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Tuesday, December 2, 2008

Northeastern University Professor Studies Limited Literacy And Mental Health Outcomes

Alisa Lincoln, Ph.D., M.P.H., associate professor of health sciences and sociology at Northeastern, recently completed one of the first studies of its kind on the role of literacy and mental health. While much attention has been focused on the role of literacy and health, little is known about the relationship between literacy and mental health. This study was designed to assess the literacy level of people seeking treatment for a full range of psychiatric disorders with the hopes of better understanding the relationship between literacy and mental health outcomes.

The results were published in the Journal of Nervous and Mental Disease.

According to the National Institutes of Health, an estimated 26.2 percent of Americans ages 18 and older - about one in four adults - suffer from a diagnosable mental disorder in a given year. In addition, millions of Americans lack the literacy proficiency necessary to understand and act on health information from health care providers.

"Although mental health issues and limited literacy are very common in the United States, there is little information about how one impacts the other," said Lincoln.

Literacy impacts health outcomes, and limited literacy creates unique challenges in mental health treatment. Current standard psychiatric evaluations do not include a literacy assessment, and many treatment methods assume a certain level of literacy, creating barriers to positive health outcomes for patients with a psychiatric diagnosis.

Professor Lincoln and her colleagues conducted this study in an urban public health clinic with patients diagnosed with a wide range of psychiatric diagnoses, including depression, bipolar disorder, anxiety, substance abuse, attention deficit hyperactivity disorder and schizophrenia.

"Most of the current information about mental health and literacy focuses only on depression," said Lincoln. "We wanted to expand on that and look at other diagnoses to examine how literacy levels vary among different diagnoses."

This study was done in collaboration with Dr. Peggy Johnson, Vice Chair of Clinical Psychiatry at Boston Medical Center.

The data collected showed that a complicated relationship exists between literacy and the aforementioned psychiatric diagnoses. There exists a correlation between limited literacy in some diagnoses, but it was not consistent.

"In order to develop effective psychiatric treatments that result in better outcomes, we need to increase our understanding of the relationships that exist between psychiatric disorders - on all levels - and health literacy," added Lincoln. "It is important for clinicians to take literacy levels into consideration when developing treatment plans for their patients."

For more information about Professor Lincoln's research, please visit http://www.northeastern.edu/bouve/faculty/lincoln_a.html

Taken from medicalnewstoday.com with permission

Statement From World AIDS Campaign On Appointment Michel Sidibé As New UNAIDS Executive Director

On this 1 December, the 20th Anniversary of World AIDS Day, World AIDS Campaign wish to extend their congratulations to the newly appointed UNAIDS Executive Director Michel Sidibé.

In accepting his new position, Mr. Sidibé said that, "We have to ensure that there is strong and long term leadership and financial commitment to respond to AIDS that is grounded in evidence and human rights." In light of the 2008 World AIDS Day theme of leadership we commend Mr. Sidibé and encourage his strong continued leadership in the response to AIDS.

At his current post as UNAIDS Deputy Executive Director, Mr. Sidibé has been a champion in promoting universal access to prevention, treatment, care and support. In addition he has worked within the UN to strengthen partnerships between governments, civil society and people living with HIV.

The World AIDS Campaign and its Global Steering Committee, composed of representatives from youth, women, positive networks, NGOs, media, labor, key populations, faith organizations and business look forward to working collaboratively with the new executive director to continue strengthening civil society campaigning in its goal of achieving universal access by 2010 and holding leaders accountable for their AIDS-related promises.

The World AIDS Campaign, with support of its Global Steering Committee networks, selects the international theme for World AIDS Day each year. "Leadership" under the slogan "Stop AIDS. Keep the Promise" is the theme for the 2008 World AIDS Day.

The World AIDS Campaign located in South Africa and The Netherlands, supports, strengthens and connects campaigns that hold leaders accountable for their promises on HIV and AIDS.

Taken from medicalnewstoday.com with permission

Friday, October 24, 2008

Genome Study Finds 26 Lung Cancer Genes

US scientists working on the largest study ever to map the genetic changes involved in lung adenocarcinoma have identified 26 genes that are frequently mutated in this most common form of lung cancer, further increasing opportunities for individualized diagnosis and treatment of the country's leading cause of cancer deaths.

The Tumor Sequencing Project (TSP) consortium study was funded by the National Human Genome Research Institute (NHGRI) of the National Institutes of Health (NIH) and was the work of investigators from many research centers throughout the US and two in Germany. It is published in the 23 October print issue of the journal Nature.

Acting Director of the NHGRI, Dr. Alan E. Guttmacher said:

"By harnessing the power of genomic research, this pioneering work has painted the clearest and most complete portrait yet of lung cancer's molecular complexities."

"This big picture perspective will help to focus our research vision and speed our efforts to develop new strategies for disarming this common and devastating disease," he added.

The TSP consortium's achievement more than doubles the number of genes that were already known to be linked to lung adenocarcinoma, a deadly form of lung cancer.

However, the study did more than identify gene mutations, it also discovered detailed gene signaling pathways involved in the development of lung adenocarcinoma, and mapped the genetic differences among subgroups of lung cancer patients, such as between smokers and never- smokers.

Most cancers, including lung adenocarcinoma happen because DNA changes accumulate as people age, but not much is known about the biology of how the DNA changes lead to uncontrolled cell growth.

The TSP consortium is one of many multi-institution groups seeking to chart the complete DNA or genome map of many types of cancer.

A senior author of this paper, Dr. Matthew Meyerson, who is a senior associate member of the Broad Institute of MIT and Harvard and an associate professor at the Dana-Farber Cancer Institute and Harvard Medical School, said:

"We found lung adenocarcinoma to be very diverse from a genetic standpoint."

Meyerson explained that the study uncovered many new targets for therapy: both in terms of oncogenes (genes that drive cancer growth) and tumor suppressor genes (genes that prevent cancer growth).

For the study, the TSP investigators took DNA from tumor tissue donated by 188 patients with lung adenocarcinoma and matched it with DNA from non-cancerous tissue. They purified the DNA and then sequenced it to look for mutations in 623 genes that were already suspected of being linked to cancer.

They found 26 genes that were mutated in a significant number of the samples. Before this, scientists only knew fewer than a dozen genes to be involved in lung adenocarcinoma.

Some of the new lung adenocarcinoma genes they found included:

* Neurofibromatosis 1 (NF1). Mutations of this gene are already known to cause neurofibromatosis 1, a rare inherited disorder that involves uncontrolled growth of nervous system tissue.

* Ataxia Telengiectasia Mutated (ATM). This gene is involved in various types of leukemia and lymphoma, and in ataxia telangiectasia, a rare inherited childhood neurological disorder.

* Retinoblastoma 1 (RB1). This gene plays a role in retinoblastoma, a relatively uncommon type of childhood cancer that starts in the retina of the eye.

* Adenomatosis polyposis coli (APC). Mutations of this gene are linked to colon cancer.

* Ephrin receptors A3 and A5 (EPHA3 and EPHA5), neurotrophin receptors (NTRK1 and NTRK3) and other tyrosine kinases tied to receptors (ERBB4, KDR and FGFR4). These genes control the action of cell receptors used by a family of enzymes known as the tyrosine kinases that play a key role in cell growth, differentiation and death, and are prime targets for new cancer treatments.

Having found the genetic mutations the TSP investigators then looked for the biological pathways they used that could be important to the development of lung adenocarcinoma. This work is valuable for improving cancer treatment.

One example of this valuable work lies in the TSP team's discovery that more than two thirds of the 188 tumors they investigated had at least one mutated form of a gene that affects the mitogen-activated protein kinase (MAPK) pathway, showing it is probably an important player in the development of lung cancer.

Such a discovery will open the way for new treatments using drugs that target the MAPK pathway. One group of similar drugs called MEK inhibitors has already shown promising results in the treatment of colon cancer in mice.

The TSP team also found that more than 30 per cent of tumors had gene mutations that affected the mammalian target of rapamycin (mTOR) pathway. The team believes this means that the drug rapamycin, which is used to treat organ transplant and renal cancer patients, may have a potential use in the treatment of lung cancer.

Among other numerous discoveries made in this study is the possibility that chemotherapy drugs currently used to treat other cancers may be effective in the treatment of certain types of lung cancer. This is because some of the genes activated in lung cancer are the same in other cancers.

The TSP team also analyzed differences in genetic patterns among subgroups of lung adenocarcinoma patients. One such analysis was the difference between smokers and never-smokers.

About 10 per cent of lung cancer patients say they have never used tobacco. In this study, the TSP investigators found that DNA samples from smokers had significantly more gene mutations than samples from never-smokers. Some of the tumors of the smokers had as many as 49 mutations, whereas none of the never-smokers' tumors had more than 5 mutations.

This discovery suggests more research is needed to find out what this means for the management of lung cancer. Information from other cancer studies suggests that the more mutations present, the faster the cancer develops and the harder it is to treat.

A senior author of the paper, Dr. Richard K. Wilson, who is director of the Genome Sequencing Center at Washington University School of Medicine, St. Louis, said:

"Our findings underscore the value of systematic, large-scale studies for exploring cancer."

"We now must move forward to apply this approach to even larger groups of samples and a wider range of cancers," he added.

His colleague and co-author Dr. Richard Gibbs, who is director of the Human Genome Sequencing Center at Baylor College of Medicine, agreed, adding that:

"Clearly, much still remains to be discovered. We have just begun to realize the tremendous potential of large-scale, genomic studies to unravel the many mysteries of cancer."

