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Thursday, October 29, 2009

Cervical Cancer Screening



Related MedlinePlus Page: Cervical Cancer

NIH-Funded Researchers Transform Embryonic Stem Cells Into Human Germ Cells

Advance Provides Potential Tool to Find Causes of Unexplained Infertility, Birth Defects

Researchers funded in part by the National Institutes of Health have discovered how to transform human embryonic stem cells into germ cells, the embryonic cells that ultimately give rise to sperm and eggs. The advance will allow researchers to observe human germ cells — previously inaccessible — in laboratory dishes.

"This achievement opens a new window into what was only recently a hidden stage of human development," said Susan B. Shurin, M.D., acting director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH Institute that provided funding for the study. "Laboratory observation of human germ cells has the potential to yield important clues to the origins of unexplained infertility and to the genesis of many birth defects and chromosomal disorders."

The results were published online in Nature on Oct. 28.

The study was conducted by Kehkooi Kee, Vanessa T. Angeles, Martha Flores, Ha Nam Nguyen and Renee A. Reijo Pera, all of Stanford University School of Medicine.

Researchers have long sought to understand the process by which cells in the early human embryo mature into germ cells, explained Dr. Reijo Pera, the study’s senior author. But studying this process in human beings has been impossible in the past, because it takes place so early in development — before the embryo is two weeks old.

Dr. Reijo Pera explained that the ability to observe germ cells in laboratory cultures opens up several promising new avenues of research. Although infertility is apparent only after sexual maturity, she said, many forms of unexplained infertility are thought to have their origins in errors that occur in the cells of the early embryo. The ability to observe embryonic germ cells as they develop may allow researchers to pinpoint potential genetic changes underlying infertility. According to the Centers for Disease Control and Prevention, infertility is a major health problem that costs the United States more than $5 billion annually.

The researchers began with human embryonic stem cells, to which they added a gene that makes a protein which flashes green when a gene found only in germ cells is turned on. After the embryonic stem cells grew and changed for two weeks, the researchers isolated the cells that flashed green.

The researchers next conducted a variety of tests to confirm that the green fluorescing cells behaved like germ cells. Once convinced that their cells were in fact germ cells, the researchers turned on and off several candidate genes to see if those genes played a role in the development of stem cells into immature germ cells. The three genes they tested are named DAZ, DAZL and BOULE, and all come from the same family of genes. Dr. Reijo Pera discovered the first of them, DAZ (Deleted in AZoospermia), in the mid-1990s, when she showed that infertile men who lack germ cells often lack the gene.

In the new study, she and her colleagues showed that DAZL was necessary to transform embryonic stem cells into germ cells. When DAZL was turned off, just half as many germ cells formed. DAZ and BOULE, by contrast, acted later in the germ cells' maturation, nudging the cells into a phase called meiosis, during which cells reduce their number of chromosomes by half.

The researchers even observed that some male germ cells went all the way through the process of meiosis, to the point where they had half as much genetic material as they had begun with. They did not stimulate female germ cells to progress through meiosis because female human germ cells pause partway through meiosis and remain in that state for many years, through sexual maturity.

Dr. Reijo Pera next plans to try the same techniques with so-called induced pluripotent stem cells. Induced pluripotent cells are adult cells that have been reprogrammed to behave like embryonic cells. If it works, she hopes to take cells from an adult with infertility, transform them into germ cells and study them for clues to the cause of the adult's infertility.

The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute's Web site at http://www.nichd.nih.gov/.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Migraine With Aura Can Double Stroke Risk

Young women who smoke and use birth control pills are most susceptible, researchers say

HealthDay



Tuesday, October 27, 2009

HealthDay news imageTUESDAY, Oct. 27 (HealthDay News) -- Women who get migraine headaches with aura should stop smoking and using birth control pills because they may increase their risk of stroke, researchers say.

For people who suffer migraine headaches with aura -- visual disturbances before or during the migraine -- the risk for ischemic stroke is doubled, they found. Being female, under 45, smoking and using oral contraceptives that contain estrogen added to the risk.

