chemical emissions but the impact will depend on what control measures are taken. When it comes to children’s lung health, we need to take steps to reduce all risk factors,” Hertz-Picciotto said. “Additional precautions particularly pertinent here in California to protect children from the harmful effects of PAHs include not smoking around children and using alternatives to wood for heating homes in the winter.”

Hertz-Picciotto and colleagues collected standardized medical records and information from parent questionnaires about work history, demographics, lifestyle, and reproductive and medical histories. Follow-up information was collected once for each child at the age of 3 for those born between 1994 and 1996 and at age 4.5 for those born in 1997 or 1998.

At the same time, the team collected detailed air quality sampling data on levels of particulate and PAH air pollution in the regions. PAHs are particularly difficult and expensive to measure. Hertz-Picciotto and her researchers had unique access to daily measures of air quality -- both particulate matter and PAHs -- for winter months, while measures were taken at three-day intervals in the fall and spring and six-day intervals in the summer when these air pollutants are at their lowest. As a result, the volume and detail of medical and environmental data used in the analysis is uniquely robust and allowed researchers to control for a whole host of potentially confounding factors.

“It is an impressive amount of very complete data, giving us a rare opportunity to look at the impact of air pollution on the health of young children and the actual components comprising that pollution,” Hertz-Picciotto explained. “We were able to correct for everything from duration of breast feeding to smoking in the home to average daily temperature.”

The PAH levels identified in the Czech Republic are comparable to those found in Western Europe and the United States. Some rural areas of California, for example, see sharp increases of PAHs in the winter due to the burning of wood stoves for heat. Likewise, increases in bronchitis in the Czech children were seen in the winter months when air quality was the poorest.

In addition to comparable air pollution profiles to those in the United States, the Czech Republic was an ideal study site for evaluating physician-diagnosed illnesses because of its open public-health infrastructure. All citizens of the Czech Republic are entitled to free, readily available medical care. Families remain with one pediatrician for all of their children from birth to adulthood. For researchers, this meant access to thousands of standardized medical records and participation rates of more than 95 percent by those asked to fill out follow-up questionnaires.

“There are virtually no barriers to receiving health care in the Czech Republic and virtually all families develop strong, lasting relationships with their pediatricians and nurses,” Hertz-Picciotto said. “This definitely helped keep participation levels high.”

Bronchitis occurs when the inner walls that line the main air passageways of the lungs become infected, inflamed and narrowed. It usually follows a cold or the flu. The result is a persistent, productive cough, shortness of breath and chest tightness and pain. Some cases of bronchitis can be treated by antibiotics but most are due to viruses, for which there are no treatments. Acute bronchitis is among the top 10 conditions for which patients seek medical care. It is a major contributor to missed school for children and workdays for parents who stay home with them. Estimated costs for evaluating and treating this illess are between $200 and $300 million each year.

“Air quality negatively impacts children’s health and has a definite economic impact on health systems and families,” Hertz-Picciotto said.

Scientists have yet to discover the biological mechanism by which air pollution in general and PAHs in particular contribute to lower respiratory illnesses. Hertz-Picciotto theorizes that the chemicals in air pollution may have an impact on the immune system.

“It’s possible that increased inflammation of the airways due to the PAH exposure compromises the immune system and makes it easier for viruses to take hold,” she explained. “We need more basic science to answer this question.”

In the meantime, Hertz-Picciotto and her colleagues will continue to investigate the impact of other air pollution components and their potential connections to childhood illnesses using the Czech data sets. They will also be looking at whether prenatal exposure to air pollution leads to increased susceptibility to illness, such as asthma and hay fever, later in life.

Prostate cancer increases hip fracture risk by eight times in 50 to 65 year-olds

Thu, 11 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Men who have prostate cancer are on average four times more likely to suffer a hip fracture, with rates rising to eight times in men aged 50 to 65, according to a study of more than 60,000 men published in the October issue of the urology journal BJU International.

Danish researchers looked at 62,865 men aged 50 and over, with an average age of just under 67.

15,716 had suffered a fracture of some description and 47,149 formed the non-fracture control group.

They discovered that prostate cancer made men 1.8 times more likely overall to suffer a fracture and 3.7 times as likely to suffer from a hip fracture. But the hip fracture risk was eight times higher in men from 50 to 65 years of age. No increased risk of vertebral fractures was found by the research.

�Our study showed that more than three per cent of hip fractures in men aged 50 and over can be attributed to prostate cancer� says lead researcher Dr Bo Abrahamsen from Copenhagen University Hospital, Gentofte. �And the risk remains even when men have recovered from the disease.�

The researchers - urologists and endocrinologists from Danish hospitals attached to the University of Southern Denmark and Copenhagen University - now plan to establish a multi-centre initiative focussing on the early diagnosis and treatment of osteoporosis in men with prostate cancer.

�Prostate cancer is now the cancer that men are most likely to develop and is a leading cause of male deaths in Europe and the USA� stresses Dr Abrahamsen.

�American research has also shown that men have a 17 per cent chance of prostate cancer during their lifetime. And Danish research has discovered that deaths from the disease have more than tripled since the Second World War.

�Medical advances are improving survival rates, but the downside is that treatment can lead to osteoporosis, where the bone loses density and becomes more fragile. This is turn increases the risk of fractures.�

The researchers used data from the Danish National Hospital Discharge Register, the National Bureau of Statistics and the National Prescription Database to identify patients aged 50 and over who had suffered a fracture. They then used the same data to identify an age-matched control group.

�Our research showed that the increased fracture risk became apparent in the early stages after diagnosis and remained pronounced even in long-term survivors� says Steen Walter, Professor of Urology at Odense University Hospital.