Over 1 million lives, including 150,000 in the US, are lost every year throughout the world because of lung cancer, the most commonly diagnosed form being lung adenocarcinoma. On average, only about 15 per cent of patients survive more than 5 years after diagnosis, with those who are diagnosed early surviving the longest.

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MS Damage May Be Reversed By Leukemia Drug

Researchers in the UK found that alemtuzumab, a drug initially developed to treat leukemia, stopped the advance of multiple sclerosis (MS) in patients with early stage active relapsing-remitting multiple sclerosis (RRMS) and may even have reversed some of the damage caused by this debilitating neurological disease.

The study was the work of scientists at the University of Cambridge and was published online on 23rd October in the New England Journal of Medicine (NEJM).

The Cambridge group has a long connection with alemtuzumab, a monoclonal antibody that started out as Campath-1H and is now licensed for the treatment of chronic lymphocytic leukaemia. The drug has also been tested for use in other diseases like MS that are caused by an overactive immune system.

MS is a disease where the immune system attacks nerve fibers and the protective myelin sheath that surrounds them. The damage means that electrical signals can't travel so well in the nerve fibers and leak through the damaged sheath, leading to loss of physical skills, sensation, vision, bladder control, and intellectual ability.

Alemtuzumab is a humanized monoclonal antibody that targets the immune system cells that attack the nerve fibers and the myelin sheath.

The study was a phase 2, randomized, blinded trial involving 334 participants who had not been treated for early, relapsing-remitting multiple sclerosis (RRMS). They had all scored 3.0 or less on the Expanded Disability Status Scale and had the disease for three years or less.

Relapsing-remitting multiple sclerosis (RRMS) is the most common form of the disease and is often followed by the more disabling form which is called secondary-progressive MS (SPMS).

The participants were randomized to one of two groups. One group received alemtuzumab intravenously (at a dose of either 12 or 24 mg a day) for five days and then again for three days one year later. The other group received 44 microgram injections of interferon beta-1a three times a week.

The participants were followed for 36 months to find out how effective the treatments were and how their disabilities changed.

The alemtuzumab therapy was stopped after one annual cycle because three patients died after developing immune thrombocytopenic purpura (low platelet count). The interferon beta-1a group continued with treatment for the rest of the study period.

The results showed that:

* Compared with interferon beta-1a, alemtuzumab significantly reduced the rate of sustained accumulation of disability (26.2 versus 9.2 per cent respectively).

* The annual rate of relapse in the interferon beta-1a group was significantly higher than the alemtuzumab group (0.36 versus 0.10).

* On a 10-point scale of disability, the mean score significantly improved by 0.39 point in the alemtuzumab group and worsened by 0.38 point in the interferon beta-1a group.

* The lesion burden (a way of assessing the neurological damage of the disease using a method called T2-weighted magnetic resonance imaging or MRI) in the alemtuzumab group was lower than that of the interferon beta-1a group.

* From month 12 to month 36 of the study, brain volume (measured by viewing T1-MRI scans) increased in the alemtuzumab group but decreased in the interferon beta-1a group.

* There were some serious increases in adverse events in the alemtuzumab group compared to the interferon beta-1a group. These were: two types of autoimmunity event (thyroid disorders [23 versus 3 per cent respectively] and immune thrombocytopenic purpura [3 versus 1 per cent]) and infections (66 versus 47 per cent respectively).

* There were no signficant differences between the two doses of alemtuzumab (12 mg and 24 mg).

The researchers concluded that:

"In patients with early, relapsing-remitting multiple sclerosis, alemtuzumab was more effective than interferon beta-1a but was associated with autoimmunity, most seriously manifesting as immune thrombocytopenic purpura. The study was not powered to identify uncommon adverse events."

The next stage will be a phase 3 trial, which principal investigator Alastair Compston, Professor of Neurology and the Head of the Department of Clinical Neurosciences at the University of Cambridge hopes will confirm that alemtuzumab "can both stabilize and allow some recovery of what had previously been assumed to be irreversible disabilities".

Head of research at the MS Society in the UK, Lee Dunster, welcome the study. He said in a press statement that:

"The MS Society has been following this trial closely and we are delighted that it has reported such positive results."

"This is the first drug that has shown the potential to halt and even reverse the debilitating effects of MS and this news will rightly bring hope to people living with the condition day in, day out," said Dunster, and although more research is needed to prove the drug's long term effectiveness, the society is:

"Very much looking forward to the results of the next stage of this important research, which is already underway."

There are nearly 100,000 people living with MS in the UK, about 400,000 in the US and several million worldwide.

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Sunday, September 28, 2008

Shocking Pictures To Appear On Cigarette Packets In UK On 1st October

The UK's ten million Smokers may see pictures of rotting teeth, throat cancer, and indications of male impotence (erectile dysfunction) on cigarette packets they buy at the beginning of October. The Department of Health (DoH) says "The warnings illustrate the devastating effects that tobacco can have on health."

Written warnings were introduced in January 2003. The DoH says they have been a great success. It says over 90,000 smokers have been moved by written warnings and consequently called the NHS Smoking Helpline (Tel - (0800 169 0 169).

There are 1.9 million fewer smokers today in the United Kingdom, compared to 1982. However, the DoH says smoking is still the nation's biggest killer. In England alone smoking is responsible for the premature deaths of 87,000 people annually.

The DoH says it expects the graphic pictures should have an even bigger impact on both triggering smokers into action (to giving up) and putting off want-to-be smokers from ever starting. These visual warnings will be changed periodically, for maximum effect. Research suggests that smokers remember the negative effects for longer if they are exposed to images, compared to written sentences.

Sir Liam Donaldson, Chief Medical Officer said:

"I welcome the introduction of picture warnings on tobacco product packaging, which show smokers the grim reality of the effects smoking can have on their health. This will help to maintain the momentum of the increasing number of people who have given up smoking following England going smoke free in 2007. Written health warnings have encouraged many smokers to stop smoking. These new stark picture warnings emphasize the harsh health realities of continuing to smoke. I hope they will make many more think hard about giving up, and get the help they need to stop smoking for good."

The Department of Health, in a recent press release, quotes Michael Shepherd, 39, who was diagnosed with throat cancer two years ago. Michael hopes that the new warnings will help make smokers realize that the risks they are taking are real. He hopes that, unlike him, they can stop before it is too late.

Michael Shepherd said "Before I was diagnosed with cancer, I felt I was invincible. I was a big strong bloke working at a trade I loved; I had a huge circle of friends and money to spend. Now I'm on invalidity benefits, and live on state handouts. I hate it and would do anything to get back into work. All this has happened to me because of smoking. I never realized you could get cancer so young. The doctors saved my life, but what I've got now is a hard struggle. I will keep on and I will fight to get better, if only for my daughter's sake."

In 2001 Canada introduced graphic warnings. Official reports indicate that 31% of Canadian ex-smokers gave up because they had seen the pictures, and 27 per cent reported they had helped them to stay smokefree. The following countries use graphic warning on tobacco products - Australia, Brazil, Canada, India, New Zealand, Singapore, Venezuela, Thailand and Uruguay.

According to local NHS Stop Smoking Services around England, 350,000 smokers in the UK stopped smoking. If you are a smoker and wish to give up you can join them and find out more - order a free DVD which explains the different types of NHS support available to help smokers who want to quit - call 0800 169 0 169.

The images come from an image bank stipulated by the European Union. The warnings 'Smoking kills' and 'Smoking seriously harms you and others around you' will continue to be used on the front of tobacco packs.

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Should Ecstasy Be Downgraded? UK

Before the turn of the century ecstasy was a big headline puller and journalists wrote about it a great deal. Recently, however, cocaine and heroin have taken front stage. Just because ecstasy is not hitting the headlines as much as it used to may not necessarily mean it is not a dangerous drug and should consequently be downgraded. The declining popularity of the rave scene has lead to a drop in ecstasy interest. Hence, ecstasy's classification is being reviewed.

According to the Department of Health, 567,000 people under the age of 60 in the UK used ecstasy in 2006. 48% of them were aged 16 to 24. Experts say these figures indicate only a very 'slight' decline since the 1990s. Prices have dropped as well, from £25 in the early 1990s to approximately £5 today.

Official figures show that 246 people died as a result of consuming ecstasy during 2003 to 2007, compared to 28 from the beginning of 1998 to the end of 1999.

Experts say that from a clinical point of view ecstasy should never have been a Class A drug, like heroin - it should have been a class B if penalties are supposed to be in proportion to consumption risks and dangers.

The government is currently carrying out a review of ecstasy's category. Prof. David Nutt, who is soon to head the ACMD (Advisory Council on the Misuse of Drugs), has said ecstasy is not as damaging to health as heroin or cocaine, both Class A drugs. The ACMD will publish its report at the end of 2009.

The police, on the other hand, are mostly against changing ecstasy from Class A to Class B.

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Sunday, August 17, 2008

Peers Versus Parents In Modern China

In metropolitan China, high school students' self-esteem depends more on good relations with peers than parents, a new UC Davis study shows. But the opposite is true for younger adolescents and young adults: Both base their self-esteem more on good relations with parents.