Ischemic stroke is caused by a blockage in a blood vessel. The connection between migraine and stroke was already suspected. What was unknown was the extent of risk and who is most at risk, the researchers said.

Migraine headaches affect up to 20 percent of the population. Women are up to four times more likely than men to get migraines, and as many as one third also experience an aura before or during a migraine.

"Migraine with aura is associated with a twofold increased risk for ischemic stroke compared to people without migraine, while migraine without aura does not appear to change the risk," said lead researcher Dr. Markus Schurks, from the division of preventive medicine at Brigham and Women's Hospital in Boston.

"But, considering the low absolute risk, there is no reason to panic, but modifiable risk factors such as smoking and oral contraceptive use should be considered," he said.

The report is published in the Oct. 27 online edition of the British Medical Journal.

For the study, Schurks and colleagues analyzed nine studies concerning the association between migraine, with and without aura, and cardiovascular disease.

"The risk appears to be highest among women with migraine with aura who smoke and use oral contraceptives," Schurks said.

In contrast, migraine alone does not appear to alter the risk for heart attack and death from cardiovascular disease, he added.

"In the scheme of things, aura is just one among many potential risk factors for stroke, so it is important to put this in context," said Dr. Elizabeth Loder, chief of the division of headache and pain at Brigham and Women's Hospital and author of an accompanying journal editorial.

"The risk of stroke for most people with migraine is low -- stroke is an uncommon event -- and so a doubling of that low baseline risk is not cause for alarm," she said. "Although it's not a reason for panic, having aura is a reason to pay extra attention to other stroke risk factors that can be modified. These include high blood pressure, high cholesterol, smoking and use of estrogen-containing contraceptives."

Other experts agreed.

Dr. Vincent Martin, an associate professor of medicine at the University of Cincinnati, said that "we have always known that the risk of stroke increased in patients with migraine, but this clarifies the situation in terms of which groups of migrainers are at more risk."

"If you are a female and you've got migraine with aura, you really need to be careful about managing your risk factors for stroke, because your risk for stroke is increased," he said. Smoking and birth control pills just aren't a good idea, he added.

SOURCES: Markus Schurks, M.D., division of preventive medicine, Brigham and Women's Hospital, Boston; Elizabeth Loder, M.D., M.P.H., chief, division of headache and pain, Brigham and Women's Hospital, and associate professor, neurology, Harvard Medical School, Boston; Vincent Martin, M.D., associate professor, medicine, University of Cincinnati, Ohio; Oct. 27, 2009, BMJ, online
HealthDay

Female veterans have fewer pain complaints than men

Reuters Health

Tuesday, October 27, 2009

NEW YORK (Reuters Health) - Female veterans of the Iraq and Afghanistan wars are less likely to complain of painful physical conditions than their male counterparts are.

The findings, from a study of more than 91,000 U.S. veterans, run counter to what is seen in the general population -- where women typically show higher rates of chronic pain conditions, including migraines, fibromyalgia and persistent abdominal pain.

Among veterans in the study, 43 percent reported some type of physical pain over one year. And of those who had their pain evaluated at least three times, 20 percent had symptoms lasting at least several months.

Men, it turned out, were more likely to report either problem: 44 percent said they had pain at some point over the year, compared with 38 percent of women. Of those assessed for persistent pain, 21 percent of men had lingering symptoms, versus 18 percent of women.

When women did have pain, however, they were somewhat more likely than men to describe it as moderate to severe. Among veterans with any pain, 68 percent of females had moderate or severe pain, compared with 63 percent of men.

Researchers led by Dr. Sally G. Haskell, of the VA Connecticut Healthcare System in West Haven, report the findings in the journal Pain Medicine.

Exactly why these findings in veterans differ from what's been found among civilians is unclear, according to Haskell's team.

