RxPG News : Psychiatry

Self-affirmation may break down resistance to medical screening

Thu, 22 Dec 2011 23:00:00 PST

( from http://www.rxpgnews.com ) People resist medical screening, or don't call back for the results, because they don't want to know they're sick or at risk for a disease. But many illnesses, such as HIV/AIDS and cancer, have a far a better prognosis if they're caught early. How can health care providers break down that resistance?

Have people think about what they value most, finds a new study by University of Florida psychologists Jennifer L. Howell and James A. Shepperd. If you can get people to refocus their attention from a threat to their overall sense of wellbeing, they are less likely to avoid threatening information, says Howell. Do that, and people are more likely to face a medical screening even if it means undertaking onerous treatment and even if the disease is uncontrollable. The findings will appear in Psychological Science, a journal published by the Association for Psychological Science.

The researchers undertook three studies, each with about 100 students of both sexes. In all three studies, they asked the participants to think of a trait they valued; they chose traits such as honesty, compassion, and friendliness. Participants then wrote either about how they demonstrated the trait (expressing self-affirmation) or a friend (not affirming themselves) demonstrated the trait.

Next participants watched a video about a (fictional) disorder called thioamine acetlyase (TAA) deficiency that ostensibly impairs the body's ability to process nutrients and can lead to severe medical complications. They then completed an online risk calculator for the disease and decided either to receive their risk feedback or not.

In the first study, fewer participants who wrote self-affirming essays avoided learning their risk than did participants who wrote non-affirming essays. In studies 2 and 3 researchers investigated the effects of affirmation on two conditions known to increase avoidance of risk feedback. In the second study, participants learned that testing at high risk for TAA deficiency would either require an easy or onerous follow-up examination process. Participants who were not affirmed avoided learning their risk more when they thought it might necessitate an onerous, as compared to an easy, follow up. However, affirmed participants showed little avoidance regardless of the difficulty of follow up. In the third study, participants learned either that TAA could be managed with a pill; or that there was no effective treatment. Again, the non-affirmed group avoided learning their risk almost twice as often when hearing they had no control over the illness. By contrast, affirmed participants were unlikely to avoid the news, regardless of the possibility of treatment.

The researchers acknowledge it’s sometimes rational to choose not to know about an incurable disease you might (or might not) get. “But when it is important to prepare for negative events—getting your affairs in order, finding the coping resources you’ll need,” Howell suggests, going through with that screening might wise.

Cigarette and alcohol use at historic low among teens

Wed, 14 Dec 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Cigarette and alcohol use by eighth, 10th and 12th-graders are at their lowest point since the Monitoring the Future (MTF) survey began polling teenagers in 1975, according to this year's survey results. However, this positive news is tempered by a slowing rate of decline in teen smoking as well as continued high rates of abuse of other tobacco products (e.g., hookahs, small cigars, smokeless tobacco), marijuana and prescription drugs. The survey results, announced today during a news conference at the National Press Club, appear to show that more teens continue to abuse marijuana than cigarettes; and alcohol is still the drug of choice among all three age groups queried.

MTF is an annual survey of eighth, 10th, and 12th-graders conducted by researchers at the University of Michigan, Ann Arbor, under a grant from the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The survey was conducted in classrooms earlier this year.

That cigarette use has declined to historically low rates is welcome news, given our concerns that declines may have slowed or stalled in recent years, said NIDA director Dr. Nora D. Volkow. That said, the teen smoking rate is declining much more slowly than in years past, and we are seeing teens consume other tobacco products at high levels. This highlights the urgency of maintaining strong prevention efforts against teen smoking and of targeting other tobacco products.

The 2011 results showed that 18.7 percent of 12th-graders reported current (past-month) cigarette use, compared to a recent peak rate of 36.5 percent in 1997 and 21.6 percent five years ago. Only 6.1 percent of eighth-graders reported current smoking, compared to a recent peak of 21 percent in 1996 and 8.7 percent five years ago.

While it is good news that cigarette use has declined to historically low rates, we can and must do more to accelerate that decline, said Howard K. Koh, MD, MPH, assistant secretary for health. The actual decline is relatively small compared to the sharp declines we witnessed in the late nineties.

For alcohol, 63.5 percent of 12th-graders reported past year use, compared to a recent peak of 74.8 percent in 1997. Similarly, 26.9 percent of eighth-graders reported past year use of alcohol in 2011, compared to a recent peak rate of 46.8 percent in 1994. There also was a five-year decrease in binge drinking, measured as five or more drinks in a row in the past two weeks, across all three grades. Binge drinking was reported by 6.4 percent of eighth-graders, 14.7 percent of 10th-graders, and 21.6 percent of 12th-graders, down from the 2006 rates of 8.7 percent, 19.9 percent and 25.4 percent respectively.

Despite the declines noted in the report, use of marijuana has shown some increases in recent years and remains steady. Among 12th-graders, 36.4 percent reported past year use, and 6.6 percent reported daily use, up from 31.5 and 5 percent, respectively, five years ago. The upward trend in teens' abuse of marijuana corresponded to downward trends in their perception of risk. For example, only 22.7 percent of high school seniors saw great risk in smoking marijuana occasionally, compared to 25.9 percent five years ago. Similarly, 43.4 percent of eighth-graders reported that they saw great risk in smoking marijuana occasionally, compared to 48.9 percent five years ago. In addition, concerns about the use of synthetic marijuana, known as K2 or spice, prompted its inclusion in the survey for the first time in 2011. Surprisingly, 11.4 percent of 12th-graders reported past year use.

K2 and spice are dangerous drugs that can cause serious harm, said Gil Kerlikowske, director of National Drug Control Policy. We will continue to work with the public health and safety community to respond to this emerging threat but in the meantime, parents must take action. Parents are the most powerful force in the lives of young people and we ask that all of them talk to their teens today about the serious consequences of using marijuana, K2, or spice.

There was mixed news seen in the non-medical use of prescription drugs. Abuse of the opioid painkiller Vicodin was reported by 8.1 percent of 12th graders -- similar to 2010 and down from 9.7 percent in 2009. There was also a decline reported by 10th graders -- to 5.9 percent from 7.7 percent in 2010. However, no such declines were seen for the opioid painkiller OxyContin.

In 2011, the non-medical use of the ADHD medicines Adderall and Ritalin remained about the same as last year among 12th-graders, at 6.5 and 2.6 percent, respectively. There was, however, a significant decline in the abuse of over-the-counter cough medicine among eighth-graders, down to 2.7 percent in 2011 from 4.2 percent in 2006, when the survey first asked about its abuse. A similar decline in cough medicine abuse was seen among 12th-graders, to 5.3 percent from 6.9 percent five years ago.

To help educate teens about the dangers of prescription drug abuse, NIDA is launching an updated prescription drug section on our teen website, said Dr. Volkow. Teens can go to our PEERx pages to find interactive videos and other tools that help them make healthy decisions and understand the risks of abusing prescription drugs. We are also encouraging teens to provide feedback on these resources through NIDA's teen blog, Sara Bellum, Twitter, Facebook, YouTube, or email. PEERx can be seen at

Opioid abuse linked to mood and anxiety disorders

Tue, 13 Dec 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Individuals suffering from mood and anxiety disorders such as bipolar, panic disorder and major depressive disorder may be more likely to abuse opioids, according to a new study led by researchers from the Johns Hopkins Bloomberg School of Public Health. They found that mood and anxiety disorders are highly associated with non-medical prescription opioid use. The results are featured in a recent issue of the Journal of Psychological Medicine.

Prescription opioids such as oxycontin are a common and effective treatment for chronic and acute pain. Non-medical use of prescription opioids has increased dramatically and, according to the Substance Abuse and Mental Health Services Administration, prescription opioids are the second most frequently used illegal drug in the U.S. after marijuana. Prescription opioids are highly addictive and prolonged use can produce neurological changes and physiological dependence. For the study, researchers examined the association between individuals with mood and anxiety disorders with non-medical prescription opioid use and opioid disorder.

Lifetime non-medical prescription opioid use was associated with the incidence of any mood disorder, major depressive disorder, bipolar disorder and all anxiety disorders. Non-medical opioid-use disorder due to non-medical prescription opioid use was associated with any mood disorder, any anxiety disorder, as well as with several incident mood disorders and anxiety disorders, said Silvia Martins, MD, PhD, lead author of the study and an associate scientist with the Bloomberg School's Department of Mental Health. However, there is also evidence that the association works the other way too. Increased risk of incident opioid disorder due to non-medical use occurred among study participants with baseline mood disorders, major depressive disorder, dysthymia and panic disorder, reinforcing our finding that participants with mood disorders might use opioids non-medically to alleviate their mood symptoms. Early identification and treatment of mood and anxiety disorders might reduce the risk for self-medication with prescription opioids and the risk of future development of an opioid-use disorder.

Using data from the National Epidemiologic Study on Alcohol and Related Conditions (NESARC), a longitudinal face-to-face survey of individuals aged 18 years and older between 2001 to 2002 and 2004 to 2005, researchers assessed participants for a history of psychiatric disorders. Non-medical use of prescription opioids was defined to participants as using a prescription opioid without a prescription or in greater amounts more often or longer than prescribed or for a reason other than a doctor's instruction to use them. Logistic regression was used to determine whether lifetime non-medical prescription opioid use and opioid disorders due to this use predicted incident mood and anxiety disorders and the reverse. Researchers believe these findings provide support for a bi-directional pathway between non-medical prescription opioid use and opioid-use disorder due to non-medical use and several mood and anxiety disorders.

With the current increased use of non-medical prescription drugs, especially among adolescents, the association with future psychopathology is of great concern. Using opioids, or even withdrawal from opioids, might precipitate anxiety disorders, suggesting that there is a subgroup of people who are vulnerable to future development of anxiety disorders, said Carla Storr, ScD, author of the study and an adjunct professor with the Bloomberg School's Department of Mental Health. Individuals using prescription opioids need to be closely monitored not only for the possibility of engaging in non-medical use, but also for the development of co-morbid psychiatric disorders.

Additional studies are needed to examine the relationship between non-medical prescription opioid use and prescription opioid-use disorder with mood and anxiety disorders since they could co-occur due to shared genetic or environmental risk factors, Martins adds.

Study IDs new genetic links to impulsivity, alcohol problems in men

Wed, 16 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Being impulsive can lead us to say things we regret, buy things we really don't need, engage in behaviors that are risky and even develop troublesome addictions. But are different kinds of hastiness and rashness embedded in our DNA?

A new study suggests the answer is yes -- especially if you're a man.

The research, led by University of Nebraska-Lincoln assistant professor of psychology Scott Stoltenberg, found links between impulsivity and a rarely researched gene called NRXN3. The gene plays an important role in brain development and in how neurons function.

The newly discovered connection, which was more prevalent among men than women in the study, may help explain certain inclinations toward alcohol or drug dependence, Stoltenberg said.

Impulsivity is an important underlying mechanism in addiction, he said. Our finding that NRXN3 is part of the causal pathway toward addiction is an important step in identifying the underlying genetic architecture of this key personality trait.

For the study, researchers measured impulsivity levels in nearly 450 participants -- 65 percent women, 35 percent men -- via a wide range of tests. Then, they compared those results with DNA samples from each participant. They found that impulsivity was significantly higher in those who regularly used tobacco or who had alcohol or drug problems.

The results, interestingly, also came down along gender lines. In men, two connections clearly emerged; first, between a particular form of the NRXN3 gene and attentional impulsivity, and second, between another NRXN3 variant and alcohol problems. The connections for women, meanwhile, were much weaker.

Stoltenberg said the gender-specific results are a rich area for further study.

We can't really say what causes these patterns of association to be different in men and women. But our findings will be critical as we continue to improve our understanding of the pathways from specific genes to health-risk behaviors, he said.

The researchers were interested in impulsivity because the trait can predispose people to any number of behavioral problems -- addictions, behavior control, failing to plan ahead or think through consequences of actions -- and settled on the role of NXRN3 from previous, recent studies.

While the results add important new evidence to the genetic role in impulsivity and, in turn, its role in substance abuse, researchers were careful to not claim a perfect cause-and-effect relationship. Impulsivity may interact with sensitivity to alcohol, for one example, or anxiety, for another, to create complex pathways to substance use problems in both men and women.

If you're working to explain how genes are associated with something like (substance) dependence, you have to connect a lot of dots, Stoltenberg said. There's a big gap between genes and a substance use disorder. Impulsivity is one factor to such problems -- not the only factor.

Association of quantity of alcohol and frequency of consumption with cancer mortality

Thu, 20 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A paper from the National Institutes of Health in the United States has evaluated the separate and combined effects of the frequency of alcohol consumption and the average quantity of alcohol drunk per occasion and how that relates to mortality risk from individual cancers as well as all cancers. The analysis is based on repeated administrations of the National Health Interview Survey in the US, assessing more than 300,000 subjects who suffered over 8,000 deaths from cancer. The research reports on total cancer deaths and deaths from lung, colorectal, prostate, and breast cancers.

The overall message of this analysis is that light to moderate alcohol intake does not appear to increase the risk of all-site cancer (and light drinking was shown in this study to be associated with a significant decrease in risk). Similarly, light to moderate consumption was not associated with site-specific cancers of the lung, colorectum, breast, or prostate.

As quantity consumed increased from 1 drink on drinking days to 3 or more drinks on drinking days (US drinks are 14g), risk of all-site cancer mortality increased by 22% among all participants. For total alcohol consumption (frequency x quantity), the data indicate a significant reduction in the risk of all-site cancers (RR=0.87, CI 0.80-0.94). Moderate drinking consistently shows no effect in the analysis, and only heavier drinking was associated with an increase in all-site cancer risk. For site-specific cancers, an increase in risk of lung cancer was seen for heavier drinkers, with a tendency for less cancer among light drinkers. There was no evidence of an effect of total alcohol consumption on colorectal, prostate, or breast cancer.

The authors excluded non-drinkers in a second analysis in which they used categories of usual daily quantity and of frequency of consumption in an attempt to investigate their separate effects. For all-site cancer and for lung cancer, these results again show an increase in risk only for drinkers reporting greater amounts of alcohol. The data also show an increase in cancer risk from more frequent drinking among women but not among men. For colorectal, prostate, and breast cancer, there is no clear pattern of an increase in risk from quantity of alcohol consumed. For frequency of drinking, again there is a suggestion of an increase in mortality risk with more frequent drinking, although the trends are not statistically significant.

Heavier drinking (three drinks or more per occasion) is known to be associated with a large number of adverse health effects, including certain cancers, as was shown in this study. When considering cancer, alcohol consumption should not be considered in isolation, but in conjunction with, other lifestyle behaviours (especially smoking when considering lung cancer). We agree with the authors that both quantity and frequency of consumption need to be considered when evaluating the relation of alcohol to cancer; further, beverage-specific effects need to be further evaluated.

UIC awarded $14 million to study tobacco pricing and media

Mon, 10 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The University of Illinois at Chicago has received $14.2 million from the National Cancer Institute to study how mass media and tax and pricing affects tobacco use and behavior.

The two five-year studies at UIC's Institute for Health Research and Policy build on previous tobacco research conducted by the institute to better understand what factors influence smoking behaviors.

In one study, senior research scientist Sherry Emery and colleagues will measure the extent to which people are exposed to, search for, and exchange both pro- and anti-tobacco information in mass media, how these activities are related to one another, and ultimately, how these actions are related to smoking behavior, beliefs and attitudes.

In evaluating pro- and anti-tobacco information the researchers will use existing data to assess passive exposure to television advertisements, banner ads that pop up on the internet, and sponsored text messaging; what people actively search for on the internet; and what people exchange via social media, such as Facebook, Twitter, and YouTube.

The hypothesis is that if you're exposed to, for example, an ad that says you should quit smoking your level of engagement with that information will be substantially lower than if you actively search the Internet for ways to quit smoking; in turn, engagement will be even greater if you share your experience with quitting via social media. These different levels of engagement may be associated in important ways to tobacco-related attitudes, beliefs and behavior, says Emery, principal investigator of the $7.2 million NCI-funded grant.

Emery's study will also collect new data from an online survey of 15,000 people in the country's top 75 media markets to obtain media market estimates of people's behavior and their consumption of pro- and anti-tobacco information from a variety of mass media, as well as smoking behavior information and demographics.

The tobacco industry is prohibited from advertising on television, but they are not prohibited from providing information about their products that can be actively searched for on the internet, says Emery, whose previous research has examined the impact of tobacco-related television advertising on youth and adult smoking attitudes and behaviors.

Watching television, while still the dominant source of information for many people, is a different behavior than it was five years ago, Emery said.

In the other study, Frank Chaloupka, distinguished professor of economics and director of the Health Policy Center at UIC, and colleagues will assess policies affecting retail tobacco prices over a 10-year period; evaluate the impact of price-reducing promotions on tobacco purchasing behaviors, such as choice of product and brand; and determine to what extent consumers will avoid paying tax on tobacco products by crossing county or state borders, or by purchasing online or by phone or mail order.

The study will also investigate how pricing and tax policies impact tobacco behaviors, including prevalence, frequency and intensity of use, youth uptake, cessation, and substitution among products.

Tobacco tax increases are widely recognized as the most effective policy governments have for reducing the death, disease and economic costs imposed by tobacco use, said Chaloupka. Findings from this project will help to ensure that these policies are designed and implemented in a way that maximizes their effectiveness in reducing tobacco use and its consequences.

Chaloupka has conducted extensive research on the economics of tobacco use and found that increases in cigarette prices -- including tax hikes -- lead to significant reductions in smoking. This research has led to many substance-abuse policy initiatives and has been cited by the U.S. surgeon general's office.

Co-investigators on Chaloupka's $6.9 million NCI grant are Emery, Jamie Chriqui, Jidong Huang, David Merriman, Sandy Slater, and John Tauras, all from UIC; Andrew Hyland, Roswell Park Cancer Institute; Chuck Alexander, Burness Communications; and Dianne Barker, Barker Bi-Coastal Health Consultants.

Co-investigators on Emery's grant are Chaloupka, Jidong Huang, and Robin Mermelstein, all from UIC; Joseph Cappella, University of Pennsylvania; and Kurt Ribisl, University of North Carolina at Chapel Hill.

The results of the research will be disseminated to policy makers, advocates, public health practitioners, researchers, and the general public.

New Systematic Review on Efficacy and Safety of Second Generation Antipsychotics (SGAs) for Off-Label Uses

Sat, 01 Oct 2011 23:00:00 PST

( from http://www.rxpgnews.com ) Medical evidence suggests that psychiatric drugs known as atypical antipsychotics are effective in reducing symptoms for some off-label conditions, but not others, according to a new RAND Corporation study.

Evidence supports the effectiveness of some atypical antipsychotics in reducing symptoms of generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder and behavioural symptoms in elderly patients with dementia, although significant side effects were noted.

Researchers found insufficient evidence to support efficacy of the medications for treating eating disorders, substance abuse and insomnia. The findings are published in the Sept. 28 edition of the Journal of the American Medical Association.

"The use of atypical antipsychotic medications has spread rapidly beyond the illnesses they originally were developed to treat," said lead author Dr. Alicia Ruelaz Maher, a psychiatrist and researcher at RAND, a non-profit research organization. "While evidence suggests the drugs help reduce symptoms for some off-label illnesses, we found a lack evidence for others."

Atypical antipsychotic medications are approved for marketing and labelling by the U.S. Food and Drug Administration to treat schizophrenia, bipolar disorders and depression under drug-specific circumstances.

Use of atypical antipsychotic medications has grown rapidly, with one study estimating that treatment visits for the drugs increased from 6.2 million in 1995 to 14.3 million in 2008. Use of these drugs for off-label indications -- uses not approved by the U.S. Food and Drug Administration -- doubled during the same period.

While prescription medications frequently are prescribed for illnesses prior to approval by the FDA, concerns have been raised about the practice with atypical antipsychotics because they have substantial side effects.

Researchers from the RAND-based Southern California Evidence-Based Practice Center conducted an extensive review of the medical literature to find studies that examined the safety and effectiveness of atypical antipsychotics for off-label uses.

They identified 162 clinical trials that involved one or more of the nine atypical antipsychotic medications approved by the FDA, as well as 231 large observational studies that followed patients being prescribed one of the medications. Relevant studies published in the English language were identified by searches of 6 databases (PubMed, EMBASE, CINAHL, PsycInfo, Cochrane DARE, and CENTRAL) from inception through May 2011. Observational studies with sample sizes of greater than 1000 patients were included to assess adverse events.

The review found that aripiprazole, olanzapine and risperidone are associated with small, but significant benefits with the treatment of behavioural symptoms in dementia. Drug dosage generally was about half of that needed in treating adults with schizophrenia or bipolar disorder.

Three large trials of quetiapine reported a modest benefit for treatment of generalized anxiety disorder. The review found risperidone is associated with improvement in symptoms of obsessive compulsive disorder among those who have not responded sufficiently to standard therapy. Risperidone also can improve symptoms of post-traumatic stress disorder among those who have not responded to standard drugs.

Atypical antipsychotics were associated with side effects, including a small but significant increased risk of death among elderly patients with dementia. Other risks in the elderly included cardiovascular problems, movement disorders and urinary tract infections. Side effects in younger patients included weight gain, fatigue and sedation.

"Because these medications pose the risk of serious side effects, I would hope they would be prescribed for these off-label illnesses only in the most-serious cases and for those patients who have not responded to other drugs," Maher said. "But use of atypical antipsychotic medications has grown so fast that we can't be sure that is the case."

The RAND analysis did not find evidence to support the efficacy of atypical antipsychotic medications for substance abuse, eating disorders or insomnia.

"This type of review is designed to help clinicians, patients and families better understand whether there is evidence regarding medications for off-label uses," said Margaret Maglione, a study co-author and a RAND policy analyst. "These findings will help physicians and families better weigh benefits and possible harms of using atypical antipsychotic medications off-label."

Brain immune cells respond to alcohol

Thu, 29 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) New research from the University of Adelaide suggests that immune cells in your brain may contribute to response to alcohol.

It's amazing to think that despite 10,000 years of using alcohol, and several decades of investigation into the way that alcohol affects the nerve cells in our brain, we are still trying to figure out exactly how it works, says lead researcher Dr Mark Hutchinson from the University's School of Medical Sciences.

Although scientists know much about how alcohol affects nerve cells, there is also a growing body of evidence that alcohol triggers rapid changes in the immune system in the brain. This immune response lies behind some of the well-known alcohol-related behavioural changes, such as difficulty controlling the muscles involved in walking and talking.

In research published in the latest edition of the British Journal of Pharmacology, Dr Hutchinson's team gave a single shot of alcohol to laboratory mice and studied the effect of blocking Toll-like receptors, a particular element of the immune system, on the behavioural changes induced by alcohol. The researchers used drugs to block these receptors. They also studied the effects of giving alcohol to mice that had been genetically altered so that they were lacking the functions of selected receptors.

The results showed that blocking this part of the immune system, either with the drug or genetically, reduced the effects of alcohol. While the research was carried out on mice, Hutchinson's team believe that similar treatments could also work in humans.

Medications targeting Toll-like receptor 4 may prove beneficial in treating alcohol dependence and acute overdoses, says Dr Hutchinson.

This work has significant implications for our understanding of the way alcohol affects us, as it is both an immunological and neuronal response. Such a shift in mindset has significant implications for identifying individuals who may have bad outcomes after consuming alcohol, and it could lead to a way of detecting people who are at greater risk of developing brain damage after long-term drinking.

UCSF, UC Merced to study effectiveness of anti-tobacco programs

Wed, 07 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Researchers with the University of California, San Francisco and the University of California, Merced will examine the effectiveness of state and local anti-smoking programs across the United States to ensure that health authorities are able to use their increasingly limited resources to support and defend the most effective approaches.

Stanton A. Glantz, PhD, UCSF professor of medicine; James Lightwood, PhD, UCSF assistant professor of clinical pharmacy; and Anna V. Song, PhD, UC Merced professor of psychology, have been awarded a five-year, $2.6 million grant from the National Institutes of Health to study which anti-smoking programs are working best and how the tobacco industry tries to prevent states from pursuing the most effective tobacco control policies and programs.

Tobacco use remains the leading preventable cause of death in California and the nation. Not all programs are equally effective in reducing smoking or bringing down health costs. Understanding which programs are best can help inform government policy decisions and make sure money is spent on effective programs, the researchers say.

California's tobacco control program has already saved California taxpayers and businesses well over $86 billion in direct health costs, Glantz said. With this research, we hope to inform policy makers and public health professionals how we can essentially eliminate tobacco as a public health problem in California in the next few years.

Glantz and Song will use qualitative and quantitative methods to accomplish three specific goals:

Document and analyze the variations in tobacco control policymaking and in how programs are run. The results will serve as the basis for recommendations to create the most effective and efficient tobacco control strategies and policies. Define the relationships between spending on state tobacco control programs, smoking, and health care expenditures, and then use these relationships to quantify the effects of program intensity and quality. Quantify the effects of tobacco control policies -- such as the clean indoor air laws California pioneered -- on smoking initiation, progression and cessation, and health disparities.

We are combining modern understanding of adolescent and young adult psychology with mathematical models to understand the spread and decline in tobacco use,'' Song said. It's similar to the way epidemiologists understand the spread of infectious diseases, with the tobacco companies playing the role of mosquitoes spreading disease.''

The field of tobacco control has remained dynamic with new legislation and advocacy programs. For example, the Family Smoking Prevention and Tobacco Control Act granted the U.S. Food and Drug Administration authority over tobacco products. It also repealed federal preemption of state and local actions to regulate the time, nature and place of tobacco advertising and promotion, creating new opportunities for state and local tobacco control policy making. California is also considering strengthening its own clean indoor air law to close loopholes that remain from the 1990s, when the current law was enacted.

Last year, the federal Centers for Disease Control and Prevention increased the visibility of tobacco control through several American Recovery and Reinvestment Act programs, including funding for tobacco control media campaigns in all states. It also has the Communities Putting Prevention to Work program, which is funding 21 state, local and tribal programs to implement policy-oriented tobacco control strategies.

Does Dad's stress affect his unborn children?

Sat, 03 Sep 2011 23:00:00 PST

( from http://www.rxpgnews.com ) According to the results of a new study in Elsevier's Biological Psychiatry, it seems the answer may be "yes, but it's complicated".

The risk of developing depression, which is significantly increased by exposure to chronic stress, is influenced by both environment and genetics. The interplay of these two factors is quite complex, but in fact, there is even a third factor that most of us know nothing about – epigenetics. Epigenetics is the science of changes in genetic expression that are not caused by actual changes in DNA sequencing. It is these mechanisms that have been the recent focus of intergenerational investigations into the transmission of stress vulnerability.

Inheritance is complex. We've all known that mothers and fathers have tremendous influence on their children, but "this study highlights how complicated the relationship between genetic, epigenetic, and environmental contributions can be with regards to the inheritance of important behavioural traits," commented Dr. John Krystal, editor of Biological Psychiatry.

Most work to date has focused on maternal effects. In this fascinating new study, researchers investigated paternal effects instead, and found that male mice exposed to chronic stress pass those stress behaviours along to their offspring. Both their male and female offspring showed increased depression and anxiety-like behaviours, although the effects were stronger in males. Importantly, these behavioural changes were only present in offspring produced through natural reproduction, and not in those offspring that were produced via in vitro fertilization. That interesting twist suggests that most stress-related vulnerabilities are transmitted to subsequent generations behaviourally, rather than epigenetically.

"This type of translational animal work is important to help scientists focus their work in humans", explained lead author Dr. Eric Nestler, from Mount Sinai School of Medicine in New York. "These findings in mice raise the possibility that part of an individual's risk for clinical depression or other stress-related disorders may be determined by his or her father's life exposure to stress, a provocative suggestion that now requires direct study in humans."

CBT is highly effective in Dental Phobia

Fri, 02 Sep 2011 23:37:56 PST

( from http://www.rxpgnews.com ) People with severe dental phobia may be able to overcome their anxieties with a single session of cognitive behavioural therapy (CBT), research published in the latest issue of the British Dental Journal (BDJ) suggests.

The authors of the study, based on an initial pilot of 60 patients who relied on having intravenous sedation before they could undergo dental treatment, concluded that the benefits were of such significance that they advise dental providers to implement this approach now rather than wait to pursue further research. They point out that patients benefit from not being exposed to the health risks associated with repeated intravenous sedation; and this approach saves money for the NHS.

The initial cohort of 60 patients had all attended a specialist dental clinic in Sheffield for people with severe dental phobia. Half the group were offered CBT, with 21 patients accepting the treatment. Twenty of these went on to have dental treatment without having to be sedated. An audit of these patients a decade later found that of the 19 patients located who had had CBT, none had returned to sedation in the intervening 10-year period.

The benefits of having CBT for severe dental phobia appear to endure over time, the authors of A joint approach to treating dental phobia: A re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on, conclude.

The latest 10-yearly survey on adult dental health published earlier this year by the NHS Information Centre suggests that as many as 12 per cent of people may experience extreme dental anxiety.

Professor Damien Walmsley, the BDA’s scientific adviser, said:

“Dental phobia is a serious problem because it deters some people from ever going to the dentist, except when they are in severe pain. At this stage, they may require more invasive treatment than might be the case if they went to the dentist regularly. Sadly, this cycle of anxiety, non-attendance and pain is often repeated in the children of those with dental phobia, perpetuating the problem and feeding another generation of oral health problems.

“CBT is one of a range of techniques than can be used to make the experience comfortable for patients who feel especially anxious about having dental treatment, and the results of this study look promising for those who experience severe dental phobia.

“All dentists are highly-skilled, caring health professionals who are trained to put patients at ease. Many also undertake additional training in techniques, such as hypnosis, and acupuncture, and of course, CBT.”

Faster progress through puberty linked to behavior problems

Thu, 01 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Children who go through puberty at a faster rate are more likely to act out and to suffer from anxiety and depression, according to a study by researchers at Penn State, Duke University and the University of California, Davis. The results suggest that primary care providers, teachers and parents should look not only at the timing of puberty in relation to kids' behaviour problems, but also at the tempo of puberty -- how fast or slow kids go through puberty.

Past work has examined the timing of puberty and shown the negative consequences of entering puberty at an early age, but there has been little work done to investigate the effects of tempo, said Kristine Marceau, a Penn State graduate student and the study's primary author. By using a novel statistical tool to simultaneously model the timing and tempo of puberty in children, we present a much more comprehensive picture of what happens during adolescence and why behaviour problems may ensue as a result of going through these changes.

The team -- led by Elizabeth Susman, the Jean Phillips Shibley Professor of Biobehavioral Health at Penn State -- created a unique nonlinear mixed-effects model that incorporated data from 364 white boys and 373 white girls that had been collected as part of the National Institute of Child Health and Human Development's Study of Early Child Care and Youth Development, which had an initial goal of determining how variations in the environment are related to children's development. The data included information about breast and pubic hair development in girls and genital and pubic hair development in boys as assessed by nurses, as well as weight and height for both boys and girls. The data also included information on internalizing and externalizing behaviour problems as reported by boys' and girls' parents or other caregivers, and risky sexual behaviours as reported by the kids themselves.

We found that earlier timing for girls was related to a slew of behaviour problems, and we also found that a faster tempo of development independently predicted those same sorts of problem behaviours, said Marceau. Although timing and tempo both predicted behaviour problems in girls, timing and tempo weren't related to each other. For boys, though, we found a strong relationship between timing and tempo. For example, we found that boys who have later timing combined with slower tempo exhibited the least amount of acting out and externalizing problems.

The team's results will appear in the September issue of the journal Developmental Psychology.

Why does going through puberty at a faster rate relate to external behavior problems and internal anxiety and depression?

"The thought is that when the major changes of puberty are compressed into a shorter amount of time, adolescents don't have enough time to acclimate, so they're not emotionally or socially ready for all the changes that happen," said Marceau. "This is the explanation that originally was attributed solely to early timing, but we suggest that the same thing also is happening if the rate of puberty is compressed."

According to Susman, timing and tempo of puberty vary dramatically across kids. "Children are extremely sensitive to how fast or slow other kids are going through puberty, and that may contribute to both the internalizing depression-type problems or the externalizing problems of acting out," she said.

