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Tuesday, April 29, 2008

Indigenous Polynesian Peoples Have Higher Cancer Mortality Rates

People who are natives of Hawaii and New Zealand have higher mortality rates for many types of cancer than do the European people who live there. This could be improved by educational programs related to screening, diet, and smoking, according to the first in a series or Reviews on worldwide cancer disparities released on April 28, 2008 in The Lancet Oncology.

Polynesia is a group of over 1,000 small islands in the Pacific Oceanic region. They extend from Hawaii in the north, to Easter Island in the east, and New Zealand in the south. To investigate the distribution of cancers in the populations of the region Dr. Gabi Dachs, University of Otago, Christchurch, New Zealand, and colleagues performed a review of cancer incidence, survival, and mortality in Polynesian populations.

They pointed out several key observations. For one, in New Zealand, cancer incidence in Maori women was slightly higher than in New Zealanders of European ancestry, while in Maori men it was slightly lower. In Hawaii, a similar relationship was found between native and non-native Hawaiian men and women. "Importantly, the incidence of site-specific cancers differs by ethnic group, with cervical and uterine cancer in women, and stomach and testicular cancers in men being in the top five most common cancers in Maori, but not in non-Maori populations."

In New Zealand, the overall cancer mortality rate is higher in Maori and Pacific people than in those of European ancestry. In cancers other than colon, brain, and bladder cancer or melanoma, the site specific mortality is also higher in Maori and Pacific people. For colorectal cancer, mortality is similar even though incidence is lower in Maori people. Mortality for breast and prostate cancer is higher in Maori and Pacific people than European New Zealanders, despite lower incidence in the former groups.

Lower income and socioeconomic status was linked to a higher cancer mortality, and Maori and Pacific people generally had lower incomes than European New Zealanders are. In Hawaii, a similar pattern was seen. Cancer survival was higher in Europeans living in New Zealand and Hawaii than in the natives of these islands.

When examining risk factors, Maori people had the following characteristics in comparison to European New Zealanders: they were twice as likely to be smokers, 50% more likely to be obese, and three times as likely to be obese smokers. An examination of risk factors in Hawaiians showed a slightly higher smoking incidence in natives than in Europeans, but a significantly higher risk of cancer for smoking history. This suggests that they may be more susceptible to carcinogens in cigarette smoke. Minimal legislation on tobacco in developing countries means that tobacco companies have been targeting many Pacific islands. Additionally, a higher proportion of Maori people have hepatitis B compared with European New Zealanders, a known risk factor for liver cancer. Other risk factors, including hormonal effects, growth factors, and genetic effects are also discussed in the review.

Maori people often presented with more advanced stages of cancer than European New Zealanders. Additionally, screening programs were observed to cover more European New Zealanders than Pacific or Maori people. For example, breast cancer screening covered 62% of European New Zealanders, but only 42% of Pacific women and 41% of Maori women. Treatment options also affected outcomes, and the authors examine New Zealand's government drug funding agency's, PHARMAC's, decisions not to fund bupropion to aid smoking cessation, as well as not to fund adjuvant cisplatin based chemotherapy. Both of these decisions were called into question, as they have been heavily criticized for discriminating against Maori and Pacific people, who are more likely to smoke and get lung cancer. In order to tackle cancer disparity, 23 projects were started as part of the the New Zealand Cancer Control Strategy Action Plan in late 2005. 17 have reported thus far, and many of the recommend specific services for Maori people along with a Maori cancer workforce.

The authors observe that these findings provide many further directions for policy and research." The extent of the differences in outcome due to different extrinsic risk factors, biological factors, or health behaviors is unclear... Advances such as adjuvant chemotherapy for breast, bowel, and lung cancer have improved survival, but data on treatment by ethnicity are lacking, and such treatment might be unequally applied between ethnicities. Evidence exists for a benefit of culturally appropriate education on screening programs, diet, and smoking, all of which could lower the cancer burden in Polynesian communities."

Dr. John Seffrin, CEO, American Cancer Society, Atlanta, GA, USA, contributed an accompanying Reflection and Reaction comment, in which he emphasizes the need to provide proper cancer control policies in all populations. He says: "Evidence-based action can control cancer to create a new reality for all people everywhere.... All individuals, organizations, and countries need to recognize the immense burden of death and suffering caused by this terrible disease, and work together to achieve worldwide cancer control by ensuring equitable access to health resources for all."

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Inherited Blindness Treated With Gene Therapy

Using a revolutionary new gene therapy, scientists in the UK have successfully treated a teenage patient who has a rare inherited blindness called Leber's congenital amaurosis (LCA). The results could have a significant effect on the treatment of eye disease said the researchers.

The world's first landmark clinical trial to test the new gene therapy is the work of researchers from the Institute of Ophthalmology at University College London (UCL) and Moorfields Eye Hospital NIHR Biomedical Research Centre, London, and is published in the early online issue of the New England Journal of Medicine (NEJM), on 27th April. The article includes video footage.

The trial began in February 2007 and involved young patients with LCA, a rare, inherited disease of the retina that appears either at birth or shortly after and progressively leads to loss of vision. It is caused by a faulty gene known as RPE65 which stops the light sensitive cells in the retina (photoreceptors) from working properly.

The project had two goals. First to test whether gene therapy would be safe for patients with retinal disease, and secondly to test whether it could improve vision in young adults with an advanced retinal disease.

The trial was led by Robin Ali Professor of Human Molecular Genetics at UCL Institute of Ophthalmology and Head of the Division of Molecular Therapy. He was accompanied by eye surgeon, James Bainbridge, a Wellcome Trust Advanced Fellow at UCL Institute of Ophthalmology and Consultant Ophthalmologist at Moorfields Eye Hospital, and retinal specialist, Tony Moore, who is Professor of Ophthalmology at UCL Institute of Ophthalmology and Consultant Ophthalmologist at Moorfields Eye Hospital and Great Ormond Street Hospital for Children.