The researchers speculate that combat exposure could be a factor. If men are more likely to be seriously injured or suffer from post-traumatic stress disorder after serving in a war zone that could explain their higher rate of pain complaints.

In addition, the researchers write, it's possible that the "persistent level of threat" faced by soldiers in Iraq and Afghanistan essentially equalizes men's and women's risk of stress-related pain.

Understanding sex differences in veterans' risks of various health problems will be increasingly important as more and more women enter the military, according to the researchers.

"As the VA plans care for the increasing numbers of female personnel," Haskell said in a written statement, "a better understanding of the prevalence of pain, as well as sex-specific variations in the experience and treatment of pain, is important for policy makers and providers who seek to improve identification and management of diverse pain disorders."

SOURCE: Pain Medicine, October 2009.

Reuters Health

Access to U.S. Burn Centers Varies by Region

Northeasterners have best proximity, southerners the worst, study finds

HealthDay

By Robert Preidt

Tuesday, October 27, 2009

HealthDay news imageTUESDAY, Oct. 27 (HealthDay News) -- Nearly 80 percent of Americans live within two hours by ground or helicopter transport of a verified burn center, but there are significant regional variations in access to these centers, a new study finds.



A verified burn center is one in which the quality of care has been assessed and confirmed by the American Burn Association. More than a half-million burn injuries and about 4,000 burn-related deaths occur each year in the United States, according to the association.



The study found that there were 128 self-reported burn centers in the United States in 2008, including 51 verified burn centers. The centers were served by 782 helipads and 804 helicopters. About 25 percent of the U.S. population lived within one hour by ground transport of a verified burn center, the study found. It also reported that 46 percent lived within two hours by ground transport and 68 percent lived within four hours by ground transport.



If taken by helicopter, about 54 percent could get to a verified burn center in an hour, and 79 percent in two hours, the study found. By helicopter, 75 percent could get to any self-reported burn center in an hour, and 96 percent in two hours.

The researchers noted that one-third of the U.S. population must be transported by air to reach a verified burn center within two hours.



Access varied greatly by region, the study authors reported in the Oct. 28 issue of the Journal of the American Medical Association.



"The greatest proportion of the population with access was highest in the northeast region and lowest in the southern United States," wrote Dr. Matthew B. Klein, of the University of Washington in Seattle, and his research colleagues.



The regional variations identified in the study "may be an influential predictor of optimal regionalization strategy," they wrote. "For states and regions with a relatively high baseline rate of access, the best strategy for improving access and reducing time to definitive care may involve optimization of air and ground emergency medical service systems. For states and regions with a relatively low baseline rate of access, the best strategy may involve construction or verification of new regional burn care facilities."



The study did not determine optimal distribution of burn centers throughout the country, but the data "provide important information about population access that may be used to guide resource allocation in burn care," the researchers concluded.



SOURCE: Journal of the American Medical Association, news release, Oct. 27, 2009

HealthDay

More Swine Flu Vaccine Coming Soon

22 million doses out now, and shortage should ease over coming weeks, CDC says

HealthDay

Tuesday, October 27, 2009

HealthDay news imageTUESDAY, Oct. 27 (HealthDay News) -- The H1N1 swine flu is spreading throughout the United States and vaccine remains in short supply, but federal health officials said Tuesday that more than 22 million doses are now available, with more expected in coming weeks.



"This is a challenging time," Dr. Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention, said during a press conference Tuesday. "We wish we had more vaccine available."

Frieden noted that they had anticipated having significantly more vaccine available by now, but "we are beginning to see significant increases in vaccine production, vaccine distribution and we do think it will get easier to find vaccine in the weeks that come," he said.



As of today, there are a total of 22.4 million doses available, an increase of 8 million doses since last week, Frieden said.



He would not say how much vaccine would be available by month's end. Earlier this year, the CDC said it expected to have as many as 40 million doses available by the end of October, but the agency later downsized that estimate to between 28 million and 30 million doses. At Tuesday's press conference, Frieden would only say that, "by Friday we will let you know what was achieved by Friday."