�Men who received hormone therapy (ADT) or had their testicles surgically removed to slow the progression of the disease were 1.7 times more likely to suffer a fracture.�

The authors point out that the research only covered the 15 per cent of ADT doses issued on prescription. The majority of the doses are issued by hospital departments, which means they cannot be traced to individual patients. So the actual impact of ADT on national fracture levels could be even greater.

Other issues were also found to lead to increased fracture rates.

�The study showed that the men in the fracture group were almost three times as likely as the control group to have suffered a previous fracture. They were also more likely to live alone and be in a lower income group� says Dr Abrahamsen.

Virtual game helps children escape realities of burn unit

Mon, 08 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) COLUMBUS, Ohio -- Nurses and physicians at Nationwide Children�s Hospital are using the latest technology to help young burn victims endure the extreme pain of dressing changes and wound care. Instead of traditional distraction devices, such as books and music, Nationwide Children�s Hospital Burn Center is now using virtual reality games to distract patients while nurses attend to the patients� burn wounds.

�It�s long been known that the actual treatment for a burn is far worse than the actual injury. Initially, the wound has to be cleaned and the dressing applied, and that can be a very painful and lengthy procedure,� said Dr. Catherine Butz, PhD, a psychologist at Nationwide Children�s Hospital and an Assistant Professor at The Ohio State University College of Medicine.

Following this initial treatment, patients must endure subsequent wound care procedures, some of which can be both extensive and painful, depending on the extent of the burn. During these procedures, anxiety often plays a major role in the patient�s pain level.

�Research shows a very strong connection between anxiety and pain,� said Dr. Butz. �Distraction does a great job in decreasing any kind of anxiety that might be associated with the anticipated procedures, so by distracting patients and keeping anxiety at a minimum, procedures tend to go much more smoothly and be much less painful for the child.�

The device, made possible by a donation from the Aladdin Shriner�s Hospital Association for Children, allows patients to escape into a computer-generated world complete with its own environment, creatures and sounds. Patients wear a virtual reality helmet, and once in this new world, they interact in the virtual environment with the help of child life specialists, trained to assist kids through stressful medical treatments.

Since Nationwide Children�s Hospital began using the device in May 2007, it has already resulted in positive feedback from burn patients. Burn nurses report several patients have noticeably improved in terms of their ability to tolerate dressing changes.

In order to better understand the effect on pain, doctors at Nationwide Children�s have launched a study to compare the results of virtual reality pain distraction with traditional distraction techniques, such as watching television, listening to music, counting and deep breathing. Patients will be randomly assigned to receive virtual reality or another pain distraction technique. Following the procedure, they will be asked to gauge their level of pain on a scale of zero to 10. The study will also assess the perspectives of parents and nurses in terms of the child�s pain and level of distress.

The burn program�s goal is to be able to better engage the child in a distraction activity which will hopefully have a beneficial affect on the procedure. An added benefit for patients may be a decrease in the amount of pain and anxiety medications needed. However doctors point out that pain is a very individual experience, and the benefits of virtual reality distraction as well as the level of medication must be determined on a case by case basis.

New telomere discovery could help explain why cancer cells never stop dividing

Thu, 04 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Lausanne, Switzerland, October 4, 2007 � A group working at the Swiss Institute for Experimental Cancer Research (ISREC) in collaboration with the University of Pavia has discovered that telomeres, the repeated DNA-protein complexes at the end of chromosomes that progressively shorten every time a cell divides, also contain RNA. This discovery, published online October 4 in Science Express, calls into question our understanding of how telomeres function, and may provide a new avenue of attack for stopping telomere renewal in cancer cells.

Inside the cell nucleus, all our genetic information is located on twisted, double stranded molecules of DNA which are packaged into chromosomes. At the end of these chromosomes are telomeres, zones of repeated chains of DNA that are often compared to the plastic tips on shoelaces because they prevent chromosomes from fraying, and thus genetic information from getting scrambled when cells divide. The telomere is like a cellular clock, because every time a cell divides, the telomere shortens. After a cell has grown and divided a few dozen times, the telomeres turn on an alarm system that prevents further division. If this clock doesn�t function right, cells either end up with damaged chromosomes or they become �immortal� and continue dividing endlessly � either way it�s bad news and leads to cancer or disease. Understanding how telomeres function, and how this function can potentially be manipulated, is thus extremely important.

The DNA in the chromosome acts like a sort of instruction manual for the cell. Genetic information is transcribed into segments of RNA that then go out into the cell and carry out a variety of tasks such as making proteins, catalyzing chemical reactions, or fulfilling structural roles. It was thought that telomeres were �silent� � that their DNA was not transcribed into strands of RNA. The researchers have turned this theory on its head by discovering telomeric RNA and showing that this RNA is transcribed from DNA on the telomere.

Why is this important In embryonic cells (and some stem cells), an enzyme called telomerase rebuilds the telomere so that the cells can keep dividing. Over time, this telomerase dwindles and eventually the telomere shortens and the cell becomes inactive. In cancer cells, the telomerase enzyme keeps rebuilding telomeres long past the cell�s normal lifetime. The cells become �immortal�, endlessly dividing, resulting in a tumor. Researchers estimate that telomere maintenance activity occurs in about 90% of human cancers. But the mechanism by which this maintenance takes place is not well understood. The researchers discovered that the RNA in the telomere is regulated by a protein in the telomerase enzyme. Their discovery may thus uncover key elements of telomere function.