Ali said:

"Showing for the first time that gene therapy can work in patients with eye disease is a very significant milestone."

"This trial establishes proof of principle of gene therapy for inherited retinal disease and paves the way for the development of gene therapy approaches for a broad range of eye disorders," he added.

In the trial, Ali and colleagues inserted healthy copies of the faulty RPE65 into the cells of the retina of three young adults using a harmless virus or "vector" to carry the gene. The vector was engineered by the US company Targeted Genetics.

Baimbridge explained what they did:

"We developed surgical techniques to enable access to the cells beneath the retinas of patients, using a very fine needle to deliver the modified virus in a controlled retinal detachment that resolves as the vector is absorbed."

All three patients achieved levels of vision that was at least the same as before the operation, but one patient in particular, 18-year old Steven Howarth, showed significantly improved night vision. Tests before and after the operation showed that Howarth's ability to negotiate an "obstacle course" simulation of a night-time street significantly improved in that he carried out tasks faster and with fewer mistakes after the operation.

But perhaps the most crucial result of the trial was that it was found to be safe. There were no side effects.

Baimbridge said they were all very excited that the method can "improve vision in a condition previously considered wholly untreatable", and that the method was safe, especially since retinal tissue is very fragile.

Speculating on why only Howarth's vision improved after the therapy, the researchers said perhaps it was because his LCA was not as advanced as it was in the other two patients. It is possible that the other two patients may still show improvement in the future, they said, but it could be a while before they notice.

Moore said:

"It is very encouraging to see that this treatment can work, even in young adults who have severely advanced disease."

"We anticipate an even better outcome in the younger patients we are now beginning to involve as the trial proceeds, as we will be treating the disease in the early stages of its development," he added.

Ali cautioned that while they were all very excited about the improvement in Howarth's vision:

"It's important to emphasize that gene therapy is still an experimental treatment not yet generally available to patients."

He said they will be testing the method with other LCA patients, and with patients who have other types of retinal disease.

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Tuesday, April 22, 2008

Risk Of Second Cancers Greatest In Younger Patients Treated For Non-Hodgkins Lymphoma

For survivors of non-Hodgkin's lymphoma the risk of developing subsequent secondary cancers is greater the younger the patient's age at diagnosis, concludes a study published in the Journal of Clinical Oncology. The study also showed that the toll of subsequent solid tumors was largest 21 to 30 years after diagnosis.

Non-Hodgkin's lymphoma (NHL) is a cancer affecting the lymphocytes (white blood cells in the lymphatic system), which are important components of the immune system. Lymphomas are divided into two distinct types - Hodgkin's lymphoma and non Hodgkin's lymphoma, which can be distinguishable under the microscope according to the shape of the cancerous cells. In NHL lymph nodes in many different parts of the body can be involved, including the stomach, small bowel, bones, brain, testicles and skin. In Western Europe NHL affects around 11 people per 100,000 of the population and represents the seventh most common type of cancer. For reasons that are not entirely clear, the incidence of NHL has gradually increased over the last 40 to 50 years.

Initially patients with NHL were treated with radiotherapy, then in the 1970s multi drug chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) was introduced. This was followed in the 1980s by innovations in autologous bone marrow transplantation with very high-dose chemotherapy (often with cyclophosphamide or other alkylating agents) for patients with relapsing high-grade NHL. A number of different studies have suggested that patients treated for NHL have a higher risk of developing secondary tumors in a range of different sites than the general population.

Kari Hemminki and colleagues, from the German Cancer Research Center (Heidelberg, Germany), together with investigators from the Karolinska Institute and Norrlands University Hospital (Umea, Sweden), used the Swedish Cancer Registry to identify patients diagnosed with NHL. In the study 28,131 patients who were recorded as having primary NHL were followed until December 31, 2004 to see if they went on to develop a second primary cancer.

In the current paper, Hemminki and colleagues compared the incidence of second malignancies among NHL patients with the incidence of these malignancies in the general Swedish population, who had not suffered from NHL. From this investigators calculated the standardized incidence ratio (SIR) for each cancer, which gives a measure of incidence compared with the general population. In addition, separate analysis were undertaken according to age of patients at NHL diagnosis and the time elapse since NHL diagnosis that the malignancy took to develop.

The novel aspects of the study (which focused on solid tumors as opposed to lymphohematopoietic neoplasms) is that in addition to the large sample size from a single country they were able to include a wide age range at NHL diagnosis.

Results show that the overall SIR for solid tumors after NHL in the study was 1.65 - i.e. people who have had NHL are 1.65 times more likely to develop other cancers than the general population who have never had NHL.

Among the 25 most common solid tumors the incidence among patients with NHL compared with the normal population increased in 16 different tumor types. The only decreased risk was observed for endometrial cancer, which was shown to be half that of the general population. (SIR=0.52). The highest risk observed was for spinal meningioma (40.8), followed by cancers in the nervous system excluding the brain (18.1), with other common sites including the thyroid (6.49), and nose (5,96).

A separate analysis showed that the overall SIRs for solid tumors declined with increasing age at diagnosis. It was 4.52 (i.e. 4.52 times that of the normal population) for people diagnosed with NHL below the age of 20, compared to 3.03 for patients diagnosed between 20 to 39, 1.59 for those between 40 and 49, 1.55 for those between 50 and 59, 1.48 for those between 60 and 69, and finally 1.12 for those aged 70 plus. An additional finding was that the development of solid tumors was greatest 21 to 30 years after diagnosis.