The study by Hairong Song, a doctoral candidate in psychology, Emilio Ferrer-Caja, an associate professor of psychology, and Ross Thompson, a professor of psychology, will be presented during a 1 p.m. (EDT) poster session on Thursday, Aug. 17, at the annual meeting of the American Psychological Association in Boston. The title of the session is "Cognitive and Sociocognitive Development."

The UC Davis researchers surveyed 584 students ages 11 to 23 from Guangzhou and Hangzhou. The students filled out questionnaires that assessed the quality of their relationships with their mothers, fathers and peers. They also filled out self-evaluations that measured self-esteem.

"This study suggests that high school is a period of special challenge to Chinese adolescents because of the competitive academic pressures they face. High school is a time when many Chinese adolescents experience intense pressures from parents to perform well in school," Thompson said.

"Even in a society that traditionally emphasizes family ties, enhanced by the government's one-child policy, competition to get into the best universities may be causing high-schoolers to turn to their peers for support and affirmation."

Claudia Morain
University of California - Davis

Leishmaniasis Parasites Evade Death By Exploiting The Immune Response To Sand Fly Bites

Cutaneous leishmaniasis, a disease characterized by painful skin ulcers, occurs when the parasite Leishmania major, or a related species, is transmitted to a mammalian host by the bite of an infected sand fly. In a new study from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, scientists have discovered L. major does its damage by not only evading but also by exploiting the body's wound-healing response to sand fly bites, as reported in the August 15 issue of Science.

"This work changes the textbook picture of the life cycle of the leishmaniasis parasite, identifying the inflammatory cell known as the neutrophil as the predominant cell involved during the initiation of infection," says NIAID Director Anthony S. Fauci, M.D.

Employing advanced microscopy techniques, which allowed real-time imaging of the skin of living mice infected with L. major, NIAID collaborators Nathan C. Peters, Ph.D., and Jackson Egen, Ph.D., found that the neutrophils - white blood cells that ingest and destroy bacteria - play a surprising role in the development of the disease.

Neutrophils were rapidly recruited out of the circulating blood and into the skin of infected mice, where they swarmed around the sand fly bite sites and efficiently engulfed the parasites. But unlike many other infectious organisms that die inside neutrophils, L. major parasites appear to have evolved in a way to evade death, actually surviving for long periods of time inside the neutrophils. Eventually the parasites escape from neutrophils and enter macrophages, another immune cell population in the skin, where they can establish long-term infection.

"Parasites transmitted by sand flies to mice lacking neutrophils have more difficulty establishing an infection and surviving. This demonstrates the importance of neutrophils at the site of an infected sand fly bite and suggests the unexpected path taken by the parasite from sand fly to neutrophil to macrophage is a critical component of this disease," says Dr. Peters.

In addition, says Dr. Egen, the study reveals how neutrophils leave locally inflamed blood vessels and move into tissues; provides new information on the movement of these immune cells within damaged tissue environments and upon contact with pathogens; and provides video images revealing active neutrophil entry into areas of damaged skin.


NIAID is a component of the National Institutes of Health. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on basic immunology, transplantation and immune-related disorders, including autoimmune diseases, asthma and allergies.

The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

Reference: NC Peters et al. In vivo imaging reveals an essential role for neutrophils in leishmaniasis transmitted by sand flies. Science DOI: 10.1126/science.1159194 (2008).

News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Linda Perrett
NIH/National Institute of Allergy and Infectious Diseases

Monday, July 14, 2008

Intermittent Preventive Treatment For Malaria In Schoolchildren Also Improves Attention Span

In treating malaria in schoolchildren in Africa, the use of intermittent preventive treatment (IPT) not only lowers the prevalence of anemia but also improves attention span in the children. These conclusions, published in an Article released on July 11, 2008 in The Lancet, could help guide future interventions in this and similar settings.

Malaria, a major cause of death and disease around the world often affects children, but its consequences on health and education during the school age years is poorly understood. Historically, standard treatments and chemical prevention methods have been effective, and are associated with lower rates of malarial parasite infection, severe anemia (a major symptom of malaria) and malaria related deaths. This results in reduced school absenteeism.

Though these therapies and methods might largely be effective, they may be too expensive to effectively implement in sub-Saharan Africa. Additionally, subclinical infections are common in the population, making directed therapies difficult. An alternative therapy, intermittent preventive treatment involves mass distribution of a full course of anti-malarial treatment, regardless of the infection status of each individual.

To investigate the effects of IPT on the biological and educational effects of malaria, Dr. Sian Clarke, London School of Hygiene and Tropical Medicine (LSHTM), UK, and colleagues performed a randomized controlled trial on children between the ages of 5 and 18 years from 30 primary schools in an area of Western Kenya with high malaria transmission rates.

IPT was administered to 2,604 children, composed of three treatments of sulfadoxine-pyrimethamine in combination with amodiaquine at four month intervals. Meanwhile, a group of 2,302 students received a placebo. The children were evaluated for anemia, defined as a hemoglobin concentration below 110g/L. A reduction in malaria occurrence was associated with IPT after 12 months. That is, prevalence of parasite presence was <5% in the IPT group in comparison with 39.7% in the placebo group. Additionally, anemia levels decreased, and the prevalence of anemia was 6.3% in the IPT group in comparison with 12.6% in the placebo group. Finally, in classroom-based tests of sustained attention, IPT group participants showed significant improvement in comparison with students in the placebo group. This effect, however, showed no effect on educational achievement or hyperactive-compulsive behaviors.

The authors conclude with a statement about the potential benefits of this new treatment if used in new policy in these areas. "The pronounced effects of the IPT intervention on anemia and malaria parasitemia, and the effect on sustained attention, highlight the issue of the continued, and often unrecognized, malaria burden among school-aged children in Africa and the potential of school-based programs for tackling the problem. Our findings also illustrate the possible gains of integrating malaria control into broader school health programs."

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Tuesday, July 1, 2008

Females With High Birth Weight More Likely To Develop Rheumatoid Arthritis

A new study published in the Annals of the Rheumatic Diseases finds that compared to females born with average birth weight, those born with heavy birth weight are two times as likely to develop rheumatoid arthritis when they become adults. Rheumatoid arthritis is a condition that occurs when the immune system attacks the joints, lungs or skin and results in inflammation, pain, and loss of functioning mobility.

Researcher L. A. Mandl (Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College) and colleagues argue that these findings support the fetal origin of disease theory. That is, factors that occur during pregnancy program an individual to be more prone to certain diseases and conditions in adult life. For example, previous research has linked low birth weight to conditions such as diabetes, coronary heart disease, and high blood pressure, and high birth weight has been associated with an increased risk of breast cancer and leukemia.

These new findings on rheumatoid arthritis development come from a survey of more than 87,000 women, age 30 to 55, who took part in the US Nurses' Health Study from 1976 and 2002. In two year intervals, the women responded to questions about their health, lifestyle, and family illness. In 1992, researchers asked them questions about birth weight.

Between 1976 and 2002, 619 women received their first diagnosis of rheumatoid arthritis. The average birth weight was between 3.2 to 3.85 kg, and women who weighed over 4.45 kg at birth were found to be twice as likely to develop the autoimmune disease known as rheumatoid arthritis. These findings held after the researchers statistically controlled for factors that may influence birth weight such as socioeconomic status, parental smoking, maternal diabetes, age at first period, use of oral contraceptives or hormone replacement therapy, breastfeeding and weight.

Though the authors do not have a clear biological explanation for their results, they do note that abnormal hormone regulation - a process thought to affect a baby while in the womb - is prevalent in adults with rheumatoid arthritis.

The authors conclude that: "The biology underlying this association is speculative, and the relative importance of fetal nutrition versus genotype is unknown. However, if fetal nutrition has an impact on future risk of RA [rheumatoid arthritis], this could be a potentially modifiable risk factor. Further study of our observation that high birth weight is associated with an increased risk of RA could provide insight into the pathogenesis of RA. These data also provide further evidence for the importance of fetal environment as a crucible for future adult diseases."

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Saturday, June 14, 2008

Gardeners: Be Cautious Of These Fungal Spores

A previously healthy man died after inhaling fungal spores from dead plant material while gardening in May 2007, and is discussed in a Case Report released on June 13, 2008 in The Lancet.

The man, 47 years old, was considered in good health, though he was a professional welder and smoked approximately ten cigarettes per day. He was admitted after one week presenting a sputum-producing cough, chest pain, and worsening shortness of breath. Running a fever of 100.4°F (38°C,) he had a low lymphocyte and neutrophil count. He also had coarse crackles in his lungs, and his chest radiography showed irregular nodules.

Assumed to have community-acquired pneumonia, he was treated with intravenous co-amoxiclav and clarithromycin, but when his symptoms worsened, a third antibiotic, flucloxacillin, was administered. In the next day, he became so short of breath that even with supplementary oxygen he needed to be transferred to the intensive care unit (ICU.) In the ICU, it became clear from blood gas measurements that despite intubation and ventilation, adequate gas exchange was not being provided in his tissues. Additionally, he showed signs of serious sepsis.

At this point, an HIV test was negative. However, two sputum samples cultured the fungus Asperillus fumigatus. According to the authors, "On closer questioning, the patient's partner revealed that his symptoms had started less than 24h after he had dispersed rotting tree and plant mulch in the garden, where clouds of dust had engulfed him." Treatment with intravenous liposomal amphotericin B was started.