�It�s too early to give yet a definitive answer,� to whether this could lead to new cancer therapies, notes Joachim Lingner, senior author on the paper. �But the experiments published in the paper suggest that telomeric RNA may provide a new target to attack telomere function in cancer cells to stop their growth.�

UT Southwestern investigating hypothermic technique in treating pediatric head injuries

Wed, 03 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) DALLAS � Oct. 3, 2007 � UT Southwestern Medical Center has been selected to take part in an $11.5 million multicenter clinical trial that is examining the effectiveness of induced hypothermia as a therapy for brain swelling in children who have suffered severe traumatic brain injuries.

The 12 centers that are participating in the trial are expected to enroll a total of 340 children up to age 16 in the five-year trial, which is being funded by the National Institute of Neurological Disorders and Stroke, a component of the National Institutes of Health. Children�s Medical Center Dallas, which has a Level I pediatric trauma center, will serve as the local coordinating site. The study is being led by Children�s Hospital of Pittsburgh.

Pediatric patients who are eligible for the trial must have severe brain injury caused by blunt trauma. This excludes patients who have suffered injuries that penetrate the skull such as gunshot wounds.

Those patients selected to receive hypothermia therapy will be cooled to between 32 and 33 degrees Celsius (89 to 90 degrees Fahrenheit), using special cooling blankets and/or cooled saline given intravenously. In addition to normal emergency care, they will remain cooled for 48 hours while being closely monitored in the intensive care unit. Children will be tracked by researchers for one year to record outcomes, with a battery of tests being conducted at six and 12 months following the injury.

�Trauma is the leading cause of death and disability in children, more than all other causes combined,� said Dr. Pam Okada, associate professor of pediatrics at UT Southwestern and lead investigator of the Dallas trial. �Previous studies have shown hypothermia is not only safe in children following severe traumatic brain injury, but may improve their chance of survival.�

It had been thought that children had better outcomes than adults following traumatic brain injury, Dr. Okada said. In fact, it has been demonstrated that younger children (those younger than 4) actually have worse outcomes. Problems that develop with motor, behavior, learning, memory and other higher-level functions are common even in children with only �moderate� or �mild� concussions or injuries, she said.

�In head injuries where the skull remains intact there is little room for swelling,� Dr. Okada said. �This causes diminished blood flow resulting in brain damage. Cooling the body may reduce the swelling and possibly prevent continuing damage. If this therapy proves effective, it would be a major breakthrough in the treatment of traumatic brain injuries.�

According to federal and state laws, those who participate in a clinical research study must provide or, in the case of a child, have a guardian provide informed consent. Because of the nature of this trial and the fact that hypothermia must be induced within six hours of injury, it may be sometimes impossible to obtain consent at the time of brain injury.

For this reason, researchers are notifying the public that informed consent will be waived. Every attempt to contact family members to provide notification and obtain consent for continued participation will be made as soon as possible after enrollment.

Researchers: No faking it, crocodile tears are real

Wed, 03 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) GAINESVILLE, Fla. � When someone feigns sadness they �cry crocodile tears,� a phrase that comes from an old myth that the animals cry while eating.

Now, a University of Florida researcher has concluded that crocodiles really do bawl while banqueting � but for physiological reasons rather than rascally reptilian remorse.

UF zoologist Kent Vliet observed and videotaped four captive caimans and three alligators, both close relatives of the crocodile, while eating on a spit of dry land at Florida�s St. Augustine Alligator Farm Zoological Park.

He found that five of the seven animals teared up as they tore into their food, with some of their eyes even frothing and bubbling.

�There are a lot of references in general literature to crocodiles feeding and crying, but it�s almost entirely anecdotal,� Vliet said. �And from the biological perspective there is quite a bit of confusion on the subject in the scientific literature, so we decided to take a closer look.�

A paper about the research appears in the latest edition of the journal BioScience.

Vliet said he began the project after a call from D. Malcolm Shaner, a consultant in neurology at Kaiser Permanente, West Los Angeles, and an associate clinical professor of neurology at the University of California, Los Angeles.

Shaner, who co-authored the paper, was investigating a relatively rare syndrome associated with human facial palsy that causes sufferers to cry while eating. For a presentation he planned to give at a conference of clinical neurologists, he wanted to know if physicians� general term for the syndrome, crocodile tears, had any basis in biological fact.

Shaner and Vliet uncovered numerous references to crocodile tears in books published from hundreds of years ago to the present.

The term may have gained wide popularity as a result of a passage in one book, �The Voyage and Travel of Sir John Mandeville,� first published in 1400 and read widely, they write.

Says the passage, �In that country be a general plenty of crocodiles �These serpents slay men and they eat them weeping.�

Shaner and Vliet also found reference to crocodiles crying in scientific literature, but it was contradictory or confusing, to say the least.

One scientist, working early last century, decided to try to determine if the myth was true by rubbing onion and salt into crocodiles� eyes. Shaner said. When they didn�t tear up, he wrongly concluded it was false. As Shaner said, �The problem with those experiments was that he did not examine them when they were eating. He just put onion and salt on their eyes.�

As a result, Vliet decided to do his own observations.

In the myth, crocodiles often cry while eating humans. However, deadpanned Shaner, �we were not able to feed a person to the crocodiles.�

Instead, Vliet had to settle for the dog biscuit-like alligator food that is the staple at the St. Augustine alligator farm. He decided to observe alligators and caimans, rather than crocodiles, because they are trained at the farm to feed on dry land. That�s critical to seeing the tearing because in water the animals� eyes would be wet anyway.