The results, say Hemminki and colleagues, provide valuable insights into the carcinogenic process. "The initially high relative risks in young patients probably reflect sensitivity of the growing organism to an aggressive and potentially carcinogenic therapy," they write, adding that the castrating effects of NHL therapy may offer an explanation for reductions in endometrial cancer, a hormone sensitive tumor.

The fact that tumor toll is largest 21 to 30 years after diagnosis has important implications for the timing of medical surveillance schemes for patients with NHL. "Longer follow-up periods of patients will be needed to fully characterize the long-term effects of NHL therapy," they write, adding the individual solid tumors are likely to show variable responses.

Limitations of the study, write the authors, include lack of data about treatments, short follow-up times, small number of subjects after the subdivisions of the initially large study population, and the large increases in the incidence of NHL during the study period.

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Sunday, April 20, 2008

Polycarbonate Baby Bottles Containing Bisphenol A May Become Banned In Canada

Tony Clement, Health Minister, and John Baird, Environment Minister, have announced that the government of Canada is considering banning polycarbonate baby bottles which contain bisphenol A.

After completing a risk assessment of bisphenol A together with industry and other stakeholders, the Canadian government has initiated a 60-day public comment period on whether to prohibit the importation, sale and advertising on polycarbonate baby bottles containing bisphenol A.

Health Canada informs that the comment period started on April 19th, 2008 - as soon as the government had published a summary notice of its assessment findings in Canada Gazette, Part 1.

Minister Clement said "Canada has been the first country in the world to conduct risk assessments on a number of chemicals of concern, as a result of a new initiative announced by the Prime Minister on December 8, 2006 known as the Chemicals Management Plan. We have immediately taken action on bisphenol A, because we believe it is our responsibility to ensure families, Canadians and our environment are not exposed to a potentially harmful chemical."

The bisphenol A assessment focused mainly on the impact it might have on newborns and infants/babies aged up to 18 months. Health Canada informs bisphenol A's impact on all age-groups was also considered.

It was considered that the main source of exposure for newborns/infants is as a result of using polycarbonate baby bottles when they are exposed to high temperatures - bisphenol A migrates from cans into infant formula. In the assessment, researchers concluded that exposure to bisphenol A is below levels that may be considered a risk to human health. Nevertheless "The gap between exposure and effect is not large enough," Health Canada wrote on its web site.

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Man Hypnotizes Himself And Has Bone-cutting Thumb Operation Without Anesthetic

Doctors were amazed when Alex Lenkei, a professional hypnotist, underwent a thumb operation which required sawing and chiseling of a bone without any aesthetic - and he said he did not feel a thing during the 80-minute operation at Worthing and Southlands Hospital, West Sussex, England.

Lenkei needed a bone removed from the base of his thumb. The surgeon then had to fuse some joints together. The successful operation should improve Lenkei's arthritis and give him more mobility.

David Llewellyn-Clark, surgeon, crushed the bone which was about the size of a walnut with a specially designed chisel, and then cleared the remaining bits with snippers.

Lenkei says it took him approximately 30 seconds to one minute for him to put himself under. He describes being completely aware of what was going on around him during the operation - he could hear the surgeon talking but could not feel any pain - he could even hear the cracking of bone.

"I remember at one point the surgeon asked for a saw, and I had images of this big thing like you get at B&Q - then he said, 'No not that one, the little one', and I thought.. oh, that's all right then. He used a hammer and chisel at one stage and I could hear him hammering away at the bone. I heard everything he was saying to his assistants and anesthetist, but there was no gossip. It was a shame - I was hoping to hear something juicy," Lenkei said.

Lenkei, 61, said he felt wonderful as he showed off his bandaged hand. Lenkei is a registered hypnotist and has been practicing since he was 16. He is now recovering at home.

Even though an anesthetist was on hand "just in case", his services were not needed. Dr. Richard Venn, the stand-by anesthetist, believes Lenkei managed somehow to get his own body to release a lot of pain-killing chemicals that prevented him from feeling pain during the procedure.

Dr. Venn explained that the patient's heart, blood pressure and breathing rate remained constant throughout the whole operation - this is an indication that he felt no pain.

Dr. Llewellyn-Clark said "I think this is possibly the extreme case of what can be done with hypnosis; but some people are very anxious about being given an anesthetic so I'm always looking to find alternatives."

Some studies have indicated that recovery speed might be better if standard anesthetics are not used.

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Tuesday, April 15, 2008

Breast Cancer Vaccine Cuts Deaths

US military researchers said at a conference yesterday, Sunday 13th April, that an experimental breast cancer vaccine called E75 reduced the risk of death in patients whose tumors expressed high levels of the protein HER2/neu.

HER2-positive breast cancer represents about 25 per cent of breast cancers and has the lowest survival rates. But in this group of patients the vaccine reduced deaths by 50 per cent, researchers informed the Washington Post, just before their presentation to the American Association for Cancer Research annual meeting, in San Diego, California.

However, the results for women whose cancer expressed low or intermediate levels of HER2/neu were even better. The vaccine lowered rate of death among this group by 100 per cent. This group of patients currently relies on treatments like surgery and chemotherapy.

E75, the most advanced of all cancer vaccines, stimulates the immune system to raise levels of cytotoxic T cell (CTL) or killer T cells that target tumor cells. It is designed to prevent breast cancer recurrence in women who have already had it. Other cancer vaccines that target tumors that have already spread have not been successful.

Senior author of the study, Dr. George Peoples, who is Director of the Cancer Vaccine Development Program at the US Military Cancer Institute and Chief of surgical oncology at Brooke Army Medical Center in San Antonio, told the Washington Post that:

"We now have something we think works in the majority of women with breast cancer who are currently underserved."

Peoples said the vaccine was well tolerated, "like a flu shot".