According to the CDC, H1N1 flu is now widespread in 46 states, with more than 1,000 related deaths reported since the strain emerged in April.



The H1N1 vaccine that is now available comes in the form of either a nasal mist or a standard injection. The first doses to reach high-risk Americans came only in the nasal spray form, called FluMist, designed for healthy people between 2 and 49 years of age. Now, more than half the doses are injectable, Frieden said.



The current H1N1 vaccine is being produced by the traditional method of growing the virus in eggs. And although the method is safe and used for most flu vaccine production, it is slow.

Had there been H1N1 vaccine available earlier it would have been incorporated as part of this year's seasonal flu shot, Frieden said.



"If we had H1N1 earlier in the season we would have most likely included it in the seasonal flu vaccine. So it would have been part of the regular flu vaccination program, as it will be for the Southern Hemisphere in [their] coming flu season," he said.



"We wish we had better technology," Frieden said. "We wish we had a technology that could produce vaccine in weeks or months rather than the six to nine months that it takes given the current tried-and-true technology," he said.



Other vaccine technologies are available, including cell-based vaccine and DNA technologies, Frieden noted. "They are all still experimental. We are not using any of them in this," he told reporters.



There is some encouraging news, Frieden said. The genetic makeup of the H1N1 virus hasn't changed since it first surfaced in April, meaning the swine flu vaccine and the antiviral drug Tamiflu are a good match.



In addition, there have been no changes in who appears most at risk for the swine flu, including children and young adults, he said.



While children continue to be particularly vulnerable to the disease, Frieden said Friday, "we are seeing it increasingly affect young adults as well as children. We are still not seeing significant numbers of cases among the elderly, and that's characteristic of this virus."



That's a marked difference from run-of-the-mill seasonal flu, which typically poses a much bigger threat to the elderly.



Last Friday, Frieden said the H1N1 flu would probably occur in waves, but "we can't predict how high, how far or long the wave will go, or when the next will come," he added.



"We are now in the second wave of pandemic influenza and whether this will continue through the fall into the winter, whether it will go away and come back in traditional flu season, only time will tell," he said.



SOURCES: Oct. 27, 2009, teleconference with: Thomas R. Frieden, M.D., M.P.H., director, U.S. Centers for Disease Control and Prevention

HealthDay

Tuesday, October 27, 2009

Treating Hypertension



HealthDay

Related MedlinePlus Pages: Blood Pressure Medicines, High Blood Pressure

Brisk Walk Can Help Leave Common Cold Behind

A stuffy head is no reason to avoid mild exercise, expert says

HealthDay

By Randy Dotinga

Sunday, October 25, 2009

HealthDay news imageSUNDAY, Oct. 25 (HealthDay News) -- To keep colds at bay during the chilliest months of the year, exercise just might be the key.

David Nieman, a representative of the American College of Sports Medicine, says that studies have shown that people who exercise at least 45 minutes four or more days a week take 25 to 50 percent less time off from work because of illness.

"This reduction in illness far exceeds anything a drug or pill can offer," Nieman said in a news release from the sports medicine group. "All it takes is a pair of walking shoes to help prevent becoming one of the thousands predicted to suffer from the common cold this winter."

But what if you're already under the weather? Should you try to get some exercise? Nieman suggests:

  • If a cold is only in your head and has not reached your chest, feel free to exercise.
  • Don't overexert yourself. That means no running: Just take a walk. Studies have not shown that moderate exercise is bad if you have a cold.
  • If you have symptoms beyond the sniffles, stay in bed. This advice holds if a cold has traveled to your chest, if you have severe aches and pains and if you're running a fever. Swollen glands spell trouble, too.
  • Take it slow when recovering from anything but a mild bout of illness. Take a couple of weeks off from exercise before you start workouts again.

Nieman has one more bit of advice: Exercise before you get your flu shot because research has shown that moderate-level physical activity will boost your immunity in the long run.