In the future, Susman plans to examine the effects of tempo of puberty on later women's health problems. "One of the things that has concerned me over the years is the relationship between early puberty and later women's health problems," she said. "Specifically, there is some indication that early timing of puberty relates to more reproductive cancers, with the speculated mechanism being estradiol. If you're an early maturer, you have a longer exposure to this hormone. The question is whether the tempo of puberty has similar implications for women's health."

Understanding gender differences in suicide methods

Tue, 30 Aug 2011 23:00:00 PST

( from http://www.rxpgnews.com ) Women who commit suicide are more likely than men to avoid facial disfiguration, but not necessarily in the name of vanity. Valerie Callanan from the University of Akron and Mark Davis from the Criminal Justice Research Center at the Ohio State University, USA, show that there are marked gender differences in the use of suicide methods that disfigure the face or head. While firearms are the preferred method for both men and women, women are less likely to shoot themselves in the head. The study is published online in Springer's journal Sex Roles.

Although a number of studies have looked at gender differences in suicide risk, few have examined gender differences in suicide methods. Understanding gender differences in suicide methods has important implications for suicide prevention efforts.

Callanan and Davis examined the medical examiner's files of 621 suicide cases in Summit County, Ohio in the US, covering a 10-year period (1997-2006). They found that women were significantly less likely than men to use suicide methods with the potential to disfigure the face or head. Indeed, men were nearly twice as likely as women to have used such methods.

The researchers also found that for every one-unit increase in blood alcohol level, the odds of using a disfiguring method increased by nearly 10 percent. Gender, age, stressful life events and prior suicide attempts all predicted the use of methods that disfigure the face and head.

The authors conclude: To suggest that women are less likely to shoot themselves in the face or head because they are more concerned about their appearance than men is to minimize the significance of the act of suicide. What we do know is that those experiencing stressful life events are at far greater risk of employing an especially lethal method of suicide than those not experiencing such events.

Scientists show how gene variant linked to ADHD could operate

Tue, 16 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A study using mice provides insight into how a specific receptor subtype in the brain could play a role in increasing a person's risk for attention-deficit hyperactivity disorder (ADHD). The research, conducted by the Intramural Research Program (IRP) at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, could also help explain how stimulants work to treat symptoms of ADHD.

Dysfunction of the dopamine D4 receptor subtype is linked to ADHD as well as other disorders characterized by decreased impulse control, including drug abuse. One subtype variant, D4.7, has been of particular interest because of its increased prevalence in those diagnosed with ADHD. However, the function of this particular variant in ADHD has been poorly understood.

In the study, published in today's Molecular Psychiatry, researchers inserted three variants of the dopamine D4 receptor into cells and into mice so that they could investigate differences in biological activities. The researchers found that the D4.7 variant, unlike its D4.2 and D4.4 counterparts, was not able to interact with the short version of the dopamine type 2 (D2S) receptor to reduce glutamate release in a brain region associated with impulsivity and symptoms of ADHD in humans.

Although previous studies have shown that dysfunctional dopamine D4 receptors are implicated in ADHD, this is the first study to show how this genetic difference might translate into functional deficits seen with this disorder, said NIDA Director Dr. Nora D. Volkow. Further research is needed to explore how this deficient interaction between receptors might be remedied, which could then lead to new medications for the treatment of ADHD.

Children with ADHD have trouble paying attention and controlling impulsive behaviors, and may be overly active, often resulting in poor school performance and social difficulties. They are also at increased risk for substance use disorders, particularly if their symptoms go untreated.

ADHD is the most commonly diagnosed neurobehavioral disorder of childhood, and the number of children diagnosed continues to rise. According to the Center for Disease Control's National Survey of Children's Health, the number of children aged 4-17 years that were identified by their parent as ever being diagnosed with ADHD increased by 21.8 percent from 2003-2007. By 2007, nearly one in 10 children aged 4-17 years were, at some point, diagnosed with ADHD. Among children with current ADHD diagnoses, 66.3 percent were taking medication for the disorder.

The most commonly used treatment for ADHD involves administering psychostimulant medications. Although these medications alleviate some of the symptoms of ADHD, it is unclear how these compounds act within the brain to do so.

Our results suggest that psychostimulants might reduce glutamate release by amplifying this D4/D2S interaction, said Dr. Sergi Ferre, primary author for the study. These results might also explain why these medications are less efficient in patients with the D4.7 variant.

Study: Graphic warning labels reduce demand for cigarettes

Mon, 08 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Will graphic cigarette package warning labels significantly reduce demand? A new study suggests it will.

Current US policy requires that tobacco companies cover 50 percent of one side of a cigarette pack with a text warning. But the FDA recently unveiled nine new cigarette warning labels, which include graphic images of lung and mouth cancer, to be unveiled in September 2012.

A sample of 404 adult smokers from four states participated in an experimental auction on cigarette packs with four different kinds of warning labels. All packs carried the same message: smoking causes mouth cancer.

The first pack featured a text-only message on the side of the pack, the current US policy. The second had a text-only message that covered 50 percent of the lower half of the front, back and one side of the pack. A third had the same text message, but with a photo depicting mouth cancer. The fourth package had the same text and graphic photo, but was a mostly unbranded pack, meaning all color and symbolic brand elements were removed except for the brand's font, size and descriptors.

We found that the label with just the front text warning had little effect on consumers, says study co-author Matthew Rousu, professor of economics at Susquehanna University in Selinsgrove, Pa. However, demand was significantly lower for packs with grotesque images, with the lowest demand associated with the plain, unbranded pack.

The bids for cigarette packs that had a grotesque photo and no brand imagery received bids that were 17 percent lower than the bids for the package with the current US warning label.

Results from our study suggest that the new health warnings with graphic pictures will reduce demand for cigarettes, says Rousu, who conducted the study with James F. Thrasher, David Hammond, Ashley Navarro and Jay R. Corrigan.

Regulators should also consider health warnings with graphic pictures, but also plain packaging policies for tobacco products, he adds. Color and brand imagery can support false beliefs about reduced risks of some brands.

What their study can't address is how the new labels will affect non-smokers. One would assume that it would also have an impact on non-smokers, that some of those people will not start smoking because they are turned off by the images, says Rousu.

The study, Estimating the impact of pictorial health warnings and 'plain' cigarette packaging: Evidence form experimental auctions among adult smokers in the United States, appears in the September 2011 issue of the journal

Daunting barriers found in accessing psychiatric care

Thu, 21 Jul 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A new study by Harvard Medical School researchers published today in the Annals of Emergency Medicine finds that access to outpatient psychiatric care in the greater Boston area is severely limited, even for people with reputedly excellent private health insurance. Given that the federal health law is modelled after the Massachusetts health reform, the findings have national implications, the researchers say.

Study personnel posed as patients insured by Blue Cross Blue Shield of Massachusetts PPO, the largest insurer in Massachusetts. They called every Blue Cross-contracted mental health facility within a 10-mile radius of down town Boston, stating they had been evaluated in an emergency department for depression and discharged with instructions to obtain a psychiatric appointment within two weeks – i.e. they signalled they needed urgent care.

Only 8 of the 64 facilities (12.5 percent) listed by Blue Cross as preferred providers offered appointments; only 4 (6.2 percent) offered an appointment within two weeks. These findings indicate that even patients with top-drawer private insurance face grave difficulties in securing mental health services in the Boston area.

According to the study, 23 percent of phone calls seeking appointments were never returned, even after a second attempt. Another common reason appointments were unavailable was that 23 percent of psychiatric providers required that the patient already be enrolled with a primary care doctor affiliated with their psychiatric facility.

"People with mental health problems often can't advocate for themselves – especially in a crisis," said lead author Dr. J. Wesley Boyd, an attending psychiatrist at the Harvard-affiliated Cambridge Health Alliance. "Health insurers know this and yet, thanks to their restrictive provider networks and their low reimbursement rates for psychiatric services, they've created a situation where a patient with a potentially life-threatening disorder, such as the severe depression portrayed in our callers' scenario, is essentially abandoned at a time of great need."

"Despite having private coverage, our simulated patient faced daunting barriers when trying to access psychiatric care," Boyd continued. "How likely is it that a real patient in the grip of severe depression would persevere through so many unsuccessful attempts?"

Senior author Dr. Rachel Nardin, chief of neurology at Cambridge Health Alliance, said: "The incentives of the current health insurance system are aligned against patients with mental illness. Insurers try to protect their bottom line by reimbursing poorly for psychiatric services and by constraining their in-network provider lists, both of which limit patients' options so severely as to make services essentially unavailable."

"Lack of adequate access to mental health care strains our entire health care system," said Nardin. "Emergency departments are overwhelmed with boarding psychiatric patients for whom no other resources exist."

"A good first step would be for insurance companies to immediately provide improved reimbursements for psychiatric care," Nardin said. "A more fundamental solution, however, would be to remove private insurers from the picture altogether and to establish a single-payer national health insurance program – a program that would cover mental health services as part of its comprehensive benefits package."

BUSM/BMC researchers awarded $3.5 million grant from the NIDA

Thu, 21 Jul 2011 04:00:00 PST

( from http://www.rxpgnews.com ) (Boston) - Researchers from the Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) were recently awarded a $3.5 million grant from the National Institute on Drug Abuse (NIDA), to improve upon the seek, test, treat, and retain paradigm in Eastern Europe among HIV-infected Russian and Eastern European injection drug users (IDUs) in narcology (addiction) care. The project will be known as LINC, Linking Infectious and Narcology Care.

Russia and Eastern Europe have one of the fastest growing HIV epidemics in the world, with transmission risk primarily from injection drug use. Russia, Ukraine and other countries in the region have implemented routine HIV testing within established addiction treatment systems (narcology hospitals). The narcology system of care, however, works largely independent of other medical care systems and hence has not adopted strategies to link HIV-infected patients to HIV care.

The research will be conducted under the direction of Jeffrey H. Samet, MD, a professor of medicine and community health sciences at BUSM and BU School of Public Health and chief of the Section of General Internal Medicine at BMC. Samet was recently selected as a NIDA International Program 2011 Awards of Excellence winner.

According to the researchers, the narcology system of care works largely independent of other medical care systems and hence has not adopted strategies to link HIV-infected patients to HIV care. As in the United States in the 1990s, delayed or non-receipt of HIV medical care, particularly among IDUs, is common in Russia. According to Samet, the principal investigator of the study, this is a missed opportunity since up to 45 percent of Russian IDUs in narcology treatment are HIV infected, yet as few as 20 percent of those infected are in care.

The objective of this study is to implement and assess a behavioral and structural intervention in Russia designed to support and motivate HIV-infected heroin dependent narcology patients to engage in HIV medical care and ultimately improve their HIV outcomes, said Samet.

LINC is a clinical model designed to coordinate narcology and HIV systems of care using an intervention inclusive of staff from both systems and composed of elements shown to facilitate engagement in medical care: HIV case management and nurse home visits. The central hypothesis is that an intervention that involves coordination between the narcology and HIV systems will lead to increased engagement in HIV medical care. Coordination will involve HIV case management delivered by a peer to help motivate and reduce barriers to HIV care engagement and enhanced outpatient narcology treatment delivered by an addiction nurse with communication between these providers, added Samet.

The project will be undertaken by an international research team experienced in addressing HIV, substance use, and clinical interventions in Russia.

International AIDS Society to launch Virtual Media Centre in July to support opioid substitution therapy in Eastern Europe and Central Asia

Tue, 19 Jul 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Tuesday, 19 July, 2011 (Rome, Italy) -- As a part of its new initiative, Expanding Access to Opioid Substitution Therapy (OST) for People Who Inject Drugs in Eastern Europe and Central Asia (EECA), the International AIDS Society (IAS) will launch a Virtual Knowledge Centre (VKC) in partnership with the Ukrainian Institute on Public Health Policy (UIPHP).

The announcement was made today at the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011), which runs from 17-20 July in Rome and is being attended by more than 5,000 researchers, clinicians and community leaders.

The VKC initiative is a scaling up of the commitment by IAS to drug policy which it adopted as one if its four key priority areas in late 2010. Provision of OST, a call for expanded access to antiretroviral therapy (ART) for injecting drug users living with HIV, campaigning against the criminalization of injecting drug users, and a special focus on the EECA region underpin the policy. (1)

The VKC will strive to contribute to improved knowledge and strengthened operations research capacity for scale up of HIV/OST programmes for people who inject drugs by creating an increased Russian-language evidence base around OST, harm reduction and HIV, as well as specialized documents and training modules relevant to professionals, public health experts, narcologists, students, parliamentarians, NGOs and any other interested and involved parties working in this field in EECA. (2)

The IAS believes that evidence-based interventions are the best way to implement HIV treatment scale-up and will continue to advocate for expanding access to Opioid substitution therapy, said IAS governing Council member Chris Beyrer, who is the Director of the Johns Hopkins Center for Public Health and Human Rights in Baltimore, USA. The science has been in since the very beginning of the AIDS epidemic 30 years ago - OST and clean needle exchange programs save lives.

Outside of sub-Saharan Africa, injecting drug use accounts for approximately one in three new cases of HIV. In some areas of rapid HIV spread, such as in Eastern Europe and Central Asia, injecting drug use is the primary cause of new HIV infections. Legal barriers to scientifically proven prevention services such as needle and syringe programs and OST mean hundreds of thousands of people become infected with HIV and Hepatitis C every year. In Russia for instance some 60 per cent of new HIV infections are linked to injecting drug use and some 80 per cent of the one million people living with HIV are estimated to be less than 30 years of age. OST is illegal in Russia.

OST is proven to be one of the most effective methods of intervention, prevention and care for people who inject drugs and hence prevent the transmission of HIV. However, globally, treatment with methadone and buprenorphine reaches only eight per cent of injecting drug users. In 2007, only 2 per cent of injecting drug users in developing countries with injection-driven HIV epidemics was accessing treatment for Opioid dependence.

Many countries in the EECA regions have been slow to adopt human rights based public health approaches to illicit drug policy, despite compelling evidence that a human rights based policy and decriminalization of drug use is the most effective approach to decreasing HIV transmission and improving treatment outcomes.

Another major challenge is the criminalization and drug policy laws that many governments have in place. Because drug use is illegal, many local police forces increase surveillance near needle exchange programs or drug treatment facilities. This increased surveillance causes fear amongst drug users and increases syringe sharing while decreasing the amount of individuals seeking health-care. For those who are arrested or caught for illegal drug use, punishment includes harassment, beatings, or detainment.

It really is time to switch from criminality to care and put an end to registries, put an end to compulsory drug detention and ended the imprisonment for drug use/possession for personal use, said Patrizia Carrieri, a researcher at the French National Institute for Health and Medical Research (INSERM U912). Governments need to stop portraying drug users as less than human and therefore less deserving of their human rights and access to proper treatment and care.

In the Ukraine up to 75 per cent of people living with HIV are dying from tuberculosis, and prisons are becoming incubators of MDR-TB filled with people convicted for minor possession. Irina Borushek , an activist with the All-Ukrainian Network of People Living with HIV/AIDS is patient pointed out that the recent implementation of a high quality drug dependency treatment programme on which she herself is a patient, should become the norm, not the exception.

.Unless we make radical changes in drug policy, ensure effective scale up of drug comprehensive drug treatment, first of all, substitution treatment, and prioritize healthcare principles over repressive drug policy - we will fail to overcome HIV epidemic, said Borushek.

Liudmyla Sulga from the International HIV/AIDS Alliance in Ukraine and a Senior Lecturer in the School of Public Health at the National University of Kyiv-Mohyla Academy in Kiev said that law reform was an essential step if treatment was to be expanded across the Ukraine.

Alliance Ukraine is the largest NGO in the field of AIDS in Ukraine providing HIV prevention programmes to more than 240,000 people. The organization was instrumental in starting and rolling out medically assisted treatment for people who inject drugs.

In recent months however Alliance Ukraine has been lobbying to stop the systematic obstructions to the legal substitution treatment programmes for people who use drugs. Interference of law enforcement bodies into treatment programmes has created an atmosphere of fear for both patients and medical staff and has resulted in the failure to meet the National AIDS programme targets.

Further treatment programme expansion in the Ukraine will only be possible if there is a revision on drugs administration, using liquid forms of methadone and making drug administration and control more flexible for medical institutions, concluded Shulga.

Alcohol drinking in the elderly: Risks and benefits

Mon, 27 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The Royal College of Psychiatrists of London has published a report related primarily to problems of unrecognized alcohol misuse among the elderly. The report provides guidelines for psychiatrists and family physicians on how to find and how to treat elderly people with misuse of alcohol and drugs. Forum members consider it very important to identify abusive drinking among the elderly and this report provides specific and very reasonable recommendations to assist practitioners in both the identification and treatment of such problems.

There is no question that, on average, very elderly people may be more sensitive to the effects of alcohol (especially those individuals with chronic diseases, lower muscle mass, a poor diet, etc.) It should be made clear, however, that 65-year-olds are healthier than people of that age a generation ago - age-specific disability rates are decreasing, not increasing.

The report also recommends lower sensible limits for older people in comparison with younger people The International Forum on Alcohol Research scientific reviewers point out inherent difficulties in providing guidelines for a very non-homogenous group of individuals whose only criterion for inclusion, in this paper, is being above the age of 65 years Such a group includes individuals varying from marathon runners to very sick, frail people.

The report was conspicuously lacking in a discussion of the important role that moderate drinking can play in reducing the risk of coronary heart disease, ischemic stroke, diabetes, dementia, and osteoporosis. Advising healthy people aged 65 years or older who are moderate, responsible drinkers to stop drinking or to markedly reduce their intake would not be in their best health interests, especially in terms of their risk of cardiovascular diseases. Forum reviewers thought that advice to lower limits of drinking for everyone in this age group is not based on reliable research, and would certainly not apply to all in this age group. Of more importance, the absolute risk for cardiovascular diseases increases markedly with age, and therefore the beneficial or protective effect of light to moderate drinking on cardiovascular diseases is greater in the elderly than in younger people.

Evidence is also accumulating that shows that the risk of Alzheimer's disease and other types of dementia is lower among moderate drinkers than among abstainers. Neurodegenerative disorders are key causes of disability and death among elderly people. Epidemiological studies have suggested that moderate alcohol consumption, may reduce the incidence of certain age-related neurological disorders including Alzheimer's disease. Regular dietary intake of flavonoid-rich foods and/or beverages has been associated with 50% reduction in the risk of dementia, a preservation of cognitive performance with ageing,a delay in the onset of Alzheimer's disease and a reduction in the risk of developing Parkinson's disease.

Further, scientific data are consistent in demonstrating that quality of life is better and total mortality is lower among moderate drinkers than among abstainers. For example, analyses by Simons et al from a large population-based patient population in New South Wales demonstrated clearly that regular moderate alcohol consumption increases life span and quality of life for men up to 80 years of age and for women indefinitely.

In another paper, by Kirchner et al of almost 25,000 American adults over age 65 seen in primary care, those reporting between 8 and 14 drinks/week (A US drink is 14g, against 8g in the UK) did not differ significantly in their characteristics from drinkers consuming 1-7 drinks/week.. Heavier drinkers and binge drinkers did not do as well.

A particular interesting paper by White et al showed a direct dose-response relation between alcohol consumption and risk of death in women aged 16-54 and in men aged 16-34, whereas at older ages the relation is U shaped. These investigators used statistical models relating alcohol consumption to the risk of death from single causes to estimate the all-cause mortality risk for men and women of different ages. The authors state that their data suggest that women should INCREASE their intake to 3 units a day over age 75, and men rise from 3 units a day up to age 54 to 4 units a day up to age 84.

Since the absolute effects of moderate drinking on cardiovascular disease are much greater in older people than in younger adults, the current limitations to intake for the elderly may not be appropriate. Attempting to persuade elderly people who currently drink moderately to decrease their current intake may not be advisable. For healthy moderate and responsible drinkers, advice to reduce or stop all alcoholic beverage intake would not be in the best health interests of such individuals.

The association of alcohol drinking with migraine headache

Mon, 13 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Migraine is a neurovascular disease that affects about 15% of the western population. Compounds in foods and beverages (chocolate, wine, citrus, etc) considered as migraine triggers include tyramine, phenylethylamine and possibly histamine and phenolic compounds. Avoiding those triggers may significantly reduce the frequency of migraines in some patients.

However, only a small percentage of patients in one study became headache-free simply by excluding those foods, epidemiological studies are pointing out that genetic factors may be an underlying cause. Discrepancies in the way people are reacting to wine intake, and whether or not it triggers migraine, may be potentially explained by genetic polymorphisms in specific enzymes related to metabolism Alcoholic drinks are a migraine trigger in about one third of patients with migraine in retrospective studies on trigger factors. Many population studies show that patients with migraine consume alcohol in a smaller percentage than the general population. Research has shown a decreased prevalence of headache with increasing number of alcohol units consumed. The classification criteria of alcohol-related headaches remain problematic.

An excellent paper from The Headache Center in Empoli, Italy by Panconesi A et al (Curr Pain Headache Rep (2011) )15:177-184 summarizes the scientific data relating to alcohol and migraine headaches. The factors that trigger an attack of migraine, or of other headaches as well, are poorly understood. While retrospective studies tend to include alcohol as a trigger for an attack, the authors describe that in a recent prospective study (in which information on the factors that could potentially trigger an attack were collected prior to the migraine attack), menstruation, stress, and fatigue were found most commonly to relate to a subsequent attack, In the present paper, the authors reviewed the role and mechanism of the action of alcohol or other components of alcoholic drinks in relation to alcohol-induced headache. They conclude from their review that reports overestimate the role of alcohol, as well as other foods, in the triggering of migraine.

International Scientific Forum on Alcohol Research members thought that this was a very balanced review of the subject, and that it provided straightforward and sensible advice. Although some individuals surely have the onset of a migraine or other type of headache after the consumption of wine or alcohol, the findings are not consistent (in this study, beer consumption on the previous day reduced the risk of a migraine attack). Forum members suggest that given that subjects reporting migraine headaches have been found to be at increased risk of cardiovascular disease, it would not be appropriate to advise all such sufferers to avoid alcohol. As suggested by the authors of this paper, it may be reasonable for migraine sufferers to drink small amounts of specific types of alcoholic beverages to see if each beverage is tolerated or not. After seeing the effects, and factoring in symptoms from other dietary or lifestyle elements (sleep, stress, dehydration), a reasonable discussion can be carried out with one's physician with respect to commencing or continued alcohol use.

Sleep loss can cause testosterone levels to plummet

Thu, 02 Jun 2011 17:25:00 PST

( from http://www.rxpgnews.com ) Cutting back on sleep can be quite disastrous for healthy young men - it sends their testosterone levels plummeting, says a study.

Men who slept less than five hours a night for one week in a lab had significantly lower levels of testosterone than when they had a full night's sleep, according to the study.

Significantly, skipping sleep was found to reduce a young man's testosterone levels by the same amount as aging 10 to 15 years, or 10 percent to 15 percent.

Low testosterone has a host of negative consequences for young men, and not just in sexual behaviour and reproduction. It is critical in building strength, muscle mass and bone density.

'Low testosterone levels are associated with reduced well being and vigour, which may also occur as a consequence of sleep loss,' said Eve Van Cauter, professor in medicine, University of Chicago Medical Centre, the US, who led the study, according to a Chicago statement.

At least 15 percent of the adult working population in the US gets less than five hours of sleep a night, and suffers many adverse health effects because of it. Low testosterone is also linked with low energy, reduced libido, poor concentration and fatigue.

The group of young men recruited for the study passed a rigorous battery of tests to screen for endocrine or psychiatric disorders and sleep problems. They were an average of 24 years old, lean and in good health.

They spent three nights in the lab sleeping for up to 10 hours, and then eight nights sleeping less than five hours. Their blood was sampled every 15 to 30 minutes for 24 hours during the last day of the 10-hour sleep phase and the last day of the five-hour sleep phase.

The effects of sleep loss on testosterone levels were apparent after just one week of short sleep. Five hours of sleep decreased their testosterone levels by 10 percent to 15 percent.

The young men had the lowest testosterone levels in the afternoons on their sleep restricted days.

They reported a decline in their sense of well-being as their blood testosterone levels declined. Their mood and vigour fell more every day as the sleep restriction part of the study progressed.

Altruistic decision making focus of NIDA's Addiction Science Award

Fri, 13 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A study of what influences decision making on issues whose consequences will only be felt by future generations won first prize in the annual Addiction Science Awards at this year's Intel International Science and Engineering Fair (ISEF) -- the world's largest science competition for high school students. The Intel ISEF Addiction Science Awards were presented at an awards ceremony Thursday night in Los Angeles. The awards were presented by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and Friends of NIDA, a coalition that supports NIDA's mission.

First place distinction went to Sarah Susie Pak, a 17-year-old senior at Roslyn High School in Roslyn Heights, N.Y., for her project Would You Do It for the Kids? Factors Involved in the Prediction of Intergenerational Preferences. The project was based on well-known phenomenon, called delayed discounting, in which people tend to discount the value of a reward that will be received at a later time vs. an immediate, but smaller, reward. Delayed discounting is abnormally high in people who are addicted to drugs and contributes to their impulsive risk taking behaviors, especially drug use. Pak's project identified generosity and patience as two key interacting factors that increase the likelihood that a person will make altruistic decisions that will primarily help future generations. The senior plans to attend Princeton in the fall.

Our first place winner took a fresh look at delayed discounting at the social and generational level, said NIDA Director Dr. Nora D. Volkow. Her studies illuminate aspects of neuroeconomics that are relevant not only to drug abuse and addiction, but that could have far reaching social, ethical, and public health policy implications.

Second place distinction in the Addiction Science Awards went to Darby Kathryn Schumacher, a 15-year-old freshman at the Girls Preparatory School in Chattanooga, Tenn. Her project, Making Heartbeats Go LOKO, investigated the effects of the alcoholic caffeinated beverage branded as Four Loko on the heart rate of the water flea (Daphnia). She chose to use this invertebrate model to test the effects of Four Loko not only because Daphnias show clear signs of intoxication when exposed to alcohol, but also because their heart rate can be easily monitored through their translucent bodies. She was able to demonstrate that alcohol, a depressant, and caffeine, a stimulant, can lower and boost Daphnia's heart rate, respectively. The caffeine content in Four Loko appears to have partially mitigated the depressant effect of the alcohol present in this beverage, supporting the notion that the caffeine in alcoholic energy drinks could mask some of alcohol's behavioral effects, making the user less aware of the true extent of their impairment.

Ms. Schumacher took a simple model of a nervous system that recreates some of the most basic features of human physiology to show how the combination of a stimulant and a depressant can affect heart function, said Dr. Susan Weiss, NIDA's head judge and acting director of the Office of Science Policy and Communications. She took a systematic and elegant approach to demonstrate why these drinks can be dangerous. The U.S. Food and Drug Administration issued warning notices to manufacturers of caffeinated alcoholic beverages in November 2010.

Third place went to 16-year-old Yamini T. Naidu, a student at Valley Catholic High School in Beaverton, Ore., for her entry, From Models to Medications: Identification of Medication Leads for Treating Methamphetamine Addiction. Using molecular modeling software that incorporated eye-catching 3D structural illustrations and vivid computer animations, Naidu discovered two potential sites in the methamphetamine binding TAA receptor. Her work predicted that these sites could have the ability to modulate the binding affinity of methamphetamine for this receptor. This work has resulted in the development of several lead compounds that are the subject of pending patents for possible novel medications for methamphetamine addiction. There are currently no medications approved for the treatment of methamphetamine addiction; thus, these lead compounds represent a potentially exciting new development in the addiction treatment field. The sophomore says she became interested in neuroscience after her uncle died of a stroke.

The non-profit organization, Friends of NIDA, partnered with NIDA to sponsor the awards as part of its ongoing support of NIDA research into the causes, consequences, and treatment of drug abuse and addiction.

We are delighted to see three young women win this year, and we hope these awards encourage them to continue their interest in addiction science, said Dr. William Dewey, Louis S. and Ruth S. Harris Professor and Chair, Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, and president and chair of the Executive Committee, Friends of NIDA. The awards were judged by Dr. Weiss, NIDA's Dr. Ruben Baler, and Dr. Walter Ling, a NIDA grantee at the University of California at Los Angeles, which hosted the fair.

Teenage alcohol consumption associated with computer use

Mon, 09 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (May 9, 2011) -- Teenagers who drink alcohol spend more time on their computers for recreational use, including social networking and downloading and listening to music, compared with their peers who don't drink.

Results of an anonymous survey of 264 teenagers were reported in the online edition of the journal Addictive Behaviors in a study authored by Weill Cornell Medical College public health researcher Dr. Jennifer Epstein.

While the specific factors linking teenage drinking and computer use are not yet established, it seems likely that adolescents are experimenting with drinking and activities on the Internet. In turn, exposure to online material such as alcohol advertising or alcohol-using peers on social networking sites could reinforce teens' drinking, says Dr. Epstein, assistant professor of public health at Weill Cornell Medical College. Children are being exposed to computers and the Internet at younger ages. For this reason it's important that parents are actively involved in monitoring their children's computer usage, as well as alcohol use.

According to a national study conducted by the Pew Internet and American Life Project, more than half of parents of teenagers had filters installed on the computers their child uses to block content parents find objectionable, yet many parents do not use any form of parental monitoring, particularly for older teens, continues Dr. Epstein.

The Weill Cornell survey was completed by participants aged 13 to 17 and residing in the United States. Results showed that teens who reported drinking in the last month used a computer more hours per week excluding school work than those who did not; however, there was no demonstrated link between alcohol use and computer use for school work. Drinking was also linked to more frequent social networking and listening to and downloading music. There was no strong link between video games and drinking or online shopping and drinking.

Going forward, we would like to collect more detailed and longer-term data on adolescent alcohol and computer use, including the degree and duration of their drinking habit, says Dr. Epstein.

Teenagers typically first experiment with alcohol at age 12 or 13. Family risk factors include lax parental supervision and poor communication, family conflicts, inconsistent or harsh discipline and a family history of alcohol or drug abuse.

Parents may also need to reinforce their family ground rules on alcohol use and computer use, Dr. Epstein says.

This is an innovative study that is an important first step to understanding the potential impact that the Internet and new media may have on today's youth, says Dr. Gil Botvin, professor of public health and chief of the Division of Prevention and Health Behavior at Weill Cornell Medical College. The Internet offers a wealth of information and opportunities for intellectual and social enrichment. However, it is becoming clear that there may also be a downside to Internet use. More systematic research is needed to better understand to those potential dangers and how to combat them.

Alcohol, mood and me

Thu, 28 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Thanks in part to studies that follow subjects for a long time, psychologists are learning more about differences between people. In a new article published in Current Directions in Psychological Science, a journal of the Association for Psychological Science, the author describes how psychologists can use their data to learn about the different ways that people's minds work.

Most psychology research is done by asking a big group of people the same questions at the same time. So we might get a bunch of Psych 101 undergrads, administer a survey, ask about how much they use alcohol and what their mood is, and just look and see, is there a relationship between those two variables, says Daniel J. Bauer of the University of North Carolina at Chapel Hill, the author of the article.

But a one-time survey of a bunch of college students can only get you so far. For example, it might find that sad people drink more, but it can't tell us whether people drink more at times when they are unhappy, whether the consequences of drinking instead result in a depressed mood, or whether the relationship between mood and alcohol use is stronger for some people than others.

One way psychologists have used to learn more about people is collecting data from people over a longer time period. For example, they might give each subject an electronic device to record blood pressure and stress several times a day, or ask them to log on to a website every night to answer a survey. In one case, Bauer's colleague, Andrea Hussong, asked adolescents to complete daily diaries with ratings of their mood and alcohol use over 21 days. The data showed that the relationship between mood and alcohol use is not the same for everyone. Adolescents with behavioral problems drink more in general, irrespective of mood, but only adolescents without behavioral problems drink more often when feeling depressed.

Analyzing this kind of data requires tougher math than the simple survey data, which is where quantitative psychologists like Bauer come in. I think even though a lot of researchers are starting to collect this data, I don't think they've taken full advantage of it, he says. In the new paper, Bauer points to other methods that can do a better job of showing how variables relate differently for different people.