The farm�s keepers don�t train the crocodiles to feed on land because they are so agile and aggressive, Vliet said. But he said he feels sure they would have the same reaction as alligators and caimans, because all are closely related crocodilians.

What causes the tears remains a bit of a mystery.

Vliet said he believes they may occur as a result of the animals hissing and huffing, a behavior that often accompanies feeding. Air forced through the sinuses may mix with tears in the crocodiles� lacrimal, or tear, glands emptying into the eye.

But one thing is sure: faux grief is not a factor. �In my experience,� Vliet said, �when crocodiles take something into their mouth, they mean it.�

War more traumatic than tsunami

Wed, 03 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The long-running civil war in Sri Lanka is causing more mental health problems and social breakdown than the catastrophic 2004 tsunami, according to research published in the online open access publication International Journal of Mental Health Systems.

The study, conducted by Professor Daya Somasundaram, currently at the University of Adelaide, is based on published data and qualitative research methods including participatory observation, key informant and focus group interviews, highlights the importance of the family and community in maintaining good mental health. For example, the terrorisation of many Tamil communities and the destruction caused by the tsunami meant many villages were abandoned and the villagers separated. Even when people returned, the village was not the same. The old structures and institutions were no longer functioning and the protective environment, the social fabric, provided by the village was no longer there.

The natural disaster was a one off catastrophic event that left a trail of destruction and loss, says Somasundaram, but it did not continue to exert a prolonged effect. As a result the severity of the collective trauma was much less. In fact, having lived through a prolonged war situation has meant that Tamil communities have learned skills and strategies that make them better able to cope with disasters.

The ecological research study suggests that grass roots work within communities may work best. Somasundaram found that the protocol developed by the Transcultural Psychosocial Organization (a WHO collaborating centre, working around the world to relieve the psychosocial problems of people affected by internal conflict and war) was very effectively adapted to the situation in northern Sri Lanka. Community-level approaches empower the community to look after their own problems, he says, through psychoeducation to transfer basic psychosocial knowledge and skills, and through encouragement, support , affirmation and re-establishment of traditional practices, rituals, resources and community relationships.

To combat post-disaster mental health problems Somasundaram argues that it is helpful to consider the extent of collective traumatisation. In the aftermath of war communities suffer from mistrust, suspicion, silence, brutalization, deterioration in morals and values, poor leadership, dependency, passivity and despair. Apart from attending to the immediate basic needs and other acute problems in the rescue and relief phases after a major disaster, rehabilitation, reconstruction and development strategies need to include collective-level interventions. In fact, our experiences show that many individually oriented mental health interventions appear to fair much better when undertaken within an overall framework of a community strategy.

Linking cigarette smoke and obesity: What our genes and environmental factors tell us

Wed, 03 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) RICHLAND, Wash. � Identifying biomarkers for the key environmental risk factors responsible for two diseases that significantly contribute to death and disease of hundreds of thousands annually will be the initial focus of a new center being established at Pacific Northwest National Laboratory. PNNL will house the Center for Novel Biomarkers of Response, made possible by a $5.9 million grant recently awarded by the National Institutes of Health�s Gene and Environment Initiative.

Scientists at the center intend to create new exposure assessment tools to better understand the role of gene-environmental interactions in human disease. Development of these tools will help scientists precisely measure personal exposure to environmental, chemical and biological agents.

�While the Human Genome Project has enabled faster, cheaper gene sequencing of individuals,� said PNNL Center Director and toxicologist Joel Pounds, �genes alone don�t tell the whole story. The environment plays an enormous role in complex disease development including cancers, asthma, diabetes and neurodegerative diseases.�

�We can identify genetic variability and the genetic factors in an individual person, but it is much more difficult to define an individual�s environment and chemicals he or she is exposed to,� said Pounds. �Our challenge will be to understand how genes and the environment interact. To do that, we have to improve the ability to measure environmental factors at the individual level.�

Two of the most important risk factors for human morbidity and mortality � cigarette smoke and obesity � will be the primary targets of interest for PNNL scientists. Research will focus on biomarkers for systemic stress caused by mainstream and second-hand cigarette smoke, with obesity as a confounding physiological factor. PNNL will team with researchers from the University of Utah and Battelle Toxicology Northwest in conducting this research.

This research, in support of the NIH Gene and Environmental Initiative, is comprised of two basic elements. The genetic component will rely on newfound abilities to swiftly identify genetic differences between people with illnesses and those who are healthy, leading to a greater understanding of genetic contribution to the disease. The environmental biology component will focus on developing new technologies to accurately measure personal exposures with small, wearable sensors that can be used to assess environmental agents.

The center will provide NIH�s National Institute of Environmental Health Sciences with a database of response biomarkers, as well as chemical substances for selected markers that are tested and validated in humans and supported by parallel studies in mice. The researchers will also develop prototype nanotechnology-based sensors for measurement of biomarkers at the point of care.

Plasma samples for the study will be obtained from 500 individuals participating in a study being conducted by the University of Utah. That study includes non-smokers, smokers, smokers with chronic obstructive pulmonary disease, and people exposed to second-hand smoke. Researchers at the W.R. Wiley Environmental Molecular Sciences Laboratory located at PNNL will identify the peptides from these samples using state-of-the art tandem mass spectrometry.

Over the course of the four-year project, scientists will work closely with PNNL�s Environmental Biomarkers Initiative. The EBI is an internally funded program, which has provided the scientific foundation and initial laboratory tools for the NIH center.

FDA approves knee-injury device for humans

Tue, 02 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) COLUMBIA, Mo. � A new knee-surgery device investigated by University of Missouri-Columbia researchers that will help to repair meniscus tears, which were previously defined as irreparable, has been approved by the FDA for use in humans.