SOURCE: American College of Sports Medicine, news release, Oct. 6, 2009

HealthDay

Is Smoking Tougher on Women?

Research suggests they're more susceptible to dangers of tobacco

HealthDay

Sunday, October 25, 2009

HealthDay news imageSUNDAY, Oct. 25 (HealthDay News) -- Women may be more vulnerable than men to the carcinogens and other noxious substances in cigarette smoke, a growing body of research suggests.

In one study of nearly 700 people with lung cancer, Swiss experts found that women tended to be younger when they received the diagnosis, even though they smoked less than the men who developed lung cancer.

In another study, researchers from Harvard University and the University of Bergen in Norway evaluated more than 950 men and women with chronic obstructive pulmonary disease (COPD), known to be linked to smoking. The result: The women with COPD were younger when they got the diagnosis and had smoked less than the men with the respiratory ailment.

"Maybe women are more susceptible to the lung-damaging effects of smoking," said Dr. Inga-Cecilie Soerheim, a visiting research fellow at Harvard and a researcher at the University of Bergen, who led the COPD study. She presented the findings in May at the American Thoracic Society's annual conference.

In fact, several other studies in the past 20 years have suggested that female smokers may be more susceptible to lung cancer than male smokers.

And Soerheim and her colleague, Dr. Dawn L. DeMeo, an assistant professor of medicine at Harvard Medical School and Brigham and Women's Hospital in Boston, found that, in 2000, the number of women dying from COPD surpassed the number of men, although the researchers aren't sure why.

However, Dr. Michael Thun, the emeritus director of epidemiology research at the American Cancer Society, isn't as quick to embrace the theory that women are more susceptible to lung cancer.

"The actual evidence suggests that men and women are remarkably similar in their risk of developing lung cancer -- with or without smoking," he said.

But, Thun added, "the types of lung cancer they get are different," referring to the sites in the lung where the cancer is likely to occur in women and men.

Addressing the new COPD research, which seems to say that women are more vulnerable, Thun said other factors might be at play. They include women's longer life expectancy, thus making them more likely to develop the condition.

Thun said the focus on possible gender differences is missing the point. Instead, he said, health experts -- and the public -- need to focus on what is certain: that smoking is an enormous contributor to both lung cancer and COPD.

"If they [smokers] quit before age 50, they avoid most of the risk," he said, citing published research.

And once they do quit, Thun said, women and men can move on to other known ways to reduce their risk for lung cancer, such as avoiding exposure to secondhand smoke.

Lung cancer is the leading cause of cancer death for both men and women in the United States. More people die of lung cancer than of colon, breast and prostate cancers combined, according to the American Cancer Society.

The society estimates that there will be more than 219,000 new cases of lung cancer diagnosed this year and that 159,390 people will die from the disease.


SOURCES: Michael Thun, M.D., emeritus director of epidemiological research, American Cancer Society, Atlanta; Dawn L. DeMeo, M.D., M.P.H., researcher, Channing Laboratory, and assistant professor, Harvard Medical School and Brigham and Women's Hospital, Boston; American Cancer Society Cancer Facts & Figures 2009; American Thoracic Society International Conference, May 15-20, 2009, San Diego; European Society for Medical Oncology, news release, May 3, 2009

HealthDay

Obama Declares Swine Flu a National Emergency

Action allows hospitals to better handle large numbers of patients as outbreak spreads

HealthDay

Sunday, October 25, 2009

HealthDay news imageSUNDAY, Oct. 25 (HealthDay News) -- President Barack Obama has declared the H1N1 swine flu a national emergency.

His proclamation, signed Friday night and released by the White House Saturday, will allow hospitals and doctors' offices to get legal waivers of federal rules so they can handle large numbers of sick people as the outbreak spreads.

"The H1N1 is moving rapidly, as expected. By the time regions or health-care systems recognize they are becoming overburdened, they need to implement disaster plans quickly," White House spokesman Reid Cherlin said Saturday, according to the Washington Post.