The small clinical trial involved 165 patients with HER2/neu tumors that had started to spread to the lymph nodes.

94 of the patients were given the vaccine (one initial shot and a booster) and 71 acted as controls.

All the women who received the vaccine showed a raised immune response, with the largest response being in those patients with low and intermediate expression of HER2/neu, reported the Post.

30 months later, although those patients with high HER2/neu expression in both the vaccine group showed similar rates of recurrence (18.2 versus 13.8 per cent), there was a 50 per cent reduction in mortality among the vaccine group.

In the low to intermediate HER2/neu expression group however, fewer than 11 per cent of the low expressors had a recurrence (compared with 18 per cent of controls), and the mortality rate in the vaccine group was zero compared to 38 per cent in the control group.

E75 is licensed under the brand name NeuVax to Arizona-based Apthera Inc, and is about to enter phase III trials for women with early stage I and stage II HER2-positive breast cancer. According to the company, so far "the clinical trial results have shown that NeuVax reduces recurrence rates while showing minimal toxicity".

The company plans eventually to seek the approval of the US Food and Drug Administration (FDA) for NeuVax to be used to treat breast cancer with all levels of HER2 expression, in women who are at high risk of relapse or recurrence of their breast cancer.

The vaccine has also undergone a small Phase I clinical trial involving 14 patients with advanced stage IV breast cancer or advanced ovarian cancer. After receiving 8 escalating doses of NeuVax, 8 of the women showed killer T cell activity against HER2 proteins. The T cells were active for between 1 and 12 months after treatment finished, said the company.

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Alcohol And Genetic Factors Linked To Breast Cancer Risk

US scientists have discovered two genes that play a role in the metabolism of alcohol, which are linked with increased risk of breast cancer in postmenopausal women who drink.

The study was presented yesterday in San Diego, California, at the Annual Meeting of the American Association for Cancer Research (AACR). The research leaders were Dr. Peter Shields, professor of medicine and oncology based at Georgetown University's Lombardi Comprehensive Cancer Center in Washington DC, and Dr. Jo Freudenheim, chair of social and preventive medicine at the State University of New York in Buffalo.

The research showed that variations in two genes, ADH1B and ADH1C, that code for an enzyme that breaks down alcohol, were linked with increased risk of breast cancer among women who drink.

Research instructor of cancer genetics and epidemiology at Lombardi, and lead author of the study, Dr. Catalin Marian said:

"The higher their alcohol consumption, the higher their risk."

The researchers examined DNA information from 991 women aged 35 to 79 residing in two western New York counties between 1996 and 2001 who had histologically confirmed primary stage breast cancer. These were matched by 1,698 randomly selected healthy participants according to age, race and county of residence.

All participants were taking part in a population-based case-control study called the Western New York Exposure and Breast Cancer (WEB) Study, conducted by Freudenheim.

The results showed that increased breast cancer risk in postmenopausal women was linked to variations in DNA sequences in two genes: ADH1B (sequence rs1042026) and ADH1C (sequence rs1614972).

Among postmenopausal women with the ADH1B (sequence rs1042026) gene variant, the risk of breast cancer for the alcohol drinkers was nearly double that of the abstainers.

Among women with the ADH1C (sequence rs1614972) gene variant, there was a protective effect against breast cancer risk that varied inversely with the amount of alcohol: the more alcohol a woman with this gene variant consumed, the less protection offered, and the higher the risk of breast cancer. (Conversely, this could be viewed as the protection conferred by the gene appeared to get stronger as alcohol consumption dropped).

Marian warned that more research was needed to confirm and replicate the findings before any firm conclusions could be drawn. This study merely suggests that the variants are linked with increased breast cancer risk, it does not suggest they cause it biologically.

Variations in the two genes will impact alcohol metabolism because they are involved in that process, explained Marian, but she was cautious to point out this may not be the whole story:

"We have to keep in mind that the gene sequence variations we observed are not located directly in coding regions, but they may be associated and inherited together with other variations that have this effect on the enzyme function."

According to the National Cancer Institute, in 2008 there will be over 180,000 new cases of breast cancer among women and nearly 2,000 among men, while over 40,000 women and nearly 500 men will die of the disease.

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European Medicines Agency (EMEA) Approves ALIMTA® (pemetrexed For Injection) For Use In Lung Cancer Treatment

On April 11, 2008, an announcement by Eli Lilly and Company (NYSE: LLY) indicated that European health authorities have approved the use of ALIMTA® (pemetrexed for injection) for a histologically-based use in the first-line treatment of advanced non-small-cell lung cancer (NSCLC), the most common form of lung cancer. This is the third approval that pemetrexed has received in Europe, and it comes after the European Medicines Agency's (EMEA) Committee for Medicinal Products for Human Use (CHMP) had issued a positive opinion in mid-February. The act will allow all 27 countries of the European Union, Norway, Iceland, and Liechtenstein to use the therapy.

Richard Gaynor, M.D. (VP of cancer research and leader of Lilly's global oncology platform) said, "This approval opens the door for a novel, tailored approach based on histology or tissue type. Our hope is that this study provides physicians with a powerful tool for choosing the right drug for the right patient that leads to optimal treatment results."

Currently, more than 85 countries allow pemetrexed in combination with cisplatin to treat malignant pleural mesothelioma (MPM) when the disease is unresectable or when curative surgery is infeasible. Countries also allow pemetrexed to be used as a second-line, single agent treatment for patients with locally advanced or metastatic NSCLC after chemotherapy. This most recent approval allows the drug to be used as a first-line treatment for patients with NSCLC who have other than predominantly squamous cell histology.