The man was subsequently transferred to another unit for extracorporeal membrane oxygenation (ECMO,) which is similar to being supported by a heart-lung machine. Upon his arrival, despite the ECMO treatment, his blood pressure remained too low and he developed kidney failure. Although a continuous dialysis was initiated, as his condition worsened, escalation of treatment was considered inappropriate. After 72 hours, ECMO was terminated and he died soon after. The diagnosis of aspergillosis was confirmed through a laboratory analysis of blood samples.

Spores of aspergillus are often found on decaying plant matter, and inhalation of these spores can cause several different types of aspergillosis. These can range from acute and invasive, like in the aforementioned patient, to chronic and necrotizing.

The authors conclude with a statement regarding how this patient was an unusual example of aspergillosis, and that his case may have been influenced by immunosuppression. "Unlike most patients with acute, invasive, aspergillosis, our patient did not seem to be immunosuppressed; however, smoking and welding could have damaged his lungs, increasing his vulnerability. Since he died so quickly, we cannot exclude the possibility that he had an undetected immunodeficiency. Acute aspergillosis after contact with decayed plant matter is rare, but may be considered an occupational hazard for gardeners," they say.

Additionally, they add, immediate antifungal treatment is essential in these cases: "Although liposomal amphotericin B has been used in such cases, and was the recommended treatment of choice within our hospital trust at the time of this case, more recent guidelines suggest voriconazole may currently be the optimum empirical therapy."

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Nicotine Addiction: Prevalence And Treatment

A Seminar released on June 13, 2008 in The Lancet discusses nicotine addiction, and the potential for reducing its disease burden and death toll by improving public knowledge and using treatments individual to patients. This includes the potential creation of an antinicotine vaccine.

Nicotine is a stimulant classically found in tobacco, and its chronic addiction is primary cause of habitual smoking. According to the seminar, there are approximately 1.2 billion smokers and approximately half of them will die from diseases directly caused by smoking. Currently, about five million smokers die each year, and if present trends continue this could increase to ten million each year by 2025.

More of these smokers are men than women, necessitating separate studies by gender. For instance, of the world's male population, 92% of them live in countries where more than 25% of all males smoke. In contrast, in the world's female population, 10% live in countries where female smoking frequency is above 24%. In the United Kingdom and the United States, between 25-35% of all males smoke. In the female population, however, there is some discrepancy, as in the USA 14-24% of women smoke but more than 24% smoke in the UK.

The distribution of smokers varies by country, ranging from as little to 5% of the population to over 55%. Some countries where male smoking prevalence is above 55% include Russia and Kenya. The female smoking frequencies are above 24% in Brazil, Germany, Spain, and the UK.

Terminating an addiction to smoking is often recognized as a significant challenge. In the USA, over 70% of the smoking population want to quit every year and 45% attempt it. However, less than 5% of the general population is successful in this endeavor.

Even simple advice from a health care professional can help improve these rates. Following guidelines set forward recently in the US, the Seminar first examines the role of counseling in quitting smoking, addressing topics including problem solving, coping, and motivational skills.

According to the Seminar, this rate of termination can be enhanced by treatment for nicotine addiction itself. "Pharmacotherapies for nicotine dependence can enhance quit rates by about
two-three fold," state the authors. They discuss and evaluate a number of nicotine-replacement therapies (NRTs) such as patches or nicotine gum, non-nicotine products based on efficacy, side effects, and precautions for each. Additionally, they examine improved rates of success with combinations of the nicotine patch and other products such as nicotine gum.

The authors of the Seminar examine not just the characteristics of termination, but also the limited benefits of cigarette reduction, which is also achieved with higher frequency with the use of NRTs. They say, however, that these effects are counteracted by changes in the habits of the smokers: "Smokers engage in substantial compensatory smoking - deeper inhalation per cigarette - so that a reduction of cigarette consumption of 50% or more results only in a 30% decrease in biomarkers for toxicant exposure." Cigarette reduction's primary benefit, therefore, may be that it acts as an intermediate step towards quitting.

There are some new treatments in development. One example is a nicotine vaccine which prompts the body's immune system to develop antibodies against the substance, and for which preliminary trials are in progress. Another is the drug rimonabant, which selectively blocks a specific cannabinoid receptor, for which large, randomized trials are being performed. Finally, pharmacogenetics, a field in which treatment is matched to the patient based on his genetic profile, is examined.

The authors conclude with comments about nicotine addiction: "Nicotine or tobacco addiction should be treated as a chronic disorder. Treatment can need persistent efforts to try to assist tobacco users in their attempts at quitting. Relapse should be seen as a probable event... Treatment can improve these outcomes... The most crucial component of care is the actual delivery of such treatments."

Dr. Kenneth Warner of School of Public Health, Ann Arbor, MI, USA, and Dr. Judith Longstaff Mackay, Bloomberg Initiative to Reduce Tobacco Use, Hong Kong, China, contributed an accompanying Comment in which they state the importance of The Framework Convention on Tobacco Control (FCTC,) which has presently been ratified by 154 countries. They indicate that the medical community should make a higher priority of treatment of tobacco dependence, especially in every day practice, and that they should lobby governments, who may have conflicts of interest due to tobacco lobbies, to put this legislation into effect. "Here is something simple, achievable, and unequivocally good that would relieve the suffering of literally millions of human beings," they say.

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For Smokers, Lung Cancer Risk Not Greater For Women

A paper published in The Lancet Oncology has concluded that women smokers are not at a greater risk of developing lung cancer than male smokers. However, among those who have never smoked, women appear to be more likely to develop the disease than men.

In the United States, the medical and health community mostly agrees that cigarette smoking is responsible for about 90% of lung cancers. One point of contention among researchers and scientists, however, deals with how cigarette smoking affects men and women differently. Existing research has not been able to provide conclusive evidence that smoking makes women more or less susceptible to lung cancer than men.

Further investigating this issue, Neal Freedman (National Cancer Institute, Rockville, MD, USA) and colleagues studied a data set of almost 500,000 American men and women that contained information on smoking habits, diet, physical exercise, and incidence of lung cancer. Regarding smoking, the 279,214 men and 184,623 women (all 50 to 71 years old) were asked if they currently smoked, if they had ever smoked, and how many cigarettes per day they had smoked.

Key results from the study include:

* Lung cancer incidence rates were 1.47% for men and 1.21% for women.
* Compared to men who never smoked, women who had never smoked were still 1.3 times more likely to develop lung cancer.
* The correlation between smoking and cancer risk was strong in both men and women.
* Smoking two packs of cigarettes per day makes you 50 times more likely to develop lung cancer than never smoking at all.
* Compared to male smokers, women smokers were only slightly less likely (0.9 times) to develop lung cancer.

Lung cancer comes in several different forms. Rates of small cell, squamous, and undifferentiated tumors were about the same for both men and women who had never smoked. Adenocarcinomas, however, were more common in women than in men. Male smokers were twice as likely as female smokers to develop squamous tumors and about as likely as female smokers to develop the other tumors.

"Our findings suggest that women are not more susceptible than men to the carcinogenic effects of cigarette smoking in the lung. Vigorous efforts should continue to be directed at eliminating smoking in both sexes," conclude the authors.

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Tuesday, June 10, 2008

AIDS Epidemic Far From Over Says UN

A new report by United Nations Secretary-General Ban Ki-moon to be released today, Tuesday 10th June, at UN headquarters in New York, says that the global fight against HIV/AIDS is making significant progress, but officials said in a press conference yesterday that the global epidemic is far from over.

Although considerable progress has been made, it is too early to celebrate, was the overall tone of the meeting between UN officials and the press at UN headquarters in New York yesterday, where the Secretary-General is today presenting the report (document A/62/780) at the opening session of the General Assembly's high-level meeting on HIV/AIDS.

"The report highlights real results," Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, told journalists.

There has been a 15-fold increase since 2001 in the number of people receiving life saving antiretroviral (ARV) treatment, from under 200,000 to 3 million, including 2 million in Africa, says the report. In 2001, more than half of the people in receipt of ARV treatment were in Brazil, the only developing country that was offering free ARV therapy to its people.

The report also says that the global rate of new infections has come down, and pregnant women living with HIV are now increasingly able to obtain drug therapy that stops the virus passing from mother to child, said Kazatchkine. At the end of 2007, around one third of pregnant women in low and middle income countries who are living with HIV accessed ARV therapy, and 200,000 children living with HIV in developing nations were also being treated, a huge leap of 80,000 from the year before.

But the UN officials tempered their optimism with a reminder of what still remains to be accomplished.

6,000 people die every day from HIV/AIDS, and another 7,000 become infected, "that's a crisis by any standard", said Peter Piot, Executive Director of the Joint United Nations Program on HIV/AIDS (UNAIDS).

"The AIDS epidemic is far from over," said Piot, in spite of the fact that resources to fight HIV/AIDS had exceeded the targets set in the Declaration of Commitment on HIV/AIDS, adopted by the General Assembly in 2001. The target was 7 billion dollars by 2005, and last year the global mobilization of HIV/AIDS resources came to 10 billion dollars.

"Despite the progress," said Kazatchkine, "only 30 per cent, or close to one third, of the people we believe to be in need of antiretroviral treatment access ARV therapy currently".

One of the problems, says the report, is that the rate at which access to essential treatment is expanding is not keeping up with the rate of expansion of the epidemic. For instance, although one million more people started ARV treatment in 2007, the rate of new infections in that year was 2.5 million people.

