A group of scientists have completed a working draft of the genome sequence of corn, also known as maize, a widely grown crop that is vital to US agriculture. They hope the unraveling of this genome will speed up the development of better crop varieties to meet growing demand for food, animal feed and fuel. The team, led by Dr. Richard K. Wilson, director of Washington University's Genome Sequencing Center in St. Louis, Missouri, will reveal its work today, Thursday 28th February, at the 50th Annual Maize Genetics Conference in Washington, DC. The draft includes about 95 per cent of the corn genome. Wilson and colleagues hope to complete the rest by the end of the year. "Although it's still missing a few bits, the draft genome sequence is empowering," said Wilson. "Virtually all the information is there, and while we may make some small modifications to the genetic sequence, we don't expect major changes," he added. Maize, or corn, is an underlying foodstuff used in the manufacture of a wide variety of foods and other products, from the more familiar breakfast cereal to ethanol, shoe polish and toothpaste. It is also a vital food for cattle and other animals. Wilson said that this first draft is "exciting" because: "It's the first comprehensive glimpse at the blueprint for the corn plant." "Scientists now will be able to accurately and efficiently probe the corn genome to find ways to improve breeding and subsequently increase crop yields and resistance to drought and disease," he added. There are 2 billion DNA nucleotide bases in the corn genome, making it about the same size as the human genome. This is significantly larger than the rice genome which has about 430 million bases. A DNA nucleotide base is a chemical building block of which there are four kinds, each represented by a letter: A for adenine, G for guanine, C for cytosine, and T for thymine. The hardest part of the work Wilson and colleagues faced was to get the order of the bases right. About 80 per cent of the DNA sequence is repeated, and corn has 50,000 to 60,000 genes, about twice as many as humans. Many of these genes are mobile (transposons), making them much more difficult to "count" compared to the stationary ones. Genes are large groups of nucleotide pairs that either code for a type of protein or cell component, or regulate the expression of other genes. An organism's complexity does not depend on the number of genes in its genome. And some genes have sequences in common with other genes. The concept of a gene is not fixed and still changing as scientists discover more about them. Wilson explained that the task of sequencing the corn genome was: "Like putting together a 1,000 piece jigsaw puzzle with lots of blue sky and blue water, with only a few small sailboats on the horizon." "There were not a lot of landmarks to help us fit the pieces of the genome together," he added. Other cereal crops could also benefit from this research, not just other varieties of corn, but also rice, wheat and barely, and other applications. The research project, backed by the National Science Foundation (NSF), the US Department of Agriculture and the US Department of Energy, with a budget of nearly 30 million dollars, started in 2005. NSF director Arden L. Bement Jr. stressed the importance of corn as "one of the most economically important crops for our nation". "Completing this draft sequence of the corn genome constitutes a significant scientific advance and will foster growth of the agricultural community and the economy as a whole," he said. The rest of the team includes scientists from the University of Arizona in Tucson, Cold Spring Harbor Laboratory in New York and Iowa State University. Wilson and colleagues have been sharing the sequencing information they have unraveled through the online public DNA database, GenBank and maizesequence.org. The precise variety of corn that Wilson and colleagues have been studying is called B73, which was developed at Iowa State University several decades ago. B73 is known for its high yield and is widely used for commercial breeding of corn and also for research. Plant biologist Dr. Ralph S. Quatrano, who is Spencer T. Olin Professor and chair of Washington University's Department of Biology spoke of the range of applications of this discovery: "The genome will help unravel the basic biology of corn. That information can be used to look for genes that make corn more nutritious or more efficient for ethanol production, for example." The genome sequence of rice has already been unraveled, so sequencing a second grain crop will help scientists to find the genetic similarities and differences between them, said Quatrano. Project collaborator Dr. Rob Martienssen of Cold Spring Harbor Laboratory, was also enthusiastic about this: "The maize genome sequence will be of great interest to maize geneticists and biologists around the world, but also will be an important resource for plant breeding and biotechnology companies." "The maize sequence will be an invaluable reference for research, especially in renewable energy and biofuels, similar in significance to the human genome sequence for biomedical research," added Martienssen. Over 40 per cent of the world's corn is produced in the US, where a record 13.1 billion bushels were grown in 2007, representing a 25 per cent increase on 2006, according to the US Department of Agriculture. See Full Article
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A new study by researchers in the US found that people with advanced dementia are frequently given antibiotics toward the end of life, and has thrown into question whether this practice should be curtailed in view of the increased risk of developing drug resistant superbugs. The study is the work of Dr. Erika D'Agata and Dr. Susan L. Mitchell of the Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, and is published in the 25th February issue of the Archives of Internal Medicine. Advanced dementia patients in nursing homes are at high risk of infections and antimicrobial exposure near the end of life, wrote the researchers. D'Agata and Mitchell studied a group of 214 residents, of average age 85.2, with advanced dementia being cared for in 21 nursing homes in and around Boston. The residents were assessed between 2003 and 2006 and then every three months for up to 18 months. At each assessment, the number and type of antibiotics prescribed, with reasons (indication), were noted from records kept at the nursing home. They found that: * Over an average 322 days of follow up, 142 (66.4 per cent) of the group received at least one course of antibiotics (mean number of courses per resident was 4.0 with standard deviation of 3.7). * The mean number of days of antibiotic treatment for every 1,000 resident days for the whole group was 53.0 (standard deviation 4.3). * The most frequently prescribed antibiotics were quinolones and third-generation cephalosporins. * These accounted for 38.3 and 15.2 per cent of 540 prescribed antimicrobial therapy courses, respectively. * The most common reason for an antibiotic prescription was respiratory tract infection, which accounted for 46.7 per cent of all courses. * Of the 99 residents who died, 42 (42.4 per cent) of them had received antibiotics in the 2 weeks before death. * Among these 99, the number who received antibiotics went up significantly as they approached death. * The proportion of residents taking antibiotics in the last two weeks of life was seven times greater compared with six to eight weeks before death. * The number of antibiotics prescribed and the days of therapy per 1,000 resident-days also went up significantly as death approached. * 30 of the 72 courses (41.7 per cent) taken in the last two weeks of life were given intravenously as opposed to by mouth (this could be distressing and uncomfortable for patients with advanced dementia). D'Agata and Mitchell concluded that: "Persons with advanced dementia are frequently exposed to antimicrobials, especially during the 2 weeks before death." With regard to the implications of this practice they suggested it should be evaluated with respect to two things: "the individual treatment burden near the end of life and its contribution to the emergence of antimicrobial resistance in the nursing home setting." Writing in an editorial in the same issue of the journal, Drs. Mitchell J. Schwaber and Yehuda Carmeli of the Tel Aviv Medical Center in Israel commented that: "The findings in this study require the medical community to ask whether the extensive use of antibiotics in this particular patient population is appropriate, taking two factors into consideration: the benefit to the patient treated and the risk imposed on other patients." They are not suggesting a flat refusal to give antibiotics to severely demented elderly people, or even that policies restricting their use should be introduced. They suggest antibiotics should be considered alongside every other carefully weighed decision such as resuscitation and major surgery. As well as weighing up the interests of the patient and the risk to others, they concluded that: "All such decisions must ultimately be made individually, based on the medical situation and the expressed wishes of the patient and family, as well as on the physician's judgment of the benefits and risks entailed in treating vs. not treating." The controversy about the public health implications arises because previous research has shown that nursing homes can harbor drug resistant bacteria, and these can spread into hospitals when nursing home residents are admitted. An Associated Press report notes the comments of various experts, discussing the implications of this study. A geriatrician and ethicist at the University of Chicago Medical Center, Dr. Daniel Brauner, said being more careful with antibiotics means doctors would have to keep a much closer watch on nursing home residents. But, he said "I'm sure a lot of these antibiotics were prescribed over the telephone". Another problem of course, even with close monitoring, is that the doctor sometimes can't tell if the patient is approaching death. Dr. Eric Tangalos, a geriatrician at the Mayo Clinic told the Associated Press that: "Until that decision is made that death is imminent, there's always hope. People do recover from those infections." On the other hand, is the problem of what constitutes quality of life in those last few weeks, as Bruce Jennings, a bioethicist with a research institute on medical ethics, the Hastings Center, put it: "You might rescue the patient from life-threatening pneumonia and they live a few days, weeks or even months longer. But the extra time you have bought them by that rescue is not beneficial." Mitchell said doctors should discuss these things with the patient's family, in the same way as they discuss whether a feeding tube should be used. She also commented that none of the residents in the study had made living wills stating their wishes on antibiotic treatment. Over 5 million Americans are living with dementia, about 70 per cent of whom will be cared for in nursing homes as they approach the end of their lives. See Full Article