More than 1 million people die from lung cancer every year, and 85 to 90 percent of all lung cancers are NSCLC. Categorized by five stages, NSCLC starts at stage 0 and rises to the level of severe at stage IV. The disease can spread through the lymphatic system, penetrating the chest lining, ribs, and the nerves and blood vessels that lead to the arm. If cancerous cells get into the bloodstream, additional potential targets include the liver, bones and brain.

The EMEA's approval is explicitly for pemetrexed combined with cisplatin as a first-line treatment for NSCLC patients who have a cell histology that is not predominantly squamous. NSCLC is categorized according to its histology (the microscopic study of tissue), and in the past all histologies were treated similarly.

This recent approval in first-line treatment of NSCLC is rooted on a Phase III randomized trial that compared pemetrexed plus cisplatin with GEMZAR® (gemcitabine HCl for injection) plus cisplatin. The phase III clinical trial, containing 1,725 patients, met its main endpoint of non-inferiority relative to overall survival.

When survival was analyzed by histology in a pre-planned histological analysis, participants that had either adenocarcinoma or large-cell carcinoma and were treated with the pemetrexed regimen in the first-line setting showed an improvement that was clinically relevant in overall survival. Patients with squamous cell histology, however, demonstrated better overall survival when treated with the gemcitabine regimen.

Lead investigator Giorgio Scagliotti, M.D. (Department of Clinical and Biological Sciences Thoracic Oncology Unit, University of Torino, Orbassano, Italy) stated that this approval is an important milestone in the quest to treat the cancer that is the leading cause of death in the world. He said, "This study provides further evidence of the need to use a tailored approach to treating lung cancer patients, rather than simply using a particular medicine because of the treatment stage."

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Thursday, April 10, 2008

Mumps Resurged in United States

Despite the widespread use of a second dose of mumps vaccine in the US, the largest outbreak for two decades occurred in 2006, prompting calls for a more effective vaccine or changes in policy.

Viral disease investigators from the US Centers for Disease Control and Prevention, and other colleagues from various state department health authorities, reported this finding in the April 10th issue of the New England Journal of Medicine.

US schoolchildren throughout the US started receiving a second dose of mumps vaccine in the early 1990s. This was followed by a period where there was a lull in reported mumps cases, and health authorities established a goal: to eliminate the disease by 2010.

But in 2006, the United States saw the largest mumps outbreak in 20 years.

This prompted an investigation by CDC viral disease experts and colleagues who examined national data on cases of mumps reported in the US in 2006. They also looked more closely at cases in the most affected states and reviewed the statistics on vaccination coverage drawn from three nationwide surveys.

They found that:

* 6,584 cases of mumps were reported in 2006.

* 76 per cent of these cases occurred between March and May.

* No deaths were reported and 85 of the cases were hospitalized.

* 85 per cent of the patients lived in eight midwest US states: Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, South Dakota, and Wisconsin.

* Overall, the national incidence of mumps that year was 2.2 per 100,000.

* The highest incidence was among people aged 18 to 24 years, where the incidence rate was 3.7 times higher than all other age groups combined.

* 93 per cent of the patients in the 18 - 24 age group were college students.

* In 8 states with known vaccination status, 63 per cent of overall patients, and 84 per cent of those between 18 and 24 had received two doses of mumps vaccine.

* The coverage of one-dose mumps vaccine among pre-schoolers for the 12 years before the outbreak was 89 per cent nationwide and 86 per cent or more in the states highly affected by the outbreak.

* In 2006, the national coverage of two-dose mumps vaccine among adolescents was 87 per cent, the highest ever recorded in the US.

The investigators concluded that:

"Despite a high coverage rate with two doses of mumps-containing vaccine, a large mumps outbreak occurred, characterized by two-dose vaccine failure, particularly among midwestern college-age adults who probably received the second dose as schoolchildren."

They suggested there may be a need either for "a more effective mumps vaccine or changes in vaccine policy", in order to "avert future outbreaks and achieve the elimination of mumps".

Speculating on how the outbreak occurred, study co-investigator and deputy director of the CDC's viral diseases division, Dr. Jane F. Seward told WebMD they suspected the high transmission settings in colleges were a potential contributory factor, while some waning immunity may have been another. But exactly how mumps got into the country, they were not sure:

"Mumps virus got in somehow, possibly transported from the UK, although we don't know that for sure," said Seward.

In 2004 and 2005 there was a huge surge in mumps cases in the UK where many parents refused to have their children vaccinated with the MMR (measles, mumps, rubella) vaccine following a scare. The UK outbreak totaled over 10,000 cases, an infection rate 50 times that of the US in 2006, Seward told WebMD.

However, she added that:

"Our experience with this outbreak in the US in 2006 reassures us how effective the vaccine is."

"Two doses of mumps vaccine are highly effective but not completely effective. But without the high coverage rate, we would have seen a much larger outbreak," said Seward.

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Insulin Problems in Mid Life linked to raised Alzheimer's Risk

A new study on men living in Sweden suggests that a poor insulin response in midlife, the main characteristic of diabetes, is linked to an increased risk of developing Alzheimer's disease up to 35 years later.

The study is published in the early online 9th April issue of Neurology and was conducted by Dr. Elina Rönnemaa, from Uppsala University in Uppsala, Sweden, and colleagues.

Rönnemaa said the findings:

"Have important public health implications given the increasing numbers of people developing diabetes and the need for more powerful interventions."

For the longitudinal study, 2,269 men living in Sweden underwent glucose testing for diabetes in 1970, when they were enrolled in the Uppsala Longitudinal Study of Adult Men at age 50.

The results showed that:

· Men who had a low insulin response at age 50 (baseline) were nearly 1.5 times more likely to develop Alzheimer's disease than men who did not have insulin problems.