The report estimates there are 33.2 million people worldwide living with HIV, as of December 2007. Although the global rate of new infections has fallen, a number of countries are seeing rising rates of new infections, including China, Indonesia, Russia and Ukraine, and some European Union and North American countries.

AIDS remains the leading cause of death in Africa, and the overall rate of infection among women is rising more rapidly than among men.

Other reasons why ARV therapy does not reach the people who need it are weak healthcare systems, critical shortages in skills, and not knowing for sure what funds will be available in the long term, said Kazatchkine.

Kazatchkine said the Global Fund enabled over 50 per cent of the people on ARV therapy to get their treatment, and it also funded over two thirds of the international fight against malaria and tuberculosis.

The Global Fund to Fight AIDS, Tuberculosis and Malaria was officially set up by the heads of state at the 2001 G8 summit, along lines suggested by two Harvard academics urging a step up in the world's commitment to fighting these devastating diseases.

Last year there was a funding gap of around 7 billion dollars, said Kazatchkine. 17 billion was needed in order for all the people who needed ARV therapy to get it, but only 10 billion was forthcoming. He told reporters that while some countries like the United Kingdom had pledged money to the Global Fund through to 2014, this was not the norm, and more long term funds were needed, such as through official development assistance (ODA), and other private and public funding channels.

Kazatchkine went on to explain that "there will always be a gap", but he hoped this will get narrower. He said we have to be careful, he did not want 2008 to be the year when nations turn and say, "You're doing alright with the AIDS epidemic. Now we have to focus on something else".

"We need a very sustained effort and we still need increased resources," urged Kazatchkine.

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Vitamin D May Help Prevent Heart Attacks

An article published in the June 9 issue of Archives of Internal Medicine reports that men who have low levels of vitamin D are at a higher risk of heart attack (myocardial infarction).

It has been shown that deaths related to cardiovascular disease are more frequent in higher latitudes and during the winter months - when and where the sun rarely shines - and are less frequent at higher altitudes. Edward Giovannucci, M.D., Sc.D. (Harvard School of Public Health and Brigham and Women's Hospital, Boston) and colleagues note that, "This pattern is consistent with an adverse effect of hypovitaminosis D [vitamin D deficiency], which is more prevalent at higher latitudes, during the winter and at lower altitudes." Although there are most likely several reasons for these observations, researchers do know that vitamin D impacts the body in ways that affect the risk of heart attack and heart disease.

Giovannucci and colleagues reviewed the medical records and blood samples of 454 men between the ages of 40 to 75 who had non-fatal heart attack or fatal heart disease. Initial data collection occurred between January 1993 and December 1995, and patients were followed until January 2004. The researchers compared this first sample with records and blood samples of 900 living men who had no history of cardiovascular disease. Self-administered questionnaires were used to collect data on the diets and lifestyles of the men.

The main finding was that men who had a vitamin D level of 15 nanograms per milliliter of blood or less (vitamin D deficiency) had a higher risk of heart attack compared to those with 30 nanograms per milliliter of blood (vitamin D sufficiency).

"After additional adjustment for family history of myocardial infarction, body mass index, alcohol consumption, physical activity, history of diabetes mellitus and hypertension, ethnicity, region, marine omega 3 intake, low- and high-density lipoprotein cholesterol levels and triglyceride levels, this relationship remained significant," write the researchers. Even men with intermediate vitamin D levels were found to have a greater risk of heart attack than those with sufficient levels.

The authors conclude their study by noting: "Vitamin D deficiency has been related to an increasing number of conditions and to total mortality. These results further support an important role for vitamin D in myocardial infarction risk. Thus, the present findings add further support that the current dietary requirements of vitamin D need to be increased to have an effect on circulating 25(OH)D [vitamin D] levels substantially large enough for potential health benefits."

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Thursday, June 5, 2008

Restless Leg Syndrome Relief Found In Rotigotine Skin Patch

Patients with restless leg syndrome (RLS) - the irresistible urge to move one's body to limit uncomfortable or odd sensations - may get some relief during day and night by using skin patches that contain the drug rotigotine. The findings come from a randomized, placebo-controlled, double-blind study published in the July edition of The Lancet Neurology.

Researchers studying RLS have analyzed the genetic basis of the disease and determined that it should be treated as a general neurological disorder. Currently, many patients with this condition are prescribed dopaminergic drugs that stimulate the body's dopamine system - a first line of treatment. Rotigotine is a type of dopaminergic drug, and it has been used to treat Parkinson's disease. To investigate the effects of transdermal rotigotine patches as treatment of RLS, Dr. Claudia Trenkwalder (Centre of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany) and colleagues conducted a randomized controlled trial.

The researchers analyzed a sample of 458 patients with moderate-to-sever RLS. Their average baseline score on the International Restless Leg Syndrome study group severity rating scale (IRLS) was 28.1, and they had a score of 4 or more on a test to measure severity of symptoms called the clinical global impressions (CGI) item 1 assessment. Random assignment resulted in 115 patients receiving transdermal rotigotine 1 mg, 112 patients receiving a 2 mg dose, 114 receiving a 3 mg dose, and 117 receiving placebo. Rotigotine was delivered via skin patches that were applied one time a day over a 6 month period. The main outcome measures were the changes from baseline to the end of the treatment period in the IRLS score and in the CGI item 1 score.

The mean changes in the IRLS group were as follows:

* -13.7 in the 1 mg group,
* -16.2 in the 2 mg group,
* -16.8 in the 3 mg group, and
* -8.6 in the placebo group.

The mean changes in the CGI item 1 score were:

* -2.09 in the 1 mg group,
* -2.41 in the 2 mg group,
* -2.55 in the 3 mg group, and
* -1.34 in the placebo group.

Three quarters of patients indicated that their rotigotine patches were "good" or "very good" in a follow-up survey, though 43% of patients (145 of 341) had (mostly mild or moderate) skin reactions to rotigotine. Only 2% of participants who received placebo reported skin reactions. Rotigotine was associated with serious adverse events in 10 patients: one patient had an elevation of liver enzymes, one had a worsening of tinnitus, one had a non-response to anticoagulation, one had electrocardiogram changes, and six had reactions at the application site. Skin reactions at the patch site were not severe enough to warrant hospital treatment, and shortly after removing the patch, the issues were resolved. There were no signs of an increase in the severity of symptoms in RLS during dopaminergic treatment, and the patients demonstrated a low the rate of typical dopaminergic side-effects.

"The results of this 6-month trial indicate that transdermal delivery of low doses of rotigotine for 24 h per day are more effective than placebo in relieving the symptoms of RLS in patients who are moderately to severely affected. This trial, together with a pilot study and dose-finding trial, suggest that, despite differences in treatment duration and other design features, there exists a clear therapeutic window in terms of dose of rotigotine to treat restless legs syndrome between 1 mg over 24 h to 3 mg over 24 h," conclude the authors.

A comment accompanying the research article is written by Dr. Kapil Sethi (Medical College of Georgia, Augusta, GA, USA). Dr. Sethi notes that, "The introduction of a patch with a constant delivery of a dopamine agonist is a welcome addition to the armamentarium. Unfortunately, the rotigotine patch has been temporarily withdrawn from the US market because of problems with manufacturing and the unreliable delivery of the drug.

"RLS causes significant discomfort and adversely affects the quality of life of patients. Whether it has more ominous consequences is unclear. A recent study showed that RLS is associated with a greater risk of cardiovascular disease, particularly in patients with greater frequency or severity of RLS symptoms. Whether treatment of RLS will reduce this risk is unknown, and further studies should help answer this question."

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Friday, May 30, 2008

C-Sections Might Be Contributing To Increase In Premature Single Births, Study Says

Medically unnecessary caesarean sections might be contributing to an increased rate of premature single births in the U.S., according to a study to be published in the June issue of the journal Clinics in Perinatology, the New York Times reports. The study, conducted by researchers from the March of Dimes Foundation, Albert Einstein College of Medicine of Yeshiva University and CDC, is based on a review of birth records and previous studies. Researchers said the link between c-sections and premature single births is unclear because medical records often do not indicate why the procedure was done.

The study found that premature births increased from 9.7% of all single births in 1996 to 10.7% of single births in 2004. About 92% of the premature single births were delivered by c-section. Most premature births were considered "late preterm" births, defined as delivery between 34 and 37 weeks' gestation, according to the Times. Normal delivery is between 38 and 42 weeks' gestation. Premature infants have higher risks of breathing and feeding disorders, delayed brain development, other health problems and death, the Times reports.

Alan Fleischman, the March of Dimes' medical director and senior vice president, said obstetrics has changed so dramatically during the past 20 years that c-section deliveries and labor inductions have become commonplace. According to the Times, the c-section rate has increased steadily in recent years, from 20.7% of all births in 1996 to 30.3% in 2005. "Perhaps for convenience, perhaps out of fear of litigation, perhaps in response to a maternal request, they are scheduling their deliveries rather than allowing labor to begin," Fleischman said, adding, "And this comes when there is an epidemic in America of prematurity."

Sarah Kilpatrick, chair of the committee on obstetric practice for the American College of Obstetrics and Gynecology and chair of the Department of Obstetrics and Gynecology at the University of Illinois, said there is no proof that unnecessary c-sections are leading in premature births but added that obstetricians might "proceed with a caesarean to deliver the fetus when the fetus is probably fine" out of fear of litigation (Grady, New York Times, 5/28).