One day they are crawling, the next day they are driving and then suddenly they aren't kids anymore. As children reach adulthood, the parent-child relationship changes as parents learn to adapt to newly independent children. A new study by a University of Missouri professor explored the differences in how mothers and fathers interacted with their young adult children. She found there were few differences in the way mothers and fathers felt and that many of the changes were positive, despite the perception that mothers in particular fall apart and experience the so-called empty nest syndrome. "As children age, direct care taking and influence diminish, and children are often seen by their parents as peers with whom they are have continuing relationships," said Christine Proulx, assistant professor of human development and family studies in the College of Human Environmental Sciences. "Although our between-families results suggest these patterns of change and continuity differ by parent and child gender, our within-family analysis suggest important similarities among mothers and fathers within the same family." Of most concern to the parents in the study were firstborns' independence, time spent together and role patterns. The study found that generally fathers and mothers reported similar changes in the parent-child relationship during their child's movements into young adulthood. Both fathers and mothers reported differences in independence/maturity of the child, closeness/openness in the relationship, contact/time spent together and changes in role pattern. Another change reported by parents was relating more like peers and having more adult-like interactions with their young adult child than in prior years. Other parents reported acting more like a mentor and giving advice to their children rather than demands. Some of the things that remained the same in the parent-child relationship were providing financial assistance and continuing to be a mentor to their young adult child. Few parents in the study reported changes in emotional support to the children. "The within-family analysis suggests that mothers and fathers in the same families in our study rarely reported divergent experiences with their young adult sons and daughters," Proulx said. "Overwhelmingly, the examination of mothers' and fathers' responses revealed similarities in mothers' and fathers' experiences as parents to their young adult child." The study interviewed 142 sets of parents with firstborn young adult sons and daughters and was published in the Journal of Family Issues. See Full Article
The most common hereditary form of hereditary mental retardation is known as Fragile X syndrome (FXS), so dubbed for its characteristic mutation on the X chromosome, or Escalante's syndrome. Manifestations of this disease in patients usually include a characteristic long facial pattern, tooth and jaw misalignment, musculoskeletal abnormalities, or autism. Additionally, many FXS patients also suffer from attention deficit and/or hyperactivity disorder (ADHD), a disorder that can make functioning socially or professionally difficult. Stimulant medications, such as Ritalin®, are often effective for ADHD patients with mental retardation, but there are counterproductive side effects such as irritability, diminished speech, and social withdrawal. L-acetyle carnitine (LAC,) a variant of the amino acid carnitine, showed promise in a previous study of reducing hyperactive behavior in FXS boys with AHDH. They were treated with it for one year, with no adverse side effects reported. The same authors have subsequently performed a randomized, double-blind, placebo-controlled study over multiple centers to determine how effective LAC can be in a larger group. This study will be published in the April 1, 2008 issue of American Journal of Medical Genetics Part A, which is available online via Wiley InterScience at the following address: http://www3.interscience.wiley.com/cgi-bin/jhome/33129. M. Giulia Torrioli and Giovanni Neri of the Università Cattolica in Rome led the study, which brought together 51 boys between the ages of 6 and 12 who had been diagnosed with FXS and ADHD. They were treated in one of eight facilities in Italy, France, and Spain. The treatment, 500 milligrams of LAC or a placebo twice a day, was continued for 12 months. A team of child neuropsychiatrists and psychologists evaluated each patient at the start of the study, after one month, 6 months, and 12 months. Neuropsychologicial tests were used to evaluate the effects of the drug and the placebo. Subjects in the LAC group showed reduced hyperactive behavior and better attention. In this group there were also no side effects, indicating that LAC provides a safe alternative to stimulant therapies. The placebo group showed less hyperactive behavior as well, but not at the magnitude of the LAC group. Additionally, LAC patients showed improved social ability. While both groups took intelligence tests, LAC did not appear to improve intellectual function. "We propose that LAC be recommended as a treatment of ADHD in FXS children," the authors state, "since it effectively reduces hyperactive behavior and improves social abilities without adverse side effects." They also suggest that these results may be applicable to children with autism, who also do not easily tolerate stimulants. See Full Article
According to a recent article published on bmj.com, antioxidants and nutrients do not help children with Down syndrome develop. Down syndrome (trisomy 21) is a disorder caused by the presence of an extra 21st chromosome. It is associated with impairment of cognitive ability and physical growth. It is the most prevalent genetic reason of learning disability in the United Kingdom, occurring in about 1 in every 1,000 new born babies. Researcher Jim Ellis and colleagues were motivated by earlier studies that have suggested possible improvements in language and psychomotor development if children are given folate (a form of vitamin B9), antioxidants, or both. Children with the condition in Europe and the United States have been consuming vitamin and mineral supplements because of the positive results claimed by marketers of such products. However, there has not been any reported significant effect on development for children with Down syndrome. The study was performed by UK researchers who gave supplements to 156 babies - all less then 7 months in age - who had Down syndrome. The studied lasted for 18 months. The babies, selected from several sites in England, were divided into four groups. One group received antioxidants once per day, one group received folinic acid (a folate), one received both antioxidants and folinic acid, and one control group took a placebo. The supplements were given in powdered form and mixed with food or drink. The study participants were evaluated for mental and cognitive development after 18 months. Findings include: * No differences were noted among the groups in the biochemical outcomes * There was no improvement in language or psychomotor development among the supplement groups The authors conclude that there is no evidence that antioxidants or folinic acid help development in children with Down syndrome. They caution that parents who are giving these supplements to children should be aware of the possible damaging consequences of long-term, high dose administration. An accompanying editorial by Tim Reynolds concurs with these general findings. He also notes that it is not prudent to recommend expensive vitamin supplements until some positive benefit is shown. See Full Article