The point of all of this is to help people, Bauer says. For example, if psychologists discover that certain kinds of people are more likely to drink when depressed, it would be possible to help those people early. Ultimately, the idea would be to identify people who might be more at risk and try to help them, he says.

Health-care alliance for tobacco dependence treatment launches training in the Middle East

Tue, 26 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) ROCHESTER, Minn. -- Global Bridges, a healthcare alliance for tobacco dependence treatment based at Mayo Clinic, and its regional partner, King Hussein Cancer Center (KHCC) in Amman, Jordan, announced today that they will start training health care providers in the Eastern Mediterranean Region (EMRO) on how to successfully treat tobacco users.

The first training, scheduled for April 27-28 at KHCC, will engage 15 health care professionals from Jordan. Feras Hawari, M.D., director of the Cancer Control Office at KHCC and regional director for Global Bridges, will conduct this workshop. In addition, KHCC will collaborate with other regional and international organizations to hold a four-day regional workshop in June.

Prevalence of tobacco use is high in most of the Eastern Mediterranean countries, and only a few countries have structured tobacco dependence services. By offering training, we are making a step towards addressing this epidemic, says Dr. Hawari, who is also chief of pulmonary and critical care service at KHCC.

Global Bridges -- a collaboration among Mayo Clinic's School for Continuous Professional Development and Mayo Clinic's Nicotine Dependence Center, the American Cancer Society and the University of Arizona -- was established in 2010 as a worldwide, science-based initiative to help health care providers unite to treat tobacco use and dependence while advocating for effective tobacco control policies. During its first year, Global Bridges has positively impacted 400,000 patients around the world through training over 5,400 health care providers in Mayo Clinic-led sessions on how to deliver culturally appropriate tobacco dependence treatment.

Global Bridges adapts to regional needs and enhances access to proven treatment methods throughout each of the World Health Organization's (WHO) six regions, says Richard Hurt, M.D., founder and director of the Mayo Clinic Nicotine Dependence Center and principal investigator of Global Bridges. The training that Dr. Hawari will lead is the first in a series of activities we are planning for WHO's Eastern Mediterranean region with our regional partner, King Hussein Cancer Center.

As a Global Bridges regional director, Dr. Hawari and his team will lead activities to grow the network and advance tobacco dependence treatment and tobacco control policies across the WHO Eastern Mediterranean Region that covers 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen.

King Hussein Cancer Center is a dedicated medical center that focuses on providing state-of-the-art comprehensive cancer care in Jordan and the Middle East. KHCC is disease-specific accredited by the Joint Commission, making it the first in the region and the sixth worldwide.

KHCC has been a strong advocate for tobacco control in Jordan. KHCC is the first hospital in Jordan to declare its campus 100 percent smoke-free. The tobacco dependence treatment program was established in 2008 under the leadership of Dr. Hawari, and was then incorporated under the umbrella of the Cancer Control Office (CCO) established in 2010.

Prevalence of tobacco use is high in most EMRO countries. The Tobacco Atlas shows rates for men ranging from 82 percent in Afghanistan to 13.4 percent in Oman. For women, rates range from 57.1 percent in Lebanon to less than 1 percent in Oman. Among youngsters, WHO reports that between 1 in 3 and 1 in 4 boys smoke in EMRO countries. In Jordan, prevalence is at 28 percent among adults but is as high as 48 percent among adult males. Thirty-five percent of boys between 13 and 15 years are smokers, and prevalence among girls is on the rise.

Countries with high happiness levels also have high suicide rates

Fri, 22 Apr 2011 06:15:28 PST

( from http://www.rxpgnews.com ) The happiest countries and happiest U.S. states tend to have the highest suicide rates, according to research from the UK’s University of Warwick, Hamilton College in New York and the Federal Reserve Bank of San Francisco.

The new research paper titled Dark Contrasts: The Paradox of High Rates of Suicide in Happy Places has been accepted for publication in the Journal of Economic Behavior & Organization. It uses U.S. and international data, which included first-time comparisons of a newly available random sample of 1.3 million Americans, and another on suicide decisions among an independent random sample of approximately 1 million Americans.

The research confirmed a little known and seemingly puzzling fact: many happy countries have unusually high rates of suicide. This observation has been made from time to time about individual nations, especially in the case of Denmark. This new research found that a range of nations - including: Canada, the United States, Iceland, Ireland and Switzerland, display relatively high happiness levels and yet also have high suicide rates. Nevertheless the researchers note that, because of variation in cultures and suicide-reporting conventions, such cross-country scatter plots are only suggestive. To confirm the relationship between levels of happiness and rates of suicide within a geographical area, the researchers turned to two very large data sets covering a single country, the United States.

The scientific advantage of comparing happiness and suicide rates across U.S. states is that cultural background, national institutions, language and religion are relatively constant across a single country. While still not absolutely perfect, as the States are not identical, comparing the different areas of the country gave a much more homogeneous population to examine rather than a global sample of nations.

Comparing U.S. states in this way produced the same result. States with people who are generally more satisfied with their lives tended to have higher suicide rates than those with lower average levels of life satisfaction. For example, the raw data showed that Utah is ranked first in life-satisfaction, but has the 9th highest suicide rate. Meanwhile, New York was ranked 45th in life satisfaction, yet had the lowest suicide rate in the country.

The researchers then also tried to make their comparison between States even fairer and yet more homogeneous by adjusting for clear population differences between the states including age, gender, race, education, income, marital status and employment status. Even with these adjustments. This still produced a very strong correlation between happiness levels and suicide rates although some states shifted their positions slightly. Hawaii then ranks second in adjusted average life satisfaction but has the fifth highest suicide rate in the country. At the other end of the spectrum, for example, New Jersey ranked near the bottom in adjusted life satisfaction (47th) and had one of the lowest adjusted suicide risks (coincidentally, also the 47th highest rate).

The researchers (Professor Andrew Oswald from the University of Warwick, Associate Professor of Economics Stephen Wu of Hamilton College and Mary C. Daly and Daniel Wilson both from the Federal Reserve Bank of San Francisco) believe the key explanation that may explain this counterintuitive link between happiness and suicide rates draws on ideas about the way that human beings rely on relative comparisons between each other.

University of Warwick researcher Professor Andrew Oswald said:

“Discontented people in a happy place may feel particularly harshly treated by life. Those dark contrasts may in turn increase the risk of suicide. If humans are subject to mood swings, the lows of life may thus be most tolerable in an environment in which other humans are unhappy.”

Professor Stephen Wu of Hamilton College said:

"This result is consistent with other research that shows that people judge their well-being in comparison to others around them. These types of comparison effects have also been shown with regards to income, unemployment, crime, and obesity."

Effects of a large reduction in alcohol prices on mortality in Finland

Fri, 08 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Does a reduction in the price of alcohol result in an increase in deaths due to alcohol? This was the subject of a study following a significant reduction in taxes in Finland in 2004 (30% for spirits, 3% for wine).The abolition of import quotas by the EU in 2004 also made it possible to import from other member countries and this led to an increase of approximately 10% in alcohol consumption in Finland. This paper is particularly interesting as it not only reports the effects of reducing costs of alcohol on alcohol-related mortality, but it also reports the effects of such changes on cardiovascular and all-cause mortality.

The authors assessed the impact of a reduction in alcohol prices by analysing the monthly aggregations of deaths for the period 1996-2006.

Key results of paper: The key results of the analyses were that for subjects over the age of 50 years, the decrease in the cost of alcohol was associated with an increase in rates of alcohol-related mortality. For men aged 40-49 years and men and women aged 50-69 years, these increases in risk estimated 1.6 to 2.9 additional monthly deaths per 100,000 person-years. On the other hand, the trend was very different for cardiovascular and all-cause mortality rates. For men and women aged 40-49 years and those >69 years, there were clear decreases in mortality from cardiovascular disease, with estimated 19 fewer monthly deaths per 100,000 person-years for men and 25 for women. For ischemic heart disease deaths among subjects >69 years of age, many fewer deaths were estimated. These effects were not different when the investigators included numbers of coronary operations as a control series in the models.

For all-cause mortality, the estimates implied 42 and 69 fewer monthly deaths in the oldest group. The lower all-cause mortality rates relate not only to decreases in CVD deaths but to fewer deaths from pulmonary disease, dementia, and diabetes; there were no changes in cancer death rates. The authors state: the negative, i.e., beneficial, point estimates found in the current study suggest that cheaper alcohol may . . . have fostered moderate consumption and its beneficial effects in at least some part of the population. They quote recent surveys showing that alcohol consumption in the 2000s has increased among persons aged >65 years and those aged 50-69 years, whose drinking is reported to be primarily low to moderate'.

Gambling problems are more common than drinking problems, according to first-of-its-kind study

Thu, 24 Mar 2011 04:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- After age 21, problem gambling is considerably more common among U.S. adults than alcohol dependence, even though alcohol dependence has received much more attention, according to researchers at the University at Buffalo's Research Institute on Addictions.

In results published this month in the Journal of Gambling Studies, John W. Welte, principal investigator on the study and a national expert on alcohol and gambling pathology, concluded that there is a distinct inconsistency between his research and much of the other research literature. Other research supports the proposition that problem gambling is more common among adolescents than among adults. Problem gambling has often been described as rare. Even the National Council on Problem Gambling describes it as rare but treatable.

Welte and colleagues conducted, then combined, results from two national surveys of gambling and alcohol -- one of youth ages 14-21 and the second of adults 18 and older -- to identify patterns of U.S. gambling and alcohol use across the lifespan. They found that gambling, frequent gambling and problem gambling increases in frequency during the teen years, reaches its highest level in the 20s and 30s and then fall off among those over 70.

No comparable analysis has been done previously and therefore none is available for a direct comparison of these results, Welte says. But, given what we found about the persistence of frequent and problem gambling through adulthood, increased prevention and intervention efforts are warranted.

Other results detailed in the article demonstrate that frequent gambling is twice as great among men (28 percent) as among women (13 percent). Men reach their highest rates of both any gambling and frequent gambling in the late teens, while females take longer to reach their highest rates.

The odds of any gambling in the past year are significantly higher for whites than for blacks or Asians, although the odds of frequent gambling are higher for blacks and Native Americans, the study found.

It is also notable that frequent and problem gambling become more common as socioeconomic status (SES) gets lower; gambling involvement tends to decline as SES rises. Welte speculated as early as 2004 that lower SES Americans may pursue gambling as a way to make money, leading to more difficulties than if their motivation were strictly recreational.

Welte's first telephone survey of adult gambling was conducted in 1999-2000 with 2,631 adults from 4,036 households nationwide. The second survey of youth gambling in 2005-2007 included 2,274 youth -- with parental permission -- from 4,467 households. Both surveys were conducted with residents drawn from all 50 states and the District of Columbia. Questions asked of those who agreed to participate ranged from frequency of drinking, quantity and type of alcoholic beverage to frequency of past-year gambling and type of gambling, such as raffles, cards, casinos, sports betting, horse or dog track, lottery involvement and games of skill.

Deep brain stimulation research expands at Barrow

Wed, 09 Mar 2011 05:00:00 PST

( from http://www.rxpgnews.com ) St. Joseph's Hospital and Medical Center's Barrow Neurological Institute has received a $10.1 million donation, the largest single gift in the organization's history and one of the biggest ever given to any Arizona hospital. The one-time cash donation from philanthropist Marian H. Rochelle to St. Joseph's Barrow Neurological Institute in Phoenix will be used to explore a new medical frontier for psychiatric and motor disorders by using novel treatments including advanced deep brain stimulation.

Deep brain stimulation (DBS) has previously been used almost exclusively for patients with movement disorders. The new Barrow center, called the Barrow Center for Neuromodulation, will expand its use, as well as the use of other technologies, to treat patients with a number of neurological and behavioral conditions such as depression, obsessive compulsive disorder, epilepsy, Tourette syndrome, addictions, autism and chronic pain.

I have grown to appreciate all that Barrow does for patients in Arizona and around the world. This is truly a gem among neuroscience centers, and I am proud to support it, says Rochelle, whose late husband was treated at Barrow for Alzheimer's disease. Each of us can play a role in making the new Barrow Center for Neuromodulation a beacon of hope for people with devastating neurological disorders. The doctors, nurses and scientists will give of their education, experience and skill, while we benefactors will give of the resources with which we are so richly blessed. I hope others will join me in supporting this amazing endeavor. Time is of the essence.

The new center will be located inside Barrow and will include neurosurgeons, neurologists, psychiatrists and clinical and basic researchers.

This donation will help insure that Barrow continues as a global leader in the neurosciences, says Barrow Director Robert Spetzler, MD. This gift will advance our understanding of the brain's pathways and their abnormal connections in patients who have movement and psychiatric disorders. There also exists the tantalizing prospect that with deep brain stimulators these abnormal pathways can be made to function in a more normal manner. This has the potential to make a dramatic difference in the lives of these patients. The Barrow Neurological Institute will be one of a small handful of medical institutions worldwide that are doing serious research to improve the lives of these patients with neuromodulation.

Deep brain stimulation involves the implantation of an electrode deep to a target area deep within the brain that is associated with a disorder. A pacemaker then sends electrical signals to the brain, alleviating symptoms. While DBS is the cornerstone of the new Barrow center, other neuromodulation therapies including transcranial magnetic stimulation and low frequency ultrasonic therapy will also be developed.

Since 1995 when DBS became available as a treatment for movement disorders, more than 80,000 people have been implanted with a deep brain stimulation device. Barrow currently conducts about 75 deep brain stimulation surgeries a year on Parkinson's patients. One of the early focuses of the new center will be use of DBS for patients with treatment-resistant depression. Barrow has already launched a research trial that will advance deep brain stimulation as a treatment for depression. (see attached sidebar)

Francisco Ponce, MD, is director of the center. A Barrow-trained neurosurgeon, Dr. Ponce received sub-specialty training in functional neurosurgery at the University of Toronto. Following his undergraduate studies at Harvard, he pursued graduate work in materials science at the University of Oxford before earning his medical degree from the University of Chicago in 2004.

This is one of the most exciting and promising areas of modern medicine. Through neuromodulation, we can improve and restore function in patients in a manner that is reversible, adjustable and safe, says Dr. Ponce. This center will combine the strengths of multiple disciplines, enabling our team to develop and implement new treatments for patients for whom current therapies fall short.

Study shows tobacco retail proximity to schools

Mon, 21 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- For years the tobacco industry has argued that efforts to ban tobacco advertising near schools would constitute a total ban on tobacco advertising in urban areas.

But public health researchers at the University at Buffalo and Roswell Park Cancer Institute have presented research that shows this is not the case in Buffalo and Niagara Falls, N.Y. The UB and RPCI researchers presented their study results in a poster session on Feb. 18 at the annual meeting of the Society for Research on Nicotine and Tobacco held in Toronto.

They found that tobacco outlets in Buffalo and Niagara Falls are more concentrated around elementary and secondary schools; the outlets (convenience stores, groceries, delis, etc.) also are more densely concentrated in lower-income areas, which may be exacerbating tobacco-use disparities between socioeconomic groups.

According to the tobacco industry's argument, the area around schools in urban areas comprises a significant percentage of land area and population that would be off-limits to tobacco advertisements if an advertising ban were in place.

The tobacco industry has stated that a tobacco advertising ban within a 1,000-foot buffer zone near schools in urban areas would be equivalent to a total ban on advertising and would, therefore, be unconstitutional on First Amendment grounds, explains Andrea Licht, a doctoral candidate in the Department of Social and Preventive Medicine in the UB School of Public Health and Health Professions. Licht is first author on the study.

However, based on our analyses, a law banning tobacco advertising within 1,000 feet of schools would affect fewer than half of their outlets, she says. We also found that only about one-third of the population potentially lives within this 1,000-foot buffer zone, so such an advertising ban would not act like a 'de facto' ban, as industry has claimed.

During 2009-10, the years covered by the study, there were 350 tobacco retail outlets and 104 schools located in the City of Buffalo.

The study found that 17.3 percent of schools in Buffalo have a tobacco retail outlet located within 500 feet, while 49.9 percent have a tobacco retail outlet located within 1,000 feet and 71.2 percent of schools have a tobacco retail outlet located within 1,500 feet.

In the City of Niagara Falls, there were 65 tobacco retail outlets and 15 schools. Of those 15 schools, 13.3 percent have a tobacco retail outlet located within 500 feet, 33.3 percent have a tobacco retail outlet within 1,000 feet and 46.7 percent of schools have a tobacco retail outlet within 1,500 feet.

The proximity to schools is significant because smoking patterns are almost exclusively developed during the adolescent and teen years, Licht explains.

These outlets near the schools and in lower-income areas may be more likely to be frequented by adolescents, young adults and other disadvantaged populations, says Licht. Since availability, accessibility and the perception that smoking is normal are all associated with higher youth smoking rates, it is likely that advertising bans near schools may serve to reduce youth smoking initiation.

Moderate-to-heavy alcohol intake may increase risk of atrial fibrillation

Mon, 14 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Atrial Fibrillation (AF) is the most common cardiac arrhythmia (abnormal heart rhythm). Its name comes from the fibrillating (i.e., quivering) of the heart muscles of the atria, instead of a coordinated contraction. The result is an irregular heartbeat, which may occur in episodes lasting from minutes to weeks, or it could occur all the time for years. Atrial fibrillation alone is not in itself generally life-threatening, but it may result in palpitations, fainting, chest pain, or congestive heart failure.

There is no doubt that heavy alcohol intake and binge drinking can lead to cardiac arrhythmias, with the Holiday Heart Syndrome being known for more than three decades. This syndrome often includes atrial fibrillation; the syndrome is usually not associated with long-standing heart disease and the arrhythmia tends to resolve when drinking stops.

Members of The international Scientific Forum on Alcohol Research comment 'This paper, Alcohol consumption and risk of atrial fibrillation. A meta-analysis. J Am Coll Cardiol 2011;57:427-436. analyzing the results of 14 papers suggests that even moderate drinking can lead to this syndrome, but others find no effect for moderate alcohol intake, only for heavy drinking. One of the best studies on alcohol consumption and risk of atrial fibrillation is a Danish cohort study (the Danish Diet, Cancer and Health Study) examining the issue among 22,528 men and 25,421 women followed over 6 years. The study included a large number of cases with atrial fibrillation, detailed information on potential confounding factors, and complete follow up through nationwide population-based registries. The results included a modest increase in risk of atrial fibrillation in men drinking more that 2 drinks/day and no association between alcohol consumption and risk of atrial fibrillation in women.

There is much evidence that heavy alcohol consumption is associated with an increased incidence of atrial fibrillation, among other health risks. The pattern of consumption (speed, time frame and without food), not often addressed, affects risk too - we know that binge drinking is associated with a greater incidence of arrhythmias, especially atrial fibrillation.

A weakness of this paper, and of essentially all meta-analyses, is that there were varying definitions for categories of alcohol consumption, and the highest category of alcohol intake included alcoholics and 6 or more drinks/day for some studies, while the highest category of alcohol intake was = 1-2 drinks/day in other studies.

The consistent message is that there is a difference between heavy and moderate use of alcohol, between binge drinking and a healthy pattern of drinking, and inherent health risk. The most important question would be: Does light to moderate drinking increase the risk of AF? The conclusion of the authors of this paper seems to be yes, while many other studies find little effect of such drinking'.

Overall, the scientific evidence from many studies suggests that heavy drinking may increase the risk of atrial fibrillation, although whether light-to-moderate intake increases the risk seems unlikely. Previous basic scientific data of mechanisms of atrial fibrillation have suggested that alcohol has little effect on this arrhythmia.

Simple feedback could be effective therapy for addictive behaviors

Mon, 07 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) As mental health care costs and problem gambling rates continue to rise, University of Missouri researchers are developing a personalized feedback tool that could serve as an effective and inexpensive way for people with addictive behavior-related problems to get the help they need.

Matthew Martens, associate professor of Educational, School and Counseling Psychology in the MU College of Education, and his team of researchers received a $172,500 grant from the Institute for Research on Gambling Disorders to expand a successful feedback based intervention program to study college student gambling. Martens and his team have been developing and testing this type of intervention for alcohol issues, and the new grant will build on that study.

Intensive therapy, such as counseling sessions or extensive rehabilitation, isn't always necessary, and in some cases may even be counterproductive, for many people who are experiencing problems associated with addictive behaviors like alcohol use and gambling, Martens said. If effective, the personalized feedback would give therapists an inexpensive tool to help people modify their behavior before it escalates.

In these interventions clients answer a series of targeted questions. After completion, the clients receive personalized responses designed to raise awareness about their current behaviors versus more desirable behaviors. For example, it is typical for heavy drinking college students to overestimate the amount of alcohol their peers drink. A client may think that drinking 20 drinks per week for a college student is normal, when actually, the nationwide average is much lower, Martens said.

With the rise of online gaming, more people are experiencing issues related to excessive gambling, such as missing appointments and classes or not meeting other responsibilities. However, most are not facing extreme issues, such as financial ruin, so intensive therapy, which can be very expensive, may not be necessary.

The gambling questionnaire will prompt clients to answer questions about how their gambling compares to national norms, the negative consequences they have experienced, and the myths about gambling they may hold that are not true, which will then be used to develop the personalized feedback, Martens said. To see all that feedback in one place can have a real positive effect.

In addition to the current alcohol and gambling questionnaires, Martens also is developing feedback based interventions that encourage physical activity in sedentary college students; alcohol interventions tailored to veterans returning from the Middle East; and a shorter, more focused alcohol intervention that includes a review of feedback and discussion with a clinician.

While similar questionnaires are available on the Internet, most of them are not associated with health care facilities. Martens believes that as research suggests that personalized feedback is an effective, low-cost intervention, more clinicians will adopt the practice.

Unhealthy eating leads to increased depression

Thu, 27 Jan 2011 06:47:30 PST

( from http://www.rxpgnews.com ) Researchers from the universities of Navarra and Las Palmas de Gran Canaria have demonstrated that the ingestion of trans-fats and saturated fats increase the risk of suffering depression, and that olive oil, on the other hand, protects against this mental illness.

They have confirmed this after studying 12,059 SUN Project volunteers over the course of six years; the volunteers had their diet, lifestyle and ailments analyzed at the beginning of the project, over its course and at the end of the project. In this way the researchers confirmed that despite the fact that at the beginning of the study none of the volunteers suffered from depression, at the end of the study 657 new cases had been detected.

Of all these cases, the participants with an elevated consumption of trans-fats (fats present in artificial form in industrially-produced pastries and fast food, and naturally present in certain whole milk products) "presented up to a 48% increase in the risk of depression when they were compared to participants who did not consume these fats," affirmed Almudena Sánchez-Villegas, Associate Professor of Preventive Medicine at the University of Las Palmas de Gran Canaria, first author of the article.

In addition, the study demonstrated a dose-response relationship, "whereby the more trans-fats were consumed, the greater the harmful effect they produced in the volunteers," the expert stated.

Furthermore, the team, directed by Miguel Ángel Martínez-González, Professor of Preventive Medicine at the University of Navarra, also analyzed the influence of polyunsaturated fats (abundant in fish and vegetable oils) and of olive oil on the occurrence of depression. "In fact, we discovered that this type of healthier fats, together with olive oil, are associated with a lower risk of suffering depression," emphasized the researcher and director of the SUN Project.

150 million persons depressed worldwide

Thus, the results of the study corroborate the hypothesis of a greater incidence of the disease in countries of the north of Europe compared to the countries of the south, where a Mediterranean dietary pattern prevails. Nevertheless, experts have noted that the incidence of the disease has increased in recent years, so that today some 150 million persons are affected worldwide, where it is the principal cause of loss of years of life in those countries with a medium-to-high per capita income.

This due, according to Almudena Sánchez Villegas, "to radical changes in the sources of fats consumed in Western diets, where we have substituted certain types of beneficial fats—polyunsaturated and monounsaturated in nuts, vegetable oils and fish—for the saturated and trans-fats found in meats, butter and other products such as mass-produced pastries and fast food".

In addition, the research—published in the online peer reviewed journal PLoS ONE—has been performed on a population with a low average intake of trans-fats, given that it made up only 0.4% of the total energy ingested by the volunteers. "Despite this, we observed an increase in the risk of suffering depression of nearly 50%. On this basis," concluded Miguel A. Martínez, "we derive the importance of taking this effect into account in countries like the U.S., where the percentage of energy derived from these foots is around 2.5%".

Finally, the analysis, headed by the University of Navarra and the University of Las Palmas de Gran Canaria, suggests that both depression as well as cardiovascular disease are influenced in a similar manner by diet, and might share similar mechanisms in their origin. This hypothesis is further suggested by numerous studies that indicate the harmful effect of trans-fats and saturated fats on the risk of cardiovascular disease.

Childhood self-control predicts adult health and wealth

Mon, 24 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) DURHAM, N.C. -- A long-term study has found that children who scored lower on measures of self-control as young as age 3 were more likely to have health problems, substance dependence, financial troubles and a criminal record by the time they reached age 32.

Self-control in the more than 1,000 New Zealand children who participated in the study was assessed by teachers, parents, observers and the children themselves. It included measures like low frustration tolerance, lacks persistence in reaching goals, difficulty sticking with a task, over-active, acts before thinking, has difficulty waiting turn, restless, not conscientious.

Fast-forward to adulthood, and the kids scoring lowest on those measures scored highest for things like breathing problems, gum disease, sexually transmitted disease, inflammation, overweight, and high cholesterol and blood pressure, according to an international research team led by Duke University psychologists Terrie Moffitt and Avshalom Caspi.

The impulsivity and relative inability to think about the long-term of the lower self-control individuals gave them more difficulty with finances, like savings, home ownership and credit card debt. They also were more likely to be single parents, have a criminal conviction record, and be dependent on alcohol, tobacco, cannabis and harder drugs.

These adult outcomes were predictable across the entire spectrum of self-control scores, from low to high, Moffitt said.

Yet study participants who somehow found a way to improve their self-control as they aged fared better in adulthood than their childhood scores would have predicted. Self-control is something that can be taught, the researchers say, and doing so could save taxpayers a pile of money on health care, criminal justice and substance abuse problems down the road.

To further corroborate the importance of self-control, Caspi and Moffitt ran the same analysis on a sample of 500 pairs of fraternal twins in Britain and found that the sibling with lower self-control scores at age 5 was more likely than their sibling to begin smoking, perform poorly in school and engage in antisocial behaviors at age 12. This shows that self-control is important by itself, apart from all other factors that siblings share, such as their parents and home life, Caspi said.

The New Zealand children with low-self control were more likely to make poor choices as adolescents, including taking up smoking, having unplanned pregnancies and dropping out of school. Naturally, this set them on a more difficult path. Even the low self-control individuals who finished high school as non-smokers without kids showed poorer outcomes at age 32.

And because of a greater likelihood of single-parent status and limited income, it's also apparent that one generation's low self-control puts the next generation at a disadvantage as well, Moffitt said.

The good news is that self-control can change. People can change, said Alexis Piquero, a professor of criminology at Florida State University who was not involved in the research.

Piquero, who studies the developmental roots of criminal behavior, said there are many time-tested approaches that give parents and teachers the tools to teach self-control. The successful programs practice decision-making, role-playing and learning the consequences of actions.

Identifying low self-control as early as possible and doing prevention and intervention is so much cheaper than dealing with prisons, drug programs and personal economic failures, Piquero said. If you're just making a dollars-and-cents decision, it's a no-brainer.

Nicotine may be a treatment for some symptoms of schizophrenia

Tue, 11 Jan 2011 17:43:16 PST

( from http://www.rxpgnews.com ) Smoking is a common problem for patients with schizophrenia. The increased tendency of patients diagnosed with this disorder is to not only smoke, but to do so more heavily than the general public. This raises the possibility that nicotine may be acting as a treatment for some symptoms of schizophrenia.

Nicotine acts through two general classes of brain receptors, those with high and low affinity for nicotine. The low affinity class of nicotinic receptors contains the alpha-7 subunit, which is present in reduced numbers in people with schizophrenia.

Two papers published in the January 1st issue of Biological Psychiatry suggest that drugs that stimulate these alpha-7 subunit-containing nicotinic receptors might enhance cortical function and treat cognitive impairments associated with schizophrenia.

In their study of healthy monkeys, Graham Williams and colleagues at Yale University and AstraZeneca found that very low doses of AZD0328, a novel drug that acts as an alpha-7 agonist, produced both acute and persistent improvements in their performance on a spatial working memory task.

"Our work demonstrates that that the neuronal nicotinic alpha-7 receptor plays a critical role in the core cognitive function of working memory, which is a key indicator of outcome in patients with schizophrenia," explained Dr. Williams. "The function of the alpha-7 receptor may account for the ability of a partial agonist to induce long-term beneficial changes for high-order cognition at such low doses."

This influence on cortical function has been exemplified by the work of Jason Tregellas and colleagues. These researchers examined the effects of DMXB-A, a novel alpha-7 partial agonist, on the brain's 'default network' in people with schizophrenia. Function of the default network, which is likely a major contributor to the intrinsic neuronal activity that accounts for 60-80% of the brain's energy use, is different in people with schizophrenia.

Dr. Tregellas summarized their findings: "We found that DMXB-A altered default network activity in people with schizophrenia in a pattern consistent with improved function of the network. We also found that these neuronal differences were related to the genotype of the alpha-7 nicotinic receptor and to drug-related improvements in symptoms."

Together, "these two studies provide additional support for a novel pharmacologic approach to treat cognitive impairments in schizophrenia", observed Dr. John Krystal, Editor of Biological Psychiatry.

Research tackles drug use, HIV in South African youth

Mon, 13 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Drug use, risky sexual behavior and violence among South African youth may be reduced thanks to Penn State researchers, who will look at expanding a leisure education and life skills program to 56 South African high schools. The researchers, led by Linda Caldwell, professor of recreation, park, and tourism management, and Edward Smith, associate director of the Penn State Prevention Research Center for the Promotion of Human Development, received a $2.8-million grant from the National Institute on Drug Abuse.

Caldwell and her colleagues will implement HealthWise, a curriculum they developed that teaches youth how to best utilize their free time, said Caldwell. HealthWise teaches adolescents to examine personal motivations and other factors leading to their decision-making, and it also provides information on safe sexual practices and how to avoid risky situations. In better understanding why they make decisions, youth can successfully prevent poor outcomes that result from risky decisions.

Recent studies show that nearly one-quarter of HIV-infected individuals in South Africa are under the age of 25, and AIDS is responsible for 71 percent of all deaths in the 15 to 49 year age group. One in eight South African high school students begins drinking alcohol before the age of 13. In grades 8 through 11, more than 10 percent of children have tried marijuana ,and about 30 percent of children have smoked cigarettes.

Caldwell and Smith first implemented HealthWise in the Cape Town Metro South Education District (MSED) in 2001 as a pilot program and later as a randomized trial involving nine schools and over 7,000 youth. Results from the trial indicated HealthWise was effective in reducing both substance use and sexual risk. Cigarette and alcohol use, for example, were significantly lower among those in the HealthWise schools. In addition, fewer males initiated sexual behavior and were less likely to push girls into unwanted sex. Importantly, from the perspective of reducing HIV risk, both males and females reported less use of substances at sexual encounters and were less likely to report having sex with someone they had recently met. There was also increased perception of condom availability, condom skills and conversations with partners surrounding condom use.

Following the success of the first trial, MSED administrators approached Caldwell and Smith requesting that they help with a large-scale implementation.

We saw great success in HealthWise over the past decade, said Caldwell. We hear constantly from teachers and district administrators of how good HealthWise is. The kids like it, too, because it's so positive. Now we're looking at what factors of success are important for a large-scale rollout of the program.

23% of young people get into fights when they go out at night

Thu, 11 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Night-time violence among young Spaniards is becoming ever more common, according to a research study carried out by the European Institute of Studies on Prevention. The study shows that 5.2% of young people carry weapons when they go out at night, 11.6% have been attacked or threatened, and 23% have got into a fight at some time.

Reports about young people being attacked or injured in fights when they go out at night are becoming increasingly common, Amador Calafat, lead author of the study and a researcher at the European Institute of Studies on Prevention (IREFREA), which is at the forefront of studies into problems of childhood and adolescence and drug abuse, tells SINC.