Previous treatment options forced surgeons to completely remove the damaged portion of the meniscus. Typically the removal of the meniscus leads to painful, debilitating arthritis in the knee. Herb Schwartz, president and CEO of Schwartz Biomedical, LLC, and James Cook, MU professor of veterinary medicine and surgery and William C. Allen Endowed Scholar for Orthopedic Research in MU�s College of Veterinary Medicine, developed the BioDuct Meniscal Fixation Device. Schwartz and Cook believe that patients with meniscus tears will now be able to have their meniscus saved along with long-term knee function.

�In the past, when faced with meniscus injuries, surgeons were often forced to completely remove the torn meniscal cartilage, leaving a deficient knee that was doomed to develop arthritis,� Cook said. �With the BioDuct Meniscal Fixation Device, surgeons will be able to repair torn menisci and induce healing. People with meniscus injuries now have a better future ahead.�

The meniscus, a padding tissue that provides shock absorption and joint stability in the knee, is crucial for normal knee function. Surgeries for meniscus tears are common with approximately one million occurring in the United States each year. When meniscus function is deficient, bone rubs on bone and arthritis is likely to develop and progress. Because two-thirds of the meniscus is avascular (lacks a blood supply), a tear in that region will not repair itself. This new device will transport blood and cells from the vascular portion of the knee to the avascular portion of the meniscus. Supplied with blood and cells for healing, the previously untreatable meniscal tear now has the potential for allowing the knee joint to be saved.

Cook�s research team performed the BioDuct surgery on 25 dogs that had worst-case scenario meniscal tears. With the BioDuct Meniscal Fixation Device, the meniscus in the dogs� knees had complete or partial repair after a few weeks in all cases.

�Currently, there are no other devices that can provide improved fixation over time,� Schwartz said. �Therefore, the BioDuct device is set apart from the rest of the field.�

In his research, Cook found that the device will significantly improve healing of avascular meniscal tears both biologically and biomechanically, which should lessen the long-term effects of meniscus injuries, including osteoarthritis. Cook�s recent findings were published in the American Journal of Sports Medicine.

�The BioDuct device could impact the industry by improving repairs of the meniscus to such an extent that fewer patients develop arthritis that results from removing the meniscal tissue,� Schwartz said. �Thus, with fewer patients developing arthritis, the result could be fewer total joint replacements or at least delaying the need for a total joint replacement.�

Acute lung injury patients one-third less likely to die in 'closed' model ICUs

Fri, 28 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Patients with acute lung injury (ALI) are nearly one-third less likely to die if they are treated at ICUs that require board-certified critical care physicians to oversee patient care, as compared to patients treated at ICUs that allow any attending physician to oversee admission and case management.

ALI is an inflammatory disorder of the lung often seen in patients with pneumonia or sepsis. Mortality rates are high -- about 40 percent -- and worsen with age and co-morbidities. Treatment generally involves addressing the underlying condition and providing protective low tidal volume mechanical ventilation and supportive therapy.

�ICUs that require patient transfer to an intensivist run team or mandate a co-attending intensivist are associated with reduced mortality in patients with ALI,� wrote Miriam Treggiari, M.D., M.P.H., of the Harborview Medical Center at the University of Washington, who led the study that appears in the first issue for October of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

The study is the first to use data from a population-based prospective cohort of patients to evaluate outcomes of different ICU organizational models. As part of the National Institutes of Health funded King County Lung Injury Project, all patients in Seattle area ICUs receiving mechanical ventilation were screened for ALI, between April 1999 and July 2000. Detailed data on co-morbidities, length of hospital stay and discharge information was collected. Questionnaires were sent to both the medical directors and/or attending physicians of the ICUs and the nurse managers to assess the organizational model and structure of the ICUs. The final study group included 1,075 patients in 22 ICUs across 16 hospitals.

Two-thirds of the patients were treated at �closed� ICUs�units that require cases to be managed by board-certified critical care physicians or that mandate intensivists to co-manage on all patients. The remaining third received care at �open� ICUs, where cases could be managed by any attending physicians with admitting privileges, and pulmonary consultations were optional. According to the American College of Chest Physicians, only 25 percent of ICUs nationwide follow the closed model.

There were no significant differences in the degree of illness between patients who were cared for in closed versus open ICUs as measured by Acute Physiological and Chronic Health Evaluation III (APACHE III) scores, but patients at closed ICUs were younger and more likely to be male.

�Patients cared for in a closed ICU had statistically significantly lower mortality than patients cared for in open ICUs,� the researchers reported. Interestingly, the effect remained significant after adjusting for a number of variables in the analysis. While 77 percent of patients in closed ICUs were seen by a pulmonary consultant, consults alone did not have a significant effect on mortality. Similarly, adjusting for nurse-to-patient ratio and hospital volume of mechanically ventilated patients had no effect on mortality. Of patients treated in open ICUs, 45 percent died; in closed ICUs there was 35 percent mortality.

The investigators noted that because of the small sample size of hospitals and the date of the data collection, it would be difficult to extrapolate their results to a general trend among ICUs in the United States. Noting that the use of low tidal volume mechanical ventilation differed between closed and open ICUs, the researchers remarked that other unrecognized differences in patient care could exist, but that their results add support for the positive effect of a closed ICU model on patient outcome.