The Ministry of Agriculture in China has confirmed there is an outbreak of H5N1 bird flu in Tibet, the second this year. This follows confirmation that a a 22 year old man from central China died of the virus last month. Chinese authorities said the Tibetan outbreak started on 6th February, in a small community on the outskirts of Lhasa, the capital of Tibet, which lies in the Himalayas. The outbreak killed over 100 domestic birds, and since then nearly 8,000 more have had to be culled. Samples tested in the laboratory over the weekend have proved positive for the deadly H5N1 form of bird flu, according to a report in the Canadian Press, which also says that the authorities have brought in emergency measures in the area. The earlier bird flu outbreak was reported last month on a poultry farm in the southwest part of the province. That killed 1,000 birds and the farm was put under quarantine regulations. The 22 year old man who died of bird flu on the 24th of January was confirmed as having had the H5N1 virus, said China's Center for Disease Control and Prevention in Beijing. The man, whose name was Li, came from Jianghua County, Yongzhou City, in the central province of Hunan, and was taken into hospital on 22nd of January. His symptoms, fever and headache, started on 16th January. Although he was treated, his symptoms got worse and he died, according to reports from state media. The province is currently experiencing extreme traffic problems because of low temperatures and severe bad weather with ice, rain and heavy snow, which have also caused blackouts. When this happens it is not unusual for disease and illness rates to go up, but the authorities say they have remained steady so far. Also, no person who came into close contact with Li has developed symptoms, and they continue to be kept under close medical observation, said the Chinese authorities. Last month China reported a case of a father and son who had caught bird flu, but officials said that although this was China's first case of bird flu in the same family, there was no evidence that the virus had passed from human to human. The son died early December 2007. According to Xinghua news agency, the new case has now been reported to the World Health Organization (WHO), and also authorities in Hong Kong, Macao and Taiwan, as well as other foreign governments. World experts in bird flu suggest it is only a matter of time before the deadly H5N1 virus mutates into a form that passes from human to human as opposed to bird to human. When it does so, they predict a world pandemic will kill millions of people. According to the WHO, as of 15th February, China has reported 27 confirmed cases of bird flu since 2003, including 17 deaths. Mr. Li's death brings the death toll in China to 18. Meanwhile in Viet Nam, the Ministry of Health confirmed last week, that a 40 year old man from Gia Loc district, Hai Duong province, died of H5N1 bird flu on 13th February after being taken into hospital 5 days earlier. He developed symptoms on the 2nd of February and it has been confirmed that he had come into contact with sick and dead domestic birds before falling ill. Local control measures are in place and so far anyone who came into contact with the man is in good health, said the authorities in Viet Nam. Viet Nam has reported 103 confirmed cases of H5N1 since 2003, of which 49 to date have been fatal, said the WHO. Worldwide, the number of human cases of H5N1 since reporting began in 2003 totals 361, including 227 deaths, a fatality rate of 63 per cent. See Full Article
Microbilogy - A gut feeling . . .Bacteria cells outnumber human cells in the average healthy human body by a factor of almost ten. Now researchers are asking if those resident microorganisms play a larger role in who we are than previously thought. ORNL researchers are joining an international collaboration to learn more about the role microorganisms play in, for example, the digestive system and how disruptions in the symbiotic balance in "gut microflora" might control the transition from healthy to disease conditions. ORNL's capabilities in mass spectroscopy offers researchers new and powerful tools for probing the extremely complex relationships between the microbiome and their human hosts. Ecology - Nature's way . . .Small streams disrupted by military training activities or commercial development can be restored with simple and inexpensive measures, according to findings of a group headed by Pat Mulholland of Oak Ridge National Laboratory. Researchers from ORNL and Auburn University learned that streams can be adversely affected even if as little as 10 percent of the watershed is disturbed. In their study, conducted at Fort Benning, Ga., the researchers found that revegetating drainage ditches that carry water only during storms and adding dead trees and woody debris to stream channels helped trap smaller organic materials and improve the habitat for stream organisms, including fish. "This project has provided the military with an improved understanding of its effects on streams and a possible approach for mitigating some of those effects," Mulholland said. The project was named Sustainable Infrastructure Project of the Year by the Strategic Environmental Research and Development Program, which funded the work. Nanoscience - Atom-scale switch . . .ORNL researchers have discovered a carbon nanotube-based system that functions like an atom-scale switch. Their approach is to perform first-principles calculations on positioning a molecule inside a carbon nanotube to affect the electronic current flowing across it. The result is an electrical gate at the molecular level: In one position, the molecular gate is open, allowing current through; in another position, the gate is closed, blocking the current. In a silicon chip, the gate is a silicon oxide barrier within the structure of the chip. In the ORNL model, the gate is a short molecule - encapsulated inside the carbon nanotube - that is about one nanometer in size, or three orders of magnitude smaller than a silicon chip. Fusion - Lassoing turbulence . . .Fusion power is a holy grail of our energy future, promising eventually to provide cheap, plentiful electricity with a minimum of environmental concerns and no greenhouse gases. Before it does, however, scientists must learn to control and contain an ionized gas hotter than the sun. Theoretical physicists from General Atomics are using ORNL's Phoenix supercomputer to understand turbulence that leaches energy from fusion reactors. In particular, they are focusing on the interaction between eddies created by gyrating electrons and much larger eddies created by gyrating ions. The answers they provide will be an important step toward an energy revolution. Climate - Improving projections . . .A new data mining tool developed by Forrest Hoffman and colleagues could lead to a better understanding of Earth's climate systems and to more accurate models. Using a novel cluster analysis technique to classify and group data, the researchers are able to take extract and compare relevant patterns from enormous datasets. For this study, researchers used data for the Southern Great Plains Atmospheric Radiation Measurement (ARM) site in Lamont, Okla., and projections from the National Center for Atmospheric Research's Community Climate System Model. One finding of note is that the model fails to capture an observed atmospheric state characterized by very low wind shear under high humidity and temperature conditions at the ARM site. Others involved in this project are Salil Mahajan of Texas A&M University, Sigurd Christensen and Richard Mills of ORNL and Bill Hargrove of the U.S. Department of Agriculture Forest Service. The research was funded by the Department of Energy's Office of Biological and Environmental Research, Climate Change Research Division.
 Reports are coming in of countries responding to Paraguay's request for extra doses of yellow fever vaccines to help it roll out an expanded vaccination program following its first outbreak in 34 years. According to the Associated Press (AP), 50,000 doses arrived from Brazil on Thursday, and Peru has promised to send 250,000 next week. Paraguay's Minister for Health and Wellbeing, Oscar Martínez Doldán, told the press that "additional requests" had been made to Taiwan and Cuba as well. According to the World Health Organization (WHO), the Paraguay health authorities reported five confirmed cases of Jungle Yellow Fever on 15h January 2008, and four other suspected cases on 11th February. All cases were said to be in the San Pedro department which is about 100 kilometers north of the capital, Asuncion, in the middle region of the country. Health Minister Doldán asked that people remain calm, following an angry protest near the capital, Asunción, where thousands of local people blocked a highway for several hours to protest against the shortage of vaccine. The Paraguay health authorities have vaccinated about 35,000 people in the outbreak region and have asked the Pan American Health Organization to supply 600,000 doses to supplement the country's 100,000 stock. Paraguay newspaper Ultima Hora reported yesterday that former health ministers have formed a commission to work on a strategy to tackle the problem. They are expected to call on the president, Nicanor Duarte Frutos, to declare a state of national emergency in order to "intensify the task of prevention". Stories are also starting to break that two more cases of yellow fever, as yet unconfirmed by the health authorities, have occurred in the region of Laurelty in San Lorenzo, a city which is only 10 kilometers from Asunción. One man died in January and another woman, his neighbor, is seriously ill in a hospital in the capital, with similar symptoms, reported Xinhua news agency. According to a Paraguayan national newspaper, La Nación, a local lawyer, Melitón Bittar, has issued a judicial order that requires all the residents of Laurelty be vaccinated. And a judge, Julián López, has ordered the Ministry for Health and Wellbeing to carry out a "massive and immediate" vaccination campaign in all neighboring districts. A vaccination program was started in the area, but it ran out of doses after a few hours, and this was said to be the cause of the angry protest that blocked the highway. Health officials tried to calm local people by assuring them that other countries were helping. The authorities were expecting hundreds of thousands of doses from Brazil and Peru, and requests had been made to the Pan American Health Organization. The Vice Minister for Health and Wellbeing, Antonio Barrios is reported to have said "We are just as anguished and desperate as every other citizen." In the meantime, he asked local people to do all they can to destroy the habitats of the "aedes aegypti" mosquito that carried yellow fever and dengue fever. He said there were a lot of these mosquito hatcheries in and around Asunción. Last year there was an outbreak of dengue fever that killed 17 people and infected 27,000, said Xinhua news agency. Paraguay is one of South America's poorest nations, and has a population of 6.1 million people. The country's economy relies on agriculture, which is being increasingly commercialized, leading to a massive rural to urban drift as the numbers of landless families increases. About 60 per cent of Paraguayans live in poverty and the numbers living in shanty towns is increasing rapidly. According to the WHO, around 30,000 people worldwide die from yellow fever, the symptoms of which include fever, vomiting, jaundice, and also hemorrhagic fever develops in 15-25 per cent of cases and causes bleeding in the mouth, nose, eyes and stomach. Case fatality is around 50 per cent. See Full Article