· The risk was still significant after adjusting for age, blood pressure, cholesterol, smoking, body mass index, insulin resistance and educational status.

· The link was stronger in those men who did not have the APOE4 gene, which is known to increase Alzheimer's risk.

· Impaired glucose tolerance increased the risk of vascular dementia but not Alzheimer's.

· Impaired insulin secretion, glucose intolerance, and estimates of insulin resistance, were all linked with elevated risk of any dementia and cognitive impairment.

The researchers concluded that:

"In this longitudinal study, impaired acute insulin response at midlife was associated with an increased risk of Alzheimer disease (AD) up to 35 years later suggesting a causal link between insulin metabolism and the pathogenesis of AD."

Rönnemaa said the results suggested:

"A link between insulin problems and the origins of Alzheimer's disease and emphasize the importance of insulin in normal brain function."

She explained that perhaps insulin problems lead to damaged blood vessels in the brain, which causes problems with memory and Alzheimer's disease, but she emphasized that further research was needed to discover the detailed underlying biology.

Rönnemaa pointed out that this finding shows that problems with insulin secretion are an important risk factor for Alzheimer's disease, when the genetic risk from the APOE4 gene is absent.

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Teenagers with Acne need Hope and Assurance

When a youth suffers from teenage acne, he or she often receives countless suggestions, suggestions about the best way to treat that acne. Yet those who must deal with teenage acne seldom invite such suggestions. What they really need is a ray of hope, assurance that they will not need to go through life with a pimple-filled face.

Teenagers usually welcome the hormone-directed changes that cause them to look "more like an adult." Those with teenage acne can benefit from learning that those changes bring with them fluctuations in hormone levels in all parts of the body (including the skin). Hormonal changes in the skin then cause the recurrence of acne flare-ups.

Good hygiene can aid the treatment of teenage acne. The traditional method for reduction of skin irritants has called for a washing of the face two times a day. Such regular washing shows an increased effectiveness, if it precedes use of a skin toner. Of course, not every teen wants to spend hours washing and toning his or her face.

Now young people have the ability to reduce the amount of oil that forms on the face. That then makes the daily cleaning of the face less of priority - giving the individual more time to enjoy life.

How can a product reduce the amount of oil on the face? The product that inhibits the production of DHT also lowers the level of oil production. That same product blocks special receptors on the skin, the androgen receptors. Those are the receptors that would normally attach to the DHT molecules, with such an attachment leading to the production of more skin oil.

Still, skin oils are not the only thing that can cause acne flare-ups. Teenage acne can arise on those with dry skin, should that skin become exposed to many irritants. Heavy use of make-up on facial skin or repeated exposure to heavily polluted air (such as in a bar) can cause acne.

The product that blocks the formation of DHT and the production of skin oils also aids the elimination of skin irritants. It helps the skin to "breathe," by having the pores open-up. A young person then finds it much easier to remove harmful bacteria and other irritants. Eventually, the acne disappears, and the skin again displays the vibrancy that is associated with youth.

An understanding of the biology behind the acne pimple can save a teen from a constant battering, a battering of useless suggestions. Adults must realize that it is OK to eat chocolates and chips, as long as those foods do not make-up the bulk of a teen's diet. Teenagers who indulge in such pleasures do not encourage the production of DHT and skin oil, the real cause of teenage acne.

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Monday, April 7, 2008

Patients' Trust earned by Healthcare Providers who discuss Intimate Piercings

Patients with genital and nipple piercings, also known as "intimate piercings," are best served by healthcare providers who initiate positive discussions about them, according to a new article in the journal Nursing for Women's Health.

Yet, too often, such discussions do not occur, even when treating infections and other conditions related to the piercings, due to healthcare providers' uneasiness over this increasingly common form of body art. An estimated 30 to 50% of youth ages 18 to 23 have piercings in places other than in their ear lobes, so it is highly likely that healthcare will encounter such piercings in their patients.

An article by Cathy Young, DNSc, APRN, BC, Associate Professor at Texas Tech University's School of Nursing and Myrna L. Armstrong, EdD, RN, FAAN, Professor at Texas Tech University's School of Nursing offers a comprehensive, practical overview of the clinical issues healthcare providers are likely to encounter related to intimate piercings. Issues range from why individuals seek and obtain such piercings to which medical procedures require such piercings to have been removed.

"Our goal is to help nurses be better informed about intimate piercings, so that they can provide optimal care to patients with piercings," the authors note. "When it's clear that we're knowledgeable and interested in a patient's piercings, we'll earn her trust."

The article, therefore, encourages healthcare providers to seek out opportunities to learn more about patients with intimate piercings.

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Are Animals Stuck in Time?

Dog owners, who have noticed that their four-legged friend seem equally delighted to see them after five minutes away as five hours, may wonder if animals can tell when time passes. Newly published research from The University of Western Ontario may bring us closer to answering that very question.

The results of the research, entitled "Episodic-Like Memory in Rats: Is it Based on When or How Long Ago," appear in the current issue of the journal Science.

William Roberts and his colleagues in Western's Psychology Department found that rats are able to keep track of how much time has passed since they discovered a piece of cheese, be it a little or a lot, but they don't actually form memories of when the discovery occurred. That is, the rats can't place the memories in time.

The research team, led by Roberts, designed an experiment in which rats visited the 'arms' of a maze at different times of day. Some arms contained moderately desirable food pellets, and one arm contained a highly desirable piece of cheese. Rats were later returned to the maze with the cheese removed on certain trials and with the cheese replaced with a pellet on others.

All told, three groups of rats were tested in the research using three varying cues: when, how long ago or when plus how long ago.

Only the cue of how long ago food was encountered was used successfully by the rats.

These results, the researchers say, suggest that episodic-like memory in rats is qualitatively different from human episodic memory, which involves retention of the point in past time when an event occurred.