The waivers, which will be issued by U.S. Health and Human Services Secretary Kathleen Sebelius, still require individual requests by the hospitals, Cherlin noted.

The goal, according to the Associated Press, is to remove bureaucratic roadblocks and make it easier for sick people to seek treatment and for medical personnel to provide it immediately. That could mean fewer hurdles involving Medicare, Medicaid or health privacy regulations, the AP added.

The H1N1 swine flu is now widespread in 46 states, and there have been 1,000 laboratory-confirmed deaths since April, according to the latest estimates released Friday by U.S. health officials.

Dr. Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention, told a news conference Friday, "We have already had millions of cases of pandemic influenza in the United States, and the numbers continue to increase."

At the same time, he said, production delays continue to hamper distribution of the H1N1 swine flu vaccine.

The vaccine is growing more slowly in egg-based cultures than manufacturers had anticipated, resulting in fewer available doses at this time, Frieden explained.

As of Friday, there were 16.1 million doses on hand nationwide, up from 14.1 on Wednesday, Frieden said. And there will be far fewer than the 40 million doses originally planned for the end of October, he added.

"Vaccine availability is increasing steadily, but far too slowly," Frieden said. "It's frustrating to all of us. We are nowhere near where we thought we would be by now. We are not near where the vaccine manufacturers predicted we would be."

The vaccine that is available comes in both nasal mist and injectable forms. The first doses were only the nasal spray, called FluMist, designed for healthy people 2 to 49 years of age. But now, more than half the doses are injectable, he said.

While children continue to be particularly vulnerable to the disease, Freiden said, "we are seeing it increasingly affect young adults as well as children. We are still not seeing significant numbers of cases among the elderly, and that's characteristic of this virus."

That's also a marked difference from run-of-the-mill seasonal flu, which typically poses a much bigger threat to the elderly.

There is encouraging news, Frieden said. The genetic makeup of the H1N1 virus hasn't changed, meaning the swine flu vaccine and the antiviral drug Tamiflu are a good match.

Frieden said the H1N1 flu would probably occur in waves, but "we can't predict how high, how far or long the wave will go, or when the next will come."

"We are now in the second wave of pandemic influenza and whether this will continue through the fall into the winter, whether it will go away and come back in traditional flu season, only time will tell," he said.


SOURCES: John Treanor, M.D., professor, medicine, and chief, infectious diseases division, University of Rochester Medical Center, Rochester, N.Y.; Oct. 23, 2009, news release, U.S. Food and Drug Administration; Oct. 23, 2009, teleconference with Thomas R. Frieden, M.D., M.P.H., director, U.S. Centers for Disease Control and Prevention; Washington Post; Associated Press

HealthDay

Sunday, October 25, 2009

Benefits of Chocolate


Benefits of Chocolate

HealthDay
October 23, 2009

Related MedlinePlus Pages: Heart Diseases--Prevention, Nutrition, Vascular Diseases

Thursday, October 22, 2009

Pregnancy and Weight



Pregnancy and Weight

HealthDay
October 22, 2009

Wednesday, October 21, 2009

Hip/Heart Connection








Hip/Heart Connection

HealthDay
October 21, 2009

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Tuesday, October 20, 2009

Car seats, out of cars, injured 43,000 U.S. kids

Reuters Health

Monday, October 19, 2009
WASHINGTON (Reuters) - Parents and caregivers who place car seats on beds, kitchen counters and other places outside the car injured 43,000 U.S. children over five years, researchers reported on Monday.

More than 3,400 of the children were injured badly enough to require hospitalization, the researchers told a meeting of the American Academy of Pediatrics.
"Many families learn the importance of strapping an infant car seat into a vehicle, but they do not learn about the dangers of using infant car seats as carriers or placing them on countertops or beds," Dr. Shital Parikh of Cincinnati Children's Hospital Medical Center told the meeting.