A recent study published in the American Journal of Respiratory and Critical Care Medicine finds that compared to whites, blacks with chronic obstructive pulmonary disease, or COPD, were less likely to receive a lung transplant. Blacks were also more likely than whites to die or be removed from the transplant list. Columbia University researcher David Lederer and colleagues analyzed 280 non-Hispanic black adults and 5,272 non-Hispanic white adults who were diagnosed with COPD or emphysema. All members of the sample were awaiting lung transplants on the United Network for Organ Sharing (UNOS) list between 1995 and 2004. The researchers tracked patients to the end of the study period until they died, received a transplant, were removed from the list, or were still living and awaiting transplant. The results were examined with respect to age, sex, disease severity, community poverty level, and transplant center volume. After controlling for age, lung function, cardiovascular risk factors, transplant center volume, type of health insurance, and approximate poverty level, Lederer and colleagues showed that "black patients with COPD were less likely to undergo lung transplantation after listing than white patients in the United States during the late 1990's and the early 2000's" They note that this finding and other "disparities are consistent with those observed among patients awaiting kidney and liver transplantation and among patients with other advanced lung diseases such as pulmonary arterial hypertension and pulmonary fibrosis." Blacks were also less likely to have private insurance and more likely to live in poorer neighborhoods. Greater cardiovascular risk factors, such as diabetes, pulmonary hypertension and lower six-minute walk distances were observed in blacks compared to whites. However, even these factors did not account for the differences between the two groups regarding lung transplantation. "Differences in insurance, socioeconomic status and cardiovascular risk factors explained some but not all of the higher risk of death or removal from the waiting list," said Dr. Lederer. The researchers also found that Hispanics had similar outcomes to non-Hispanic blacks. During the ten-year study period, only 280 black and 64 Hispanic patients with COPD were put on the lung transplant waiting list in the United States. Lederer adds that "based on what we know about COPD, we expected that twice as many black patients would have been put on the ling transplant waiting list. Our findings point to significant barriers to accessing lung transplantation for minorities." The authors maintain that their findings "should alert primary care physicians and pulmonologists to consider referral of black patients with COPD for transplantation at the earliest signs of advanced disease." In addition, patients can protect themselves from these racial differences by preparing themselves for transplantation "by discussing all of their treatment options with their doctor. To be eligible for lung transplantation, patients must quit smoking, use medications and oxygen as prescribed, and participate in a pulmonary rehabilitation program to increase their strength and endurance." Since the study period, the organ allocation system has been replaced with one that prioritizes patients based on the survival benefit of the transplant. However, blacks will still be more likely to be removed from the transplant list or to die due to poor insurance and poverty compared to whites, warns Lederer. The authors conclude by calling for research that identifies "the specific barriers that patients encounter while trying to get on the waiting list for a lung transplant. Once we figure out the root of the problem, we can begin to improve access for all patients with COPD." See Full Article
Researchers in Denmark have found that using high efficiency particle air (HEPA) filters significantly improved cardiovascular health in healthy, non-smoking elderly people, according to a recent study published in the American Journal of Respiratory and Critical Care Medicine. Doctors suggest that (HEPA) filters - along with weight loss, smoking cessation, and exercise - will become part of standard cardiovascular health. The study sample consisted of 21 non-smoking couples aged 60-75 who lived near roads with heavy traffic. Researchers measured microvascular function (MVF) and ambient airborne particles in the participant's homes. For two 48-hour periods, the couples used an air purifier. During only one of the periods, the purifier was equipped with a HEPA filter. Since the participants did not know when the HEPA filter was attached, the researchers were able to use each couple as its own control. Throughout the study, the size distribution and number concentration of indoor air particles in each home were monitored. A noninvasive finger sensor allowed researchers to analyze each participant's MVF. They also assessed biomarkers from blood and urine samples to look for markers of inflammation, hemostasis (halted bleeding), and oxidative stress (damage to cells caused by free radicals, for example). The researchers found that "reduction of particle exposure by filtration of recirculated air for only 48 hours improved the microvascular function in healthy elderly citizens." These results suggest that "indoor air filtration represents a feasible means of reducing cardiovascular risk," according to Dr. Steffen Loft, coauthor of the study. A key finding associated with a reduction of indoor air particles was a significant improvement in the function of small finger blood vessels. "This effect most likely indicates a general improvement in the function of the inner lining of small vessels, including those supplying the heart," said Dr. Loft. When the inner linking of small vessels is not functioning properly, people are at greater risk of dangerous or possibly fatal cardiovascular events. The findings include: * HEPA filtration removed about 60 percent of the ultrafine, fine and coarse air particles in homes * HEPA filtration was associated with an 8.1 percent improvement in individual MVF. * Secondary biomarkers from blood and urine were not significantly affected by HEPA filtration "We expected that removing air particles with the HEPA filters would result in improvement of MVF but we were heartened and surprised by the extent it did, considering the modest levels of particles in the indoor air of the homes of the elderly," stated Dr. Loft. The authors maintain that further study is needed to determine the mechanisms underlying the improvement of MVF after filtration. "The results of this study indicate that reduction of particles in recirculated indoor air by filtration significantly improves MVF in a healthy, non-smoking, elderly population," wrote Dr. Loft. "The improvement could not be ascribed to significant reduction in inflammation or oxidative stress by means of biomarkers." See Full Article
A new study published in Cancer reports that the likelihood of patients' obtaining colorectal cancer screenings is dependent on health care providers. Dr. Melissa M. Farmer of Veterans Affairs and colleagues suggest that interventions targeting both the provider and the patient are needed to boost colorectal cancer screening rates. Specifically, patient barriers such as concerns about payment and worries that cancer will be discovered must be taken into account. Despite colorectal cancer being the third leading cause of cancer death in both US men and women, national screening rates remain relatively low. However, there has been growing recognition of the importance of screening in reducing cancer mortality. Dr. Farmer and colleagues were chiefly interested in the potential barriers to colorectal cancer screening. The researchers analyzed data from a study conducted at UCLA's Jonsson Comprehensive Cancer Center and the UCLA School of Public Health. They examined trends and predictors of colorectal cancer screening from telephone surveys done prior to and after a quality improvement intervention for screening. Survey participants were all members of a large managed care health plan, allowing the researchers to assess barriers to screening in an environment where access to care was not one of them. Two surveys were conducted. The first contained 498 individuals aged 50 years and older surveyed in 2000. The second consisted of 482 different individuals in the same age group surveyed in 2003. The researchers used specific guidelines to assess whether individuals received colorectal cancer screening - a fecal occult blood test every year, sigmoidoscopy every 5 years, or colonoscopy every 10 years. A fecal occult blood test is a check for hidden blood in the stool, a sigmoidoscopy is a minimally invasive medical examination of the large intestine from the rectum through the last part of the colon, and a colonoscopy is an examination of the large colon and the distal part of the small bowel with a camera. Key findings include: * Colorectal cancer screening rates increased over the three-year period, though there was evidence of underutilization * 38% of patients in 2000 reported that they had been screened with any test * 50% of patients in 2003 reported that they had been screened with any test * Patients who reported discussing colorectal cancer screening with doctors were significantly more likely to have a screening. * Participants who were concerned about cost or who were afraid of a cancer diagnosis were less likely to be screened. The results "suggest that interventions focused solely on educating patients are not likely to increase rates significantly," according to the authors. "The provider and related health care system must be able to include discussions and recommendations for colorectal cancer screening in practice." They conclude by calling for multilevel interventions that target both the provider and patient in order to increase screening rates. See Full Article