�These findings add to the evidence of the important role of intensivist staffing in caring for critically ill patients, and support the recommendations to implement closed-model ICUs in the United States,� said Dr. Treggiari. �Further studies will need to investigate if the beneficial effects of closed ICU derive from higher degree of staffing that could facilitate earlier recognition of critical/deteriorating conditions or greater expertise in the specific management aspects of critical care patients.�

Center gets national funding for child trauma research

Fri, 28 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded a four-year $1.6 million grant to the newly established University of Kentucky Center for the Study of Violence Against Children (CSVAC). The grant, one of only 10 being presented across the nation, is going to organizations helping children and adolescents deal with traumatic experiences.

These grants will strengthen the nation's capacity to provide help to children of all ages who experience traumatic events, such as interpersonal violence, natural disasters, or acts of terrorism, said Terry Cline, a SAMHSA administrator.

CSVAC received one of the 10 Community Treatment and Services (CTS) Center grants, which are designed to promote and evaluate effective treatment systems in community and youth-oriented settings. These grants also promote enhanced network systems for clinical, methodological, policy, financing and training issues. Each grant recipient will receive up to $400,000 per year for up to four years. Likewise, the CTS grant officially establishes CSVAC as a member of the National Child Traumatic Stress Network.

We are honored that CSVAC was chosen as one of the select group of organizations to participate in this national endeavor, said Ginny Sprang, principal investigator for the project, director of CSVAC and nationally recognized expert in trauma. This grant will provide us with opportunities to adapt and test best practice approaches to treating traumatic stress in children exposed to violence.

As a grant recipient, CSVAC will use the federal funding to establish the Child and Adolescent Trauma Treatment Institute (CATTI), which will provide clinical training and information on evidence-based practices in eastern, western, southern and central regions of Kentucky. CATTI will present three specific intervention methods, Parent Child Interaction Therapy (used with children 2 to 12), Trauma-Focused Cognitive Behavioral Therapy (for children 3 to 17), and Abuse-Focused Cognitive Behavioral Therapy (for school-age children). These approaches were selected due to the exposure profile of at-risk children in these four regions of the Commonwealth, where the majority of this group of kids suffer from exposure to interpersonal, family and community-based violence.

Based on needs and readiness assessments found through CATTI, CSVAC clinical staff will train regional partners to deliver services in their area to children in need using a train the trainer approach. This collaboration will benefit regional sites by educating area staff in new interventions and supplying them with colleagues at UK practicing cutting-edge research and practices in child welfare. The project, through these relationships, will also enjoy a positive ripple effect as newly educated staff become best practice ambassadors in their areas of the state and share the practices they learned with additional child welfare staff in the region. Key stakeholders across the Commonwealth, including the state's public child welfare system and various school systems, consumer groups, community mental health representatives, and advocacy organizations, will serve as advisers on the project.

Other UK researchers from the College of Social Work, Center for Drug and Alcohol Research (CDAR) and Department of Psychiatry will work with Sprang on CATTI. These co-principal investigators are Allen Brenzel, associate director of CSVAC and chair of the Child and Adolescent Division-Department of Psychiatry; James Clark, associate director of CSVAC and associate dean for research in the College of Social Work; Carlton Craig, assistant professor of social work; Otto Kaak, associate director of CSVAC and professor of psychiatry and pediatrics; Michele Tindall, assistant professor in both the Department of Behavioral Science and College of Social Work with an appointment at CDAR; and Bob Walker, assistant professor of psychiatry at CDAR with appointments in the College of Social Work and Department of Behavioral Science.

The CATTI project is housed at CSVAC, which gained its center status at UK earlier this month. The translational research center, established in the College of Social Work, combines clinical practice, research and training on child and family violence in an effort to develop, assimilate and disseminate knowledge and best practices that will contribute to reducing and ending violence against children and the effects of that violence across the life cycle.

The other nine CTS grant recipients are: Children's Institute, Inc., of Los Angeles; Denver Department of Human Services; Children's Home Society of Florida, of Pensacola; Mental Health Services for Homeless Persons, Inc., of Cleveland; Latino Health Institute, of Boston; Kennedy Krieger Research Institute, Inc., of Baltimore; Community Counseling Center, of Portland, Maine.; Catholic Charities, Inc., of Jackson, Miss.; and Aliviane, Inc., of El Paso, Texas.

High school footballers wearing special helmets to monitor brain injuries

Thu, 27 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) As they root for the home team from the bleachers this fall, high school gridiron fans in the small Illinois town of Tolono don�t necessarily see anything out of the ordinary down on the field.

But just out of sight, tucked inside many of the maroon helmets worn by the Unity High School Rockets, a revolution of sorts is taking place. This season, 32 varsity team members are sporting helmets outfitted with the same electronic encoder modules now used by a handful of college teams.

The purpose of the high-tech headgear, which uses six strategically placed, spring-loaded accelerometers to wirelessly beam information to a Web-based system on a laptop computer on the sidelines, is to more effectively � and more immediately � detect when blows to players� heads may result in concussions or more severe brain injuries.

In addition, impact data � including location of hits, magnitude of force and length of hits � is recorded for analysis by a University of Illinois research team led by kinesiology and community health professor Steven Broglio.

�Unity is the only high school in the country using the Head Impact Telemetry System, or HITS,� Broglio said. �There are 12 million high school football players across the nation,� he said. �This is a huge population we don�t know much about.�

The system being used in the research partnership between the U. of I. and Unity was developed by Simbex, a research and product-development company based in New Hampshire. It works in tandem with helmets made by Riddell, the nation�s largest helmet manufacturer, and was first tested on the Virginia Tech football team in 2002.

Broglio said a number of other researchers at universities across the nation, including Virginia Tech, the University of North Carolina and Dartmouth, also are using the system as the basis for studies of biomechanical processes caused by concussions and traumatic brain injuries.