The research, published in the latest issue of the Journal Psicothema, analyses the phenomenon of violence among young Spaniards (under the age of 25), in particular in terms of factors related to the night-time leisure context, among a selected sample of 440 participants in the Balearic Islands, Galicia and Valencia who regularly go out at night and consume alcohol or other substances.

Of this sample, 11.6% had been attacked or threatened at some time. This percentage rose to 23% for fights. The research goes further, finding that 5.2% of the young people studied carry weapons when they go out at night. Having been threatened or hurt with a weapon was associated with having frequent arguments related to the use of alcohol and drugs, Calafat explains.

The authors state that adolescence is a risk factor itself, since young people are more prone and vulnerable to this kind of behaviour. Some important aspects for preventing night-time violence relate to the way in which environmental conditions are managed. These include preventing crowds from building up, using soft music when bars and clubs close and bright lights when it is time to leave.

In order to prevent night-time violence, alcohol consumption among young people should be controlled by offering water and soft drinks at affordable prices, steering away from 'happy hour'-type alcohol offers, and strictly ensuring that alcohol is not sold to underage drinkers, the researcher concludes.

Violence among young tourists

Tourist destinations in southern Europe attract young people because of the good times and night-time action they promise. In another study, financed by the European Commission Daphne programme, the same research group studied the behaviour of young British and German tourists who chose to spend their 2009 holidays in Portugal, Spain, Italy, Greece and Cyprus.

The figures were impressive. Almost one-quarter of the study's participants (24%) visited bars and clubs every night during their holidays, and 95% consumed alcohol during their stay. More than two-thirds of the young respondents got drunk, and more than one in 10 took illegal drugs.

The 6,000 young tourists surveyed reported significant problems during their holidays. Almost 9% were sexually abused (7% of males and 10% of females), 6% suffered injuries and 4% were involved in cases of physical violence. More than half of the violent incidents (51%) took place in bars or nightclubs, while the rest (36%) took place on the street.

New NIH data show gains in COPD awareness

Tue, 09 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) The number of Americans who report being aware of chronic obstructive pulmonary disease, or COPD, increased by 4 percentage points between 2008 and 2010, but many people at risk are still unaware of the disease, according to mailed survey results released today by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

Sixty-nine percent of adults said they are aware of COPD. However, up to 30 percent of Americans reported that they were unaware of the condition. Awareness increased steadily among current and former smokers as well as nonsmokers.

COPD kills more than 120,000 adults each year. That's one death every four minutes -- more than breast cancer and diabetes combined. Yet people go undiagnosed and untreated because they don't recognize the symptoms, said James P. Kiley, Ph.D., director of the NHLBI's Division of Lung Diseases. Through the NHLBI's COPD Learn More Breathe Better campaign, we are focusing on empowering people with knowledge that can bring greater quality of life.

To improve awareness of COPD symptoms, the NHLBI is launching a new public service announcement campaign that highlights common COPD signs and symptoms including: frequent shortness of breath, chronic cough, wheezing, and excessive phlegm production.

Individuals living with these symptoms often believe it is just a result of getting older or being out of shape, and may not think the symptoms warrant a doctor's visit. Not true. COPD is a serious lung disease that makes it difficult to breathe and can cause long-term disability. Sometimes referred to as emphysema or chronic bronchitis, COPD is now the fourth leading cause of death in the United States. More than 12 million people are currently diagnosed with COPD. And it is estimated that another 12 million may have COPD but not realize it.

For those who may be experiencing a recurrent cough or shortness of breath, particularly those who may have a history of smoking, awareness of the symptoms is not enough. They need to have their lungs tested, said Kiley. There is no cure for COPD -- but the good news is that we have come a long way in terms of improving how a person with COPD lives, and it only takes a few minutes in the doctor's office to get tested.

The NHLBI analyzed the results of the annual HealthStyles surveys of the public health attitudes, knowledge, practices, and lifestyle habits of consumers, conducted each year by Porter Novelli, communications contractor for the NHLBI's COPD Learn More Breathe Better campaign. The results represent a sample of 4,184 consumers through a mailed survey with a margin of error of plus or minus 1.5 percentage points. Both surveys were conducted in summer 2010.

The NHLBI initiated the COPD Learn More Breathe Better campaign, the first national awareness campaign on COPD, in 2007 to improve knowledge about COPD among those already diagnosed or at risk for COPD as well as health care providers, particularly those in a primary care setting.

2 studies present new data on effects of alcohol during pregnancy

Fri, 15 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Scientific data continue to indicate that higher intake of alcohol during pregnancy adversely affects the fetus, and could lead to very severe developmental or other problems in the child. However, most recent publications show little or no effects of occasional or light drinking by the mother during pregnancy. The studies also demonstrate how socio-economic, education, and other lifestyle factors of the mother may have large effects on the health of the fetus and child; these must be considered when evaluating the potential effects of alcohol during pregnancy.

A very large population-based observational study from the UK found that at the age of 5 years, the children of women who reported light (no more than 1-2 units of alcohol per week or per occasion) drinking did not show any evidence of impairment on testing for behavioral and emotional problems or cognitive ability. There was a tendency for the male children of women reporting heavy/binge drinking during pregnancy (7 or more units per week or 6 or more units per occasion) to have poorer behavioural scores, but the effects were less clear among female offspring.

A second study, published in Pediatrics, based on a population in Western Australia examined the associations between dose, pattern, and timing of prenatal alcohol exposure (PAE) and birth defects and found similar results, that there was no association between low or moderate prenatal alcohol exposure and birth defects.

Data from a randomly selected, population-based cohort of non- indigenous women who gave birth to a live infant in Western Australia (WA) between 1995 and 1997 (N = 4714) were linked to WA Midwives Notification System and WA Birth Defects Registry data. Information about maternal alcohol consumption was collected 3 months after birth for the 3 month period before pregnancy and for each trimester separately.

Low alcohol consumption was defined as less then 7 standard drinks (10g) a week, and no more than 2 drinks on any one day. Women who consumed more than 70g per week were classified as heavy drinkers and women consuming more than 140g were classified as very heavy drinkers.

The study results indicate that the prevalence of birth defects classified as ARBDs by the IOM was low. Compared with abstinence, heavy prenatal alcohol exposure in the first trimester was associated with increased odds of birth defects classified as ARBDs (adjusted odds ratio: 4.6 [95% confidence interval: 1.5-14.3]), with similar findings after validation through bootstrap analysis. There was no association between low or moderate prenatal alcohol exposure and birth defects.

Overall, current scientific data indicate that while drinking during pregnancy should not be encouraged, there is little evidence to suggest that an occasional drink or light drinking by the mother is associated with harm. Heavy drinking, however, is associated with serious developmental defects in the fetus.

Legalizing marijuana in California would not substantially cut cartel revenues, study finds

Tue, 12 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Legalizing marijuana in California will not dramatically reduce the drug revenues collected by Mexican drug trafficking organizations from sales to the United States, according to a new RAND Corporation study.

The only scenario where legalization in California could substantially reduce the revenue of the drug trafficking organizations is if high-potency, California-produced marijuana is smuggled to other U.S. states at prices that are lower than those of current Mexican supplies, according to the study from the RAND Drug Policy Research Center. RAND is a nonprofit research organization.

The study calculates that Mexican drug trafficking organizations generate only $1 billion to $2 billion annually from exporting marijuana to the United States and selling it to wholesalers, far below existing estimates by the government and other groups.

The RAND study also finds that the often-cited claim that marijuana accounts for 60 percent of gross drug export revenues of Mexican drug trafficking organizations is not credible. RAND's exploratory analysis on this point suggests that 15 percent to 26 percent is a more credible range. Given that California accounts for about 14 percent of the nation's marijuana use, this suggests that if marijuana legalization in California only influences the California market, it would have a small effect on drug trafficking organizations -- cutting total drug export revenues by perhaps 2 to 4 percent.

However, the impact of legalization on Mexican drug trafficking organizations' bottom line could be magnified if marijuana cultivated in California is smuggled into other states, according to the study. After legalization, if low-cost, high-quality marijuana produced in California dominates the U.S. marijuana market, then the Mexican drug trafficking organizations' revenue from exporting marijuana could decline by more than 65 percent and probably closer to 85 percent. In this scenario, results from the RAND study suggest the drug trafficking organizations would lose roughly 20 percent of their total drug export revenues.

Legalizing marijuana in California would not appreciably influence the Mexican drug trafficking organizations and the related violence unless exports from California drive Mexican marijuana out of the market in other states, said Beau Kilmer, the study's lead author and co-director of the RAND Drug Policy Research Center. If that happens, then legalization could reduce some of the Mexican drug violence in the long run. But even then, legalization may not have much impact in the short run.

In November, California voters will consider a ballot measure titled the Regulate, Control and Tax Cannabis Act of 2010 -- on the ballot as Proposition 19 -- that would authorize local jurisdictions to regulate and tax the commercial cultivation and sale of marijuana. Such activities would remain illegal in jurisdictions that do not opt in. In addition, the measure would make it legal for those aged 21 and older to cultivate marijuana on a 5-foot-by-5-foot plot and possess, process, share or transport up to one ounce of marijuana.

Some Proposition 19 supporters argue that legalizing marijuana could help curb drug violence in Mexico and frequently reference a 2006 U.S. government report suggesting that marijuana exports account for 60 percent of all Mexican drug trafficking organization revenue. The government has since retracted the 60 percent figure.

No publicly available source verifies or explains the mythical 60 percent figure and subsequent government analyses revealed great uncertainty about the estimate, said study co-author Jonathan P. Caulkins, the H. Guyford Stever Professor of Operations Research at Carnegie Mellon University's Heinz College and Qatar campus. Our analyses suggest that smuggling marijuana across the Southwest border accounts for 15 to 26 percent of the export revenues generated by Mexican drug trafficking organizations.

Researchers examined other examples of organized crime groups losing substantial revenues to assess how drug-related violence in Mexico might be affected.

Projections about the effect of a large revenue decrease on violence in Mexico are particularly uncertain, but there are some scenarios that suggest a large decline in revenues might provoke increased violence in the short run and a decline after some years, said study co-author Peter Reuter, a professor of public policy and criminology at the University of Maryland.

The RAND study employs replicable methods for estimating revenue earned by Mexican drug trafficking organizations for exporting marijuana and other drugs to the United States. Most estimates of international drug profits and supplies do not use methods that allow others to review the findings and reproduce the methods at a later date, researchers say.

The study does not calculate revenue from drug trafficking organization production and distribution within the United States, which -- apart from marijuana in California -- would not be affected by Proposition 19 and is extremely difficult to estimate with existing data, according to researchers.

Kilmer said the work underscores the need to develop better information about marijuana use and supplies to help guide public policy. For example, surveys asking the public about marijuana use should ask about the amount and type of marijuana used and how it is consumed -- key questions not asked today.

Unprecedented effort to seek, test and treat inmates with HIV

Thu, 23 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Twelve scientific teams in more than a dozen states will receive National Institutes of Health (NIH) grants to study effective ways to prevent and treat HIV/AIDS among people in the criminal justice system. The grants, announced today, will be awarded primarily by the National Institute on Drug Abuse (NIDA), with additional support from the National Institute of Mental Health (NIMH) and the National Institute of Allergy and Infectious Diseases (NIAID), all components of NIH. The research will take place over a five-year period.

These important and wide reaching research grants will focus on identifying individuals with HIV within the criminal justice system and linking them to highly active antiretroviral therapy (HAART) during periods of incarceration and after community re-entry, said NIDA Director Dr. Nora D. Volkow. We hope this effort will lead to decreased HIV/AIDS-related illness and death among those in the criminal justice system, as well as decrease HIV transmission in the community at-large, making an important impact on public health.

The seek, test and treat funding opportunity follows NIH-sponsored research conducted over the last few years which has indicated that identifying and offering treatment to all medically eligible HIV-positive individuals cannot only stop progression to AIDS and AIDS-related death, but can also help to prevent HIV transmission. These new grants will apply this strategy to the criminal justice system, where there is a high prevalence of HIV/AIDS and often poor access to treatment.

The newly funded research will compare different modalities of the seek, test, and treat strategy to identify, test, engage and retain HIV-positive offenders in treatment. Some of the projects will create and compare systems to better integrate and coordinate HIV management efforts within jails, prisons, health departments, universities, and community organizations. The grants will also support randomized controlled trials among large groups of HIV-positive parolees and probationers comparing varied approaches for linking them to screening, treatment and social services in their communities.

We are learning that treatment can be one of the most powerful forms of prevention, said NIMH Director Dr. Thomas Insel. But treatment of HIV-infected men and women during or after incarceration is a challenge, especially when many have co-occurring mental or substance abuse disorders. We know that patients will stay connected to HIV care if their mental health improves. NIMH's project involves intensive case management for African-American and Latino parolees in Oakland, California.

The grants will support research in a diverse group of jails and prison systems, including the Los Angeles County Jail; the Cook County Jail in Chicago; the Rikers Island correctional facility in New York City; jail facilities in Washington, D.C., as well as prison systems in Illinois, North Carolina, Texas, Wisconsin and Rhode Island. One of the grants will compare levels of care and adherence to HAART treatment among HIV-positive injection-drug using detainees in Hanoi, Vietnam, a city with a high rate of HIV infection related to drug use. Two of the projects will study the effectiveness of medication used to treat heroin addiction among HIV-positive injection drug users who are transitioning to home communities.

The strategy of providing widespread, voluntary testing for HIV infection, identifying individuals infected with the virus and better linking those patients to antiretroviral treatment and medical care is one that NIH is pursuing in a number of different populations, said NIAID Director Dr. Anthony S. Fauci. It is a potentially viable way to reduce HIV transmission and improve the health of those infected with the virus.

Currently, an estimated 1.1 million people in the United States are infected with HIV. Since the late 1990s, the number of new HIV infections has remained relatively stable with approximately 56,000 new infections reported annually. The funding opportunity, Seek, Test, and Treat: Addressing HIV in the Criminal Justice System, represents NIH's largest research initiative to date to aggressively identify and treat HIV-positive inmates, parolees and probationers and to help them continue care when they return to their communities. Close to $50 million dollars in grants over a five-year period are expected under this research initiative.

About four of every 10 AIDS deaths are related to drug abuse. Each year, an estimated one in seven individuals infected with HIV passes through a correctional facility suggesting that a disproportionate number of people in the criminal justice system are infected with the virus.

Could brain abnormalities cause antisocial behavior and drug abuse in boys?

Wed, 22 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) AURORA, Colo (Sept. 22, 2010) Antisocial boys who abuse drugs, break laws, and act recklessly are not just bad kids. Many of these boys may have malfunctioning brains, according to a new study by researchers at the University of Colorado School of Medicine.

Brain responses to everyday rewards and punishments gradually guide most youngsters' decisions to conform with society's rules. However, when these seriously troubled kids experience rewards and punishments, and make decisions, their brains apparently malfunction, said Thomas Crowley, MD, a professor of Psychiatry at the School of Medicine and lead author on the study. Our findings strongly suggest that brain malfunction underlies their frequent failure to conform to rules, to make wise decisions, and to avoid relapses back to drug use and antisocial acts.

The scientists, including collaborators at the University of Colorado at Boulder and the University of Maryland, studied 20 adolescent boys. On average they had been on probation 139 of the last 180 days; 19 of the 20 had the psychiatric diagnosis of conduct disorder, and all had diagnoses of substance use disorder. They had been abstinent, however, an average of about five weeks when studied. They were compared with 20 other boys who did not have serious antisocial or drug problems, but who were of similar age, ethnicity, and home neighborhoods.

All played a computerized risk-taking game that repeatedly presented a choice between a cautious and a risky behavior: press the left button and always win one cent, or press the right button and either win five cents or lose ten cents. The scientists examined brain activation with functional magnetic resonance imaging (fMRI) as the boys decided to press right or left, and then as they experienced wins or losses after right presses.

Brain activation differed dramatically in the two groups. The anterior cingulate cortex monitors changing rewards and punishments, and then sends that information to another brain region (dorsolateral prefrontal cortex), which regulates one's choices among possible behaviors. During decision-making, antisocial boys had significantly less brain activity than normals in both of those regions, and also in other decision-making areas (orbitofrontal cortex, amygdala, insula).

Altogether, during decision-making about 6000 voxels (a voxel is a tiny cube in the brain) activated significantly less in antisocial boys than in comparison boys. No voxels activated more in antisocial boys. Such under-activity during decision-making could contribute to disinhibited antisocial and drug-using behaviors.

As predicted by others not associated with the study, the antisocial boys also had dysphoria, a chronic sad-anxious state, with reward insensitivity; in the game their brains responded less than the comparison boys' brains to wins. They also had punishment hypersensitivity, with greater brain response to losses than comparison boys.

Interestingly, the number of risky right presses was similar in the two groups. The scientists speculate that this occurred because the game forced the boys to deliberate for several seconds before pressing either button.

Gene-environmental interactions and MS progression is focus of new study

Tue, 21 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- A $634,000 grant from the Department of Defense is allowing researchers at the University at Buffalo to investigate a trio of environmental factors and their influence on the progression of multiple sclerosis.

The two-year project, headed by Murali Ramanathan, PhD, tests the hypothesis that nicotine metabolism, the byproducts of vitamin D metabolism and increased levels of anti-Epstein-Barr virus (EBV) each interact with variations in specific genes to cause increased neurodegeneration and increased lesions in MS patients.

Ramanathan is a professor of pharmaceutical sciences and neurology in the School of Pharmacy and Pharmaceutical Sciences and the School of Medicine and Biomedical Sciences, respectively.

The study is a collaboration between the UB and investigators from Charles University in Prague, Czech Republic, and will be conducted on samples obtained at both universities' MS centers.

The research aims to identify gene-environmental interactions between key molecules in the vitamin D pathway, anti-Epstein-Barr virus antibodies, cigarette smoking and key genetic variants that are implicated in conversion of patients with clinically isolated syndrome (CIS) to definite MS.

They will assess the risk of developing clinically definite MS and the time to progression, as well as the neurodegeneration in the brain of MS patients, as measured by brain atrophy, and the extent of brain injury caused by lesions.

We will use a novel approach to measure the levels of vitamin D and its metabolites, EBV exposure and nicotine metabolites from cigarette smoking, says Ramanathan. We have developed sensitive and selective measurements for key metabolites in the vitamin D and nicotine metabolism pathways using mass spectrometry, a method that has not been used previously to study vitamin D metabolism.

The novel study design will include the genetic variations that were associated with the risk of developing MS, as well as genes that determine the levels and responses to environmental factors. MS patients will be divided into two equal groups: a training group that will be used to identify gene-environmental interactions, and a group that will be used to replicate the training group result.

Identifying gene-environmental interactions is critical for developing better strategies for slowing the progression of MS, because it could enable patients with preexisting genetic risk factors to reduce the rate of disease progression through lifestyle modification, Ramanathan says.

The study results will identify the gene-environment interactions that promote disease progression in MS and facilitate the development of preventive and therapeutic interventions for MS that disrupt these interactions, notes Ramanathan.

Latent HIV infection focus of NIDA's 2010 Avant-Garde Award

Mon, 13 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, announced today that Dr. Eric M. Verdin of the J. David Gladstone Institutes in San Francisco, Calif., has been selected as the 2010 recipient of the NIDA Avant-Garde Award for HIV/AIDS Research for his proposal to study the mechanisms of latent HIV infection. NIDA's annual Avant-Garde award competition, now in its third year, is intended to stimulate high-impact research that may lead to groundbreaking opportunities for the prevention and treatment of HIV/AIDS in drug abusers. Awardees receive $500,000 per year for five years to support their research. Dr. Verdin is Senior Investigator and Associate Director of the Gladstone Institute of Virology and Immunology and Professor of Medicine at the University of California, San Francisco.

Highly active antiretroviral therapy (HAART) has been very successful in managing HIV. However, these medications do not rid the body of the virus, and patients can become symptomatic and more infective if their treatment is interrupted, said NIDA Director Dr. Nora D. Volkow, who announced the award. Dr. Verdin's innovative proposal seeks to identify the cellular proteins that control the latency process, which allows the virus to remain in a persistently dormant state, so that we can better understand how to completely eliminate the virus from the body.

The long-term persistence of HIV in a latent state in patients treated with HAART prevents the eradication of the disease, and forces patient to remain on HAART for their entire life. At this time, our understanding of how latent HIV infection occurs is basic. Dr. Verdin's project aims to develop a new single cell technology to examine how HIV latency is established, maintained, and how the virus becomes reactivated, in primary human lymphoid cells. By observing the fate of the virus in single cells, Dr. Verdin hopes to be able to devise novel strategies to eliminate latent HIV infection, or to restrict the latent pool to a size that can be controlled by the immune system.

Dr. Verdin was selected from 30 applicants whose proposals reflect diverse scientific disciplines and approaches to HIV/AIDS research. The Avant-Garde Awards are modeled after the NIH Pioneer Awards and are granted to scientists of exceptional creativity who propose high-impact research that will open new avenues for prevention and treatment of HIV/AIDS among drug abusers.

Drug abuse and its related behaviors, such as sharing drug injection equipment and/or engaging in risky sexual behavior while intoxicated, have been central to the spread of HIV/AIDS since the pandemic began more than 25 years ago. NIDA's HIV/AIDS research program supports a multidisciplinary portfolio that investigates the role of drug use and its related behaviors in the evolving dynamics of HIV/AIDS epidemiology, natural history, etiology, pathogenesis, treatment, and prevention.

Asking women about reproductive coercion reduced the likelihood that the women would continue to experience such pressures

Mon, 30 Aug 2010 09:22:49 PST

( from http://www.rxpgnews.com ) Specifically asking young women during visits to family planning clinics whether their partners had attempted to force them to become pregnant — a type of intimate-partner violence called reproductive coercion — dramatically reduced the likelihood that the women would continue to experience such pressures, according to a new pilot study led by researchers at the UC Davis School of Medicine.

Young women who recently experienced partner violence had a 70 percent reduction in the odds that they would continue to experience pregnancy coercion following the questioning, which is called a brief intervention, the study found. The study participants also were 60 percent more likely to report ending a relationship with a partner because they felt unsafe or the relationship felt unhealthy.

“This pilot study was focused on how we might better identify intimate-partner violence and reproductive coercion in clinical settings and offer women specific strategies to reduce their risk of an unwanted pregnancy and increase their safety,” said Elizabeth Miller, associate professor of pediatrics at the UC Davis School of Medicine and the study’s lead author. “These findings are extremely encouraging, and suggest that such clinical interventions may be useful in reducing both partner violence and unintended pregnancy.”

Published online in the journal Contraception the study, “A Family Planning Clinic Partner Violence Intervention to Reduce Risk Associated with Reproductive Coercion,” assessed the effectiveness of what the authors said is the first step toward a harm-reduction health-care protocol for reducing women’s risk of becoming pregnant by abusive partners, a widespread public-health problem.

Reproductive coercion involves both pregnancy coercion, in which partners verbally pressure women to become pregnant, and birth-control sabotage. Birth-control sabotage involves partners’ interference with contraception, including secretly or overtly damaging condoms to force a woman to become pregnant or throwing away or preventing her from using birth control pills.

The study was conducted in four Northern California family-planning clinics between May 2008 and October 2009. The intervention was designed collaboratively with the Family Violence Prevention Fund and reproductive health experts. Family planning counselors and clinicians were trained to implement the intervention at two of the four sites. Two control sites provided standard domestic violence and sexual assault screening. Participants included approximately 900 English- and Spanish-speaking women between 16 and 29 years old, with the vast majority of the women, 76 percent, aged 24 or younger.

The intervention involved assessing for partner violence and reproductive coercion during a reproductive health visit, discussing harm-reduction strategies to reduce risk for unintended pregnancy and connecting women to violence-related resources. In the context of inquiries about the reason for the clinic visit, the participants who received the intervention were asked straight-forward questions about pregnancy coercion and birth-control sabotage integrated into their reproductive health visit. A positive response to any of these inquiries was considered reproductive coercion. The inquiries included:

• “Have you hidden birth control from your partner so he wouldn’t get you pregnant?”
• “Has your partner tried to force you to become pregnant when you didn’t want to be?”
• “Does your partner mess with your birth control?”
• “Does your partner refuse to use condoms when you ask?”
• “Has your partner ever hurt you physically because you didn’t agree to become pregnant?”

Study participants at control clinics who did not receive the intervention received standard-of-care questionnaires that asked: “Have you ever been hit, kicked, slapped or choked by your current or former partner?" and “Have you ever been forced to have sex against your will?” Follow-up surveys with all participants were conducted between 12 and 24 weeks from the date of the initial interviews.

While the odds of pregnancy coercion dropped by 70 percent for women who received the intervention, there was no significant change in the odds of pregnancy coercion for women who had not reported experiencing intimate-partner violence within the past three months, or for women who did not receive the intervention. However, awareness of intimate-partner violence-related resources increased in both the intervention group and the control group, the authors said.

“Given recent reports that question the usefulness of screening for intimate-partner violence in clinical settings and the current critical need for effective low-cost unintended- and teen-pregnancy prevention, it is extremely encouraging that this combination of screening for reproductive coercion and abuse and providing simple educational information significantly reduced women’s pregnancy coercion,” said Jay Silverman, senior author of the study and associate professor of society, human development and health at the Harvard School of Public Health.

“There is a strong, indisputable link between domestic and dating violence and unintended pregnancy. This study is extremely important because it identifies an effective solution that can be implemented relatively easily,” said study author Rebecca Levenson, of the Family Violence Prevention Fund. “We need to build on these results by making this intervention the norm in health-care settings throughout the nation as quickly as possible.”

Experimental treatments for cocaine addiction may prevent relapse

Thu, 26 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Doctors have used the drug disulfiram to help patients stay sober for several decades. It interferes with the body's ability to metabolize alcohol, giving a fierce hangover to someone who consumes even a small amount of alcohol.

More recently, disulfiram was shown to be effective in treating cocaine addiction as well, even though alcohol and cocaine affect the nervous system in different ways.

Now, researchers at Emory University School of Medicine have identified how disulfiram may exert its effects, and have shown that a newer drug with fewer side effects works by the same mechanism.

The results are published online this week by the journal Neuropsychopharmacology. Research assistant professor Jason Schroeder, PhD, and graduate student Debra Cooper are co-first authors of the paper, and the research also involved collaborations with P. Michael Iuvone, PhD, director of research at the Emory Eye Center, Gaylen Edwards, DVM, PhD, head of the department of physiology and pharmacology at the University of Georgia's College of Veterinary Medicine, and Philip Holmes, PhD, professor of psychology at the University of Georgia.

Disulfiram has several effects on the body: it interferes with alcohol metabolism, but it inhibits several other enzymes by sequestering copper, and can also damage the liver, says senior author David Weinshenker, PhD, associate professor of human genetics at Emory University School of Medicine. We wanted to figure out how disulfiram was working so we could come up with safer and potentially more effective treatments.

In treating cocaine addiction, there are several challenges: not only getting people to stop taking the drug, but also preventing relapse. Cocaine boosts the levels of several neurotransmitters, including dopamine and norepinephrine, at the junctions between nerve cells by blocking the machinery the brain uses to remove them.

Under normal conditions, dopamine is important for the sensation of pleasure produced by natural rewards such as food or sex, Weinshenker says. Cocaine hijacks the dopamine system, which plays a large role in addiction. Similarly, norepinephrine has a role in attention and arousal, but its overactivation can trigger stress responses and relapse, he says.

Weinshenker's team showed that disulfiram prevents rats from seeking cocaine after a break, a model for addicts tempted to relapse. At the same time, it doesn't stop them from taking cocaine when first exposed to it, or from enjoying their food.

Disulfiram appears to work by inhibiting dopamine beta-hydroxylase, an enzyme required for the production of norepinephrine. A dose of disulfiram that lowers the levels of norepinephrine in the brain by about 40 percent is effective, while doses that do not reduce norepinephrine have no effect on relapse-like behavior in rats.

To confirm that the beneficial effects of disulfiram were because of dopamine beta-hydroxylase inhibition, the researchers turned to a drug called nepicastat, which was originally developed for the treatment of congestive heart failure in the 1990s.

Nepicastat is a selective dopamine beta-hydroxylase inhibitor that does not sequester copper or impair a host of other enzymes like disulfiram, Weinshenker says. We reasoned that if disulfiram is really working through dopamine beta-hydroxylase, then nepicastat might be a better alternative.

Researchers at the University of Texas Medical Branch at Galveston have recently completed a Phase I safety trial studying nepicastat for the treatment of cocaine addiction in human subjects.

Asynchronous telepsychiatry can assess a patients' mental health

Sat, 14 Aug 2010 21:16:45 PST

( from http://www.rxpgnews.com ) A new study by researchers at the UC Davis School of Medicine has found that psychiatrists can accurately assess a patient's mental health by viewing videotaped interviews that are sent to them for consultation and treatment recommendations.

The approach, called asynchronous telepsychiatry, uses store-and-forward technology, in which medical information is retrieved, stored and transmitted for later review using e-mail or Web applications. It has been used extensively for specialties like dermatology, with photos of skin conditions sent to dermatologists, or x-rays sent to radiologists for assessment.

However, the current study is the first to examine store-and-forward technology for psychiatry, said Peter Yellowlees, professor of psychiatry and behavioral sciences and the study’s lead author. “A Feasibility Study of the Use of Asynchronous Telepsychiatry for Psychiatric Consultations” is published in the August issue of the journal Psychiatric Services.

“We’ve demonstrated that this approach is feasible and very efficient,” said Yellowlees, who is an internationally recognized expert in telepsychiatry. “Using store-and-forward technology allows us to provide opinions to primary-care doctors much more quickly than would usually be the case.”

The researchers conducted the study to determine the effectiveness of asynchronous telepsychiatry for patients in Tulare County, a rural county in California's San Joaquin Valley. Sixty male and female patients between the ages of 27 and 64 who had mostly mild-to-moderate mental-health disorders were included in the study.

Researcher Alberto Odor, associate adjunct professor of anesthesiology and pain medicine, conducted 20- to 30-minute structured videotaped interviews at a community-based primary-care clinic. The videos were then uploaded to UC Davis’ specially designed Web-based telepsychiatry consultation record. Yellowlees and Donald Hilty, professor of psychiatry and behavioral sciences, reviewed the videotapes and provided psychiatric evaluations to the patients' community-based primary-care physicians.

Fifty-one percent of patients received diagnoses of mood disorders, 19 percent received diagnoses of substance use disorders, 32 percent received diagnoses of anxiety disorders and 5 percent received other diagnoses — including kleptomania, schizophrenia and parasomnia. Five patients also were diagnosed with disorders such as borderline personality disorder, obsessive-compulsive disorder or personality disorder. Some of the individuals had multiple diagnoses.

One patient was referred for a face-to-face consultation with a psychiatrist because of the possibility of a diagnosis of early psychosis. The psychiatrists recommended additional laboratory evaluations for more than 80 percent of patients and made recommendations for medication changes in 95 percent of patients. In instances where medication changes were recommended, physicians also received long-term treatment plans. A variety of psychotherapies, such as individual and cognitive-behavioral therapy, were recommended for many of the patients. Community-based primary-care physicians said they found the practice worked well, the study says.

The consulting psychiatrists provided feedback to referring physicians within two weeks, but asynchronous telepsychiatry could occur within 24 hours if it were to become a regular service, Yellowlees said.

Asynchronous telepsychiatry should not take the place of face-to-face psychiatric evaluations and is not suitable for patients with urgent psychiatric conditions, he said. But there are a number of circumstances in which it would be helpful in providing more primary-care physicians greater access to psychiatric consultations.

“There is a substantial shortage of psychiatrists,” Yellowlees said. “Asynchronous telepsychiatry would allow us to have better access to information about patients being referred by primary providers and to provide more comprehensive opinions. This approach could be used by the military and in many different rural and metropolitan settings. It signals the beginning of the true multimedia electronic medical record with clinical video recordings becoming part of the data set.”

Study describes health effects of occupational exposures in Paducah Gaseous Diffusion Plant workers

Thu, 22 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A five-year study into the causes of deaths of workers at Paducah Gaseous Diffusion Plant (PGDP) shows significantly lower death rates from all causes and cancer in general when compared to the overall United States population. This is known by occupational health researchers as the healthy worker effect. However, death from lymphatic and bone marrow cancers such as leukemia or multiple myeloma were slightly above national rates.