Doctors are "outraged" that medical insurance company Blue Cross of California sent them a letter asking them to check whether their patients had omitted to mention pre-existing medical conditions on their insurance application form. The company has now withdrawn the letter. Richard Frankenstein, president of the California Medical Association advocacy group, told the Los Angeles Times that: "We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality." The letter, which was sent to doctors along with a copy of their patient's insurance application form, asks: "Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately." "We ask your assistance to identify medical omissions because you, being the primary care provider, will have first-hand knowledge of services provided and/or requested," the letter explains. A spokesperson for WellPoint, who own Blue Cross, told the LA Times that enrolling applicants who did not reveal pre-existing medical conditions results in "increased utilization of services, which drives up costs for all members". In a statement released on PRNewswire yesterday, 12th February, Blue Cross of California said that its action was nothing new. This "notification process" had been in place for years and they have never received calls or letters complaining about it. The company said it: "Highly values the trust of its members and understands the personal relationship members have with their physicians and medical groups." However, the insurer said it had responsibility to ensure members' records were up to date and one way it did this was to send a member's application form to his or her doctor to make sure it "mirrors what is reflected in the physician's notes for that member". Following the reaction by the California Medical Association, Blue Cross consulted with provider partners and state regulators, and determined the letter was no longer necessary and would be withdrawn because it was "creating a misimpression and causing some members and providers undue concern". The company urged that the letter be seen in context, saying the action only pertained to a very small fraction (0.0015 per cent) of its 8 million plus members. Insurance companies are allowed to cancel policies where they discover the applicant has failed to reveal a pre-existing medical condition, but there are limits to how far they can go. WellPoint is currently fighting a 1 million dollar fine imposed on it last year for inappropriately canceling health insurance policies. The state appeals court said that insurers who wanted to cancel policies had to show that members "willfully misrepresented" their health status, or that the applications had been investigated before issuing coverage. See Full Article
Two US studies have suggested that it's never too late to make a difference to one's odds of living longer. One study showed that having a healthy lifestyle in early elderly years was linked to greater odds of living to 90 in men, and a second study showed that although some people live to be over 100 by avoiding certain diseases, others do live with them to this age without becoming disabled. Both studies are published in the 11th February issue of Archives of Internal Medicine. While research on twins has shown that genes play a part in how long we are likely to live, nearly three quarters of the odds of living to a ripe old age of 90 or more, is down to "modifiable factors", or things we can change, wrote researchers in one of the articles. In the first study, Dr. Laurel B. Yates of Brigham & Women's Hospital, Boston, and colleagues examined records on 2,357 men of average age 72 when they became participants in the Physician's Health Study between 1981 and 1984. The records included a range of demographic and health data such as height, blood pressure, weight, how often they took exercise, and cholesterol levels. The men also completed questionnaires twice in the first year and then once every following year until 2006. This asked them about their health, habits and ability to carry out every day tasks. The results showed that: * 970 men lived to be 90 or more (41 per cent). * Several "modifiable" factors about their biology and behavior were linked with survival for this group. * Smoking, diabetes, obesity, and high blood pressure appeared significantly to reduce the odds of living to 90 or more. * On the other hand, vigorous exercise, "substantially improved it". * Also, men who lived to 90 and beyond had better physical function, mental wellbeing and rated themselves as healthier in late life than the men who died younger. * Smoking, obesity and having a sedentary lifestyle were also significantly linked to poorer functional status in elderly years. Yates and colleagues estimated that a 70 year old man who did not smoke, was of normal weight, had no diabetes, exercised two to four times a week, and had normal blood pressure had a 54 per cent chance of living to be 90 years old. But, if he had any "adverse" risk factors, his chances of living to 90 were reduced, depending on what they were. Thus each factor would reduce the 54 per cent to the following amount: * Sedentary lifestyle reduced the chances of living to 90 from 54 to 44 per cent. * High blood pressure reduced it to 36 per cent. * Obesity, 26 per cent. * Smoking, 22 per cent. * Three factors together, such as sedentary lifestyle, obesity and diabetes, 14 per cent. * Five factors, 4 per cent. The authors concluded that: "Although the impact of certain midlife mortality [death] risks in elderly years is controversial, our study suggests that many remain important, at least among men." They therefore recommended that: "Healthy lifestyle and risk management should be continued in elderly years to reduce mortality and disability." For the second study, Dr. Dellara F. Terry of the Boston University School of Medicine and Boston Medical Center, and colleagues, examined data on 523 women and 216 men age 97 or older. The data came from questions the participants had answered in a telephone interview or mailed questionnaire about their health and medical history and their ability to function. Dellara and colleagues put them into groups according to gender and the age at which they developed diseases normally linked to aging, such as COPD (chronic obstructive pulmonary disease), dementia, hypertension, osteoporosis, Parkinson's disease, stroke, diabetes and heart disease. Those who developed these diseases at the age of 85 or more were called "delayers", and those who developed the diseases before they reached the age of 85 were called "survivors". The results showed that: * 32 per cent of the participants were survivors and 68 per cent were delayers. * Centenarians who had developed heart disease and/or high blood pressure before they got to 85 showed similar levels of function as those who delayed illness until 85 or later. * Levels of function were described as "independent" in men and "requires minimal assistance" in women. * Though fewer men than women live to an extremely old age, the men in this study who did so appeared to have better mental and physical function than the women. Speculating on their results, the authors suggested that "men must be in excellent health and/or functionally independent to achieve such extreme old age." But women, they said, "may be better physically and socially adept at living with chronic and often disabling health conditions". The researchers concluded that the timing of illness in centenarians may explain the "various ways in which people can survive to extreme old age". "Determining the mechanisms that facilitate the delay or escape of disability in the face of clinically evident age- and mortality-associated morbidities merits further investigation," they added. In an accompanying editorial, Dr. William J. Hall, of the University of Rochester School of Medicine & Dentistry, New York, wrote that the 85s and over is the fastest growing group of older Americans. They will need regular medical care, he added: "The challenge to current health care providers is to become adept at caring for present and future centenarians with only the beginnings of concrete evidence-based research." "Our ability to adapt to this challenge may be a prime determinant in shaping the nature of primary care practice in this country," wrote Hall. See Full Article