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Sunday, May 25, 2008

Access To The Bloodstream For Kidney Dialysis Not Improved By Reducing Blockage

Reducing early blockages in bloodstream access for kidney failure treatment does not increase the likelihood that the access will function adequately for long-term treatments, according to a study funded by the National Institutes of Health. Results were published in the Journal of the American Medical Association.

"Since most of the 470,000 Americans with kidney failure depend on hemodialysis for survival, there is a clear and compelling need to evaluate therapies that reduce or prevent access failure," said NIH Director Elias A. Zerhouni, M.D. "These results tell us we need to keep looking for solutions."

Hemodialysis filters waste and extra fluid from the bloodstream and requires a vascular access - a site on the body where blood is removed and returned. Fistulas are the preferred type of access since they clot less often, experience fewer infections, and are less costly; patients with fistulas also have lower mortality. A fistula is created by joining a section of an artery and a vein to make one large vessel capable of handling high volumes of blood during hemodialysis. But maintaining any access site is a major clinical challenge. Blood clotting in the fistula is the most frequent cause of early fistula failure. Clotting, infection and low blood-flow rates in the access site are common reasons for hospitalizations requiring multiple treatments or surgeries. Click here to read about vascular access.

The Dialysis Access Consortium (DAC) found that only 12 percent of patients developed blood clots in the fistula when treated with the clot-preventing drug clopidogrel, compared to nearly 20 percent of patients treated with placebo. Nevertheless, about 60 percent of new fistulas in each group could not be used for long-term dialysis treatments. Complications such as bleeding were similar across the study groups.

DAC studied nearly 900 patients at 9 U.S. medical centers in academic and community practices in urban and rural settings. Participants received a new fistula and took the anti-platelet drug clopidogrel (Plavix) or a placebo tablet daily for 6 weeks to determine if the drug would maintain blood flow in fistulas and increase the number suitable for dialysis.

"Because vascular access is critical for delivering lifesaving care, we are already organizing another multi-center study to look for other ways to improve fistulas," said co-author Catherine M. Meyers, M.D., a kidney specialist in charge of DAC at NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which funded the study.

The DAC Fistula Trial is the largest multi-center trial to look at preventing blood clots in new fistulas and the first to test whether prevention would allow more fistulas to be usable for dialysis. NIDDK has funded DAC since 2000. Clopidogrel and placebo were donated by what is now Sanofi Aventis/Bristol-Myers Squibb.

The National Institute of Diabetes and Digestive and Kidney Diseases, a component of the NIH, conducts and supports research in diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic, and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans. For more information about NIDDK and its programs, see http://www.niddk.nih.gov/.

The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/.

Source: Mary Harris
NIH/National Institute of Diabetes and Digestive and Kidney Diseases

Patients With Acute Kidney Injury Do Not Have Improved Outcomes With More Intensive Dialysis

No significant difference in death rates or other outcomes was found between a group of patients with acute kidney injury that received intensive dialysis and another group that received a more standard regimen of dialysis, according to a joint Department of Veterans Affairs (VA) and National Institutes of Health (NIH) study published in the June issue of the New England Journal of Medicine. Acute kidney injury, also called acute renal failure, is a common complication in hospitalized patients that is associated with very high mortality rates. In-hospital mortality rates of critically-ill patients typically range from 50 percent to 80 percent.

Several prior single-center studies in patients with acute kidney injury had suggested improved survival with more intensive dialysis, which is significantly more costly to administer. "We now have definitive evidence that intensive treatment of acute kidney injury is no more beneficial in improving treatment outcomes than the usual level of care," said NIH Director Elias A. Zerhouni, M.D. "As a result, the findings of this well-designed study may help prevent unnecessary medical expenditures."

Within 60 days after starting dialysis, 302 patients (53.6 percent) in the intensive treatment group died compared to 289 patients (51.5 percent) in the less-intensive treatment group. Also, the study reports no significant differences between the two groups in recovery of kidney function, the rate of failure of organs other than kidneys, or the number of patients able to return to their prior living situations.

No medications have been found to be effective in treating acute kidney injury, so doctors use hemodialysis and other forms of renal-replacement therapy to support patients whose kidneys do not function properly. Hemodialysis uses a machine to clean waste and extra fluid from the blood when the kidneys can't do the job.

In this study, doctors provided renal-replacement therapy to both patient groups. Patients who did not require medications to maintain their blood pressure were treated with conventional dialysis, either three times per week in the less-intensive arm of the study or six times per week in the intensive arm. Patients who were unstable and required medications to increase their blood pressure were treated with more gentle forms of dialysis, either a slower form of hemodialysis called SLED or a continuous form at a lower or higher dose as randomly assigned. Patients were able to switch between forms of therapy as their clinical condition changed, while remaining within the lower or higher intensity treatment arms of the study.

"The main purpose of this study was to see if intensive therapy would reduce the death rate, shorten the duration of the illness, and decrease the number of new complications in other organs among patients with acute kidney injury," said co-author Robert A. Star, M.D., director of NIDDK's Division of Kidney, Urologic and Hematologic Diseases. "Though this was found not to be the case, it is important that we know this so we can focus future research on finding more beneficial treatment strategies."

"Unlike earlier studies that used only a single method of therapy, our use of an integrated strategy of continuous and intermittent methods of therapy allows us to apply these study results more readily to clinical practice," explained study chair Paul M. Palevsky, M.D., chief of the Renal Section at the VA Pittsburgh Healthcare System and a professor of medicine at the University of Pittsburgh School of Medicine. "What is important about these results is that they outline the limits of effective therapy."

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Wednesday, May 21, 2008

Sleep Apnea Raises Risk Of Low Blood Oxygen During Air Travel

People who have obstructive sleep apnea are more likely to have low blood oxygen and experience higher physiological stress (which can raise heart risk) during air travel than people who do not suffer from the condition, suggesting they may need extra oxygen during flight, like patients with chronic lung diseases.

The study was the work of Leigh Seccombe, MSc, of Concord Repatriation General Hospital in Sydney, Australia, and colleagues, and was presented on Sunday 18th May 2008 at the annual meeting of the American Thoracic Society in Toronto, Canada.

Obstructive sleep apnea (OSA) is a common condition where a person's breathing pauses during sleep because of an obstruction in their airway.

In this study, Seccombe and colleagues investigated the physiological response of 22 patients with severe OSA and without lung disease, to a simulation of an aircraft cabin and compared it to that of 10 healthy subjects.

The researchers measured the participants' ventilatory response (the volume of air going in and out of the lungs), and also the amount of oxygen circulating in their bloodstream.

In the simulator, the participants were exposed to the equivalent of cabin air at 6,000 ft (16.8 per cent O2) and 8,000 ft (15.1 per cent O2).

The results showed that:

* Half of the 22 OSA patients would need supplemental oxygen when flying, if current guidelines issued to patients with lung disease were to be followed.

* There was no difference in the ventilatory response change with increasing simulated cabin altitudes between the OSA and the healthy group.

* But in the OSA group only, the oxygen uptake and heart rates were significantly higher than they would be at "sea level".

* Oxygen demand in the OSA group went up from 0.3 liters per minute at sea level to just under 0.4 l/m at 8,000 feet.

The researchers concluded that:

"Patients with OSA, without lung disease, are more likely to develop significant hypoxemia [low blood oxygen] and have increased oxygen demands during flight. Ventilatory response was not impaired."

Speculating on their findings, Seccombe told MedPage Today that it was too early to say what the clinical implications might be:

"Many people fly, many people get hypoxic, but not many have adverse events," said Seccombe, adding that one explanation could be obesity, since the average BMI (body mass index) of the OSA participants was 36 compared to 24 for the healthy participants.

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Blood Donation More Risky For Teenagers

Compared to older blood donors, sixteen and seventeen year olds are much more likely to experience complications related to donation, such as fainting and bruising. This was published in a study in JAMA published on May 21, 2008.

According to the authors, blood donation centers are continuously challenged with finding more safe blood as donors dwindle. They write: "The unremitting need and increasing demand for blood components constantly challenges blood centers to maintain a safe and adequate blood supply from a decreasing pool of eligible donors that is now estimated at only 38 percent of the U.S. adult population." To find eligible donors, blood centers have advocated several measurements for recruitment, including legislation allowing the collection of blood from donors aged 16 to 17 years in states that do not presently allow it. Of the American Red Cross's present donations, 14.5% of come from the 16 to 19 year old group annually, according to the article.

It has previously been suggested that younger donors are more susceptible to complications from donation. To investigate this, Anne F. Eder M.D., Ph.D., of the American Red Cross, Washington, D.C., and colleagues examined the adverse reactions experienced by 16 and 17 year olds. Data was collected in 1996 from nine American Red Cross blood centers which regularly collect donations from this age group, which comprises approximately 80% of donations in high school blood drives. In this time, 145,678 whole blood donations were collected from 16- and 17-year-olds (group 16-17), 113,307 from 18- and 19-year-olds (group 18-19), and 1,517,460 from donors age 20 years or older (group 20+).

Complications, including loss of consciousness or bruising, were present in 10.7% of donations made by 16-17, 8.3% made by 18-19, and 2.8% made by 20+. In comparison to 18-19 and 20+, the 16-17 group was more likely to experience some loss of consciousness or major complications. Injuries directly related to fainting were not common, and for every 10,000 blood collections there were 86 events in group 16-17. That said, this was 2.5 more likely in this group than group 18-19, and 14 times more likely than in group 20+. Almost half of all injuries in total occurred in sixteen and seventeen year old donors. Many episodes required outside medical care, including many involving concussion, laceration involving stitches, dental injuries, or broken jaw.