The study was conducted by faculty at the University of Louisville School of Public Health and Information Sciences and collaborators from the University of Cincinnati and the University of Kentucky. It was funded through the National Institute for Occupational Safety and Health, thanks to the effort of U.S. Senator Mitch McConnell, who was instrumental in getting the study off the ground.

This was an important study, because it addressed lingering concerns about the health of workers at the Paducah Gaseous Diffusion Plant, said David Tollerud, MD, MPH, professor of environmental and occupational health sciences at UofL's School of Public Health and Information Sciences. It is important for occupational health and public health research to attempt to answer pressing concerns of impacted populations, and we were able to report that we didn't find unexpectedly high rates of disease in this workforce.

Security workers had higher overall death rates than other employees, while chemical operators had higher death rates from leukemia and multiple myeloma than the rest of the workers.

The increased number of lymphatic and bone marrow cancer deaths is consistent with what we expected. Based on other studies, these forms of cancer have been linked to low levels of radiation exposure, Tollerud said.

The team compiled data on thousands of employees who worked at the plant for at least 30 days in different job classifications from 1952 through 2003. The data were used to assess exposure levels. Overall, 1,638 workers died out of the 6,759 in the study. This is less than the 2,253 deaths that would have been expected in the general public during the same time.

The team now plans to present its findings to PGDP workers and distribute a study fact sheet that summarizes the main findings and directs workers to resources that are available if they have concerns or questions.

The Paducah Gaseous Diffusion Plant, located in western Kentucky, is the only operating uranium enrichment facility in the United States, and the only one where a worker mortality study had not been conducted. The plant was commissioned in 1952 under the U.S. Department of Energy as part of a U.S. government program to produce enriched uranium to fuel military reactors and nuclear weapons. The plant's mission changed in the 1960s from enriching uranium for nuclear weapons to enriching uranium for use in commercial nuclear reactors to generate electricity.

New global report launched by the International AIDS Society recommends a new paradigm for treating injecting drug users: 'Seek, test, treat and retain'

Thu, 22 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Thursday, 22 July, 2010 (Vienna, Austria)-- Against the backdrop of some of the globe's fastest growing HIV epidemics in Eastern Europe and Central Asia, a report launched today at the XVIII International AIDS conference (AIDS 2010) in Vienna makes the case for a new model for scaling up treatment and prevention of HIV amongst Injecting Drug Users (IDUs).

The report, Prevention and Treatment of HIV/AIDS amongst Drug Using Populations: A Global Perspective, advocates a science based approach and stresses the urgent need to increase access and expand take up of highly active anti retroviral therapy (HAART) among drug using populations to improve health and reduce new infections. (1)

Increasing evidence supports the idea of expanding the implementation of outreach to high-risk, hard-to-reach drug using populations (seek), to encourage HIV testing (test), to link HIV+ individuals to care (treat), and to sustain these individuals in care (retain). The seek, test, treat, and retain model is also deliverable within the criminal justice system.

The evidence is in, individuals with and without a history of injection drug use derive similar survival benefit from HAART. There is an urgent need to treat drug users, not abuse them as much of the current drug policies do, said Dr Julio Montaner, President of the International AIDS Society. Sound public health policy demands that we increase access to HIV treatment and prevention for this population.

Two decades of experience have demonstrated that needle exchange programs are a proven way of preventing HIV infection amongst injecting drug users (IDUs). The report outlines how programs can increase this effectiveness by scaling up a comprehensive package of harm reduction interventions.

Offering Opioid Substitution Therapy (OST), such as methadone or buprenorphine, significantly decreases HIV acquisition and transmission and increases the chances of HIV positive people who inject drugs taking up and staying on highly active anti retroviral therapy (HAART), said Professor Dr Charles O'Brien, a researcher from the University of Pennsylvania and one of the contributors to the report. This in turn can lead to reductions in the community viral load and decrease new infections.

Wider uptake of HAART is associated with reduced community viral load and reduced transmission as well as individual survival. Not only does treatment offer health benefits for the individual, said Dr Montaner, but in diverse populations, we can now see that HAART is HIV prevention.

The selection of Vienna as the host city of the XVIII International AIDS Conference reflects the role the city has played in bridging Eastern and Western Europe. During the past week there has been a strong focus on Eastern Europe and Central Asia region, now home to what is the fastest growing HIV/AIDS epidemic in the world. Injecting drug use is the main driver of HIV infection in the region.

Some 65 per cent of HIV infections in Russia for instance, are through injecting drug use. The number of HIV infected people in Russia has increased tenfold in the past decade from an estimated 100,000 to one million. Eighty per cent of HIV positive people are under 30 years of age. Methadone is illegal in Russia.

The Russian government does not implement an evidence based approach to decision-making on public health, said Dasha Ocheret, spokesperson for the Eurasian Harm Reduction Network (EHRN). The prohibition of substitution treatment such as methadone is based on Soviet ideology and denies drug users the right to life saving treatment and prevention that exist in the vast majority of countries in the region. Methadone treatment began in Lithuania as far back as 1984.

Russian Government funds are used for policing rather than sound public health policy. All attempts by the Russian government over the past decade to control drug trafficking have been counterproductive and resulted in increased incarceration rates of people who use drugs and social exclusion and led to numerous deaths from overdoses and HIV and TB infections.

The report argues that it is now recognized that a punitive approach leads to the creation of incubators for HIV, HCV and TB in prisons.

We've been witness this week in Vienna to what is an all too familiar story: the unacceptable criminalisation and stigmatisation of a group of people, in this case, people who inject drugs, said Montaner. As a result of repressive drug policies and frankly, appalling public health policy in many parts of Eastern Europe, people who inject drugs are now shouldering the burden of an HIV epidemic that shows all the signs of moving into the wider community.

On the other hand we've also heard success stories in the region that give hope to scientists, researchers and policy makers who are committed to addressing HIV and injecting drug use based on sound scientific empiric evidence along the lines suggested in the report we have released today, concluded Montaner.

The report's recommendations include:

Individuals confess alcohol abuse to clergy

Wed, 14 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---Persons with alcohol problems are finding comfort in speaking about their situation to clergy, a new study shows.

Among 1,910 people with any alcohol-related problems, 14.7 percent said they used clergy services.The study, from researchers at the University of Michigan Health System and Saint Louis University, also indicates the majority of those who used services from clergy also used professional services at some point; only 0.5 percent used clergy services exclusively for their alcohol use-related problem.

Although professional services are used more commonly, these findings show that clergy services are an important part of the overall system of care for persons with alcohol problems.

Researchers sought to examine the prevalence of use of clergy services among those adults who received help for an alcohol use problem in the United States, as well as characteristics and correlates of individuals with alcohol-related problems who used clergy services compared to individuals who used other types of services. Researchers also examined the degree to which individuals who receive help from the clergy receive other types of services as well.

The factors that were associated with an increased likelihood of clergy service used included being Black, aged 35-54 years, a lifetime history of alcohol dependence, major depressive disorder and personality disorder, according to the data from the National Epidemiologic Survey on Alcohol and Related Conditions.

Individuals who met criteria for alcohol dependence were more likely to have used clergy services for alcohol use-related problems than individuals who never met criteria or who only met criteria for alcohol abuse.

This may in part reflect the fact that individuals who meet criteria for alcohol abuse by definition have experienced legal, occupational, and/or social problems due to their alcohol consumption, and may be more likely to enter treatment through the legal system, employee assistance programs, or social services, says lead author Amy Bohnert, Ph.D., M.H.S., assistant professor of psychiatry at the U-M Medical School and research investigator in the Department of Veterans' Affairs National Serious Mental Illness Treatment Resource and Evaluation Center.

What makes ministers, priests and rabbis ideal are they are involved in their communities, know their congregants well, and see them on a regular basis, researchers say.

Clergy are in a unique position to notice changes in behavior over time, says Brian Perron, assistant professor of social work at U-M. Their roles as senior leaders of churches, their embodiment of important tenants of their faiths, and their formal roles as caregivers of their congregations also lend clergy considerable credibility, particularly within African American communities. Clergy are often seen as being deeply committed to their congregants and willing to honor desires for confidentiality.

URI researcher: Teens drink more during summer before college

Wed, 07 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) KINGSTON, R.I. --July 7, 2010--Summertime and the living is easy. But not too easy for parents whose children will head to college in the fall.

University of Rhode Island Psychology Professor Mark Wood, a nationally recognized alcohol researcher, wants parents to be aware that this is a time when teens tend to increase their alcohol consumption.

The URI expert advises parents to monitor their children--know where they are, whom they are with and what they are doing.

This type of monitoring, particularly in combination with an emotionally supportive parenting style, is associated with less drinking and fewer alcohol-related problems across numerous studies, Wood said.

It is also important for parents to express clear disapproval of alcohol use and to provide clear and fair consequences associated with breaking the rules. Research shows this combination of factors decreases alcohol use and problems through adolescence and into college, continued Wood who helps create interventions to reduce alcohol related-harm, particularly among college-age students. Results of his recent study bear this out.

Is Wood advocating that parents become helicopter parents--ones who hover over their children and their problems or experiences, especially when they are in college?

We live in a era when students are texting and talking to parents, sometimes many times a day. Although the term helicopter parent does have a negative connotation, I think conversations about drinking are good whenever and wherever they occur, said the researcher.

But is it too late for parents to begin monitoring teenagers after they have already graduated from high school?

Most American teenagers begin to drink by age 15. By the time they go off to college, most have considerable drinking experience, explained Wood. Ideally, parents should be having conversations about alcohol throughout high school. But it's never too late to begin an ongoing dialogue about drinking with teens.

There is good reason to be concerned. It's estimated that more than 1,800 college students die each year in car accidents and more than 750,000 are involved in alcohol related physical or sexual assaults.

Summer before college, first semester

Adolescents tend to increase their alcohol use the summer before entering college and during their first semester at college. This is also true of children who have been consistently monitored and emotionally supported. However, these children don't increase consumption to the levels of kids who didn't have that kind of parental involvement in high school.

The protective effects that parents exert in high school continue to be influential into college even at a time when the kids have left the home. It's the internalization of those values, attitudes, expectations that seem to continue to exert an effect, said Wood.

Study Intervention

Wood and his team applied some of their research findings to an intervention to reduce the increases in drinking and the negative consequences that typically occur during matriculation and into college. Results of the study were published in the June 2010 issue of the

Legalizing marijuana in California would lower the price of the drug and increase use, study finds

Wed, 07 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Legalizing the production and distribution of marijuana in California could cut the price of the drug by as much as 80 percent and increase consumption, according to a new study by the nonprofit RAND Corporation that examines many issues raised by proposals to legalize marijuana in the state.

While the state Board of Equalization has estimated taxing legal marijuana could raise more than $1 billion in revenue, the RAND study cautions that any potential revenue could be dramatically higher or lower based on a number of factors, including the level of taxation, the amount of tax evasion and the response by the federal government.

Past research provides solid evidence that marijuana consumption goes up when prices go down, but the magnitude of the consumption increase cannot be predicted because prices will fall to levels below those ever studied, researchers say. Consumption also might rise because of non-price effects such as advertising or a reduction in stigma, researchers say.

In addition to uncertainty about the taxes levied and evaded, researchers do not know how users will respond to such a large drop in price. Even under a scenario with high taxes ($50 per ounce) and a moderate rate of tax evasion (25 percent), researchers cannot rule out consumption increases of 50 percent to 100 percent, and possibly even larger. If prevalence increased by 100 percent, marijuana use in California would be close to the prevalence levels recorded in the late 1970s.

The analysis, prepared by the RAND Drug Policy Research Center, was conducted in an effort to objectively outline the key issues that voters and legislators should consider as California weighs marijuana legalization.

There is considerable uncertainty about the impact that legalizing marijuana in California will have on consumption and public budgets, said Beau Kilmer, the study's lead author and a policy researcher at RAND. No government has legalized the production and distribution of marijuana for general use, so there is little evidence on which to base any predictions about how this might work in California,

The analysis also suggests that the annual cost of enforcing current marijuana laws is smaller than suggested by others. The RAND study estimates that the cost of enforcing the current laws probably totals less than $300 million.

It is critical that legislators and the public understand what is known and unknown as the state weighs this unprecedented step, said Rosalie Liccardo Pacula, a study co-author and co-director with Kilmer of the RAND Drug Policy Research Center.

Two proposals are pending that would legalize the production and sale of marijuana in California. Assembly Bill 2254 authored by Assemblyman Tom Ammiano (D-San Francisco) would legalize marijuana for those aged 21 and older and task the state Department of Alcoholic Beverage Control with regulating its possession, sale and cultivation. The bill would create a $50 per ounce excise tax and these funds would be used to fund drug education, awareness, and rehabilitation programs under the jurisdiction of the State Department of Alcohol and Drug Programs.

In November, California voters will consider a ballot measure titled the Regulate, Control and Tax Cannabis Act of 2010 that would make it legal for those aged 21 and older to cultivate marijuana on a 5-foot-by-5-foot plot, and possess, process, share or transport up to one ounce of marijuana. In addition, the initiative would authorize cities or counties to allow, regulate and tax the commercial cultivation and sales of marijuana. Such activities would remain illegal in jurisdictions that do not opt in.

In only two countries have there been changes in the criminal status of supplying marijuana. The Netherlands allows for sale of small amounts of marijuana (5 grams) in licensed coffee shops and in Australia four jurisdictions have reduced the penalties for cultivation of a small number of marijuana plants to confiscation and a fine. Neither has legalized larger-scale commercial cultivation of the sort California is considering.

In 1975, California was one of the first states to reduce the maximum penalty for possessing less than an ounce of marijuana from incarceration to a misdemeanor with a $100 fine. In 1996, California became the first state to allow marijuana to be grown and consumed for medical purposes.

RAND researchers say one effect of legalizing marijuana would be to dramatically drop the price as growers move from clandestine operations to legal production. Based on an analysis of known production costs and surveys of the current price of marijuana, researchers suggest the untaxed retail price of high-quality marijuana could drop to as low as $38 per ounce compared to about $375 per ounce today.

RAND researchers caution there are many factors that make it difficult to accurately estimate revenue that might be generated by any tax on legal marijuana. The higher the tax, the greater the incentives would be for a gray market in marijuana to develop, researchers say.

A fixed excise tax per ounce may give producers and users an incentive to shift to smaller quantities of higher-potency forms of marijuana, said study co-author Jonathan P. Caulkins, the H. Guyford Stever Professor of Operations Research at Carnegie Mellon University's Heinz College and Qatar campus. Such a shift is another factor that could lower revenues collected from marijuana taxes.

In addition, since the November ballot initiative leaves it to local governments to set tax rates, the size of any levy could vary broadly. A jurisdiction with a low tax rate might attract marijuana buyers from elsewhere in the state or even other states, further complicating efforts to predict government revenues from the sale of legal marijuana, according to researchers.

The RAND report also investigates some of the costs to the state and society in general, such as drug treatment and other health expenses, that may change if marijuana is legalized in California.

It's unclear whether legalizing marijuana may increase or decrease drug treatment costs, according to the study. More than half of the 32,000 admissions for treatment of marijuana abuse in California during in 2009 resulted from criminal justice referrals, which could drop if legalization is approved. However, an increase in marijuana use could cause a spike in those who voluntarily seek treatment for marijuana abuse, researchers say.

Ignoring stress leads recovering addicts to more cravings

Wed, 23 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Recovering addicts who avoid coping with stress succumb easily to substance use cravings, making them more likely to relapse during recovery, according to behavioral researchers.

Cravings are a strong predictor of relapse, said H. Harrington Cleveland, associate professor of human development, Penn State. The goal of this study is to predict the variation in substance craving in a person on a within-day basis. Because recovery must be maintained 'one day at a time,' researchers have to understand it on the same daily level.

Cleveland and his colleague Kitty S. Harris, director, Center for the Study of Addiction and Recovery, Texas Tech University, used data from a daily diary study of college students who are recovering addicts to identify the processes that trigger cravings and prevent some addicts from building a sustained recovery.

The researchers found that how addicts cope with stress -- either by working through a problem or avoiding it -- is a strong predictor of whether they will experience cravings when faced with stress and negative mood.

Whether you avoid problems or analyze problems not only makes a big difference in your life but also has a powerful impact on someone who has worked hard to stay away from alcohol and other drugs, explained Cleveland. When faced with stress, addicts who have more adaptive coping skills appear to have a better chance of staying in recovery. The findings appeared in a recent issue of Addictive Behaviors.

Researchers supplied Palm Pilots to 55 college students who were in recovery from substance abuse ranging from alcohol to cocaine and club drugs. The students were asked to record the their daily cravings for alcohol and other drugs, as well as the intensity of negative social experiences -- hostility, insensitivity, interference, and ridicule -- and their general strategies for coping with stress.

We looked at variations in the number of cravings across days and found that these variations are predicted by stressful experiences, said Cleveland. More importantly, we found that the strength of the daily link between experiencing stress and the level of cravings experienced is related to the participants' reliance on avoidance coping.

Statistical analyses of the survey data suggests that the magnitude of the link between having a stressful day and experiencing substance use cravings doubles for recovering addicts who cope with stress by avoiding it.

We found that addicts who deal with stress by avoiding it have twice the number of cravings in a stressful day compared to persons who use problem solving strategies to understand and deal with the stress, explained Cleveland. Avoidance coping appears to undercut a person's ability to deal with stress and exposes that person to variations in craving that could impact recovery from addiction.

According to Cleveland, the findings suggest the impulse to avoid stress is never going to help recovering addicts because stressful experiences cannot be avoided.

If your basic life strategy is to avoid stress, then your problems will probably end up multiplying and causing you more problems, he added.

Violence, not overdose, the likely method of suicide in veterans with substance use disorders

Mon, 21 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Veterans with substance use disorders who die by suicide are more likely to use violent means (such as a firearm) rather than nonviolent means (such as a drug overdose), new research suggests.

In a study of more than 5,000 Veterans Affairs (VA) patients with substance use disorders, researchers found that, despite having access to potentially lethal substances, 70% of those who died by suicide used violent means. The study was reported in the July issue of the Journal of Studies on Alcohol and Drugs.

This research is the largest known study of risk factors for suicide in individuals with alcohol or drug problems and one of the first to examine risk factors for suicide based on method of attempt. To perform the study, the researchers looked at two distinct groups. They identified 854 VA patients who died by suicide and had substance use disorders, as well as a control group of 4,228 VA patients with substance use disorders who did not die by suicide.

The researchers found that the people who committed suicide by overdose had more -- and more severe -- mental disorders such as depression or posttraumatic stress disorder than people who used violent means.

What's troubling about these findings is that some of the predictors that we typically think of as good indicators of suicide risk were not as closely related to violent suicide as nonviolent suicide, although violent suicide was the most common type of suicide, said lead researcher Dr. Mark Ilgen, a psychologist at the Ann Arbor VA Health Care System and an assistant professor in the psychiatry department at the University of Michigan in Ann Arbor. It's potentially scary if there's a group of patients that is somewhat large in number that we might be missing by paying attention only to psychiatric problems.

The researchers say the findings highlight the importance of suicide prevention in people with substance use disorders. Previous research has found that people with substance use disorders are about 10 to 14 times more likely to die by suicide than people without these problems.

Ilgen said that substance use disorders and suicide are probably linked in several ways: First, people who develop a drug or alcohol addiction may already be at higher risk for suicide. Second, having a substance use disorder can cause problems at work and in relationships, which may increase suicide risk. Third, being under the influence of alcohol or drug can make someone more likely to engage in impulsive behaviors -- such as a suicide attempt.

Care providers should be aware of the high risk of suicide in this group and do an initial screening for current suicidal thoughts and plans, said Ilgen. It's easy to wait to think about suicide prevention until someone is depressed, but it's really a conversation worth having with someone who has a substance use disorder, since they're already at risk.

Anxiety/panic disorder most frequent disabling comorbid disorder in TS patients, study finds

Thu, 17 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- An assessment of patients with adult Tourette syndrome (TS) to identify clinical factors that contribute to psychosocial and occupational disabilities resulting from the vocal or motor tics that define TS found that anxiety/panic disorder may be the most disabling psychiatric condition associated with the disorder. The results of the study, based on the Global Assessment of Functioning (GAF) scale, will be used to identify patients who are more likely to have or develop significant disabilities related either to the severity of their tics, or to the psychiatric disorders associated with TS, such as obsessive-compulsive disorder, mood disorders and drug or alcohol abuse.

Results were presented today (June 17) at the 14th International Congress on Parkinson's Disease and Movement Disorders, being held in Buenos Aires, Argentina, June 14-17.

David G. Lichter, MD, professor of clinical neurology in the University at Buffalo's School of Medicine and Biomedical Sciences, is first author.

Our study identified the most significant predictors of disability, says Lichter. Now having identified these at-risk patients, we can follow them more closely and begin appropriate interventions as early as possible.

Lichter also noted that the finding of anxiety/panic disorder as the most-disabling psychiatric disorder associated with TS was unexpected.

The main surprise was that depression was not a major predictor of psychosocial or occupational disability in these patients, says Lichter. Depression has been identified as an important predictor of quality of life in TS.

Tics, both motor and vocal, are the primary symptoms of Tourette syndrome. Vocal tics are involuntary sounds, such as whistles, hums, or throat clearing. Complex vocal tics can be repeating words or phrases or involuntary swearing. Motor tics are muscle spasms, such as involuntary eye blinks, shoulder shrugs, repetitive kicking, head jerks, eye darts and nose twitches.

In most patients, tics wane after mid-to-late adolescence. However, the study data indicates that in those patients whose tics persist into adulthood, tic severity remains the primary factor contributing to global psychosocial and occupational disability, according to Lichter.

In many TS adults, motor tics remain more enduring and prominent than vocal tics and, in our study, motor tics were more severe overall than vocal tics and were more closely correlated with GAF scale score, says Lichter.

The study involved 66 patients -- 45 male and 21 female -- who had been followed for an average of 8.2 years at a UB-based TS clinic. They ranged in age from 20 to 80.

Results showed that nearly 32 percent were diagnosed with obsessive-compulsive disorder (OCD), while 62 percent showed OCD behavior. Nearly 29 percent had anxiety/panic disorder with another 21 percent exhibiting anxiety symptoms.

Prevalence of other TS-associated conditions were depression (16.7 percent), depressed mood (12.1 percent), bipolar disorder (12.1 percent), rage attacks and severe self-injury behavior (4.5 percent), childhood ADHD history (33.3 percent), adult ADD (18.2 percent), substance-use disorder (22.7 percent) and psychosis and restless legs syndrome (1.5 percent).

In the future Lichter and colleagues plan to collect prospective data on both quality of life and psychosocial and occupational functioning in TS patients.

We will look more closely at the interactions of tic severity, mood disorders, substance abuse and social support systems and determine how these issues relate to personal and social/occupational adjustment, Lichter says.

We hope this information will help us improve the lives of our TS patients, especially those who are at highest risk for a poor outcome.

NIDA announces 2010 Addiction Science Award winners at Intel ISEF

Fri, 14 May 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A project using cutting edge computer modeling to identify potential new medications for nicotine addiction won first place distinction at the annual Addiction Science Awards at this year's Intel International Science and Engineering Fair (ISEF) --- the world's largest science competition for high school students. The Intel ISEF Addiction Science Awards were presented at an awards ceremony last night in San Jose, Calif., by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and Friends of NIDA, a coalition that supports NIDA's mission.

First place distinction for the special Addiction Science Awards went to Ameya Ashish Deshmukh, a 16-year-old junior at Upper Arlington High School in Upper Arlington, Ohio. His winning project was titled Rational Drug Design Methods for the Identification of a Novel Negative Allosteric Modulator of a4b2 Nicotinic Receptors. Because identifying a molecule that will effectively bind to nicotine receptors can be like finding a needle in a haystack, Mr. Deshmukh used what is known as rational drug design. He first selected candidate molecules based on previous research. He then used computerized molecular models to narrow the list of potential compounds. Finally, he tested these on human cells to identify which compounds show promise for treating nicotine addiction.

Our first place winner realized the potential of rational drug design to address the need for more effective medications for treating nicotine addiction, said NIDA Director Dr. Nora Volkow. The result of this project, if developed further, has the potential to dramatically improve our smoking cessation strategies.

Second place distinction in the Addiction Science Awards went to Improving ADHD Treatment: A Comparison of Stimulant Medication Treatment for Children with ADHD, Computerized Cognitive Training of Attention and Working Memory, and the Combination of the Two. Seventeen-year-old Kevin Michael Knight, a junior at Collegiate High School at Northwest Florida State College in Niceville, Fla. submitted the entry. As a student diagnosed with ADHD who had difficulties with the side effects of stimulant medication, Knight wanted to identify other ways to treat the attention and memory problems ADHD causes. He asked whether it is possible to use specialized computer programs to re-train the brains of students with ADHD, either as an alternative or as a complement to the stimulant medications typically prescribed to treat ADHD. The results of his pilot study suggest that some cognitive games could be useful as an adjunct to currently available ADHD medication.

Third place went to Joseph Hunter Yagoda, a 17-year-old student at the William A. Shine Great Neck High School in Great Neck, N.Y. for his analysis of the thought process that goes into a teenager's decision to cut classes at school. For Risky Business: What Cognitive Factors Influence Risk Taking in the Academic Setting? the risk of class cutting was modeled by an innovative simulation mimicking a prototypical classroom. Following the risk scenario, he measured his subjects' perceptions of the risks of skipping class. His project concluded that schools should increase the benefits of attending class, have clear enforcement of consequences, and minimize the perception that everyone cuts class.

Our second and third place winners showed enormous enthusiasm for using a sound scientific process to solve problems that they or their friends contend with, said Dr. Cindy Miner, NIDA's chief ISEF judge and deputy director of NIDA's Office of Science Policy and Communications. These are important issues since we know that succeeding in school is crucial for future achievement, and is also a preventive factor for drug abuse and related health problems. We were thrilled that these brilliant young people already understand how science is key to solving these kinds of challenging social and health issues.

This year, more than 1,500 students from more than 50 countries participated in the ISEF competition, coordinated by the Society for Science and the Public, at the San Jose Convention Center. The nonprofit organization Society for Science and the Public partners with Intel - along with dozens of other corporate, academic, government and science-focused sponsors to provide support and awards for the Intel ISEF each year.

Winners of the Addiction Science Award received cash awards provided by Friends of NIDA in a ceremony Thursday night, with a $2,500 scholarship for the first-place honoree. NIDA has developed a special section on its website, which includes other resources on addiction science, to help science fair entrants understand the criteria for the awards:

Keeping kids away from R-rated movies may prevent early drinking

Mon, 26 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Middle-school children whose parents restrict access to R-rated movies are substantially less likely to start drinking than their peers who are allowed to see such films, a new study suggests.

In a study of nearly 3,600 New England middle school students, researchers found that among kids who said their parents never allowed them to watch R movies, few took up drinking over the next couple years.

Of that group, 3 percent said they had started drinking when questioned 13 to 26 months after the initial survey. That compared with 19 percent of their peers who'd said their parents sometimes let them see R-rated films, and one-quarter of students who'd said their parents allowed such movies all the time.

The researchers say the findings, reported in the May issue of the Journal of Studies on Alcohol and Drugs, underscore the importance of parents paying close attention to their children's media exposure.

We think this is a very important aspect of parenting, and one that is often overlooked, said Dr. James D. Sargent, a professor of pediatrics at Dartmouth Medical School in Hanover, New Hampshire.

The current findings build on evidence linking children's exposure to R-rated movies and onscreen adult content in general not only to early drinking but also to early smoking and kids' likelihood of having sex or behaving violently.

The research to date suggests that keeping kids from R-rated movies can help keep them from drinking, smoking and doing a lot of other things that parents don't want them to do, Sargent said.

He pointed out that it could be argued that parents who restrict access to R movies are simply more careful in general -- keeping tabs on their children's friends or making sure their kids have no access to alcohol at home, for instance. However, Sargent and his colleagues accounted for this in the current study by asking students questions that gauge authoritative parenting -- which gauges the adolescent's perception of parental responsiveness (ability to respond to the adolescent's point of view) and demandingness (ability to set and enforce limits).

The researchers found that, even with such factors considered, exposure to R-rated movies was still linked to the likelihood of early drinking.

Ninety percent of R-rated films have depictions of drinking, and that may be one reason that middle-schoolers who see the films are more vulnerable to early drinking. But Sargent said that the R-rated movie effect goes beyond that. Other research suggests that children who see R-rated movies become more prone to sensation seeking and risk taking. We think seeing the adult content actually changes their personality, Sargent said.

The bottom line, according to the researcher, is that parents should restrict their kids from seeing R-rated films. But he also pointed out that PG-13 movies, as well as many TV shows, often portray drinking and other adult situations -- and that supports limiting children's media time in general.

The American Academy of Pediatrics currently recommends that children watch no more than one to two hours of quality media, including movies, TV and videos, each day.

Online CBT is Effective in Depression & Panic Disorders: RCT

Wed, 14 Apr 2010 11:58:28 PST

( from http://www.rxpgnews.com ) The online Cognitive Behaviour Therapy is as effective in treating panic disorder and depression as the traditional group-based method, a new study has found.

'Internet-based CBT is also more cost-effective than group therapy,' said Jan Bergstrom, a researcher with the Center for Psychiatry Research at the Swedish medical university Karolinska Institute.

'The results therefore support the introduction of internet treatment into regular psychiatry, which is also what the National Board of Health and Welfare recommends in its new guidelines for the treatment of depression and anxiety,' Bergstrom said.

It is estimated that depression affects some 15 percent and panic disorder 4 percent of all people during their lifetime.

Depression can include symptoms such as low mood, lack of joy, guilt, lethargy, concentration difficulties, insomnia and a low zest for life.

It is known from previous studies that CBT is an effective treatment for both panic disorder and depression. However, there is a lack of psychologists and psychotherapists that use CBT methods, and access to them varies greatly in Sweden as well as in many other countries. Internet-based CBT has therefore been developed, in which the patient undergoes an Internet-based self-help programme and has contact with a therapist by email.

In the internet-based CBT, the patient undergoes an online self-help counselling programme and can contact a therapist via email.

The new research is based on a random clinical trial of 104 patients with panic disorder and comparison of the effectiveness of internet-based CBT and group CBT within a regular healthcare service.

Both treatments worked very well and there was no significant difference between them, either immediately after treatment or at a six-month follow-up, the research said.

Proteins may point to alcohol use test

Tue, 23 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Measuring a set of protein changes in the blood linked to alcohol use may potentially lead to a more accurate diagnostic test than those currently available, according to Penn State College of Medicine researchers.

The challenge in alcohol abuse as opposed to substance abuse -- things like cocaine or heroin or PCP -- is that alcohol is a perfectly legal substance for those over 21, said Willard M. Freeman, Ph.D., department of pharmacology and lead investigator. Unlike routine testing for illicit drugs, you can't just look for a trace of alcohol because many people enjoy a drink in a responsible manner and alcohol is very quickly metabolized. Discriminating between excessive and responsible levels of drinking makes this a greater challenge.

Penn State Hershey researchers, working for two-and-a-half years in cooperation with Kathleen A. Grant, Ph.D., at the Oregon National Primate Research Center, identified a set of 17 proteins in the blood that accurately predicted alcohol usage 90 percent of the time in non-human primates. Researchers were able to separate usage into three categories -- no alcohol use, drinking up to two drinks per day and drinking at least six drinks per day.

Protein levels rose and declined depending on alcohol consumption.

We observed that the levels of some proteins increased or decreased with as little as one or two drinks a day, Freeman said. These same changes occurred with heavier levels of drinking. We also found other proteins that responded only to heavy levels of drinking. Combined, these proteins allow us to classify subjects into non-drinking, alcohol-using, and alcohol-abusing groups.

The researchers are continuing their work, first by determining whether the changes measured return to normal levels with cessation of drinking. Second, they are looking for additional proteins to both increase accuracy and provide alternates if some of the initial 17 do not work in humans.

Working with groups around the world, Penn State Hershey researchers -- led by Freeman and Kent Vrana, chair, department of pharmacology -- plan to collect blood from people undergoing inpatient treatment for alcohol abuse.

We'll collect blood throughout their stay to see if the patients' protein pattern reverts from an excessive drinking pattern to a pattern that's indicative of alcohol abstinence, Freeman said.