In a paper published 7 Feb 2008, deCODE scientists establish a substantial and consistent positive correlation between the kinship of couples and the number of children and grandchildren they have. The study, which analyzes more than 200 years of deCODE's comprehensive genealogical data on the population of Iceland, shows that couples related at the level of third cousins have the greatest number of offspring. For example, for women born between 1800 and 1824, those with a mate related at the level of a third cousin had an average of 4.04 children and 9.17 grandchildren, while those related to their mates as eighth cousins or more distantly had 3.34 children and 7.31 grandchildren. For women born in the period 1925-1949 with mates related at the degree of third cousins, the average number of children and grandchildren were 3.27 and 6.64, compared to 2.45 and 4.86 for those with mates who were eighth cousins or more distantly related. The findings hold for every 25-year interval studied, beginning with those born in the year 1800 up to the present day. Because of the strength and consistency of the association, even between couples with very subtle differences in kinship, the authors conclude that the effect very likely has a biological basis, one which has yet to be elucidated. The paper, 'An association between the kinship and fertility of human couples,' is published online in Science magazine at www.sciencemag.org. This study provides the most comprehensive answer yet to the longstanding question of how kinship affects fertility in humans. Previous studies in other parts of the world have suggested that the two phenomena are positively correlated, though confounding variables, such as the impact of socioeconomic status on the size of families or age at marriage, have made the results difficult to interpret. The analysis of such a long-term series of data from Iceland effectively eliminates these variables by encompassing an entire population which has historically been highly homogeneous both culturally and economically. Moreover, the results are strikingly consistent from eras in which Iceland was a predominantly poor and rural country, to the present-day era of a highly urbanized society with one of the highest standards of living in the world. The authors note that the findings are somewhat counterintuitive from an evolutionary perspective because closely-related parents have a higher probability of having offspring homozygous for deleterious recessive mutations, although closer parental kinship can also decrease the likelihood of immunological incompatibility between mother and offspring, for example in rhesus factor blood type. Perhaps most importantly, today's findings also suggest that the recent and dramatic demographic shift experienced in Iceland - from a rural society to a highly urbanized one - may serve to slow population growth, as individuals are exposed to a much broader range of distantly related potential mates. If so, this could be of relevance to slowing population growth in the many other - and much more populous - societies around the world undergoing transition from closely-knit rural societies to more urbanized ones. Indeed, the UN estimates that in the 2007-2008 period the majority of the world's population will, for the first time in human history, live in town and cities. See Full Article
A recent article in the Archives of General Psychiatry reports that women who undergo an extremely stressful event during the first three months of pregnancy have an increased risk of having children who develop schizophrenia. Researcher Ali S. Khashan of the University of Machester, England and colleagues note that there is some consensus that a mother's psychological state influences her unborn baby. "Severe life events during pregnancy are consistently associated with an elevated risk of low birth weight and prematurity." Schizophrenia is a disabling condition associated with abnormal brain structure and function, and it is believed to begin in early brain development. Risk of the condition is influenced by susceptibility genes that can interact with environmental factors that occur during pregnancy. The data are drawn from 1.38 million Danish births occurring between 1973 and 1995. A national registry linked mothers to close family members, and the registry informed researchers if mothers experienced stressful events during pregnancy such as a family member dying or receiving diagnosis of cancer, heart attack, or stroke. The data allowed the research team to follow children from their 10th birthday through June 30, 2005 or until they died, left the country, or received a schizophrenia diagnosis. During the study period, 21,987 mothers were exposed to the death of a relative during pregnancy, 14,206 were exposed to serious illness of a relative during pregnancy, and 7,331 of the offspring developed schizophrenia. One result suggests a 67 percent greater risk of schizophrenia or related disorders among the children of women who experienced the death of a relative during the first trimester of pregnancy. The researchers note that if the death of a relative occurred up to six months before conception or any other time during pregnancy, the event was not associated with a risk for schizophrenia. In addition, a mother's exposure to a relative's serious illness is also not linked to schizophrenia. Only for individuals without a family history (parents, grandparents or siblings) of mental illness was there a significant association between a family death and risk of schizophrenia. The authors conclude that "risk associated with exposure to a well-defined, objective stressful event confined to the first trimester of pregnancy suggests a number of possible mechanisms." They suggest a possible effect on the fetus' brain of chemicals released by the mother's brain when she experiences stress. During early pregnancy, the protective barriers between the mother and fetus are not fully constructed, and the effects may be strongest. See Full Article
The previously supposed link between autism the MMR jab, a vaccination against measles, mumps, and rubella, has been discredited, according to a study published in the Archives of Disease in Childhood on February 5, 2008. The MMR vaccine had been linked to the development of autism in the light of a 1998 publication, which has since been discredited by the scientific community. Autism spectrum disorders are a set of psychological conditions that are similar to autism, characterized by abnormal social interaction, restricted interests, and repetitive behavior. They are found in approximately 6 to 12 cases per 1000 children depending on the specific diagnostic criteria that are applied. The group studied was taken from a population of approximately 57,000 in one area of Southern England. Almost 250 children, born between 1990 and 1991 and aged between 10 and 12, were selected for examination. Of these: 98 children had an autism spectrum disorder; 52 were characterized as children with special educational needs, but no evidence of autism spectrum disorders; and 90 children were developing normally. A set-back or regression early in development had been experienced by some of the autistic children. All of the children in the sample had been administered the MMR vaccine, but not all had been given both doses. The study analyzed blood samples from each child to investigate the presence of any circulating measles virus or increased antibody levels. Such results might indicate the presence of persistent measles infection or an abnormal immune response. this examination revealed no significant difference between the two groups of children. This conclusion was not affected by whether the child was administered both MMR doses, or by any regression of development. Additionally, no bowel symptoms (entercolitis) were found in the autistic children, regardless of any early regression. Notably, autistic children and children with special educational needs had fewer instances of the second vaccination. This could reflect parental concern about vaccination following the diagnosis of a developmental abnormality. This is now the third, and largest, study which has failed to show a link between the MMR jab and autism, note the authors. See Full Article
Among elderly people, lower levels of folate can be associated with a three-fold increase in risk for dementia, claims a study published in the Journal of Neurology, Neurosurgery, and Psychiatry, part of the British Medical Journal Specialist Journals, on February 5, 2008. Folate, vitamin B12, and the protein homocysteine are involved in reactions that are needed to produce several chemicals, including some neurotransmitters, lipids, and nucleotides. Previously, studies have shown a link between deficiencies in these chemicals and the prevalence of dementia, however, the results have been controversial because of the physical changes dementia often creates. High levels of homocysteine have also been associated with cardiovascular disease. In this study, the researchers followed 518 people over 2 years (2001-2003), tracking the development of dementia within the population. All participants were more than 65 years old and lived in one rural or one urban area in the south of the country. To do this, at the beginning and the end of the two year period, validated tests were run to test for any dementing illness. Additionally, blood tests were taken to assess folate, vitamin B12 Similarly, blood tests were taken to assess levels of folate, vitamin B12, and homocysteine levels, and the changes with time were observed. At the beginning of the period, almost one in five participants showed high levels of homocysteine, almost the same had low levels of vitamin B12, and 3.5% were deficient in folate. Higher levels of folate were associated with higher vitamin B12 levels and lower homocysteine. At the end of the study, 45 of the participants had developed dementia. Of these, 34 had been diagnosed with Alzheimer's disease, seven with vascular dementia, and four with "other" types of dementia. Dementia showed more prevalence in older patients, in the relatively uneducated, the inactive, and those with deposits of the protein ApoE. Dementia onset was more likely in those who were older, relatively poorly educated, inactive, and had deposits of ApoE, a protein associated with the breakdown of lipids. It was also much more likely in those whose folate levels fell further over the two years while homocysteine levels increased. Individuals with folate deficiency at the start of the study were at risk for dementia almost 3.5 times more than others. This suggests, according to the authors, that changes in micronutrients such as folate could be linked with the other typical signs that lead up to dementia, such as weight loss and low blood pressure. Weight loss could indicate a dietary change in quality or quantity of food intake, but it is unlikely to itself change the levels of micronutrients in the blood. See Full Article