"The rats remember whether they did something, such as hoarded food a few hours or five days ago," explained Roberts. "The more time that has passed, the weaker the memory may be. Rats may learn to follow different courses of action using weak and strong memory traces as cues, thus responding differently depending on how long ago an event occurred. However, they do not remember that the event occurred at a specific point in past time."

Previous studies have suggested that rats and scrub jays (a relative of the crow and the blue jay) appear to remember storing or discovering various foods, but it hasn't been clear whether the animals were remembering exactly when these events happened or how much time had elapsed.

"This research," said Roberts, "supports the theory I introduced that animals are stuck in time, with no sense of time extending into the past or future."

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Alcohol Dependence may respond to Aripiprazole

Aripiprazole is currently approved by the US Food and Drug Administration to treat bipolar disorder as well as schizophrenia. A study of aripiprazole's potential for treating alcohol dependence has found that it significantly and dose-dependently increases the sedative effects of alcohol and, to a lesser degree, decreases the euphoric effects of alcohol.

Results are published in the April issue of Alcoholism: Clinical & Experimental Research.

"Aripiprazole is a dopamine partial agonist," explained Henry R. Kranzler, a professor in the department of psychiatry at the University of Connecticut Health Center and corresponding author for the study. "Since dopamine is involved in the rewarding effects of alcohol, we thought that aripiprazole might reduce those effects."

"Aripiprazole is an unusual drug in that it has different pharmacological effects at different doses and it might do one thing acutely and another during chronic dosing," said Raymond F. Anton, Distinguished University Professor and director of the Clinical Neurobiology Laboratory at the Medical University of South Carolina. "In general, it appears to have the potential to reduce drinking if you get the dose right for an individual patient. More work needs to be done to 'fine tune' its effectiveness, which is what this study attempts to do."

Researchers recruited 18 social drinkers from the community: nine men and nine women between the ages of 21 and 45 years of age. Each participant completed three experimental sessions in a randomized sequence; receiving on the day before the laboratory session either no medication, or 2.5 mg or 10 mg of aripiprazole. During each session, participants consumed three standard drinks, for a total of 0.8 g/kg of alcohol for the men, and 0.7 g/kg for the women. Breath alcohol concentrations, heart rate, blood pressure, static ataxia (body sway), and subjective effects were measured regularly throughout the laboratory sessions.

"Findings show that aripiprazole made the drinkers sleepier and they experienced less pleasure from alcohol than they might have without it," said Kranzler.

"Aripiprazole might 'shift the balance' from alcohol being more stimulating to being more sedating," added Anton. "This has implications for both treatment and side-effect management for people taking this medication, [becoming] a balance of useful versus aversive effects. Most other dopamine-blocking drugs have too many aversive [or side] effects that make them not suitable for treatment of alcohol-use disorders. Aripiprazole might be more tolerated and have less long-term negative effects."

Kranzler concurred. "Other antipsychotic drugs - such as haloperidol and, olanzapine, which are full dopamine antagonists - reduce the pleasurable effects of alcohol, but they are associated with more adverse effects than aripiprazole is. The list of side effects associated with most medications that exert powerful enough effects to be of value in treating psychosis is long. The ones that occur substantially more commonly than with placebo are headaches, insomnia, nausea, dizziness, and vomiting."

"Aripiprazole is one of a growing list of medications that are being evaluated for the treatment of alcoholism," said Anton. "Readers should really see this as preliminary evidence and should be on the lookout for more studies to inform them of the potential treatment utility of aripiprazole by itself or in combination with other medications for alcohol-use disorders." He suggested that future research test aripiprazole on heavier drinkers and non-treatment-seeking alcoholics under longer-term dosing and natural drinking conditions, and also explore potential genetic predictors of its stimulatory versus sedation effects, with and without alcohol.

"These findings help to demonstrate that alcohol has effects on many different brain chemicals and, as such, that many different treatment approaches for alcohol dependence may be useful," said Kranzler. "That having been said, it's unclear whether aripiprazole will be very useful in this effort because its side effects may outweigh its beneficial effects."

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Thursday, April 3, 2008

HIV Epidemic in London spread quickly and in Clusters

The HIV/AIDS epidemic in London in the late 1990s was driven by transmission of the AIDS virus within clusters of sexual contacts in short periods of time, according to a study published in the open-access journal PLoS Medicine in March 2008.

To determine transmission patterns for sexually transmitted diseases, scientists sometimes construct sexual contact networks among the infected individuals. The information about these sexual contact networks can additionally be used for various health initiatives, including identifying, treating, and advising potentially unknowingly infected individuals. The information on the network structures can also be used to implement community-based prevention strategies.

Traditionally, sexual contact networks are constructed by interviewing infected persons. However, this may not be completely appropriate when studying HIV infection for several reasons. Namely, the period of transmission is long, and the risk of transmission from a single sexual contact is relatively low.

To learn more about the HIV/AIDS epidemic in London in the 1990s, Andrew Leigh Brown and colleagues at the University of Edinburgh and London's Chelsea and Westminster Hospital examined sexual contact networks among men who have sex with other men. However, rather than the traditional oral method of collecting information, they used phylogenetics to examine the level of genetic relation between the viruses obtained by different individuals.

Collecting genetic data on HIV in individual patients is a part of determining an effective treatment regimen, so the scientists were able to compare the sequences of genes in HIV from over 2,000 patients, largely men who have sex with men, who attended a large HIV clinic in London between 1997 and 2003. The analyzed sequences showed 402 that very closely matched at least one other viral sequence in the group. After more extended analysis, it was found that patients whose viruses matched largely arranged into six clusters each with ten or more individuals, with additional smaller clusters outside of these.