The goal is to create a diagnostic test for alcohol consumption that may be used in areas of public safety like aviation or national security, for parole conditions and for helping physicians determine if a patient may have an alcohol abuse problem. Currently there are tests that try to address this issue, but Freeman said these tests are not sensitive and specific enough to serve as diagnostics.

Many of these tests rely on just one protein, he said. The limitation to this approach is that these tests often look at proteins produced by the liver. While these proteins increase with excessive alcohol intake, they also increase with any type of injury to the liver. For example, a lot of prescription drugs are hard on the liver. These tests let us know that the liver is being stressed but can't discriminate between excessive drinking and other conditions, which therefore reduces the utility of these tests.

That's where we see the promise in this panel of proteins. The proteins are produced by a number of organs including the liver, the muscle, and the brain. This unique fingerprint that is indicative of alcohol abuse is less likely to be produced by unrelated conditions.

Freeman stresses, a diagnostic test would not be testing for alcoholism, but rather, alcohol intake.

In a strictest use of the words, alcoholism is a psychological diagnosis as opposed to a level of drinking, he said. The Diagnostic and Statistical Manual really classifies alcohol abuse and alcoholism based on how alcohol is interfering with your life. Obviously we can't use a blood test to say yes, your drinking is interfering with your home life. But the amount of drinking and the amount of problems it causes in your life are tightly correlated.

We envision, a number of years down the line if this becomes a diagnostic test, that if the test indicates that you're drinking a lot, it would prompt a referral to a specialist in alcohol abuse and alcoholism. This test could provide an objective indicator to help people begin addressing what may really be a problem in their lives.

Behavioural signs of autism become evident between the ages of 6 and 12 months

Tue, 16 Feb 2010 14:05:04 PST

( from http://www.rxpgnews.com ) A study of the development of autism in infants, comparing the behavior of the siblings of children diagnosed with autism to that of babies developing normally, has found that the nascent symptoms of the condition — a lack of shared eye contact, smiling and communicative babbling — are not present at 6 months, but emerge gradually and only become apparent during the latter part of the first year of life.

Researchers conducted the study over five years by painstakingly counting each instance of smiling, babbling and eye contact during examinations until the children were 3. They found that by 12 months the two groups’ development had diverged significantly. Intentional social and communicative behavior among children developing normally increased while among infants later diagnosed with autism it decreased dramatically. The study is published online early and will appear in the March issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

“This study provides an answer to when the first behavioral signs of autism become evident,” said Sally Ozonoff, the study’s lead author, a professor of psychiatry and behavioral sciences and a researcher with the UC Davis MIND Institute. “Contrary to what we used to think, the behavioral signs of autism appear later in the first year of life for most children with autism. Most babies are born looking relatively normal in terms of their social abilities but then, through a process of gradual decline in social responsiveness, the symptoms of autism begin to emerge between 6 and 12 months of age.”

Autism is a pervasive developmental disorder of deficits in social skills and communication, as well as in repetitive and restricted behaviors, with onset occurring prior to age 3. Abnormal brain development, probably beginning prenatally, is known to be fundamental to the behaviors that characterize autism. Current estimates place the condition’s incidence at between 1 in 100 and 1 in 110 children in the United States.

Children with a sibling already diagnosed with autism are known to be among those at greatest risk of developing the disorder. The current study included 25 high-risk children who met criteria for autism at 3 years of age, matched with 25 low-risk peers who were developing normally. It was conducted at the MIND Institute and the University of California, Los Angeles. The sole inclusion criterion for the high-risk group was having a sibling with autism; low-risk participants had to have been born after 36 weeks gestation and have no autistic family members.

The children’s development was evaluated at 6, 12, 18, 24 and 36 months of age using a series of widely implemented diagnostic tools, including the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). Examiners were not told which babies were at high- or low-risk when evaluating the participants’ development.

The researchers found that there were few discernable differences between the two groups at the outset but that after six months, 86 percent of the infants who developed autism showed declines in social communication that were outside the range for typical development. “After six months,” the study found, “the autism spectrum disorder group showed a rapid decline in eye contact, social smiling, and examiner-rated social responsiveness.” Group differences were significant by 12 months in eye contact and social smiling and all other measures by 18 months, the study found.

The study is notable because of the accuracy and precision of its prospective methodology, assiduously recording exact numbers of social and communicative behaviors during lab visits. Previously, researchers have constructed evidence of autism’s earliest manifestations by interviewing parents about when they believed their children’s symptoms first arose or by reviewing home movies for clues to when children begin exhibiting symptoms of autism.

"Until now, research has relied on asking parents when their child reached developmental milestones. But that can be really difficult to recall, and there is a phenomenon called the “telescoping effect” where people usually say that they remember something happening more recently than when it occurred,” Ozonoff said. In addition parents frequently will turn off the video camera when their children are behaving poorly — precisely when autistic symptoms may appear.

Ozonoff said that the study provides a deeper understanding for parents, caregivers and health-care providers and for future research of the developmental trajectory for very young children with autism.

“We need to be careful about how we screen, and we need to know what we’re looking for,” Ozonoff said. “This study tells us that screening for autism early in the first year of life probably is not going to be successful because there isn’t going to be anything to notice. It also tells us that we should be focusing on social behaviors in our screening, since that is what declines early in life.”

“This study also found that the loss of skills continues into the second and third year of life,” she said. “So it may not be adequate, as the American Academy of Pediatrics currently suggests, that providers screen for autism twice before the end of the second year. Autism has a slow, gradual onset of symptoms, rather than a very abrupt loss of skills.”

“Screening may need to continue into the third year of life, since symptom emergence takes place over a long time. If a child starts exhibiting a declining trajectory and a sustained reduction in social communication we want to refer them into therapy, especially if they are at risk,” Ozonoff said, “even before we might be able to make a definitive diagnosis.”

Ozonoff said that the study does not address the etiology of autism or causality. In this study, the infants who participated were at high risk due to having strong family histories of autism, suggesting that genetics plays a major role in the later autism diagnoses, despite the fact that their symptoms were not apparent at birth.

Are bees also addicted to caffeine and nicotine?

Wed, 10 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) *A study carried out at the University of Haifa has found that bees prefer nectar with a small concentration of caffeine and nicotine over nectar that does not comprise these substances at all. This could be an evolutionary trait intended to make the bee addicted, the researchers say.*

Bees prefer nectar with small amounts of nicotine and caffeine over nectar that does not comprise these substances at all, a study from the University of Haifa reveals. This could be an evolutionary development intended, as in humans, to make the bee addicted, states Prof. Ido Izhaki, one of the researchers who conducted the study.

Flower nectar is primarily comprised of sugars, which provide energy for the potential pollinators. But the floral nectar of some plant species also includes small quantities of substances known to be toxic, such as caffeine and nicotine. The present study, carried out by researchers at the Department of Environmental and Evolutionary Biology and the Department of Science Education at the University of Haifa-Oranim, headed by Prof. Ido Izhaki along with Prof. Gidi Ne'eman, Prof. Moshe Inbar and Dr. Natarajan Singaravelan, examined whether these substances are intended to entice the bees or whether they are byproducts that are not necessarily linked to any such objective.

Nicotine is found naturally in floral nectar at a concentration of up to 2.5 milligrams per liter, primarily in various types of tobacco tree (Nicotiana glauca). Caffeine is found at concentration levels of 11-17.5 milligrams per liter, mostly in citrus flowers. In the nectar of grapefruit flowers, however, caffeine is present in much higher concentrations, reaching 94.2 milligrams per liter. In order to examine whether bees prefer the nectar containing caffeine and nicotine, the researchers offered artificial nectar that comprised various natural sugar levels and various levels of caffeine and nicotine, alongside clean nectar that comprised sugar alone. The caffeine and nicotine concentrations ranged from the natural levels in floral nectar up to much higher concentrations than found in nature.

The results showed that bees clearly prefer nectar containing nicotine and caffeine over the clean nectar. The preferred nicotine concentration was 1 milligram per liter, similar to that found in nature. Given a choice of higher levels of nicotine versus clean nectar, the bees preferred the latter.

According to the researchers, it is difficult to determine for sure whether the addictive substances in the nectar became present in an evolutionary process in order to make pollination more efficient. It can be assumed, however, based on the results of the study, that the plants that survived natural selection are those that developed correct levels of these addictive substances, enabling them to attract and not repel bees, thereby giving them a significant advantage over other plants. The researchers emphasized that this study has proved a preference, not addiction, and they are currently examining whether the bees do indeed become addicted to nicotine and caffeine.

Autism clusters indentified in California

Mon, 04 Jan 2010 22:14:36 PST

( from http://www.rxpgnews.com ) Researchers at UC Davis have identified 10 locations in California where the incidence of autism is higher than surrounding areas in the same region. Most of the areas, or clusters, are in locations where parents have higher-than-average levels of educational attainment. Because children with more educated parents are more likely to be diagnosed with an autism spectrum disorder, one need look no further for a cause, the authors say. The other clusters are located close to major autism treatment centers.

The clusters are located primarily in the high-population areas of Southern California and, to a lesser extent, in the San Francisco Bay Area. The researchers said that, while children born within the clusters during the study period were more likely to be diagnosed with autism, the majority of the state's children with autism were born in adjacent areas outside the clusters.

For the rigorous study, published online today in the journal Autism Research, scientists examined nearly all of the approximately 2-1/2 million births recorded in the state of California from 1996 through 2000. About 10,000 children born during that five-year period were later diagnosed with an autism spectrum disorder, according to the California Department of Developmental Services (DDS).

After mapping the state’s birth cohort based on where the mothers lived at the time when their children were born, the researchers pinpointed birth locations of children who were later diagnosed with autism. The study looked for areas of higher incidence within each of the service zones of DDS’s regional centers, which coordinate services for individuals with developmental disorders like autism.

“This is the first time that anyone has looked at the geography of autism births in California in order to see whether there might be some local patches of elevated environmental risk. This method ignores unknown widespread factors (such as a regional pollutant) that could increase autism incidence,” said Karla Van Meter, the study’s lead author. Van Meter is an epidemiologist and was a doctoral student in the UC Davis Department of Public Health Sciences and at the Center for Animal Disease Modeling and Surveillance when the study was conducted.

“This spatial study was extremely rigorous because we developed a methodology that greatly improved accuracy in identifying areas of higher autism incidence. With so many possible environmental health risk factors, we see this method as generally useful for focusing studies on exposures that are elevated in such clusters,” Van Meter said.

However, the researchers said that in this investigation the clusters probably are not correlated with specific environmental pollutants or other “exposures.” Rather, they correlate to areas where residents are more educated.

“What we found with these clusters was that they correlated with neighborhoods of high education or neighborhoods that were near a major treatment center for autism,” said senior author Irva Hertz-Picciotto, a professor of public health sciences and a researcher with the UC Davis MIND Institute.

“In the U.S., the children of older, white and highly educated parents are more likely to receive a diagnosis of autism or autism spectrum disorder. For this reason, the clusters we found are probably not a result of a common environmental exposure. Instead, the differences in education, age and ethnicity of parents comparing births in the cluster versus those outside the cluster were striking enough to explain the clusters of autism cases,” Hertz-Picciotto said.

Autism is a neurodevelopmental disability characterized by impaired social development and communication and restricted, repetitive behaviors. It is considered a lifelong condition that develops by the time a child is 3 years old. The researchers limited their study to the five-year period between 1996 and 2000 in order to allow all of the children born during that time to grow to an age by which they probably would have received a diagnosis — 6 years old.

Van Meter said that the increased risk of autism in these areas is roughly a doubling of the incidence of autism over the incidence in the surrounding zone. For example, for the cluster area located in the service zone of the San Diego Regional Center, the autism incidence was 61.2 per 10,000 births and, in the rest of the Regional Center service zone, 27.1 per 10,000 births. For the Harbor Regional Center the incidence was 103.4 and 57.8, respectively. Van Meter added that it is important to remember that most of the children with autism were not born in the cluster areas.

In Southern California, the areas of increased incidence were located within these Regional Center service zones:

1. The Westside Regional Center, headquartered in Culver City, Calif., which serves the communities of western Los Angeles County, including the cities of Culver City, Inglewood and Santa Monica;
2. The Harbor Regional Center, headquartered in Torrance, Calif., which serves southern Los Angeles County, including the cities of Bellflower, Harbor, Long Beach and Torrance;
3. The North Los Angeles County Regional Center, headquartered in Van Nuys, Calif., which serves the San Fernando and Antelope valleys — two clusters were located in this regional center’s service zone.
4. The South Central Los Angeles Regional Center, headquartered in Los Angeles, which serves the communities of Compton and Gardena;
5. The Regional Center of Orange County, headquartered in Santa Ana, Calif., which serves the residents of Orange County; and
6. The Regional Center of San Diego County, headquartered in San Diego, which serves people living in Imperial and San Diego counties.

In Northern California, the areas of increased incidence were located within these regional centers’ service zones:

7. The Golden Gate Regional Center, headquartered in San Francisco, which serves Marin and San Mateo counties and the City and County of San Francisco. Two clusters were located within the Golden Gate Regional Center’s service zone; and
8. The San Andreas Regional Center, headquartered in Campbell, Calif., which serves Santa Clara, Santa Cruz, Monterey and San Benito counties.

Two areas of increased incidence were located in Central California regional centers’ service zones:

9. The Central Valley Regional Center, headquartered in Fresno, Calif., which serves Fresno, Kings, Madera, Mariposa, Merced and Tulare counties; and
10. The Valley Mountain Regional Center, headquartered in Stockton, Calif., which serves Amador, Calaveras, San Joaquin, Stanislaus and Tuolumne counties.

The South Central Los Angeles and Valley Mountain Regional Center autism clusters were listed as “potential clusters” because their clusters met a reduced set of statistical conditions.

All of these areas were identified using a sophisticated new biostatistical testing procedure developed by Van Meter in collaboration with study co-author Lasse Christiansen and constructed on Christiansen’s earlier statistical work. This method looked for combinations of events, in this case, autism, within a set of locations, in this case, births, whose occurrence would not be expected to occur at random. This is the first application of that method. UC Davis undertook the epidemiological study as a step toward identifying geographic risk factors for autism in California, Van Meter said.

The study also examined demographic factors recorded on the children’s birth records that are known to be associated with both autism and residential location. These included having an older parent — a known autism risk factor. The researchers found a statistically significant but small association of the cluster areas with older parental age at the time their child was born.

Hertz-Picciotto said that the findings do not counter the idea that the environment plays a role in autism, but rather, help to focus attention toward certain types of exposures.

“Because of the strong link between demographics, particularly parental education, and the locations of clusters, other explanations for these pockets of high autism incidence, such as localized sources of exposure, are not likely," Van Meter explained.

“The risk for a child with highly educated parents to be diagnosed with autism is probably not caused by the location of the mother’s residence or any local shared environmental exposures," she said. "Our result indicates that the most likely sources of environmental hazards for autism in California are in or around the home or else are widespread."

"The strong link between demographics, particularly parental education, and the locations of the clusters validated the effectiveness of the statistical method that we employed because it successfully identified areas where a known risk factor was concentrated," she added.

Undergrad researchers lay groundwork for drug addiction remedy

Tue, 08 Dec 2009 05:00:00 PST

( from http://www.rxpgnews.com ) DURHAM, N.C. -- Sarah Steele and Langtian Ren Yuan were both self-admittedly inexperienced Duke freshmen in the spring of 2006. But then they followed helpful directions of an assistant chemistry professor, added their own patience and ingenuity, and ended up identifying compounds that might allay the powerful cravings of methamphetamine and cocaine addiction.

The two women, now seniors, have since moved on to other things. But their earlier accomplishment was recently celebrated by a research paper in a British journal. It also helped bring the professor, Jiyong Hong, a $390,000 stimulus grant from the National Institutes of Health and the American Recovery and Investment Act to do follow-up research.

I think this is a kind of showcase for something that Duke is very strong in -- undergraduate research, Hong said. And, socioeconomically, it deals with drugs of abuse that are huge problems.

Hong, whose research group investigates the synthesis of natural products for drug design as well as small molecules' roles in biological processes, got interested in finding small molecules that could inhibit the good feelings induced by meth and coke after reading a 2006 paper in the journal Science.

That study implicated a derivative of an enzyme called protein kinase C zeta (abbreviated PKCzeta) in brain chemistry changes involved in memory and learning.

When people take methamphetamines and cocaine, that gets engraved in their memories, Hong said. So the hypothesis was that by inhibiting a specific enzyme, in this case PKCzeta, we might be able to delete those memories.

The problem was that researchers had never identified a PKCzeta inhibitor, he added. PKCzeta is one of the least studied members of the PKC family. In other words, his quest would be like searching for needles in a haystack.

Enter the two undergraduates. Steele, an intended biology major, showed up in Hong's lab to do an independent study tied to a freshman chemistry research seminar class. I hadn't taken organic chemistry, but he explained everything to me so I was sure of what I was doing, she said.

Following Hong's elaborate instructions, Steele began the task of canvassing about 1,200 different small molecules looking for candidate PKCzeta blockers. It was repetitive work, but once we learned the concept it was easy to continue, she recalled.

The work involved placing each candidate inhibitor into one of 96 tiny wells on a sample plate, along with PKCzeta and an energy-providing chemical called adenosine triphosphate (ATP), plus a light-emitting enzyme called luciferase.

If a candidate compound was ineffectual, then the ATP in the well would be used by PKCzeta's activity. But if a compound did interfere with the PKCzeta, then the energy of the ATP would instead cause the luciferase to light up. The better the blocking action, the brighter the glow.

Yuan, originally a premed student planning to triple major in biomedical engineering, economics and public policy, had also approached Hong seeking freshman work as a lab assistant, though not as part of a class.

Originally I was asked to try to find an inhibitor for something other than PKCzeta, she said. But when Steele entered a different summer research program after the spring semester, I kind of picked up where Sarah stopped.

I was doing similar things as she, but really trying to pinpoint which specific compounds worked as inhibitors, Yuan recalled. We were almost out of molecules to test by then. But, in the last batch, there were a series that were similar that all lit up really well.

The work required lots of transferring chemicals with the aid of a pipette, and then incubating them at different temperatures and at different concentrations. That was a lot of hours, she said. I was working almost full time during the summer. But I'm glad it paid off.

Other researchers from Duke's Chemistry Department and Medical Center, as well as a separate group from Korea, filled in gaps in the research. Their results were published online on May 8, 2009 in

Schema therapy offers hope for mental disorder patients

Sat, 21 Nov 2009 12:24:04 PST

( from http://www.rxpgnews.com ) Patients coping with mental disorders can now look forward to major changes in their lives through an innovative treatment called Schema Therapy -.

Schema therapists help patients change their entrenched, self-defeating life patterns - or schemas - using cognitive, behavioural, and emotion-focused techniques.

Three major outcome studies have shown that many patients with 'borderline personality disorder' - can fully recover across the complete spectrum of symptoms.

In one study, ST was shown to be more than twice as effective in bringing about full recovery as a widely-practiced traditional treatment. It was also found to be more cost-effective and to have a much lower dropout rate.

In a second study, group ST led to even stronger outcomes than those in the previous investigation over a briefer period with a zero percent drop out rate and a recovery rate of 94 percent over an eight month period.

A third study, now in press, shows that individual ST can be successfully implemented in regular mental health care settings with no loss of effectiveness.

While other specialised treatments for BPD have demonstrated empirical support, all but ST have serious limitations in their impact on patients' functioning and quality of life, says a release of the International Society of Schema Therapy.

Dutch investigators, including Josephine Giesen-Bloo and Arnoud Arntz, were associated with the study along with Joan Farrell, Ida Shaw and Michael Webber of the Indiana University School of Medicine.

The first of these studies was reported in the Archives of General Psychiatry, published by the American Medical Association, the second published in the Journal of Behavioural Therapy and Experimental Psychiatry and the third will soon be appearing in Behaviour Research and Therapy.

These findings will be published by the Cambridge University Press this year.

Depression as deadly as smoking

Tue, 17 Nov 2009 05:00:00 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.'

Anxious women more likely to have smaller babies

Wed, 04 Nov 2009 12:13:43 PST

( from http://www.rxpgnews.com ) Women with severe and chronic anxiety during pregnancy are more likely to have smaller babies, says a new study.

The study authors demonstrated that the mother's anxiety during pregnancy impacts birth outcomes, including smaller babies, over and beyond factors such as drug use, education, and race.

Low to moderate levels of anxiety in women during either the first or second trimester did not significantly affect the birth outcomes, but women who are severely anxious during much of their pregnancy should be considered for anxiety-reducing interventions.

Shahla M. Hosseini of the University of Pittsburgh Medical Centre, co-authored the study with Minhnoi W. Biglan, Cynthia Larkby, Maria M. Brooks, Michael B. Gorin, and Nancy L. Day.

'One way to prevent health problems in children and adults is to focus care on the prenatal period,' the authors note.

'It is key to pursue further research which addresses interventions to ameliorate the effects that a woman's trait anxiety has on the development of foetuses,' they said.

The study was published in Paediatric and Perinatal Epidemiology.

Smoking bans reduce the risk of heart attacks associated with secondhand smoke

Thu, 15 Oct 2009 04:00:00 PST

( from http://www.rxpgnews.com ) WASHINGTON -- Smoking bans are effective at reducing the risk of heart attacks and heart disease associated with exposure to secondhand smoke, says a new report from the Institute of Medicine. The report also confirms there is sufficient evidence that breathing secondhand smoke boosts nonsmokers' risk for heart problems, adding that indirect evidence indicating that even relatively brief exposures could lead to a heart attack is compelling.

It's clear that smoking bans work, said Lynn Goldman, professor of environmental health sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, and chair of the committee of experts that wrote the report. Bans reduce the risks of heart attack in nonsmokers as well as smokers. Further research could explain in greater detail how great the effect is for each of these groups and how secondhand smoke produces its toxic effects. However, there is no question that smoking bans have a positive health effect.

About 43 percent of nonsmoking children and 37 percent of nonsmoking adults are exposed to secondhand smoke in the United States, according to public health data. Despite significant reductions in the percentages of Americans breathing environmental tobacco smoke over the past several years, roughly 126 million nonsmokers were still being exposed in 2000.

A 2006 report from the U.S. Surgeon General's office, THE HEALTH CONSEQUENCES OF INVOLUNTARY EXPOSURE TO TOBACCO SMOKE, concluded that exposure to secondhand smoke causes heart disease and indicated that smoke-free policies are the most economical and effective way to reduce exposure. However, the effectiveness of smoking bans in reducing heart problems has continued to be a source of debate.

The IOM committee conducted a comprehensive review of published and unpublished data and testimony on the relationship between secondhand smoke and short-term and long-term heart problems. Eleven key studies that evaluated the effects of smoking bans on heart attack rates informed the committee's conclusions about the positive effects of smoke-free policies. The studies calculated that reductions in the incidence of heart attacks range from 6 percent to 47 percent. Given the variations in how the studies were conducted and what they measured, the committee could not determine more precisely how great the effect is. Only two of the studies distinguished between reductions in heart attacks suffered by smokers versus nonsmokers. However, the repeated finding of decreased heart attack rates overall after bans were implemented conclusively demonstrates that smoke-free policies help protect people from the cardiovascular effects of tobacco smoke, the committee said.

The report also provides a detailed discussion of the evidence from animal research and epidemiological studies showing a cause-and-effect relationship between secondhand smoke exposure and heart problems. The committee was not able to determine the exact magnitude of the increased risk presented by breathing environmental tobacco smoke, but noted that studies consistently indicate it increases the risks by 25 percent to 30 percent. Although there is no direct evidence that a relatively brief exposure to secondhand smoke could precipitate a heart attack, the committee found the indirect evidence compelling. Data on particulate matter in smoke from other pollution sources suggest that a relatively brief exposure to such substances can initiate a heart attack, and particulate matter is a major component of secondhand smoke.

Young age at first drink may affect genes and risk for alcoholism

Fri, 18 Sep 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The age at which a person takes a first drink may influence genes linked to alcoholism, making the youngest drinkers the most susceptible to severe problems.

A team of researchers, led by scientists at Washington University School of Medicine in St. Louis, studied 6,257 adult twins from Australia. They wanted to learn whether twins who start drinking at an early age are more likely to develop a more heritable form of alcohol dependence than those who begin drinking later in life. The researchers found that the younger an individual was at first drink, the greater the risk for alcohol dependence and the more prominent the role played by genetic factors.

There seemed to be a greater genetic influence in those who took their first full drink at a younger age, says first author Arpana Agrawal, Ph.D. That's very consistent with what has been predicted in the literature and in the classification of types of alcohol dependence, but we present a unique test of the hypothesis.

Agrawal and her colleagues examined previously collected data from identical and fraternal, male and female twins, using statistical methods to measure the extent to which age at first drink changed the role of heritable influences on symptoms of alcohol dependence. Using the twin model, they were able to tease out genetic influences, shared environmental influences and non-shared environmental factors.

Agrawal's team found that when twins started drinking early, genetic factors contributed greatly to risk for alcohol dependence, at rates as high as 90 percent in the youngest drinkers. For those who started drinking at older ages, genes explained much less, and environmental factors that make twins different from each other, such as unique life events, gained prominence.

The twins in the study were 24 to 36 years old when they were interviewed, but some reported taking their first drink as young as age 5 or 6. The researchers found that those who were 15 or younger when they started drinking tended to have a greater genetic risk for alcohol dependence. Some who were 16 or older before they took their first drink later became alcohol dependent, but their dependence was related more to environmental factors.

We don't have actual gene expression data in this study, but we could hypothesize that exposure to early-onset drinking somehow modifies the developing brain, Agrawal says. Particularly frequent or heavy early drinking may influence gene expression and contribute to more severe outcomes. Our research cannot prove that, but it's something that neuro-imaging and gene expression studies certainly should investigate.

Another possibility is that early drinking exposes adolescents to certain environment influences, such as their peer groups, that somehow enhance genetic influences that contribute to risk for alcohol dependence.

Something about starting to drink at an early age puts young people at risk for later problems associated with drinking, Agrawal says. We continue to investigate the mechanisms, but encouraging youth to delay their drinking debut may help.

Prevalence of Mental Illness May Be Twice Than Believed

Fri, 11 Sep 2009 15:41:33 PST

( from http://www.rxpgnews.com ) The prevalence of anxiety, depression and drug dependency may be twice as high as the mental health community has been led to believe.

Duke University psychologists Terrie Moffitt, Avshalom Caspi and colleagues used a long-term tracking study of more than 1,000 New Zealanders from birth to the age 32 to conclude that people vastly under-report the degree of mental illness they have suffered.

But such self-reporting from memory is the basis of much of what we know about the prevalence of anxiety, depression, alcohol dependence and marijuana dependence.

Longitudinal studies like the Dunedin Study in New Zealand that track people over time are rare and expensive, Moffitt said.

'If you start with a group of children and follow them their whole lives, sooner or later almost everybody will experience one of these disorders,' said Moffitt, professor of psychology at Duke.

The Great Smoky Mountains Study, a similar effort based at Duke, tracked 1,400 American children from age 9-13 into their late 20s and found similar patterns, said Jane Costello, professor of medical psychology at Duke.

'I think we've got to get used to the idea that mental illness is actually very common,' Costello said. 'People are growing up impaired, untreated and not functioning to their full capacity because we've ignored it.'

Similarly, the survey studies have reported a six to 17 percent lifetime rate of alcohol dependence between the ages 18-32, versus nearly 32 percent in the Dunedin Study.

Moffitt and Caspi's findings appeared online in Psychological Medicine.

Longitudinal study investigates cocaine's impact on adolescent development

Wed, 19 Aug 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Teen years are filled with experimenting. Sometimes that means trying some risky behaviors.

Nearly 400 teens, half of which were prenatally exposed to cocaine, will be studied in their adolescent years. Researchers will look at the youths' choices when it comes to using drugs, having sex or engaging in delinquent behaviors, and see if there is an association with prenatal cocaine exposure. The study will also closely follow the cognitive development and mental health behavior of the young people.

Sonia Minnes, an assistant professor from the Mandel School of Applied Social Sciences at Case Western Reserve University and now the lead researcher in phase four of a long-term study of cocaine exposed children, has received a five-year, nearly $5 million grant from the National Institute on Drug Abuse (NIDA).

This latest funding will help us to continue to tell the story of what happens in the development of prenatally cocaine-exposed children, says Minnes.

With the inception of this new study, Prenatal Cocaine Exposure in Adolescence, Minnes and her co-investigators will follow the children through age 18.

The study began with 415 infant-mother (or caretaker) pairs recruited at the infant's birth. Over the years, the children's development has been followed, as well as the mental health and substance abuse by the mother or caregiver. In three previous phases of NIDA funding, the researchers found that prenatal cocaine exposure negatively affects attention, language development, behavior and the ability to process visual information.

Most people know that mothers should not use drugs during pregnancy, says Minnes. This study over time will tell us what risks are associated with a specific prenatal drug exposure and how environmental influences shape developmental outcomes.

She adds that they have found important environmental factors such as elevated blood lead, maternal mental health and vocabulary level and the type of caregiver placement, are important to consider in evaluating prenatal cocaine exposure's effect on developmental outcome. The study will help us understand what interventions are needed at different developmental stages in their lives.

The study has been underway since 1994, when Lynn Singer, deputy provost and professor of pediatrics in the school of medicine, questioned what happens to prenatally cocaine-exposed children as they grow older. Minnes, who worked as the project coordinator since its beginning, became the study's principal investigator in 2007.

Her recent appointment to the Mandel School of Applied Social Science, where she earned her doctorate in social work, comes at a pivotal point in the study's progress as the focus shifts towards social behavior issues traditionally studied in the realm of social work, says Minnes. She will draw from the expertise of colleagues at MSASS who can provide additional insight regarding the effects of neighborhood and family violence, parental substance use, and placement issues on the development of prenatally cocaine-exposed adolescents.

Findings from the study will provide important information to early intervention specialists and child policy experts who can then develop targeted therapeutic interventions.

New reagents for genomic engineering of mouse models to understand human disease

Wed, 19 Aug 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The ability to specifically target and modify genes in the mouse allows researchers to use this small rodent to study how certain genes contribute to human disease. A common method used to make genetic changes in mice and cells is called site-specific recombination, where two DNA strands are exchanged. The two strands may contain very different sequences, but are designated at their ends by specific target sequences that are not commonly found elsewhere in the genome. A protein, called a recombinase, cuts the DNA at its target sites and rearranges it. Scientists use this technique to exchange a naturally occurring DNA sequence for an altered or deleted gene to gain insight into the gene's normal function or how it contributes to disease.

Currently there are a few systems available to create genetic mutations in mice, including the recombinases FLP and Cre. These proteins are very efficient genetic modifiers and specifically target their appropriate sequences. They can also be turned on or off at precise times, or within specific tissues, to make carefully reegulated genetic changes. However, the small number of available methods that can be used together to mutate genes limits the complexity of the modifications that can be produced. For example, it would be informative to independently regulate the temporal and tissue-specific expression of genes with overlapping functions to understand their individual and combined effects.

Scientists now report that a new recombinase, Dre, induces controlled genetic changes in mice. Dre works similarly to the currently popular recombinase Cre, with an important exception: Dre recognizes a distinct target sequence and only recombines DNA around its target sequence, even if the target sequence for Cre is present. The ability of the related proteins, Cre and Dre to distinguish their own target sequences indicates that Dre can be used in combination with Cre, and other recombinases, to produce more sophisticated mouse models. This should facilitate the analysis of complex gene interactions and how they function in disease.