A new study by researchers in the US suggests that the human papillomavirus (HPV) causes as many cases of oral cancer in men as tobacco and alcohol and will overtake the latter within the next ten years. They suggest the main reasons are changes in men's sexual behavior and the decline in oral cancers not caused by HPV. The study is published in the February 1st issue of the Journal of Clinical Oncology and is the work of researchers at the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, and the Johns Hopkins Medical Institutions, Baltimore, also in Maryland. HPV is known to cause cervical cancer in women, and there are vaccination programs in many countries, including the US, to immunize girls and young women against the strains of HPV that are thought to cause over 70 per cent of cervical cancers, for which there are 12,000 new cases and nearly 4,000 deaths in the US alone every year. Previous research has already shown there is a risk of a range of genital and oral cancers in men also resulting from HPV infection, but as yet there are no immunization programs for men against HPV. The only vaccine against HPV is the drug Gardasil, made by Merck & Co. According to an Associated Press (AP) report at the weekend, the drug company will be asking for the US Food and Drug Administration (FDA) to approve the vaccine for boys later this year. So far, the primary argument for vaccinating men has been to stop the virus spreading to women and cutting down cervical cancer cases. But research on men is catching up, and there is mounting evidence that vaccinating boys will also benefit men directly. Apart from oral cancer, HPV also causes genital warts, penile and anal cancer. Study co-author, Dr. Maura Gillison of Johns Hopkins University, told the AP news agency that: "We need to start having a discussion about those cancers other than cervical cancer that may be affected in a positive way by the vaccine." Gillinson led a study published in May 2007 that suggested people who had oral sex with 5 or more partners during their lifetime had a much greater chance of having throat cancer and that the cause was most likely to be a well known strain of HPV. In this new study, Gillinson and colleagues examined nearly 46,000 cases of oral cancer occurring between 1973 and 2004 whose data is held by the National Cancer Institute in nine Surveillance, Epidemiology, and End Results program registries. They split the cases into two groups: those linked to HPV (over 17,500) and those that were not (over 28,000). The results showed that: * HPV-related oral cancers were diagnosed at younger ages than HPV-unrelated ones (mean ages at diagnosis were 61.0 and 63.8 years respectively). * Incidence of HPV-related oral cancers rose significantly from 1973 to 2004, particularly among white, younger men. * This compared to a stable, unchanging incidence of HPV-unrelated oral cancers from 1973 to 1982, and a declining rate after that. * Improvements in 2-year survival rates from radiation treatment were more pronounced for HPV-related cancers than HPV-unrelated ones. The researchers concluded that: "The proportion of OSCCs that are potentially HPV-related increased in the United States from 1973 to 2004, perhaps as a result of changing sexual behaviors. Recent improvements in survival with radiotherapy may be due in part to a shift in the etiology of OSCCs." OSCC stands for oral squamous cell carcinoma, by far the most common form of oral cancer. According to the AP report, a cause-effect relationship between oral sex and HPV-related cancers is not proven, and some experts have even suggested unwashed hands could also be a risk factor. Gillinson and colleagues suggested sex was an explanation for the rise in male upper throat cancers. However, HPV-related upper throat cancers has gone down significantly in women in the last 30 years. There is no evidence to suggest that Gardasil will work in men. Merck are doing a study on the effectiveness of Gardasil for protecting against genital warts, anal and penile cancer in men, but not oral cancers, a Merck spokesperson told the AP, although they will be considering other studies in the future. It would appear that more studies are needed on the effect of HPV in men, to bring the mountain of evidence up to that already available for its effect on women, and perhaps make the case for male vaccine development equally compelling. There are about 40 sexually transmitted HPV strains, of which 13 or so are known to cause cancer in men and women. Gardasil does not "cure" infection once it occurs, but it can block 4 of the strains known to cause the vast majority of cervical cancer cases from infecting the body. That is why HPV vaccination programs are aimed at girls before they become sexually active. See Full Article
A European survey has issued preliminary results which show flu virus resistance to oseltamivir (Tamiflu). Some samples of the A (H1N1) virus, a human flu virus which is spreading in Europe this winter, is resistant to Tamiflu, a well-known antiviral drug. The EU-funded VIRGIL network has tested 437 samples of the A (H1N1) flu virus strain between November 2007 and January 2008 in 18 European countries - of which 59 from nine different countries have become resistant to oseltamivir, 26 of them from Norway out of 37 that were sent for testing (in Norway). Norwegian authorities, as soon as this high level of resistance to oseltamivir in the A H1N1 viruses became evident, notified other EU nations as well as the WHO (World Health Organization). An advisory to doctors and the general public has been issued by Norwegian authorities (advisory in Norwegian). The significance of this latest data from the VIRGIL network is being assessed by experts from ECDC (European Center for Disease Prevention and Control), the European Commission, and WHO. Authorities say an interim joint-assessment will be issued soon, based on the preliminary results. It is not possible at this stage to be precise as to how widespread and at what level influenza virus resistance to Tamiflu is in Europe. Experts suggest that resistant is significant throughout the continent, but perhaps not as high as it is in Norway. Patients who become infected with the A (H1N1) flu virus strain do not seem to become sicker than those infected with "normal" seasonal influenza, the ECDC reports. Nevertheless, one should bear in mind that influenza A can be a serious and life-threatening illness for the elderly, the very young, and for those with debilitating illnesses. See Full Article
Diuretics appear to show similar or better results for treating hypertension in patients with metabolic syndromes, when compared with calcium-channel blockers, alpha-blockers, or angiotensin-converting enzyme (ACE) inhibitors. In a report in the January 28 issue of Archives of Internal Medicine, a JAMA/Archives journal, the latter appeared to offer no advantage in improving the clinical outcome. When compared across racial groups, this seemed to be especially true for black patients. Metabolic syndrome (a set of medical disorders that contribute to cardiovascular disease and diabetes), coupled with hypertension (high blood pressure) can put patients at an especially high risk of complications from cardiovascular disease. In this study, metabolic syndrome was defined by hypertension combined with at least two of the following factors: diabetes or pre-diabetes; a body mass index (BMI) of at least 30; high triglyceride levels; or low levels of high-density lipoprotein ("good" cholesterol). Some medications for high blood pressure, including alpha-blockers, ACE inhibitors, and calcium-channel blockers, have been advocated over other drugs, such as beta-blockers and diuretics, for their favorable short term effects on metabolic parameters such as blood glucose or blood cholesterol levels. Jackson T. Wright Jr., M.D., Ph.D., of Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, and colleagues evaluated data collected in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). This study engaged a total 42,418 participants with hypertension and at least one other risk factor for cardiovascular disease. In this trial, patients were randomly assigned to take one drug as follows: diuretic (chlorthalidone, 15,255 patients), a calcium channel blocker (amlodipine besylate, 9,048 patients), an alpha-blocker (doxazosin mesylate, 9,061 patients) or an ACE inhibitor (lisinopril, 9,054 patients). This drug was used to start treatment, and if necessary for blood pressure control, other drugs could be added. Followup of participants continued for an average of 4.9 years for all drugs, with the exception of the alpha-blocker. The latter was discontinued after an average of 3.2 years due to increased rate of cardiovascular disease including an almost two-fold increased rate of heart failure in comparison to the diuretic population. Of the ALLHAT population, 23,077 ALLHAT participants (54.4 percent) met criteria for metabolic syndrome. In their analysis, the authors report that, "No differences were noted among the four treatment groups, regardless of race or metabolic syndrome status for the primary end point (non-fatal myocardial infarction [heart attack] and fatal coronary heart disease)." In patients displaying metabolic syndrome (7,327 black and 15,750 white patients), the calcium channel blocker, ACE inhibitor and alpha-blocker showed higher rates of heart failure compared with the diuretic; the ACE inhibitor and the alpha-blocker additionally carried an increased risk for combined cardiovascular disease. "The lack of benefit of the agents with the most favorable metabolic profile (i.e., ACE inhibitors and alpha-blockers) was especially marked in the black participants with metabolic syndrome," the authors continue. "The magnitude of the excess risk of end-stage renal [kidney] disease (70 percent), heart failure (49 percent) and stroke (37 percent) and the increased risk of combined cardiovascular disease and combined coronary heart disease strongly argue against the preference of ACE inhibitors over diuretics as the initial therapy in black patients with metabolic syndrome. Similar higher risk was noted for those randomized to the alpha-blocker vs. the diuretic." The authors conclude, "These findings fail to provide support for the selection of alpha-blockers, ACE inhibitors, or calcium channel blockers over thiazide-type diuretics to prevent cardiovascular or renal outcomes in patients with metabolic syndrome, despite their more favorable metabolic profiles." See Full Article