These complications correlated repeat donor rates. Sixteen year old donors with even minor complications were 60% less likely to return to donate within 12 months in comparison with those who experienced no complications (52% versus 73% return rate). The researchers write that this likely influenced donors interest in returning: "Consequently, any negative experience diminishes the likelihood of return blood donation, and increases the possibility that a short-term yield in donations incurs the ultimate expense of deterring future blood donation by young donors. These findings are particularly pertinent at a time when blood centers are becoming increasingly reliant on young donors to maintain an adequate blood supply. "

They conclude, stating that these results should be considered in the application of new legislation. "These data on common and infrequent complications of blood donation should be considered when age limits are deliberated by state authorities. The relatively comparable reaction rates in 16- and 17-year-old donors, and their increased complication rates compared with young adults and adults, suggest the need for a consistent approach. Blood centers have an obligation to constantly monitor risks of blood donation and to make a concerted and committed effort to achieve the lowest possible rate of complications. Although zero risk may not be attainable even in adults, the rate of complications in minors calls for ongoing attention to a sustained operational effort that is continually focused on donation safety."

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Friday, May 16, 2008

7 Steps to control Migraine

Author: Raeburn Forbes MD

This assumes your diagnosis is correct. If you are not sure of your diagnosis you are advised to speak to your doctor.

Migraine affects 16% of women and ^5 of men. If you are a practicing nurse, it is inevitable that you will care of someone who has migraine and they may ask you about how to control them. Here's my 7 steps....

Step 1 - Sleep

Sleep has been recognized as a treatment for migraine. Many people with migraine take to their bed, as it is the only way to get comfortable. Sleep will inevitably follow, and it is a common experience to waken with your head feeling a lot better - if not completely gone.

An irregular sleep pattern and sleep deprivation can trigger migraine attacks. If you are able to do so, try and improve your sleep hygiene - wind down before bedtime, have a milky drink, make sure your day is active enough that you feel tired, avoid stressful situations - it is common sense really.

Step 2 - Water

Dehydration - a lack of water - can make migraine more likely to occur. A recent study looked at drinking habits and found that those who keep hydrated, were less likely to experience migraine attacks. I'd suggest aiming for about 1-2 pints extra each day (500 to 1000ml) on top of what you routinely drink. Please note that if you have kidney trouble, you may not be able to be free to increase your fluid intake by this amount - check with your doctor if you are unsure.

Step 3 - Exercise

It is a commonly accepted fact that exercise causes naturally made painkillers (called endorphins) to be released into your brain. While a direct link cannot be proven, it seems likely that regular exercise will contribute to a sense of well being, and that when you feel fit, headaches are less likely to occur. A problem is that migraine people can sometimes cause headaches by exercising too much, especially if tired or dehydrated or if exercising in bright sunlight. I'd suggest starting with gentle exercise such as walking half to one mile a few times each week, then building this up until you enjoy walking 2 or 3 miles at a time. Walk interesting routes, go with a friend, anything to make you stick to the routine. You do not have to train to run a marathon, but regular exercise, I'm sure, is a big help.

Step 4- Diet & Weight Management

There is no end to the amount of information written about diets. A lot of people talk about triggers such as coffee or chocolate. If you find that a specific food always produces a migraine, then it makes sense to avoid it. However, if you analyze a trigger food, you may find that when you ate the chocolate you were a bit underslept, had missed your lunch, were under a bit of stress and it was a warm day when you hadn't had much to drink. No wonder when you took that mid-afternoon snack of chocolate, you ended up with a migraine! My advice is this - eat regularly, try to avoid missing meals. When you eat - enjoy it! Better to enjoy your food and relax than get stressed over what is supposed to be one of life's simple pleasures.

If you do happen to be overweight, reducing your weight through a planned calorie restriction and exercise program can reduce the amount of headache you have.

Step 5 - Stress avoidance

This is hard. You are a young mother, holding down a job, your partner works long hours, you have deadlines, need to keep the house running, children or parents to sort out etc etc etc. This sort of common stress can take its toll. More major stress will also provoke headaches. Learning to deal with stress is difficult. However, I often find that people who get stressed are usually very bad at looking after themselves - when did you last take a few hours off just for yourself? Stress avoidance is helpful.

Step 6 - If you get a migraine take a medicine that is likely to work

There have been lots of studies on migraine treatment over the years. The tried and tested medicines can be obtained from your pharmacist (chemist) without prescription. These include (for adults) Aspirin, anti-emetics (metoclopramide, buclizine), non-steroidals (ibuprofen, naproxen), and some combinations that also contain caffeine. These will get about 50% to 75% of people with a migraine episode nearly pain free in 1-2 hours in most cases. There are specific migraine drugs that can usually be obtained on prescription only - called triptans, the commonest of which is sumatriptan. Any tablet for a migraine attack works best if taken as early as possible. I usually recommend that you take a painkiller or triptan as soon as you think "oh no, it's one of these rotten headaches again". If you leave it too late, you may have 'missed the boat' and will have to put up with the pain and take to your bed.

Step 7 - A preventative medicine that works.

There are several medicines which will reduce the number of migraine episodes if taken every day. They usually fall into one of three categories:

· beta-blockers (also used in treating blood pressure or angina)

· anti-convulsants (also used for treating epilepsy or chronic pain)

· anti-depressants (also used for treating depression!)

It is not clear how these drugs work, but if used at low doses on a regular basis, they can minimize the number of migraine headaches you have.

So that's it - 7 steps to controlling migraine - exactly what I tell my patients. Note that a lot of this is within your own control - sleep, exercise, water intake, diet, stress avoidance - it is a powerful thing to feel in control. Medicines will help, but unless you look after yourself, medicines are not the whole answer.

You can download a free copy of this article 7 Steps to Treat Your Migraine. Right click, then click 'save target as..', and you can save to your computer.

If you use this article, please be courteous enough to make sure you acknowledge the author and websites.


Raeburn Forbes MD(Hons) is a practicing neurologist from Northern Ireland. He runs medical information websites in his spare time including www.lumbarpuncture.net and www.migrainenews.co.uk

Monday, May 12, 2008

Virus Hijacks Cell Division Machinery

Viruses are masters of deception, duping their host's cells into helping them grow and spread. A new study has found that human cytomegalovirus (HCMV) can mimic a common regulatory protein to hijack normal cell growth machinery, disrupting a cell's primary anti-cancer mechanism.

Writing in the May 9 issue of Science, researchers from the University of Wisconsin-Madison and Harvard Medical School report that a viral protein, called UL97, masquerades as a normal regulatory enzyme to modify a tumor-suppressing protein in human cells. Unlike the normal enzyme, which can be switched on and off by the cell as needed, the viral stand-in lacks an off switch and evades cellular control. The findings represent a previously unknown way that viruses can cause uncontrolled cell growth and division.

Cells normally have tight regulatory mechanisms in place to limit multiplication to appropriate situations, such as replacing worn-out cells or repairing damage. Uncontrolled cell proliferation can lead to cancer and other disorders.

One of the most important cellular control mechanisms works through a protein called the retinoblastoma tumor suppressor protein, which slows cell growth.

"The retinoblastoma pathway is like the brakes on a car. It prevents tumor cells from growing out of control," says Robert Kalejta, an assistant professor in the UW-Madison Institute for Molecular Virology and McArdle Laboratory for Cancer Research, who led the new study. "This pathway is mutated in essentially all human cancers."

Disrupting this pathway is also advantageous for viruses. Unable to reproduce on their own, viruses rely on co-opting their host's cellular machinery, like an occupying army taking over a local factory. They are especially good at overriding or bypassing built-in control mechanisms, Kalejta says.

"Viruses are well known to encode proteins that have similar activities to cellular proteins, but they're just different enough that they're beneficial to the virus," he says. "[UL97] shares the same activities as the cellular protein, but it lacks all of the control mechanisms."

In essence, UL97 disables the brakes and hits the gas. Once a host cell is primed toward growth, HCMV takes over and steals the cell's machinery to reproduce itself.

The virus's bloodhound-like ability to seek out and target the most essential pieces of a cell's machinery makes it a valuable research tool, Kalejta says.

"Viruses are smarter than we are. They know a lot more about cells than we do, because their life depends on it - they're obligate intracellular parasites," he says. "If they attack a part of the cell - a process or a protein - you know it's important for the cell. If the virus pays attention to it, you should too."

Kalejta next hopes to use UL97 to find other proteins that may be important for cell growth. He also sees potential clinical applications down the road. HCMV infection is very common and, though it remains asymptomatic in most people, it has been implicated in some cancers and can cause trouble in people with compromised or suppressed immune systems, such as AIDS patients and transplant recipients. In addition, UL97-like proteins are also found in the other seven human herpes viruses, some of which are directly linked to cancers.

The advantages of the research are two-fold, Kalejta says. "We're studying a virus that causes human disease and might eventually find a way to treat that infection and help patients. At the same time, we're learning about how the cell works, which has implications for patients that don't have infections," he says. "You get two for the price of one."

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Sunday, May 11, 2008

Sexual Health Screening Without Mention Of Sex

Young women would accept age-based screening for the sexually transmitted infection chlamydia, but would want this test to be offered to everyone, rather than to people 'singled out' according to their sexual history.