At Unity, each varsity player was given a baseline assessment for neurocognitive function prior to the start of the season.

�The baseline assessments are all over the map,� Broglio said. �Because the kids� brains are still developing, they have different ranges and abilities.�

On the field during practice or on game day, when the encoder in an athlete�s helmet registers a hit, the system beams impact information to the sidelines laptop, which is monitored by the team�s athletic trainer.

�If an athlete is diagnosed with a concussion, he will not return to play until neurocognitive function returns to baseline performance,� Broglio said.

The fact that high school athletes� brains may not yet be as fully developed as their college or professional counterparts is a large part of Broglio�s motivation for studying the system�s effectiveness on the younger players.

The U. of I. researcher noted in many high schools across the country it�s not unusual for players to take a forceful hit, sit out briefly, then return to play. And sometimes they�ll even mask symptoms from coaches and trainers because they don�t want to miss the action.

Unfortunately, Broglio said, �what other researchers are finding is that people with multiple concussions have incurred Alzheimer�s Disease at a higher rate. Getting their �bell rung� as high school athletes may have permanent repercussions. There seems to be a link.�

He noted that there�s also some evidence in the literature that among high school athletes, the force of an impact may actually be less than it is with older players.

The main focus of Broglio�s continuing research is to sort it all out � to determine how the younger players actually function on the field, and gather data that �will ultimately protect and treat athletes who suffer concussive head injuries.�

�We will look at how hard and where they get hit,� he said, adding that one possible outcome of the work may be determining the need to develop a different type of helmet for high school athletes.

�We may find they�re getting hit in different places and need more padding in those areas of the helmet, for example.�

In Tolono, the system�s ability to monitor where athletes are incurring hits has already led to another discovery, just a couple of weeks into the season.

�The system picked up one athlete who was hitting with the top of his head, a practice that could result in spinal-cord injury,� Broglio said. Because they were able to identify the pattern, the team�s coaches were able to work with the athlete to correct the habit.

�As we�ve gone through this first few weeks using the system, for the most part it�s been very good,� said Scott Hamilton, the Rockets� head coach. �As this revolutionizing (of the sport) gets better and better, it will be great. Anything to protect our kids is a wonderful concept.�

As is often the case with most innovative technologies when they�re first developed, however, the initial cost of the system is likely to prohibit widespread use � especially at the high school level. Broglio said the system being tested at Unity has a price tag of about $60,000; each helmet costs an additional $1,000.

Nonetheless, he and Hamilton remain hopeful that as more companies compete and additional systems enter the marketplace, the cost eventually will become more affordable for more schools.

�Anytime you talk about money, it�s a fine line between how much money do you spend, and how much is it worth to protect the kids.�

Genes linked to suicidal thinking during antidepressant treatment

Thu, 27 Sep 2007 03:59:37 PST

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Climate may increase heat-related deaths by 2050s, says Mailman School of PH study

Thu, 27 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) While some uncertainty does exist in climate projections and future health vulnerability, overall increases in heat-related premature mortality are likely by the 2050s, according to a recent study by Columbia University�s Mailman School of Public Health and soon to be published in the November 2007 issue of the American Journal of Public Health. In metropolitan New York, researchers estimate a 47 percent to 95 percent increase in summer heat-related deaths when compared to the 1990s.

Recent reports strongly suggest that both emissions and warming trends will continue to affect the atmosphere into the 21st century, with annual average temperatures for the region in the 2050s projected to rise by 2.5 degrees Fahrenheit to 6.5 degrees Fahrenheit, and summer temperature increasing 2.7 degrees Fahrenheit to 7.6 degrees Fahrenheit.

�These new results indicate that climate change will put additional stress on the health of New York residents in the absence of concerted efforts to reduce vulnerability to heat waves,� says Patrick Kinney ScD, associate professor of Environmental Health Sciences at the Mailman School of Public Health, who designed and directed the study. The research findings also indicate that urban counties will experience greater numbers of deaths than less-urbanized counties. Currently, counties experiencing the hottest summers are the highly urbanized counties in and around New York City, which also have the greatest population density. Millions of residents are already exposed to periodic summer heat stress, which can lead to increases in heat-related illness and premature deaths. Cities such as New York may be at particular risk from climate change because the �urban heat island effect� further increases regional temperatures, and some communities in densely populated urban centers are among those most vulnerable to heat.

�The relatively large percentage of households who live in poverty or in older residential neighborhoods in New York City where multifamily rental buildings often do not haveair conditioning may enhance urban population vulnerability to heat stress,� says Kim Knowlton, DrPH, assistant clinical professor of Environmental Health Sciences, science fellow on global warming and health at the Natural Resources Defense Council, and first author. �Although temperatures are projected to warm considerably in the urban core by the 2050s, our global-to-regional model results suggest that the greatest increases in mean daily temperatures relative to the 1990s will occur in the nonurban counties well beyond the city limits of the five boroughs of New York City.�

The diverse urban population of New York includes millions of residents aged 65 years and older or with cardiovascular or respiratory illness, risk factors that increase vulnerability to summer heat stress. With the aging of the baby boomers, the proportion of the U.S. population aged 65 years and older is expected to increase until 2020, placing additional millions among those most vulnerable to heat stress. �Because this study did not factor in the future growth in population that is projected for New York City and which will expose even more New Yorkers to sweltering summer heat, it can be argued that the population constant method provides a conservative projection of possible future climate-related changes in temperature-related mortality,� noted Dr. Knowlton.