Those who are physically active in their leisure time seem to be younger than those with inactive lifestyles, from a biological perspective. Generally, people who participate in regular exercise already have lower rates of cardiovascular disease, type 2 diabetes, cancer, high blood pressure, obesity, and osteoporosis. However, according to a report in the January 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, there might be more to this than just avoiding these diseases. "A sedentary lifestyle increases the propensity to aging-related disease and premature death," the authors write. "Inactivity may diminish life expectancy not only by predisposing to aging-related diseases but also because it may influence the aging process itself." A group of 2,401 white twins was studied by Lynn F. Cherkas, Ph.D., of King's College London, and colleagues. The team administered questionnaires related to physical activity level, smoking habits, and social and economic factors. Notably, the participants also provided a blood sample, and DNA was extracted from the white blood cells (leukocytes.) The leukocyte DNA samples were analyzed for the length of their repeating sequences at each end of the chromosomes. These sequences, called telomeres, may serve as a marker of biological age, as they progressively shorten over time. As expected, telomere length decreased with age, contributing to an average loss of 21 nucleotides (the basic structural units of DNA) per year. Less physically active men and women displayed shorter leukocyte telomeres than those who were more active in their leisure time. Even after normalizing for various factors, this trend remained. "Such a relationship between leukocyte telomere length and physical activity level remained significant after adjustment for body mass index, smoking, socioeconomic status and physical activity at work," observe the authors. "The mean difference in leukocyte telomere length between the most active [who performed an average of 199 minutes of physical activity per week] and least active [16 minutes of physical activity per week] subjects was 200 nucleotides, which means that the most active subjects had telomeres the same length as sedentary individuals up to 10 years younger, on average." When pairs of twins with different levels of physical activities were subsequently analyzed, similar results were shown. The authors suggest a few mechanisms by which more sedentary lifestyles might contribute to telomere degeneration. One could be damage to cells caused by exposure to oxygen, called oxidative stress. Increased inflammation in sedentary persons may also create this effect Additionally, telomere length has been linked to perceived stress levels. This psychological stress may be reduced by physical activity, thus lessening its severity on telomeres and the aging process. The authors conclude, relating this to daily life. "The U.S. guidelines recommend that 30 minutes of moderate-intensity physical activity at least five days a week can have significant health benefits," state the authors. "Our results underscore the vital importance of these guidelines. They show that adults who partake in regular physical activity are biologically younger than sedentary individuals. This conclusion provides a powerful message that could be used by clinicians to promote the potential anti-aging effect of regular exercise." This study was supported in part by a grant from the Welcome Trust, grants from the National Institutes of Health and a grant from The Healthcare Foundation of New Jersey. See Full Article
The US Food and Drug Administration (FDA) issued new information, yesterday, 31st January, to alert doctors and other health professionals about the increased risk of patients having suicidal thoughts and behaviors as a result of taking antiepileptic drugs for epilepsy, bipolar disorder, migraines, and other conditions. The agency has just completed a review of placebo controlled studies on 11 antiepileptic drugs and found that patients who took them had two times the risk of suicidal thoughts and behaviors (suicidality) of patients who took placebo only (0.43 versus 0.22 per cent). In epidemiological terms, this is an extra 2.1 per 1,000 patients. In March 2005, the FDA asked manufacturers of marketed antiepileptic drugs for which there were adequately designed controlled clinical trials, for the data following a preliminary analysis of several drugs that suggested an increased risk of suicidality. The agency received and analyzed data from 199 such trials covering 11 drugs. The analysis covered 27,863 patients on the drugs, and 16,029 on placebo. Among the patients taking the drugs there were 4 suicides and 105 reports of suicidal thoughts and behaviors. Among the placebo patients, there were no suicides and 35 reports of suicidal thoughts and behaviors. The risk of suicidality was observed to increase after one week of starting on the drugs, and stayed higher for at least 24 weeks. There was no clear pattern of risk across age groups, and the risk was the same for all 11 drugs and all demographic subgroups, said the agency. Director of the Division of Neurology Products in the FDA's Center for Drug Evaluation and Research, Dr. Russell Katz said: "We want health care professionals to have the most up to date drug safety information." " This is an example of FDA working with drug manufacturers throughout products' life cycles to keep health care professionals informed of new safety data," he added. The agency advises patients who are presently on antiepileptic medication not to change or stop their dose until they have discussed the impact of this information with their doctor. Doctors and other health care providers should contact their patients, their patients' caregivers and families and let them know about the increased risk of suicidal thoughts and behaviors so they can look out for any changes in behavior. See Full Article
Using imaging technology for the first time to investigate the phenomenon, US researchers have revealed what goes on in the brain when we scratch, giving new clues about why the behavior brings relief and is hard to stop. The study is the work of researchers at Wake Forest University Baptist Medical Center in North Carolina, and is published in the 31st January early online issue of the Journal of Investigative Dermatology. Lead author and dermatologist specializing in itch-related conditions, Dr. Gil Yosipovitch said: "It's important to understand the mechanism of relief so we can develop more effective treatments." "For some people, itch is a chronic condition that affects overall health," explained Yosipovitch. He and his colleagues wrote that imaging studies had looked at how the brain reacts to pruritis or itching conditions, but not what happens when the behavioral response, scratching, is going on. The researchers recruited 13 healthy participants to undergo functional magnetic resonance imaging (fMRI), a type of scan where you can see different areas of the brain light up when the volunteer is doing different things, for instance when using limbs, thinking or talking. A small brush was used to scratch participants on the lower leg for 30 seconds, then stopped for 30 seconds, then started again, and so on, for five minutes altogether. The researchers found, to their surprise, that during the 30 seconds of scratching time, parts of the brain normally active when aversive emotions and memories are experienced, became significantly less active. The parts of the brain showing reduced activity during scratching were the anterior cingulate cortex, which is linked with aversion to unpleasant sensory stimuli, and the posterior cingulate cortex, which is associated with memory. Lowest activity in these areas coincided with times when the participants felt the scratching to be most intense. Yosipovitch said: "We know scratching is pleasurable, but we haven't known why. It's possible that scratching may suppress the emotional components of itch and bring about its relief." He said sometime patients find intense scratching, sometimes so hard that the skin bleeds, is the only way to relieve chronic itching. "This is the first real scientific evidence showing that itch may be inhibited by scratching," said Yosipovitch. He was keen to point out that scratching is not recommended because it damages the skin, but it is important to find out what is going on when people feel relief from scratching so new treatments can be developed, such as drugs that target the relevant part of the brain to produce the same effect. As well as finding that some parts of the brain became less active during scratching, Yosipovitch and colleagues found that other parts became more active. This included activation of both sides of the secondary somatosensory cortex, which is involved in pain, and the prefrontal cortex, which is linked to compulsive behavior. Other parts of the brain that also became bilaterally more active during scratching were the insular cortex, the inferior parietal lobe, and the cerebellum. The activation of the prefrontal cortex, which is associated with compulsive behavior, might explain the compulsive nature of scratching behavior - the urge to keep on scratching, said the researchers. There is one limitation to the study which could be significant, and that is the scratching was not done when itch was present. The scientists are carrying on with the research to see if they get the same results with chronic itch. They suggested that: "Future studies that investigate the central effects of scratching in chronic itch conditions will be of high clinical relevance." The researchers said it was important to find new treatments because moderate to severe itch bothers many people, for instance anyone with eczema, which in American alone affects 30 million people. Another group that will benefit from new treatments are over 40 per cent of kidney dialysis patients, who have a 17 per cent higher risk of dying, probably because of lack of sleep, if they have itch. See Full Articles
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