Then, based on the time of sample collection, and using information about what rates changes occur in the viral genes, the scientists found dated phylogenies, or family trees, for the clusters. Most of the transmissions within each cluster occurred in 3-4 year periods in the late 1990s, with at least one in four transmissions in the large clusters occurred within 6 months following the infection of the transmitting partner.

The results indicate that the growth of the HIV epidemic in London among men who have sex with men often occurred in short, rapid episodes rather than slowly over a longer time frame. Frequently, it seems that individuals passed on the virus to others just months after becoming infected themselves. This implies that transmission of the virus in the early stages of HIV likely drove the epidemic forward considerably.

It is likely, but not yet proven, that these results apply generally to HIV infections in larger populations of men having sex with men. If this is confirmed in additional studies, then this quantitative description of HIV transmission using phylogenetics can help design future strategies to strengthen HIV prevention in this population.

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New Species found that causes Leptospirosis

Leptospirosis is an acute infectious disease caused by bacterial spirochetes of the genus Leptospira. An article published in the open-access journal PLoS Neglected Tropical Diseases reports that a new species of Leptospira has been identified in the highly biodiverse Peruvian Amazon region. Researcher Michael A. Matthias (Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine) and colleagues found that the domestic rat is the animal source of this species, and they demonstrated how the disease was identified in patients in Iquitos, Peru by modifying the diagnostic routines to include the new species.

Leptospirosis is especially common in low-income areas with poor sanitation and contaminated water. The Amazon region of Iquitos, with its diverse animal population, tropical weather, and lack of sufficient sanitation, is a model ecological setting for maintaining and transmitting leptospirosis. Although the infectious disease has become globally important (not isolated to the Amazon), the difficulties involved in its diagnosis interfere with the ability to gage the precise public health impact.

The researchers provisionally named the new species Leptospira licerasiae after isolating and identifying it. They then included the new isolate when testing the blood of patients with acute febrile illness (fever fits) in Iquitos, Peru. Finding a much higher incidence of leptospirosis than expected, the authors demonstrate the importance of diagnosing with region-specific Leptospira.

The authors conclude: "Based on serological data that take advantage of its antigenic uniqueness, 'Leptospira licerasiae' serovar Varillal appears to be an important cause of leptospirosis in the Peruvian Amazon region, but is uncommon elsewhere in Peru. The peridomestic rat is likely the major reservoir of this new species. Elucidation of virulence differences between pathogenic and intermediate leptospires will provide insight into leptospiral evolution and disease mechanisms, and may contribute to the control and amelioration of leptospirosis in the developing world."

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Maternal Cocaine use affects Long-Term Health of Offspring

A study published in the open-access journal PLoS ONE reports that maternal cocaine use results in lasting neurochemical and functional changes in the offspring. Dr. Ashiwel Undieh, PhD (Professor and Chair of the Department of Pharmaceutical Sciences at Thomas Jefferson University's Jefferson School of Pharmacy) and colleagues came to these conclusions while investigating how maternal cocaine use affects the long-term health of the child.

It is known from previous studies that cocaine exposed mothers tend to have offspring that demonstrate significant behavioral changes. Undieh and colleagues added to these findings by investigating the alterations in fetal epigenetic machinery of mothers exposed to cocaine.

Epigenetic refers to biological features such as DNA modifications that are stable over rounds of cell division and do not involve changing the underlying DNA sequence of the organism.

This current study uses mice to conclude that if mothers are exposed to cocaine during the last two trimesters of gestation, the result is potentially profound structural and functional changes in the epigenomic programs of neonatal and prepubertal offspring. The results suggest s strong link between maternal cocaine exposure and alterations in global DNA methylation, in CGI-specific methylation, and in the transcriptional processes of many genes that are responsible for coding proteins involved in critical neural functions.

Since cocaine is one of the most abused drugs in the Western hemisphere, the conclusions of this study are important for human mothers and children. It is widely known that when mothers abuse cocaine, there is an increase in the likelihood of both immediate and long-term harmful effects on both the mother and the child. Though there is not complete consensus on the effects of cocaine use by expectant mothers, animal studies have shown significant damage to nervous system structure and function in offspring.

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Wednesday, April 2, 2008

A walk to Remember

Our site, Nursing Gazette has taken a long walk since its launching on October of 2007 and it has come a long way now. I remember the time when it first started, it only got 2-5 visitors, it was a pathetic site looking for attention, promoting itself to Nursing Groups, begging people to at least visit and see. But now, Nursing Gazette is one of the trusted sites of the net, it served Wikipedia as a reference, and is used by people as source of Nursing and Medical related information worldwide.

The site did start from humble beginnings. It was first suggested by Anthony (a.k.a. AL2Fenrir), a BSN Graduate and one of the forerunners of this site. To be reliable, we consistently look for RNs, who could serve as our guide, adviser, and editor-in-chief, someone who could look into our articles and insure that our works are accurate, and due to our earnest sincerity, we were successful in our endeavor.

Now, Nursing Gazette has earned another RN. One of its topic researchers Lovely Stinson is now a Registered Nurse.. she had taken her vow as a Nurse on March 31, 2008. She had helped our site in the past by helping with the research, and now she had finally earned her place among the ranks of professionals.

Lovely S.
Topic Researcher

And also, we would like to introduce a new member.. Jither Jade Magbanua, an RN, a friend of Anthony, and is also among those who had taken their Nursing vow on March 31, 2008. He will be providing our site with NCLEX Nursing Bullets in the future.

Nursing Gazette will continue to provide Nursing-related newsworthy information to everyone who seeks it, most especially among our fellow Nurses...

And to everyone who supports us.. Our heartfelt thanks..

RN, Writer, Researcher, Assistant Site Manager