In the study, published in the BioMed Central open access journal BMC Infectious Diseases, the Australian women interviewed did not like discussing their sex lives with their GPs. Some said they would even lie about how many sexual partners they had if asked. In response to these findings, the study authors suggest that a detailed sexual history should not be required before testing women for chlamydia.

Chlamydia is Australia's and the UK's most commonly diagnosed sexually transmitted infection (STI). It is most prevalent in the under-25s and can have serious long-term health consequences, including causing infertility in women.

A team comprising three doctors, a sociologist and an epidemiologist at the University of Melbourne, Australia aimed to find out what young Australian women thought about the introduction of chlamydia screening into general practice. The researchers interviewed 24 sexually active women aged 16 to 24 who attended one of a sample of general practices. Equal numbers of women from rural, regional and urban areas were questioned.

In contrast to previous research, which suggests women are not concerned about giving information about their sexual history in the context of a family planning or sexual health clinic, interviewees were reluctant to provide such a history to their GPs. This is a new finding which raises the question of whether a sexual history is really necessary when screening for chlamydia.

The authors acknowledge that it is important for young women to understand that chlamydia is an STI and that sexual partners should be notified if someone tests positive. However, they said that chlamydia testing should be destigmatized. "In general practice the offer [of a chlamydia test] may seem to come 'out of the blue'" says Natasha Pavlin, who coordinated the study. "The importance of normalizing the offer of chlamydia testing, so that individual women do not feel singled out, cannot be overemphasized."

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New Technique Measures Ultrashort Laser Pulses At Focus

Lasers that emit ultrashort pulses of light are used for numerous applications including micromachining, microscopy, laser eye surgery, spectroscopy and controlling chemical reactions. But the quality of the results is limited by distortions caused by lenses and other optical components that are part of the experimental instrumentation.

To better understand the distortions, researchers at the Georgia Institute of Technology developed the first device to directly measure complex ultrashort light pulses in space and time at and near the focus. Measuring the pulse at the focus is important because that's where the beam is most intense and where researchers typically utilize it. Knowing how the light is distorted allows researchers to correct for the aberrations by changing a lens or using a pulse shaper or compressor to manipulate the pulse into the desired form.

"Researchers have always measured the pulse immediately as it exited the laser, so they didn't realize the extent to which the pulse became distorted by the time it reached the focus after traveling through the optics and lenses in the system," said Rick Trebino, a professor in the Georgia Institute of Technology's School of Physics and Georgia Research Alliance Eminent Scholar in Ultrafast Optical Physics.

The device was described in a presentation at the Conference on Lasers and Electro-Optics on May 8. This research was funded by the National Science Foundation and published in the August 2007 issue of the journal Optics Express.

It is difficult to measure ultrashort pulses because they typically last between a few femtoseconds and a picosecond, which are 10-15 and 10-12 of a second, and faster than the response time of the fastest electronics.

"The light comes out as a train of extremely short bursts. The laser crams all of the energy of a continuous laser into a few femtoseconds, which creates really intense laser pulses," said Pam Bowlan, a graduate student supported by the Technological Innovation: Generating Economic Results (TI:GER) program.

To achieve the highest possible intensity of the laser, the pulse must be as small as possible in space and as short as possible in time. However, focused pulses nearly always have distortions in time that vary significantly from point to point in space due to lens aberrations in focusing optics.

To address those issues, the new device, called SEA TADPOLE (Spatial Encoded Arrangement for Temporal Analysis by Dispersing a Pair of Light E-fields), allows researchers to measure complicated ultrashort pulses simultaneously in space and time as they go through the focus.

"A lot of chemists and biologists use ultrafast lasers, so it was important that our device be easy to use because non-laser scientists don't want to spend all day measuring their laser pulses," noted Bowlan.

The research team - which also included former graduate students Pablo Gabolde and Selcuk Akturk - used the concept of interferometry to measure a pulse in space and time. Two pulses, one reference and one unknown, were sent through optical fibers. The fibers were mounted on a scanning stage so that the pulses could be measured at many locations around the focus.

The pulses were crossed and an interference pattern was recorded for each color of the pulse at each location with a digital camera. The patterns were used to determine the shape of the unknown pulse in space and time and to create movies showing how the intensity and color of the pulse changed in space and time as it focused.

"Because the laser pulses enter SEA TADPOLE through optical fibers, which only collect a very small portion of the light, the device naturally measures pulses with high spatial resolution and can measure them at a focus spot size smaller than a micron," explained Bowlan. To further improve the spatial resolution of the device, the research team began to use specialized fibers, called near-field scanning optical microscopy fibers, which can resolve features smaller than the wavelength of the light.

The researchers tested the device by measuring ultrashort pulses focused by various lenses, since each lens can cause different complex distortions. To validate the measurements, Bowlan performed simulations of pulses propagating through the experimental lenses. Results showed that a common plano-convex lens displayed chromatic and spherical aberrations, whereas more expensive aspheric and doublet lenses exhibited mostly chromatic aberrations.

Spherical aberrations occur when the light that strikes the edges of the lens gets focused to a different point than the light that strikes the center, creating a larger, inhomogeneous focused spot size. Chromatic aberrations occur because the many colors in the laser travel at different speeds and do not stay together in space and time as the pulse passes through glass components in the experimental setup, such as lenses. As a result, each color arrives at the focus at a different time, creating a rainbow of colors in the electric field images.

Aberrations can drastically increase the pulse length, which decreases the laser intensity. A lower intensity forces researchers to increase the power of the laser, increasing the possibility of damaging the sample. Aberrations can also yield odd pulse and beam shapes at the focus, which complicate the interpretation of the experiment or application.

"Our system tells researchers what types of aberrations are present in instrumentation, which then allows them to test different lenses in the instrumentation setup or use a pulse shaper to create the desired pulse at the focus that's free of distortions," added Bowlan.

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Wednesday, May 7, 2008

Women Who Quit Smoking Quickly Reduce Heart Risk But Lungs Take Longer

Women who quit smoking significantly reduce risk of death from coronary heart disease within 5 years, but impact on risk of death from lung and other cancers take longer.

These are the findings of Dr. Stacey A Kenfield, of the Harvard School of Public Health, Boston, USA, and colleagues in a new study published in the May 7th issue of the Journal of the American Medical Association, JAMA.

According to the World Health Organization, about 5 million deaths were smoking related in 2000, and estimates suggest that by 2030, this figure will rise to 10 million worldwide, 7 million of which will be in developing countries, wrote the authors, who also said that tobacco use is the leading cause of death in the United States.

But while the link between smoking and increased risk of death from a range of diseases has been well established, the effect of quitting compared to continuing to use tobacco has not.

Kenfield and colleagues examined data from the Nurses' Health Study on over 100,000 women who were followed from 1980 to 2004. In this group there were nearly 12,500 deaths, with nearly 4,500 among never smokers (36 per cent), 3,600 among current smokers (29 per cent) and just under 4,400 among past smokers (35 per cent).

They calculated the relative risks (as hazard ratios) among the three subgroups of death from any cause, and from specific diseases such as cardiovascular, respiratory, lung and other cancers, and other causes.

The results showed that:

* There was a 13 per cent reduction in the risk of death from any cause within the first 5 years of quitting compared to continuing to smoke.

* This risk reduced to the same level as the never smokers after 20 years of quitting.

* Within this overall 20 year figure some causes took less time to go down to the never smokers' risk level and others took longer.

* Vascular disease showed the most rapid reduction in risk to the never smokers' level, with much of it showing in the first 5 years of quitting.

* These included coronary heart disease (62 per cent of excess risk gone in first 5 years of quitting) and cerebrovascular disease (42 per cent of excess risk gone in first 5 years of quitting).

* These figures were obtained from comparing the hazard ratios of recent quitters of less than 5 years with long term quitters of 20 years or more.

* Death from respiratory diseases showed an 18 per cent reduction in risk of death 5 to 10 years after quitting, going down to the never smokers' level after 20 years.

* Risk of death from lung cancer showed a significant 21 per cent reduction in the first 5 years of quitting compared to continuing to smoke, but the excess risk did not go away for 30 years.

* Past smokers who had quit for 20 but less than 30 years, had an 87 per cent reduction in risk of death from lung cancer compared to current smokers.

* When risk of death from other smoking-related cancers was included, this figures approached the never smokers' risk level more than 20 years after quitting.

* Risk of death from all causes, respiratory diseases, and smoking related cancers, was significantly higher among women who started smoking at a younger age.

* The figures also showed smoking was linked to increased risk of death from colorectal cancer but not ovarian cancer.

* About 64 per cent of deaths among current smokers and 28 per cent among past smokers were linked to cigarette smoking.

The authors concluded that:

"Most of the excess risk of vascular mortality due to smoking in women may be eliminated rapidly upon cessation and within 20 years for lung diseases."

They added that:

"Postponing the age of smoking initiation reduces the risk of respiratory disease, lung cancer, and other smoking-related cancer deaths but has little effect on other cause-specific mortality. These data suggest that smoking is associated with an increased risk of colorectal cancer mortality but not ovarian cancer mortality."

The researchers emphasized the importance of maintaining school programs on preventing tobacco use and enforcing laws that deny young people access to tobacco, given that early initiation is linked to higher risk of death. They also wrote that:

"Effectively communicating risks to smokers and helping them quit successfully should be an integral part of public health programs."

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