This technological advance also highlights the progress that might be made through open reagent sharing within the scientific community. The discovery of Dre recombinase was originally reported by Sauer and McDermott at the Stowers Institute for Medical Research. The Institute holds an intellectual patent for the system that allows it to be shared openly for non-commercial purposes and evaluates requests on a case-by-case basis for its use by for-profit institutions. Thus, the authors of the new DMM report do not have any proprietary claims to the system that they used to create this valuable mouse model. This is the first of a series of Resource Articles that will appear in

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

Fri, 17 Jul 2009 04:00:00 PST

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

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

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

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

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

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

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

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

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

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

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

DOD, VA should take stronger steps to combat tobacco use in military, veteran populations

Fri, 26 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) WASHINGTON -- Because tobacco use impairs military readiness, harms the health of soldiers and veterans, and imposes a substantial financial burden on the departments of Defense and Veterans Affairs, these agencies should implement a comprehensive strategy to achieve the Defense Department's stated goal of a tobacco-free military, says a new report from the Institute of Medicine. DOD should gradually phase in a ban on tobacco use in the military, starting at military academies and officer training programs and among new recruits, the report says. DOD should also stop selling tobacco products in Army and Air Force commissaries -- Navy and Marine Corps commissaries already do not sell them -- and should stop selling them at a discount in military exchanges and other stores. In addition, Congress should allow VA to establish tobacco-free medical centers.

The report was requested by DOD and VA, who asked the Institute of Medicine to identify policies and practices that could lower rates of smoking and help soldiers and veterans quit.

Tobacco use reduces soldiers' physical fitness and endurance and is linked to higher rates of absenteeism and lost productivity, the report says. In 2005, 32 percent of active-duty personnel and 22 percent of veterans were smokers; rates among active-duty personnel have recently increased, possibly because of growing tobacco use by deployed troops.

We found that the adverse effects of tobacco use on military readiness, the health of both smokers and nonsmokers, and the financial cost of the medical care of smoking-related illness in military and veteran populations are a sound basis for moving systematically toward a tobacco-free military, said Stuart Bondurant, professor of medicine and dean emeritus of the School of Medicine at the University of North Carolina, Chapel Hill, and chair of the committee that wrote the report. The state of the art in tobacco control is such that with well-managed programs, DOD and VA could eventually be tobacco free with minimal disruption, and with substantial benefit to military personnel and veterans.

DOD and VA should ensure that all personnel have quick and easy access to comprehensive, evidence-based tobacco-cessation services, the report says. All DOD and VA health care providers should be able to provide brief counseling and nicotine-replacement therapy to patients. In addition, the committee recommended that VA and DOD develop toll-free quitlines to provide military personnel and veterans with counseling on quitting tobacco. Quitline counselors should be trained to deal with issues related to these populations, such as post-traumatic stress disorder.

The Defense Department should set a date by which the military will be tobacco-free and require each of the four services to develop and enforce a timeline for achieving this goal, the report says. Recognizing that immediately banning tobacco use in deployed personnel is not realistic, the committee urged an incremental strategy, starting with closing the pipeline of new tobacco users entering the military. Smoking should be banned at military academies, and the current ban on tobacco use during basic training should be extended to include subseqent technical training. That ban could eventually be extended to all new enlistees, who would be informed during recruitment that they would be expected to remain tobacco-free during their entire military careers.

Eventually, all military installations and active-duty personnel should be required to be tobacco-free -- a goal that could realistically be achieved in 20 years or even sooner, if the plan's initial phase for military academies and new recruits starts within a year, the report says.

Only with assistance from DOD and VA will tobacco use be stopped, the report says, and ideally DOD should not sell tobacco products as they inhibit military readiness. As a first step, DOD should prohibit tobacco sales in Army and Air Force commissaries and stop selling tobacco products at a discount in other military stores. Congress should direct DOD to sell any tobacco products in military exchanges at prices equal to those in the civilian sector, and preferably higher.

Congressional action is also necessary to allow VA to implement tobacco-free medical facilities. The VA's efforts to do so have been hampered by the language of the Veterans Health Care Act of 1992, which requires them to maintain smoking areas for veterans and employees. This act should be repealed, the report says.

Care Management Reduces Suicidal Ideation in Geriatric Depression

Wed, 24 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Depression in older adults too often goes unrecognized and untreated, resulting in untold misery, worsening of medical illness, and early death. A new study has identified one important remedy: Adding a trained depression care manager to primary care practices can increase the number of patients receiving treatment, lead to a higher remission rate of depression, and reduce suicidal thoughts.

"Almost one in 10 older adults in the United States has some form of depression, and one-fifth among them contemplates suicide. Two-thirds of these patients are treated by primary care physicians. Sadly, their depression is often inadequately treated due to the primary care physician's time constraints and the patient's reluctance to discuss their symptoms and adhere to treatment," says Dr. Alexopoulos.

The critical finding of the PROSPECT study is that adding a trained care manager to primary care practices increases the number of depressed older patients who receive treatment and improves their outcomes, not only in the short term, but over two years.

"This is important because depression can either become chronic or relapse after an initial improvement," adds Dr. Alexopoulos. "Most diseases have worse outcomes when an old person becomes depressed. Depression almost doubles the risk for death. It follows that treating depression effectively can reduce sickness, disability and death."

The study, conduced by NewYork Presbyterian/Weill Cornell, the University of Pittsburgh, and the University of Pennsylvania, followed 599 patients aged 60 years and older with depression at 20 primary care practices of varying sizes in New York and Pennsylvania. Participants were randomized to receive either the PROSPECT intervention or usual care. Those in the PROSPECT group were assigned a care manager -- a trained social worker, nurse or psychologist -- who helped the physician offer treatment according to accepted practice guidelines, monitored treatment response and provided follow-up over two years. Practice guidelines included the antidepressant citalopram (Celexa), with the option of other drugs or psychotherapy.

The PROSPECT intervention worked especially well for a subgroup of patients with major depression, the more severe form of the disease, with a greater number achieving remission, or the near absence of symptoms. Patients with minor depression had favorable outcomes regardless of their study group.

Various forms of care management are being used successfully for cardiovascular patients needing anticoagulation medication and for diabetes patients needing insulin monitoring, says Dr. Alexopoulos. "The PROSPECT study has demonstrated that care management is highly successful for older adults with major depression."

"At this time, our nation is focused on disease prevention as a way to improve the health of Americans and to reduce health care cost. Reducing depression over long periods of time can be one of the ways to achieve this objective," continues Dr. Alexopoulos. "Care management, like that of the PROSPECT study, is relatively inexpensive. Finding ways to reimburse it can make it broadly available and have a major impact on the overall heath care."

Snoring due to sleep apnea can damage brain severely

Mon, 22 Jun 2009 11:23:57 PST

( from http://www.rxpgnews.com ) Snoring due sleep apnea may impair brain function in a much worse way than previously thought, according to a new study.

Sufferers of Obstructive Sleep Apnea - experience similar changes in brain biochemistry as people who have had a severe stroke or who are dying, the research shows.

OSA is caused by obstruction of the airway, a disorder characterised by pauses in breathing during sleep.

A study by University of New South Wales - Brain Sciences is the first to analyse, in a second-by-second timeframe, what is happening in the brains of sufferers as they sleep.

Previous studies have focussed on recreating oxygen impairment in patients who are awake.

'It used to be thought that apnoeic snoring had absolutely no acute effects on brain function but this is plainly not true,' said study co-author Caroline Rae, professor at Prince of Wales Medical Research Institute.

Sleep apnea affects as many as one in four middle-aged men, with around three percent going on to experience a severe form of the condition characterised by extended pauses in breathing, repetitive asphyxia and sleep fragmentation.

Children with enlarged tonsils and adenoids are also affected, raising concerns of long-term cognitive damage.

Rae and collaborators from Sydney University's Woolcock Institute used magnetic resonance spectroscopy to study the brains of 13 men with severe, untreated, obstructive sleep apnea, said a UNSW release.

They found that even a moderate degree of oxygen desaturation during the patients' sleep had significant effects on the brain's bioenergetic status.

'The findings show that lack of oxygen while asleep may be far more detrimental than when awake, possibly because the normal compensatory mechanisms don't work as well when you are asleep,' said Rae.

These findings were published in the May edition of Journal of Cerebral Blood Flow and Metabolism.

Meditation may be effective for treating insomnia

Thu, 18 Jun 2009 13:01:21 PST

( from http://www.rxpgnews.com ) Meditation may be an effective remedy in treating insomnia, latest research suggests.

According to Ramadevi Gourineni, principal study investigator and director of the insomnia programme at Northwestern Memorial Hospital in Illinois, insomnia is thought to be a 24-hour problem of hyper-arousal. Moreover, elevated measures of arousal are seen throughout the day.

The study collected data from 11 healthy subjects between the ages of 25 and 45 years who suffered from chronic primary insomnia. Participants were divided into two intervention groups for two months.

The first group was taught Kriya Yoga, a form of meditation that is used to focus internalized attention and has been shown to reduce measures of arousal. The second group received health education.

Participants of the health education group also received information about health-related topics and how to improve health through nutrition, exercise, weight loss and stress management.

Results suggested that patients saw improvements in subjective sleep quality and sleep diary parameters while practicing meditation. Patients who practiced meditation saw improvements in sleep latency, total sleep time, total wake time, wake after sleep onset, sleep efficiency and sleep quality.

Findings of this study were presented at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies.

Dr. Ramadevi Gourineni completed her medical school at Kurnool Medical College in Andhra Pradesh, India. She was raised in the United States prior to this. Dr. Gourineni's has a special interest in behavioural treatment of insomnia and currently is involved in research studying the effects of meditation on stress and sleep in individuals with chronic insomnia.

Society doing hyperactive kids a disservice

Thu, 18 Jun 2009 11:30:46 PST

( from http://www.rxpgnews.com ) Authors and educators are doing hyperactive children a disservice by insisting that hyperactivity has always existed.

Canadian researcher Matthew Smith said not only is that notion wrong, it misleads patients, their parents and their physicians. Smith, from Edmonton is completing his doctorate at the Centre for Medical History, University of Exeter.

Hyperactivity disorder - is currently the most commonly diagnosed childhood psychiatric disorder, said Smith, and millions of children are prescribed drugs including Ritalin to treat it. Yet prior to the 1950s, it was clinically and culturally insignificant.

He argued in a paper that hyperactivity disorder as we understand it today is a modern construct that was first described in 1957. Before that hyperactive behaviour existed - but it wasn't always thought of as a disorder or pathology worth treating, said Smith.

However, Smith said many today assert that hyperactivity is a universal phenomenon, which can be seen in historical figures like Mozart or Einstein. Smith argues that hyperactivity is rooted in social, cultural, political and economic changes of the last half century.

'When history is extended back beyond 1957, it overlooks all the social factors that contributed to the idea that children were hyperactive - and that that was a problem,' he says.

Smith says that whether you consider hyperactivity a disease worth treating often depends on context - and the context changed in the late 1950s when the US refocussed its education system in response to the space race, said an Exeter release.

'If a child's playing soccer, there's a chance hyperactivity isn't going to be a problem. But if they are stuck in a classroom, it is a problem,' he said.

Brain protein BDNF might get you hooked on drugs, alcohol

Wed, 17 Jun 2009 14:23:59 PST

( from http://www.rxpgnews.com ) A brain protein can practically hook you on to drugs and alcohol by hijacking the normal functioning of its reward circuitry.

Researchers investigating this addiction 'switch' have now implicated a naturally occurring protein, a dose of which allowed them to get rats hooked with no drugs at all.

Chronic drug users, as noted by previous research, can experience an increase in this protein called BDNF - in the brain's reward circuitry.

Researchers noted that a single injection of BDNF made rats behave as though they were dependent on opiates -.

Though rats instinctively prefer certain smells, lighting and texture, these rats left their comfort zone in search of a fix.

'If we can understand how the brain's circuitry changes in association with drug abuse, it could potentially suggest ways to medically counteract the effects of dependency,' said Scott Steffensen, neuroscientist at Brigham Young University -.

He co-authored the study with two of his undergraduate students, one of his graduate students, and a team of researchers at the University of Toronto, said a BYU release.

'This work may reveal a mechanism that underlies drug addiction,' said study co-author Hector Vargas-Perez, a Toronto neurobiologist.

The study was published in Science.

Caffeine may prevent risk taking after sleep deprivation

Fri, 12 Jun 2009 14:36:11 PST

( from http://www.rxpgnews.com ) Washington, June 12 - A dose of caffeine may prevent increased risk taking that occurs after several nights of total sleep deprivation, according to the latest research.

Results suggest that despite extreme sleep deprivation, subjects who consumed caffeine did not exhibit increased risky behaviour on the Balloon Analog Risk Task -, a computerized measure of impulsive risk-taking.

According to William Killgore, principal study investigator and research psychologist at Harvard Medical School, sleep deprivation may not have a simple linear effect on risk taking, but there may be a 'breaking point' during which a person may show a drastic reduction in their ability to control or inhibit behaviour. In this study, caffeine appeared to protect against that breaking point.

'People who were awake for three days straight became more impulsive and acted with less regard for consequences. However, if they had consumed caffeine each night -, they showed no increase in risky behaviour' said Killgore.

Though this study looked at the most extreme range of sleep deprivation and most people may not experience such effects under normal circumstances, results from a previous study have shown that those who were constantly restricted to three hours of sleep per night for a week showed an increase in risk-taking behaviour.

Findings of this study were presented at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies.

Report on US tobacco control policies and use finds stark contrasts in progress among states

Wed, 10 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- The United States is becoming a nation of haves and have-nots when it comes to tobacco control, according to a comprehensive publication on cigarette smoking prevalence and policies in the U.S. that was released today.

The new report, Cigarette Smoking Prevalence and Policies in the 50 States: An Era of Change -- the Robert Wood Johnson Foundation ImpacTeen Tobacco Chart Book, was presented today at the National Conference on Tobacco or Health meeting in Phoenix.

It was prepared for the Robert Wood Johnson Foundation by researchers in the University at Buffalo Department of Health Behavior in UB's School of Public Health and Health Professions and at the Roswell Park Cancer Institute. Researchers from eight other institutions also contributed, including the University of Illinois at Chicago, the National Cancer Institute and the Robert Wood Johnson Foundation.

The report includes individualized data on smoking behaviors for all 50 states as well as a discussion of national trends revealed by the data.

States can reduce death and disease by reducing smoking prevalence, said Gary G. Giovino, Ph.D., professor and chair of the Department of Health Behavior in the UB School of Public Health and Health Professions and principal investigator on the report. It's that simple.

States should feel morally obligated to use a higher proportion of the revenues they receive from cigarette excise taxes and settlement payments to prevent smoking initiation, protect nonsmokers and help people who smoke to quit. Strong tobacco control programs save lives, he added.

The report points out that even after four decades of tobacco control efforts, one-fifth of American adults still smoke and prevalence is especially high among populations with lower levels of education and income, Native Americans and those with psychiatric and substance abuse problems.

While much progress has been made in reducing cigarette smoking in the United States, there still is much work to do, said Giovino, who has long studied the epidemiology of tobacco use among youth and adults and how it is affected by public health policies; he was previously chief of the Epidemiology Branch in the Office on Smoking and Health of the U.S. Centers for Disease Control and Prevention.

According to the report, serious disparities remain in the use of tobacco and access to effective policies and treatments that curtail it.

There is wide variation in cigarette smoking prevalence across states and a clear relationship between smoking prevalence and the rate of mortality that can be attributed to smoking, Giovino said.

For example, among 18-29 year olds, smoking prevalence was 2.5 times higher in Kentucky (36.2 percent) than in California (14.4 percent). And in 2006-07, 66 percent of adults aged 30 or older in New Hampshire who had ever smoked said they had quit, while in West Virginia for the same age group, only 45 percent of smokers said they had quit.

The report also presents state-level analyses showing that in states with the lowest prevalence of smoking, the remaining smokers are less likely to show indicators of dependence and more likely to want to quit, compared to smokers in high prevalence states.

The same programs and policies that lower prevalence also reduce the number of cigarettes smoked each day and motivate quitting, Giovino stated.

He said that while a combination of outreach programs, legislation, cigarette price increases and coverage for and access to stop-smoking treatments has been proven to work, the report nevertheless reveals that most states are not fully implementing these approaches to reduce smoking rates and protect nonsmokers.

According to the report, in 2006, approximately 27 percent of adult Medicaid recipients were smokers, significantly higher than the 17 percent rate among adults with private insurance. But in 2006, Medicaid programs in a dozen states still did not provide coverage for proven tobacco treatment to their clients who smoked.

The report also reveals that increases in excise taxes on cigarettes have consistently been proven to be effective in both preventing smoking and causing people to quit, but these taxes range from a high of $3.46 in Rhode Island to a low of just 7 cents in South Carolina.

Even considering the recent 61-cent federal excise tax increase, state and federal excise taxes still accounted for a smaller percentage of the retail price of a pack of cigarettes in 2009 (40 percent) than they did in 1970 (49 percent).

The percentage of resources available to states from cigarette excise taxes and settlement payments that is dedicated to tobacco prevention and cessation is dwindling, said Giovino. This is a tragic development.

According to the report, the increase in state programs and policies designed to reduce both smoking prevalence and exposure to tobacco smoke pollution has resulted in numerous positive outcomes from 1992-93 to 2006-07, including:

High Risk of Disordered Eating in OCD

Mon, 08 Jun 2009 10:56:15 PST

( from http://www.rxpgnews.com ) Doctors and other health workers should be more aware of the high risk of eating disorders among people with obsessive compulsive disorder (OCD) and other anxiety disorders.

According to new research presented at the recently concluded Royal College of Psychiatrists’ 2009 Annual Meeting, as many as one in five people with OCD could also have some form of disordered eating. In addition, disordered eating may occur in as many as one in three patients with other anxiety disorders.

OCD is a serious anxiety-related condition that affects 2-3% of the adult population. People with severe OCD may find it difficult to work regularly, or even take part in their family or social life.

Dr Lynne Drummond, a consultant psychiatrist at South West London and St George's NHS Mental Health Trust, collected data from a sample of patients with severe OCD who were referred to a specialist unit for treatment. A control group of patients with other anxiety disorders referred for treatment to the same unit was also studied.

The study found that a fifth of the patients with OCD also had signs of disordered eating. The prevalence for those with other anxiety disorders was a one in three.

Dr Drummond said: “Although these have been several studies examining the prevalence of OCD and obsessive symptoms in patients with eating disorders, there is a dearth of studies where patients with OCD and other anxiety disorders are examined for eating disorders.

“This study suggests that clinicians should be made aware of the high prevalence of disordered eating in patients with all anxiety disorders as well as OCD.”

'Happy hour' gene discovery suggests cancer drugs might treat alcoholism

Thu, 21 May 2009 04:00:00 PST

( from http://www.rxpgnews.com ) A class of drugs already approved as cancer treatments might also help to beat alcohol addiction. That's the conclusion of a discovery in flies of a gene, dubbed happyhour, that has an important and previously unknown role in controlling the insects' response to alcohol.

Animals with a mutant version of the gene grow increasingly resistant to alcohol's sedative effects, the research shows. The researchers report further evidence that the gene normally does its work by blocking the so-called Epidermal Growth Factor (EGF) pathway. That EGF pathway is best known for its role in cancer, and drugs designed to inhibit the EGF receptor, including erlotinib (trade name Tarceva) and gefitinib (trade name Iressa), are FDA-approved for the treatment of non-small cell lung cancer.

Now, the researchers show that flies and mice treated with erlotinib also grow more sensitive to alcohol. What's more, rats given the cancer-fighting drug spontaneously consumed less alcohol when it was freely available to them. Their taste for another rewarding beverage -- sugar water -- was unaffected.

This is a very powerful example of how simple model organisms -- and the little fruit fly in particular -- can be used to move quickly from an unknown gene to a potential therapy for drug addiction, said Ulrike Heberlein of the University of California, San Francisco, noting that erlotinib and gefitinib, along with other EGFR inhibitors, not only cross the blood-brain barrier in humans, but they are also well-tolerated in general.

Alcohol is one of the most popular and abused drugs in the world, the researchers said. Therefore, a better understanding of the genetic and environmental factors that lead to its addiction would have considerable benefit for those who suffer its consequences and for society at large. Despite the well-known effects of alcohol consumption on behavior and cognition, the underlying basis for those effects on the nervous system are still rather incomplete.

Human studies have pointed to a strong genetic component to alcoholism, but identifying the specific genes responsible has proved difficult. Studies have also indicated that an individual's sensitivity to alcohol intoxication acts as a predictor of future alcoholism, with a link between lower initial response and increased risk of addiction. Therefore, Heberlein's team explained, genes and pathways involved in the acute response to alcohol can yield insight into the genetic factors contributing to the more complex process of addiction.

Earlier studies have shown that fruit flies are a useful tool for unraveling the basis for the effects of alcohol. Several genes previously identified as playing a role in fruit flies' alcohol response hold similar roles in mammals.

In search of more in the new study, the researchers screened mutant flies for those less sensitive to ethanol. That screen led them to happyhour, a gene closely related to mammalian enzymes known as the Ste20-family kinases of the GCK-1 subfamily.

Heberlein said they still don't know exactly how alcohol exerts its influence on the EGFR pathway or how that leads to the telltale changes in behavior that come with alcohol intoxication. Those questions will be the subject of future investigation. Her team is also exploring other new gene candidates that turned up in the fly screens. She says that several of those appear to be tied to the EGFR pathway in different ways.

It's not yet clear how it all fits together, she said. But the fact that we've come, in an unbiased way, to molecules in the same pathway is telling us this is really, really important.

Experience vital for complex decision-making

Wed, 20 May 2009 11:31:46 PST

( from http://www.rxpgnews.com ) Experience is vital when we have to make complex decisions based on uncertain or confusing information, a new study has found.

'Learning from experience actually rewires our brains so that we can categorise the things we are looking at, and respond appropriately to them,' said Zoe Kourtzi from the University of Birmingham, who led the research.

In selecting a course of action that is most likely to be successful, the brain has to interpret and ascribe meaning to inherently uncertain information - being able to do this is vital for our survival.

This ability is critical when we are responding to visual stimuli that are very similar - for example, trying to recognise friends in a crowd or discern a tumour from healthy tissue on a medical scan.

'We have shown that this learning process is not just a matter of learning the structure of the physical world - when I look at something I'm not just playing a game of 'snap' in my head where I try to match images to each other,' Kourtzi said.

'In fact, areas in our brains are actually trained to learn the rules that determine the way we interpret sensory information,' he said, according to a university statement.

Kourtzi and colleagues wanted to find out about the human brain mechanisms that mediate flexible decision-making through learning, which have so far not been well understood, despite it being fairly clear that successful decisions benefit from previous experience.

They combined measurements of behaviour and brain signals to study how volunteers learned to discriminate between highly similar visual patterns and to assign them in different categories.

The research was published in Wednesday's edition of Neuron.

Disrupted UBE3A Gene Causes Angelman Syndrome

Mon, 11 May 2009 10:24:23 PST

( from http://www.rxpgnews.com ) Washington, May 11 - A disrupted gene triggers severe mental retardation known as the Angelman Syndrome, according to a new study.

The syndrome is one of a small family of single gene, autism-related, neuro-developmental disorders.

The study by Duke University Medical Centre - and University of North Carolina - researchers identified the gene as UBE3A in mice, which helps neurons form and connect with other neurons for storing sensory information.

Angelman Syndrome develops typically when children are between one and two years old. This is the period when the cortex, the sheet of convoluted folds at the brain surface, undergoes profound rearrangements driven by sensory experiences.

The experience of seeing reorganises the visual cortex, for example, during the same period when symptoms are becoming obvious in Angelman Syndrome.

'We wanted to look at an animal model to learn if this experience-dependent reorganisation of the cortex was abnormal in animals that were missing the gene,' said Michael Ehlers, Duke professor of neurobiology and co-senior author of the study.

The authors found that brains cells in Angelman Syndrome mice lacked the ability to appropriately strengthen or weaken in the cortex, an area of the brain important for cognitive abilities, said a DUMC release.

'By strengthening and weakening appropriate connections between brain cells, a process termed synaptic plasticity, we are able to constantly learn and adapt to an ever-changing environment.' Ben Philpot, UNC professor in Cell and Molecular Physiology and co-senior author of the study.

Afflicted children appear to respond normally to stimuli during their first year but around 12-18 months, they start missing milestones of cognitive development and language, typically learning only a two to three words over their lifetime.

These findings were published in Nature Neuroscience.

Mind over muscle

Fri, 24 Apr 2009 04:00:00 PST

( from http://www.rxpgnews.com ) One in five women between the ages of 18 and 24 are smokers, and most say they keep lighting up for fear of gaining weight. But researchers at Temple University have found that when it comes to quitting, a little bit of dialogue and support can be more effective than an exercise plan in helping women not only keep off the weight, but also stay smoke-free.

A lot of college--age women report smoking to keep their weight down and for body image reasons, and we think that by providing them with the tools to make them feel better about themselves, it alleviates some of those stressors, said Melissa Napolitano, a clinical psychologist at Temple's Center for Obesity Research and Education.

In a two-phased study, Napolitano and a team of researchers looked at the smoking habits and weight gain of women aged 18-24. The first phase collected data from focus groups who stated that stress, peer pressure and weight management were the main reasons why they smoked. Participants also felt that group-based programs that provide ongoing social support would be instrumental in helping them quit.

Those results laid the groundwork for the project's next phase, dubbed Fit to Quit, a small pilot study of 24 women who were randomly assigned to either a supervised group exercise program or body image group counseling sessions. All women were provided with a nicotine patch as well.

After eight weeks, the body image counseling group showed a rate of smoking cessation that was more than double that of the exercise group (18 percent vs. 8 percent). In addition, the body image group lost more than three times the weight of their exercise counterparts (3.3 pounds vs. less than a pound). These findings were presented this week at the Society for Behavioral Medicine's annual meeting.

Smoking has psychological and psychosocial implications, especially for young women, said Napolitano, an associate professor of kinesiology and public health in the College of Health Professions. We wanted to design a program that would not only address the physical addiction by providing a nicotine patch, but would also address those social and behavioral aspects as well.

Another aspect of the program relied on technology to reach their population of smokers. Text message and email were used to stay in contact with participants, more so than phone calls, because those were the preferred methods of communication among the young women in the study.

A lot of times, we would try to call participants to remind them of different sessions, and they would respond back via text or e-mail, so we took that message and used avenues like text messaging and the Internet not just as a means of getting information out, but for support as well.

Napolitano says that the results derived from this study have laid the groundwork for larger future studies at Temple and nationwide that focus on smoking cessation in college age women. The hope is to see if the results continue to hold true in studies with larger numbers of participants.

Temple's Student Health Services supported the Fit to Quit program, and Napolitano says it has the potential to be permanently offered as part of the menu of health promotion services on campus.

Our hope is to make programs like Fit to Quit sustainable on other college campuses, because we know that if we can give young people the tools they need to make better health decisions, it helps them not only improve their health but it also helps them do better academically.

Adolescent risk-taking has major consequences when it comes to marriage

Wed, 22 Apr 2009 04:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N. Y. -- A national study of data collected over 12 years finds that delinquent teens marry earlier than their peers, while substance-abusing teens -- especially girls who abuse marijuana -- marry later than peers, if at all.

The Influence of Risk-Taking Behaviors on the Transition into Marriage: An Examination of the Long-Term Consequences of Adolescent Behavior by University at Buffalo sociologist Sampson Lee Blair, Ph.D., is a rare look at the long-term effects of teen delinquency and drug abuse on adult role attainment.

Delinquency was defined as anti-social behavior, including frequency of running away, arrests, physical fights and behavioral problems in school.

The study analyzed data from a U.S. Department of Education survey collected from a nationally representative sample of 9,813 young adults from 1988 to 2000. The results were presented at the March conference of the Eastern Sociological Society in Baltimore, Md.

The results are significant, says Blair, associate professor of sociology at UB, because in the U.S. marriage is commonly regarded as offering substantial economic, social and health advantages for individuals. The vast majority of high school girls -- much more so than boys -- tend to view marriage as extremely important to them.

But adolescent substance abuse and delinquent behaviors, he says, clearly have far-reaching consequences for the marital status of young adults, particularly girls.

Most previous studies have focused on the relatively short-term effects of adolescent substance use and delinquency, he says, but here we find good evidence that, for both sexes, delinquent behavior is linked to an increase in the likelihood of marriage and a lower age at first marriage. On the other hand, adolescents with relatively high levels of abuse of alcohol and marijuana have a lower likelihood of marriage even by their late 20s.

The likelihood of marriage by that age is substantially lower among female adolescent substance abusers, particularly if the substance abused is marijuana.

He says the results suggest that delinquency and substance abuse may influence adolescents' orientation toward other adult roles as well.

The analyses employed data from 5,331 females and 4,482 males participants in the National Educational Longitudinal Study (NELS), a nationally representative sample of high school students that collected information from respondents over a 12-year period.

NELS, conducted by the U.S. Department of Education, collected data from surveys of students, parents, teachers and school administrators in 1988, 1990, 1992, 1994 and 2000, at which time most of the students in the sample were in their mid- to late-20s, had completed their educational goals and had already entered into marriage.

Adolescent respondents were asked about the frequency of their alcohol use and marijuana use; delinquent and anti-social behavior, including frequency of running away, arrests, physical fights and school problems (cutting classes, skipping school, getting into trouble for violating rules, suspension or probation, transfer for disciplinary reasons).

The study also assessed data relative to family income, parental expectations about college attendance and the importance peers placed on various activities like going to parties, drinking alcohol, having sex and using drugs. Control measures for the race/ethnicity of respondents were used as well.

It is certainly the case that many of these variables had an effect on the timing of the participants' marital experience, Blair says.

Nevertheless, this analysis clearly suggests that even when all of them are considered, adolescent substance abuse and delinquent behaviors have far-reaching consequences for the marital status of young adults, he says.

Additional research is needed to learn how developmental processes of adolescence are affected by delinquent behavior and substance abuse and the relative influences of these sex-based differences on other forms of adult status attainment.

Naltrexone also curbs compulsive thieving instincts

Wed, 01 Apr 2009 14:57:00 PST

( from http://www.rxpgnews.com ) Washington, April 1 - A medication for treating alcohol and drug addiction also curbs compulsive thieving instincts, according to a new research.

University of Minnesota - Medical School's psychiatry department conducted an eight-week, double-blind study of 25 men and women aged 17-75, who spent an average of at least one hour a week stealing.

Those who took the drug Naltrexone - reported significantly greater decline in stealing behaviour compared to those taking placebo.

'It gets rid of that rush and desire,' said Jon Grant, U-M associate professor of psychiatry and principal investigator of the study. 'The difference in their behaviour was significant, and these people were really troubled by their behaviour,' he added.

A recent epidemiological study of about 43,000 adults found that more than 11 percent admitted to having shoplifted in their lifetime. Epidemiology is the study of factors affecting the health and illness of populations.

It is unclear, however, how many people who steal suffer from kleptomania -.

While the drug is not a cure for kleptomania, Grant said it offers hope to those who are suffering from the addiction. He also said the drug would most likely work best in combination with individual therapy, said a U-M release.

'These are people who steal even though they can easily afford not to,' Grant said.

The research was published in the Wednesday issue of the Journal of Biological Psychiatry.

People With Schizophrenia Face Increased Risk Of Diabetes - Research

Tue, 31 Mar 2009 14:34:02 PST

( from http://www.rxpgnews.com ) Are people with schizophrenia at an increased risk of developing type-2 diabetes? It would seem so, according to the results of a new study.

Of the 50 people diagnosed with schizophrenia or a related psychotic disorder that participated in the study, eight had either diabetes or an abnormal rate of glucose metabolism, said Brian Kirkpatrick, vice-chairman of the Medical College of Georgia's - Department of Psychiatry and Health Behaviour.

'These findings point toward there being some shared environmental factors or genetic factors between the development of schizophrenia and diabetes,' he said.

Schizophrenia symptoms include memory and attention problems, hallucinations, disorganised thinking and behaviour and delusions. Psychotic symptoms typically start in late adolescence and early adulthood.

People with diabetes cannot produce or properly use insulin, a hormone that converts glucose, starch and other food into energy.

Kirkpatrick and colleagues at the Universities of Barcelona - and Maryland - administered a two-hour oral glucose test to patients who had not yet been placed on anti-psychotic medication.

Catching them before prescriptive treatment was important because researchers already knew that some of the most effective schizophrenia drugs also cause rapid weight gain - a risk factor for type-2 diabetes, according to MGC release.

'We know the medicine causes problems but we wanted to know whether the disease also causes them,' said Kirkpatrick.

Researchers believe that developmental abnormalities they don't yet know about also increase diabetes risk.

Kirkpatrick presented his findings at the International Congress on Schizophrenia Research in San Diego March 28-April 1.