Married esophageal cancer patients fare worse in some quality of life aspects than single patients

Wed, 26 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: In a surprising finding, American scientists have found that when battling oesophageal cancer, married patients don�t fare as well as their single counterparts in certain aspects of their quality of life.

In the study, presented today (Wednesday) at the European Cancer Conference (ECCO 14) in Barcelona, 212 oesophageal cancer patients and 489 patients with Barrett�s oesophagus, a non-cancerous condition linked to acid reflux, filled out two quality of life questionnaires a year apart. Changes in the scores between the two assessments were analysed according to marital status.

No differences in quality of life changes over time were seen between marital states in the patients with Barrett�s oesophagus. That finding was expected because the condition is not a potentially fatal one requiring stressful major treatment.

�In general, there were not major differences in quality of life between single and married oesophageal cancer patients, but there were slight differences in some aspects,� said the study�s lead researcher, Dr. Robert Miller, an assistant professor of oncology at the Mayo Clinic in Rochester, Minnesota.

For the single patients, quality of life scores relating to pain frequency, overall physical wellbeing and legal worries improved between the first and second questionnaire. However, married patients reported less improvement in their legal worries than the single patients did, and worsening physical wellbeing and increasing pain frequency over time.

�In the second questionnaire, single people rated their overall physical quality of life at a score 0.7 points higher on a scale of one to 10 than they did on the first questionnaire. However, for married people, the score dropped 0.4 points,� Miller said.

The results for pain frequency were similar, with the singles improving by 0.6 points and the married patients reporting a 0.9-point deterioration.

When it came to perceptions of legal worries, all patients reported improvement, but the singles moved 1.1 points up the scale, while the married patients gained only 0.2 points.

�These findings were surprising, as we thought we�d be demonstrating improved outcomes in married patients,� Miller said.

Most previous studies comparing the quality of life of married and single cancer patients, chiefly in breast but also in brain cancer, indicate that married people do better than single people, noted Miller. He said one reason why the current study came out differently could be that oesophageal cancer has a worse prognosis in comparison to some of the other types of cancers previously studied.

Also, there were approximately nine men to every woman in the oesophageal cancer group. This gender ratio may account for the difference between the latest results and those seen in studies of breast cancer patients.

�It�s hard to interpret why married patients didn�t do as well as single patients, but one explanation could be that having a family to support and care for when you have a serious and potentially life-threatening disease may increase a person�s worries, leading to a decrease in quality of life,� said Miller. �Being single may be associated with less negative changes in quality of life over time because the disease is more disruptive if you have others relying on one�s participation in family social and economic activities.�

Married patients diagnosed with oesophageal cancer may require extra diligence when evaluating pain and other somatic complaints, and there may be issues outside the standard concerns of medicine, Miller said.

New type of drug shows promise in attacking melanoma in an innovative way

Wed, 26 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: An experimental drug that attacks cancer in an entirely new way has shown promise in treating advanced melanoma, delaying progression of the disease and prolonging the lives of patients.

New research presented today (Wednesday) at the European Cancer Conference (ECCO 14) in Barcelona found that giving the new drug in addition to chemotherapy more than doubled the amount of time patients survived without progression of their cancer.

The study, according to Dr Anthony Williams, vice president of clinical research at Synta Pharmaceuticals Corp. in Lexington, Massachusetts, USA, included 81 patients with metastatic melanoma. Of those, 28 received treatment with the chemotherapy drug paclitaxel alone and 53 received paclitaxel plus the new drug, STA-4783.

�The median progression free survival was 1.8 months in the group who got chemotherapy alone, but 3.7 months in the group who got the combination,� Williams said. �This doubling in progression free survival is impressive for this cancer, and the result was achieved without substantial additional toxicity.�

He added: �Progression-free survival was linked to improvements in overall survival. Patients on the experimental combination survived on average for 12 months after being diagnosed, while those getting only paclitaxel survived on average 7.8 months. This is the first time an improvement in survival has been seen in a randomised, double-blind, multi-centre controlled trial for metastatic melanoma.�

The drug is the first in a new class called oxidative stress inducers. It works by increasing the amount of reactive oxygen species (ROS), such as hydrogen peroxide and superoxide, in cells. When the level exceeds the antioxidant capacity of cells, the cells are in a state of oxidative stress. All cells have some low level of ROS, but cancer cells naturally operate with a higher level of ROS and oxidative stress relative to normal cells. However, too much oxidative stress for too long results in cell death. STA-4783 kills only tumour cells because the additional stress introduced pushes cancer cells, but not healthy cells, over the critical threshold. Melanoma is one of several cancer types that are known to operate at a higher level of oxidative stress.

The concept of cancer cells operating at a higher level of oxidative stress than normal cells has been around for many years. However, it is only recently becoming a greater focus of attention in the oncology field.

Metastatic melanoma, where the skin cancer has spread to other parts of the body, is difficult to treat. Current therapies either have limited power or are highly toxic. The average survival of patients diagnosed with advanced melanoma is about six months.

The study also indicated that STA-4783 might boost the efficiency of chemotherapy drugs that induce cell death, or apoptosis, because it appears to lower the hurdle for activating that process, Williams said.

�These results are encouraging not only because of the findings in themselves but also because there are so few treatment options for patients. We believe STA-4783 has the potential to improve survival with a manageable side effect profile,� he said.

�We also believe there is nothing unique about metastatic melanoma and that oxidative stress has the potential to be an entirely new class of cancer treatment that could have applications in other types of cancer,� Williams added.

A larger study of STA-4783 in melanoma patients across Europe is now under way to further investigate the drug�s potential. Synta, the drug�s developer, funded the study presented at ECCO.