Inconsistancy in response underlies impaired working memory in ADHD

Wed, 25 Mar 2009 00:41:44 PST

( from http://www.rxpgnews.com ) Children with attention-deficit hyperactivity disorder (ADHD) show more variable or inconsistent responses during on ‘working’ or short-term, memory tasks when compared with typically developing peers, a study by UC Davis M.I.N.D. Institute Julie Schweitzer has found.

“We think poor working memory is a characteristic present in many children and adults with ADHD,” said Schweitzer, an associate professor in the Department of Psychiatry and Behavioral Sciences.

“Our study helps explain why working memory may be fine at one moment and poor at another, just as one day a child with ADHD seems to be able to learn and focus in class and on another day seems distracted and not paying attention,” Schweitzer said.

According to the national Centers for Disease Control and Prevention (CDC), an estimated 4.4 million youth, ages 4 to17, have been diagnosed with ADHD by a healthcare professional. In 2003 nearly 8 percent of school-aged children were reported to have an ADHD diagnosis by their parent. The current study, published online in February in the journal Child Neuropsychology, supports the idea that what underlies impaired working memory is a problem in how consistently a child with ADHD can respond during a working memory task.
“We have known for some time that children with ADHD vary in how fast they are able to complete working memory tasks when compared to normally developing control subjects,” Schweitzer explained .

Previous studies have suggested that children with ADHD might be slower at responding to tasks. The current study took a closer look at their performance using a relatively newer statistical analytical approach, to determine whether the children with ADHD were indeed faster, slower, or if perhaps another, more complicated process was occurring. The hypothesis was that children with ADHD were actually mostly responding at the same rate as healthy children, but with more frequent very slow responses than the control subjects.

To test this hypothesis, the study authors presented 25 children with ADHD and 24 typically developing peers with the Visual Serial Addition Task, a computerized program that presents children with a number on one screen and then asks them to mentally add it to another number shown on a second screen. The children are then asked to decide whether or not a given sum is correct. From session to session, the task is presented at different speeds and at different levels of difficulty.

“We found that the children with ADHD were much less consistent in their response times,” said Wendy Buzy, study lead author and a graduate student when the experiments were conducted.

Schweitzer and Buzy were both at the University of Maryland at the time. Buzy said that the children with ADHD had more frequent longer response times when compared with their typically developing peers, but the responses they did give were just as accurate.
“Once we controlled for omission errors, the accuracy of the two groups was the same,” she said.

Buzy and Schweitzer pointed out that one of the unique things about their study was the way in which their data were analyzed. Previous studies compared only the range of reaction times and average reaction times for children with ADHD and controls. The method used in the current study allowed researchers to compare variation in response times within and between individuals, as well as within and between the two groups. The researchers also showed that working memory variability correlated with ADHD symptoms as scored by parent surveys (using the Conners’ ADHD rating scale) prior to testing.

“We found that higher levels of hyperactivity and restlessness or impulsivity correlated with slower reaction times,” Schweitzer said.

The current results led another Schweitzer laboratory member, postdoctoral fellow Catherine Fassbender, to design a study looking at variability in response time during a working memory task in the brains of children with ADHD using functional magnetic resonance imaging (fMRI).

“This study increases our understanding of what might be happening at a physiological level that underlies the inconsistency in responding in ADHD,” she said.

Schweitzer also hopes to look at whether behavioral interventions and/or medications can help reduce the kind of variability observed in the current study. Variability in working memory, she said, means children cannot generalize what they learn in one situation to another.

“Improving consistency in how children with ADHD respond to the environment should help them generalize what they learn in clinical interventions improving their skills across situations.”

Drawing enhances emotional verbalization among children under the shadow of drug-addicted fathers

Thu, 12 Mar 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Research at the new School of Creative Arts Therapies at the University of Haifa: Drawing enhances emotional verbalization among children who live under the shadow of drug-addicted fathers

*The use of art seems to help with verbalizing trauma. It is usually difficult to express the trauma through speech, yet the body remembers it, said Prof. Rachel Lev-Wiesel, Head of the Graduate School of Creative Arts Therapies who carried out the study.*

Drawing helps children whose fathers are drug addicts to express their feelings, concludes a new study carried out at the School of Creative Arts Therapies at the University of Haifa. It is difficult to verbally describe a trauma, yet the body remembers it, said Head of the school Prof. Rachel Lev-Wiesel, who carried out the study alongside Revital Liraz of the Hosen Center in Beer Sheba.

People who have experienced trauma often find it difficult to describe their feelings and experiences in words. Art therapy enables the client to expose these feelings first through non-verbal symbols, and then narrate them. The Graduate School of Creative Arts Therapies at the University of Haifa is the first Israeli academic track that grants an MA degree in creative arts therapies to its graduates. There are three courses of study in the school: Plastic Art Therapy, Movement Therapy, and Drama Therapy. The importance of therapy through the arts has increased over the past years, and as with every other discipline of therapy, much weight ought to be placed on basing therapist training on research, said Prof. Lev-Wiesel.

Participating in this study were 60 children, aged nine to fourteen, who were arbitrarily divided into two groups. The children in the first group were asked to draw their life in the shadow of a drug-addicted father and then to describe their experiences to a social worker who interviewed them. The second group was asked to describe life with a drug-addicted father without use of drawings. It was observed that already while drawing the first group of children spoke freely about their lives.

An analysis of the narratives provided by the two groups revealed that the descriptions given by those children who had been asked to draw first included more feelings and sensations, were longer, and expressed optimism for the future. The children in the second group, however, were more reluctant to talk. Their narratives were shorter, without feeling, and less coherent. Emotional-verbal ability is crucial for growth and for social skills, so enabling a child to increase ability of expression and sharing by means of drawing pictures is beneficial in contributing to the efficiency and effectiveness of therapy, Prof. Lev-Wiesel concluded.

Therapy through art is a relatively new field, she said, there is still a lack of empirical studies. One of the goals of the new school is to expand the pool of researchers in the field.

UCSF Gallo team reports hormone disorder drug could help drinkers stay sober

Mon, 23 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) A drug prescribed for male and female infertility and menstrual disorders could hold the key to a more effective treatment for alcoholism, according to a study by researchers at the UCSF-affiliated Ernest Gallo Clinic and Research Center.

The study showed that alcoholic rodents, when injected with the drug cabergoline, decreased their alcohol consumption and alcohol-seeking behavior and were less likely to relapse.

Cabergoline, which is marketed under the trade name Dostinex, is approved by the Food and Drug Administration in pill form to treat conditions caused by excess of the hormone prolactin.

The study, led by Dorit Ron, PhD, a principal investigator at the Gallo Center and associate professor of neurology at UCSF, is now on line (February 20, 2009), in the journal Biological Psychiatry. (See end of news release for link to paper.)

Notably, cabergoline did not impact the rats' consumption of sucrose and, in a subgroup of binge-drinking mice, the drug did not appear to significantly affect intake of water or saccharin.

This is encouraging, says Ron, because it demonstrates that cabergoline is specific for alcohol, but does not affect general reward or pleasure. One of the problems with some existing drugs to treat alcoholism is a side effect that decreases pleasure, making compliance an obstacle to sobriety.

The research builds on an earlier, provocative finding by Ron and her colleagues regarding the protein GDNF (glial cell line-derived neurotrophic factor), which they had injected into rats' VTA (ventral tegmental area) brain region, associated with drug-seeking behavior.

In this earlier study, the scientists had trained rats to consume alcohol. Some, like humans, drank in moderation, while others binged. But when GDNF was administered, both heavy and light drinkers lost at least some of their craving for alcohol. This effect became apparent within 10 minutes and lasted at least 24 hours, the scientists discovered. Importantly, administration of GDNF into the brain prevented the rats from relapsing after a period of abstinence.

While the discovery broke new ground, the scientists knew that GDNF could not be used to treat alcoholic humans because its molecule is too large to cross the blood-brain barrier. So, in the present study, Ron and her colleagues looked at cabergoline, a compound that has been shown in cells to increase the expression of GDNF.

After establishing that cabergoline treatment resulted in an increase of the level of GDNF and activation of the GDNF pathway in the rats' VTA, the researchers sought to test its impact on rodents' drinking habits.

Rats underwent a two-month training program in which they learned to press a lever to obtain alcohol. Researchers found that when rats were injected with cabergoline, they were less likely to press the lever. The higher the dose of cabergoline, the lower the number of lever presses reported. The researchers also found that binge-drinking mice consumed less alcohol after cabergoline administration.

In further study, the researchers found that cabergoline was effective in reducing both craving for alcohol and relapse to drinking. Relapse is a critical issue for alcoholic patients trying to stay abstinent.

As further evidence of the interplay between cabergoline and GDNF, alcohol intake was tested on mice that had been genetically engineered to have a single copy of the GDNF gene, and therefore less GDNF in the brain. As expected, the scientists found that the drinking habits of these genetically modified mice were not affected by cabergoline.

Although the results of the study offer fresh hope to problem drinkers, Ron cautions that human clinical trials are needed before cabergoline can be safely prescribed. Higher doses of cabergoline have been used to treat Parkinson's disease and have been linked to heart valve problems.

However, notes Ron, we show that in mice and rats, a low dose of the drug is enough to reduce excessive alcohol consumption, alcohol seeking and relapse. The dose is similar to what is given to humans for the treatment of hyperprolactinemia.

Cabergoline may eventually be prescribed for other addictions. A pilot study conducted on cocaine addicts, cited in Ron's paper, reported a substantial reduction in cocaine use.

In the United States, 17.6 million people -- approximately one in every 12 adults -- abuses alcohol or is alcohol-dependent, according to the National Institutes of Health. But there are just three medications approved to treat alcohol dependence -- disulfiram (Antabuse), naltrexone (Depade, ReVia), and acamprosate (Campral).

Virtual studies answer real questions

Sat, 14 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Are online games just for male teenagers?

About 80 percent of Ever Quest II players are male, but the hardcore players are women. And, almost all players are adults.

The women play more intensely than the guys do, Williams says. They're less likely to quit, and they're happier playing.

They also buy into the males-only stereotypes of technology use: women under-reported their playing time much more than men. Williams believes that female players may lie about their playing habits out of a sense of shame.

But female players spent an average of 29 hours a week in-world, versus 25 for males.

Can game researchers trust players to self-report their playing time?

No. As the first researcher with the ability to compare survey responses to server data, Williams found a large discrepancy, with most players systematically underestimating by 3-4 hours per week. This potentially calls into question 30 years of game research based on self-reported data.

Why don't we do anything together anymore?

Server data doesn't lie: in the online game EverQuest II, men in committed heterosexual relationships prefer to play alone, while women prefer to play with their partner. Follow-up surveys confirm that what's good for the goose is not good for the gander, Williams says.

Men are happier when playing without their partner. Women are happier when they play with them, says Williams, a sociologist and assistant professor in the USC Annenberg School for Communication. He will report findings at AAAS from his upcoming study of gender differences.

If I'm a head case, will role-playing make it worse?

Not necessarily, says Williams: We found it to be, surprisingly, a pretty healthy thing.

Only a small number of players adopt a character other than their real self, Williams explains. Those that do tend to have more mental health problems than average.

Every psychological indicator is worse for them: drug use, ADD, depression, substance abuse, Williams says.

However, Williams found that online play provided a valuable outlet.

They're very aware of the pitfalls of doing it for the wrong reasons or in the wrong way, and most of them see it as a release. It's people who feel they can't express themselves offline.

Williams was the first game researcher to be granted access to a major online world's database. As a result, he was able to match hard data about in-world behavior with survey responses. Nearly 7,000 players of EverQuest II agreed to participate in exchange for an in-world prize, The Great Staff of the Sun Serpent.

The symposium Analyzing Virtual Worlds: Next Step in the Evolution of Social Science Research, will start at 8:30 a.m. on Feb. 14 in the Columbus GH room of the Hyatt Regency Hotel.

The symposium organizers are Jaideep Srivastava of the University of Minnesota, Noshir Contractor of Northwestern University, and Scott Poole of the University of Illinois at Urbana-Champaign. Each will present on a different aspect of virtual world research.

Smokers putting their loved ones at risk of heart attacks

Wed, 11 Feb 2009 05:00:00 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.

Methamphetamine use cost the US about $23 billion in 2005, RAND study estimates

Wed, 04 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) The economic cost of methamphetamine use in the United States reached $23.4 billion in 2005, including the burden of addiction, premature death, drug treatment and many other aspects of the drug, according to a new RAND Corporation study.

The RAND study is the first effort to construct a comprehensive national assessment of the costs of the methamphetamine problem in the United States.

Our findings show that the economic burden of methamphetamine abuse is substantial, said Nancy Nicosia, the study's lead author and an economist at RAND, a nonprofit research organization.

Although methamphetamine causes some unique harms, the study finds that many of the primary issues that account for the burden of methamphetamine use are similar to those identified in economic assessments of other illicit drugs.

Given the uncertainty in estimating the costs of methamphetamine use, researchers created a range of estimates. The lowest estimate for the cost of methamphetamine use in 2005 was $16.2 billion, while $48.3 billion was the highest estimate. Researchers' best estimate of the overall economic burden of methamphetamine use is $23.4 billion

The study was sponsored by the Meth Project Foundation, a nonprofit group dedicated to reducing first-time methamphetamine use. Additional support was provided by the National Institute on Drug Abuse.

We commissioned this study to provide decision makers with the best possible estimate of the financial burden that methamphetamine use places on the American public, said Tom Siebel, founder and chairman of the Meth Project. This is the first comprehensive economic impact study ever to be conducted with the rigor of a traditional cost of illness study, applied specifically to methamphetamine. It provides a conservative estimate of the total cost of meth, and it reinforces the need to invest in serious prevention programs that work.

The RAND analysis found that nearly two-thirds of the economic costs caused by methamphetamine use resulted from the burden of addiction and an estimated 900 premature deaths among users in 2005. The burden of addiction was measured by quantifying the impact of the lower quality of life experienced by those addicted to the drug.

Crime and criminal justice expenses account for the second-largest category of economic costs, according to researchers. These costs include the burden of arresting and incarcerating drug offenders, as well as the costs of additional non-drug crimes caused by methamphetamine use, such as thefts committed to support a drug habit.

Other costs that significantly contribute to the RAND estimate include lost productivity, the expense of removing children from their parents' homes because of methamphetamine use and spending for drug treatment.

One new category of cost captured in the analysis is the expense associated with the production of methamphetamine. Producing methamphetamine requires toxic chemicals that can result in fire, explosions and other events. The resulting costs include the injuries suffered by emergency personnel and other victims, and efforts to clean up the hazardous waste generated by the production process.

Researchers caution that their estimates are in some cases based on an emerging understanding of methamphetamine's role in these harms and should be further refined as understanding of these issues matures. The RAND report also identifies costs that cannot yet be adequately quantified.

Estimates of the economic costs of illicit drug use can highlight the consequences of illegal drug use on our society and focus attention on the primary drivers of those costs, Nicosia said. But more work is needed to identify areas where interventions to reduce these harms could prove most effective.

Methamphetamine is a highly addictive substance that can be taken orally, injected, snorted or smoked. While national surveys suggest that methamphetamine use is far from common, there is evidence that the harms of methamphetamine may be concentrated in certain regions. One indicator of the problem locally is treatment admissions. Methamphetamine was the primary drug of abuse in 59 percent of the treatment admissions in Hawaii in 2004 and accounted for 38 percent of such admissions in Arizona in 2004.

Genetics may increase propensity for alcoholism

Tue, 03 Feb 2009 23:21:01 PST

( from http://www.rxpgnews.com ) In Poland, alcohol dependence (AD) affects about four percent of the population, causing about 10,000 deaths per year. While a number of biological markers have been linked to a predisposition for developing AD, a new study has found a link between the Val66Met (rs6265) polymorphism in the brain-derived neurotrophic factor (BDNF) gene and risk for post-treatment relapse among AD patients.

Results will be published in the April issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Some people are simply more likely than others to become dependent on alcohol," explained Marcin Wojnar, associate professor of psychiatry at the Medical University of Warsaw and adjunct researcher at the University of Michigan. "Clearly, cultural, social, and psychological factors are involved. AD also runs in families, so there is an inherited component to it. Once AD has developed, certain people are more likely to relapse after treatment than others. Some studies show that a family history of alcoholism can lead to a more severe illness that is harder to treat, which is why our group and others are looking at genetic factors."

"Although some biological predictors of the re-emergence of AD have been described," said Lance Bauer, professor of psychiatry at the University of Connecticut School of Medicine, "biological measures can be affected by many variables, such as the time of day; the patient's gender, age, or medical background; or medications that have been prescribed. Most genetic differences are not complicated by these same variables. Accordingly, this study by Wojnar and colleagues points us toward a new and promising approach."

"We selected genetic polymorphisms that were, one, related to serotonin or dopamine function; and two, associated with suicidality and/or impulsivity," said Wojnar, who is the study's first author. "Serotonin's decreased functioning has consistently been reported to be associated with both impulsivity and suicidal behaviors. Regarding dopamine, most researchers agree that it plays an essential role in addiction, either by causing pleasure from taking drugs or by telling the brain to associate that pleasure with certain cues in the environment."

The researchers examined 154 patients (117 males, 37 females) from addiction-treatment programs in Poland who met Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition criteria for AD. All were assessed for demographics, severity of alcohol use, suicidality, impulsivity, depression, hopelessness, and severity of alcohol use at baseline; 123 patients were followed for approximately one year to evaluate treatment outcomes. In addition, patients were tested for genetic polymorphisms in several genes as predictors of relapse – defined as "any drinking during follow-up" – which were: rs1386483 in the tryptophan hydroxylase type 2 gene, C102T (rs6313) in the serotonin receptor 2A gene, 5-HTT gene-linked polymorphic region in locus SLC6A4, C(-1019)G (rs6295) in the serotonin receptor 1A gene, Val158Met (rs4680) in the catechol-O-methyl transferase gene, and the Val66Met (rs6265) in the BDNF gene.

"Our study indicated that some patients may have inherited a tendency to return to drinking even after intensive treatment," said Wojnar, "and [may be] more treatment-resistant than other patients. Specifically, we found that a particular type or variant of the gene that codes for BDNF was associated with an increased risk for relapse in alcoholic patients, particularly those with a family history of AD." BDNF is a protein found in the brain that helps nerve cells survive and connect to one another.

"These findings provide further support for the assertion that alcoholic patients are not all alike," said Bauer. "Some possess genetic propensities which … may motivate or promote risk for alcoholism as well as risk for treatment failure."

"These patients may have special difficulty in responding well to currently available treatments because of their biological makeup," added Wojnar, "and therefore may need newly constructed intensive programs of therapy that are preferably individualized. This might be a step forward towards 'personalized medicine.'"

Bauer agreed. "During the past 10 years, several new treatments have become available," he said. "However, 'how does one decide among the options?' Genetic differences may eventually help us make the decision. For example, individuals possessing the high-risk-for-relapse variant of the BDNF gene might warrant assignment to the most intensive – and usually most expensive – treatment. Individuals with the low-risk variant might not require this level of treatment to have a good outcome."

Increase in the number of children born in California with autism

Thu, 08 Jan 2009 12:45:17 PST

( from http://www.rxpgnews.com ) A study by researchers at the UC Davis M.I.N.D. Institute has found that the seven- to eight-fold increase in the number children born in California with autism since 1990 cannot be explained by either changes in how the condition is diagnosed or counted — and the trend shows no sign of abating.

Published in the January 2009 issue of the journal Epidemiology, results from the study also suggest that research should shift from genetics to the host of chemicals and infectious microbes in the environment that are likely at the root of changes in the neurodevelopment of California’s children.

“It’s time to start looking for the environmental culprits responsible for the remarkable increase in the rate of autism in California,” said UC Davis M.I.N.D. Institute researcher Irva Hertz-Picciotto, a professor of environmental and occupational health and epidemiology and an internationally respected autism researcher.

Hertz-Picciotto said that many researchers, state officials and advocacy organizations have viewed the rise in autism's incidence in California with skepticism.

The incidence of autism by age six in California has increased from fewer than nine in 10,000 for children born in 1990 to more than 44 in 10,000 for children born in 2000. Some have argued that this change could have been due to migration into California of families with autistic children, inclusion of children with milder forms of autism in the counting and earlier ages of diagnosis as consequences of improved surveillance or greater awareness.

Hertz-Picciotto and her co-author, Lora Delwiche of the UC Davis Department of Public Health Sciences, initiated the study to address these beliefs, analyzing data collected by the state of California Department of Developmental Services (DDS) from 1990 to 2006, as well as the United States Census Bureau and state of California Department of Public Health Office of Vital Records, which compiles and maintains birth statistics.

Hertz-Picciotto and Delwiche correlated the number of cases of autism reported between 1990 and 2006 with birth records and excluded children not born in California. They used Census Bureau data to calculate the rate of incidence in the population over time and examined the age at diagnosis of all children ages two to 10 years old.

The methodology eliminated migration as a potential cause of the increase in the number of autism cases. It also revealed that no more than 56 percent of the estimated 600-to-700 percent increase, that is, less than one-tenth of the increased number of reported autism cases, could be attributed to the inclusion of milder cases of autism. Only 24 percent of the increase could be attributed to earlier age at diagnosis.

“These are fairly small percentages compared to the size of the increase that we’ve seen in the state,” Hertz-Picciotto said.

Hertz-Picciotto said that the study is a clarion call to researchers and policy makers who have focused attention and money on understanding the genetic components of autism. She said that the rise in cases of autism in California cannot be attributed to the state’s increasingly diverse population because the disorder affects ethnic groups at fairly similar rates.

“Right now, about 10 to 20 times more research dollars are spent on studies of the genetic causes of autism than on environmental ones. We need to even out the funding,” Hertz-Picciotto said.

The study results are also a harbinger of things to come for public-health officials, who should prepare to offer services to the increasing number of children diagnosed with autism in the last decade who are now entering their late teen years, Hertz-Picciotto said.

“These children are now moving toward adulthood, and a sizeable percentage of them have not developed the life skills that would allow them to live independently,” she said.

The question for the state of California, Hertz-Picciotto said, will become: 'What happens to them when their parents cannot take care of them?'

“These questions are not going to go away and they are only going to loom larger in the future. Until we know the causes and can eliminate them, we as a society need to provide those treatments and interventions that do seem to help these children adapt. We as scientists need to improve available therapies and create new ones,” Hertz-Picciotto said.

Hertz-Picciotto and her colleagues at the M.I.N.D Institute are currently conducting two large studies aimed at discovering the causes of autism. Hertz-Picciotto is the principal investigator on the CHARGE (Childhood Autism Risk from Genetics and the Environment) and MARBLES (Markers of Autism Risk in Babies-Learning Early Signs) studies.

CHARGE is the largest epidemiologic study of reliably confirmed cases of autism to date, and the first major investigation of environmental factors and gene-environment interactions in the disorder. MARBLES is a prospective investigation that follows women who already have had one child with autism, beginning early in or even before a subsequent pregnancy, to search for early markers that predict autism in the younger sibling.

“We’re looking at the possible effects of metals, pesticides and infectious agents on neurodevelopment,” Hertz-Picciotto said. “If we’re going to stop the rise in autism in California, we need to keep these studies going and expand them to the extent possible.”

Decreased Dopamine processing ability - cause for high risk behaviour?

Wed, 31 Dec 2008 08:31:47 PST

( from http://www.rxpgnews.com ) For risk-takers and impulsive people, New Year's resolutions often include being more careful, spending more frugally and cutting back on dangerous behavior, such as drug use. But new research from Vanderbilt finds that these individuals--labeled as novelty seekers by psychologists--face an uphill battle in keeping their New Year's resolutions due to the way their brains process dopamine. The research reveals that novelty seekers have less of a particular type of dopamine receptor, which may lead them to seek out novel and exciting experiences--such as spending lavishly, taking risks and partying like there's no tomorrow.

The research was published Dec. 31, 2008, in the Journal of Neuroscience.

The neurotransmitter dopamine is produced by a select group of cells in the brain. These dopamine-producing cells have receptors called autoreceptors that help limit dopamine release when these cells are stimulated.

"We've found that the density of these dopamine autoreceptors is inversely related to an individual's interest in and desire for novel experiences," David Zald, associate professor of psychology and lead author of the study, said. "The fewer available dopamine autoreceptors an individual has, the less they are able to regulate how much dopamine is released when these cells are engaged. Because of this, novelty and other potentially rewarding experiences that normally induce dopamine release will produce greater dopamine release in these individuals."

Dopamine has long been known to play an important role in how we experience rewards from a variety of natural sources, including food and sex, as well as from drugs such as cocaine and amphetamine. Previous research has shown that individuals differ in both their number of dopamine receptors and the amount of dopamine they produce, and that these differences may play a critical role in addiction. Zald and his colleagues set out to explore the connection between dopamine receptors and the novelty-seeking personality trait.

"Novelty-seeking personality traits are a major risk factor for the development of drug abuse and other unsafe behaviors," Zald and his colleagues wrote.

"Our research suggests that in high novelty-seeking individuals, the brain is less able to regulate dopamine, and this may lead these individuals to be particularly responsive to novel and rewarding situations that normally induce dopamine release," Zald said.

Previous research in rodents showed that some respond differently to novel environments. Those who explore novel environments more are also more likely to self-administer cocaine when given the chance. Dopamine neurons fire at a higher rate in these novelty-responsive rodents, and the animals also have weak autoreceptor control of their dopamine neurons. Zald and colleagues speculated that the same relationships would be seen in humans.

The researchers used positron emission topography to view the levels of dopamine receptors in 34 healthy humans who had taken a questionnaire that measured the novelty-seeking personality trait. The questionnaire measured things such as an individual's preference for and response to novelty, decision-making speed, a person's readiness to freely spend money, and the extent to which a person is spontaneous and unconstrained by rules and regulations. The higher the score, the more likely the person was to be a novelty seeker.

The researchers found that those that scored higher on the novelty-seeking scale had decreased dopamine autoreceptor availability compared to the subjects that scored lower.

Monthly shot for holiday drinkers on wagon

Wed, 17 Dec 2008 05:00:00 PST

( from http://www.rxpgnews.com ) ALCOHOLICS struggling to keep off shots of the hard stuff over the festive season may want to consider an alternative shot: a monthly injection that keeps them off the booze.

For people battling alcoholism, holidays pose a strong danger of relapse. When you interview patients about triggers for drinking, they often say holidays and family events, says David Rosenbloom, a specialist in substance abuse at Boston University School of Public Health. For some it's the stress of being lonely, for others it's the stress of being with people. Over Christmas and New Year, social pressure and opportunities to drink add to the intoxicating mix.

Some people take pills containing naltrexone, a substance that reduces the desire to drink by blocking the receptors in the brain responsible for the high that drinking brings. But during the holiday season, pressures often drive alcoholics to stop taking the tablets. With a pill, they have to make a decision every day, says Sandra Lapham at the Behavioral Health Research Center of the Southwest in Albuquerque, New Mexico.

In 2006, the US Food and Drug Administration approved a slow-release formulation of naltrexone, in which the drug is stored in microscopic spheres made of a biodegradable polymer and injected into muscle once a month. Lapham wondered if this might help people who stop taking naltrexone pills during holidays. Working with the company that manufactures the formulation - Alkermes, based in Cambridge, Massachusetts - she reanalysed data from a previous clinical trial, focusing on the drug's performance during 10 US holidays and celebrations.

The study was small - just 28 patients received full-dose naltrexone shots, compared with another 28 given placebos. The shots reduced the frequency of drinking days, the number of drinks and the percentage of days classed as heavy drinking sessions - five or more drinks a day for men, and four for women. Crucially, the drug was just as effective during the holidays as it was for the rest of the year (Journal of Substance Abuse Treatment, vol 36, p 1).

The results have impressed Rosenbloom, who describes their significance for public health as huge. Lapham warns that naltrexone injections must be given with care, because they can cause abscesses if the drug is deposited into fatty tissue.

The treatment might also reduce deaths from drink-driving: in the US, 40 per cent of road deaths over Christmas and the New Year involve at least one driver impaired by alcohol, compared with about 28 per cent for the rest of December. Rosenbloom would like to see courts offer naltrexone shots to repeat drink-driving offenders.

Up to 2 drinks per day not linked with higher risk of irregular heart beat for women

Tue, 02 Dec 2008 05:00:00 PST

( from http://www.rxpgnews.com ) Women who have up to two alcoholic drinks per day do not appear to be at increased risk of atrial fibrillation (irregular heart beat), but drinking more than that amount is associated with a higher risk, according to a study in the December 3 issue of JAMA.

Studies assessing the effects of regular alcohol consumption on the risk of atrial fibrillation have provided inconsistent results, with several studies finding significant associations between moderate to high amounts of alcohol intake and increased risks of atrial fibrillation among men, but not among women. However, these studies were not of adequate size to detect significant associations among women, according to background information in the article.

David Conen, M.D., M.P.H., of Brigham and Women's Hospital, Harvard Medical School, Boston, and University Hospital, Basel, Switzerland, and colleagues analyzed data from a completed randomized controlled trial involving 34,715 women participating in the Women's Health Study, to assess the effects of regular alcohol consumption on the risk of atrial fibrillation. The participants were older than 45 years and had no atrial fibrillation at the start of the study and underwent follow-up from 1993 to October 2006. Alcohol consumption was assessed via questionnaires at the beginning of the trial and at 48 months of follow-up and was grouped into 4 categories: 0 drinks per day, greater than 0 and less than 1, 1 or more and less than 2, and 2 or more drinks per day. Atrial fibrillation was self-reported on the yearly questionnaires and subsequently confirmed by electrocardiogram and medical record review.

During a median (midpoint) follow-up of 12.4 years, there were 653 confirmed cases of new atrial fibrillation. Among women consuming no alcohol (n = 15,370), there were 294 events (1.9 percent); for women consuming more than 0 and less than 1 drink per day (n = 15,758), there were 284 events (1.8 percent); for 1 to 2 drinks per day (n = 2,228), there were 35 events (1.6 percent); and for women consuming 2 or more drinks per day (n = 1,359), there were 40 atrial fibrillation events (2.9 percent).

In the present study, alcohol consumption of up to 2 drinks per day was not associated with an increased risk of incident atrial fibrillation among initially healthy, middle-aged women. In contrast, the small group of women who consumed 2 or more alcoholic beverages per day had a 1.6-fold greater risk for atrial fibrillation relative to nondrinking women. While this finding needs to be interpreted with some caution because of the small number of women in some subgroups, it supports a possible threshold effect in the relationship between alcohol consumption and risk of atrial fibrillation among women, the authors write.

Genes behind bipolar disorder mapped by scientists

Sun, 23 Nov 2008 11:44:57 PST

( from http://www.rxpgnews.com ) New York, Nov 22 - In a first, scientists have comprehensively mapped the genes believed to cause bipolar disorder.

Indiana University neuroscientists combined data from the latest gene hunting studies for bipolar disorder with information from their own studies to zero in on the best candidate genes for the illness.

Their findings, reported in the latest issue of the American Journal of Medical Genetics, describe how researchers analysed how these genes work together to create a comprehensive biological model of bipolar disorder.

'Based on our work, we now project that there will be hundreds of genes -- possibly as much as 10 percent of the human genome -- involved in this illness,' said Alexander B. Niculescu, who led the team, in a press release.

'Not all genetic mutations will occur in every individual with bipolar disorder. Different individuals will have different combinations of genetic mutations. This genetic complexity is most likely what made past attempts to identify genes for the disorder through genetic-only studies so difficult and inconsistent.'

Until now there have been few statistically significant findings in searches of the human genome as it applies to bipolar disorder, he said.

'By integrating the findings of multiple studies, we were able to sort through, identify genes that were most likely to be involved in bipolar disorder, and achieve this major breakthrough in our understanding of the illness,' Niculescu said.

Bipolar disorder, sometimes called manic depression, affects millions worldwide and people who suffer from it can experience mild or dramatic mood swings, shifts in energy and a diminished capacity to function.

The findings of the study hold out the hope that, having assessed individual gene combinations, individuals likely to suffer from bipolar disorder can be identified even before the illness manifests itself.

This could result in preventive measures like lifestyle changes, counselling and low-dose medications.