Most of the children were injured on the head, but they also broke leg and arm bones, he said.
"When parents or caregivers place the infant car seat on top of a table or elevated surface, the infant can wiggle and end up toppling off out of the seat onto the floor, which can lead to severe injuries," Parikh said in a statement.
"Another accident that can happen is the turning over of the car seat on to a soft surface, which can lead to suffocation."

Parikh used a Consumer Products Safety Commission database to make his calculations.
(Reporting by Maggie Fox; Editing by Eric Walsh)

Reuters Health

Centralized Review Process Markedly Expedites Approval of Cancer Clinical Trials

A Central Institutional Review Board (CIRB) for cancer clinical trials that was created by the National Cancer Institute (NCI), part of the National Institutes of Health, in 2001 helps trials start more quickly (just over a month faster, on average) and thus expedite the time from concept to completion of crucial investigational research according to a new finding.

This study of the CIRB was performed by scientists at the Veterans Affairs Palo Alto Health Care System (VAPAHCS) and Stanford University School of Medicine, Palo Alto, Calif., with assistance from NCI and appears online October 19, 2009 in the Journal of Clinical Oncology.

Over the past 40 years, more than 1,700 institutions in the United States have enrolled up to 20,000 patients annually in phase III clinical trials coordinated by NCI and have used separate IRBs to monitor research involving patients. Federal regulations require that most NIH-funded clinical trials be monitored by an IRB.

To determine whether a new treatment is safe and more effective than current treatments using clinical trials is a lengthy process that can take up to 10 years and cost more than $1 billion, in some cases. Many researchers have complained that administrative requirements, including IRB oversight, are delaying the release of new treatments. One solution NCI proposed was to form a CIRB to conduct IRB review of large, multi-site oncology trials.

"Mounting a CIRB that is nationwide in scope has been challenging for NCI due to the complexity involved in assuring high-quality protection for study participants while attempting to speed the process," said Jeffrey Abrams, M.D., associate director of NCI's Cancer Therapy Evaluation Program. "For all the volunteer reviewers and participating sites, this study provides objective confirmation that a centralized approach significantly improves the overall process for participants in multi-site trials."

The study assessed whether use of NCI’s CIRB was associated with lower effort, time and cost in processing adult phase III oncology trials, which are the gold-standard of trials for validating whether a therapy becomes a new standard of care. Early phase trials (phase I and II) and pediatric trials were not included in the analysis due to the lower patient enrollment populations required.

Clinical trial sites that are not enrolled with the CIRB must have their local IRB conduct a full board review as they would with any research study. Sites enrolled with the CIRB have their local IRB conduct a facilitated review, which is a review category requiring only that the local IRB chairperson or designee signal acceptance of the CIRB's review.

To determine whether the CIRB was achieving the hoped-for efficiencies, researchers compared clinical trial review at sites affiliated with the NCI CIRB with the review at unaffiliated sites that used their local IRB. Oncology research staff and IRB staff were surveyed to understand differences in effort, timing and costs of clinical trial review. CIRB affiliation was associated with faster local review (about 34 days) and about six hours less research staff effort. Many clinical trials sponsors value faster and more predictable reviews and often pay commercial, fee- for-service, central IRBs to perform reviews.

Affiliation with NCI's CIRB was also associated with a savings of $717 per initial review, of which about half was associated with time savings for research staff and the remainder was associated with savings for the IRB staff. Overall, the program resulted in a net cost of $55,000 per month for NCI, but the CIRB could actually save costs if more sites were to use the CIRB. Moreover, this net cost estimate does not include the benefits of bringing new cancer therapeutics to market more quickly.

"Efforts are underway to expand enrollment in the CIRB and to encourage sites to use the CIRB to minimize administrative inefficiencies," said lead researcher Todd H. Wagner, Ph.D., health economist, VAPAHCS and Stanford University School of Medicine, Palo Alto, Calif., "and based on our research, increased efficiencies and net savings are likely."

The Veterans Affairs Palo Alto Health Care System (VAPAHCS) comprises three divisions, including a large tertiary care facility. It is affiliated with Stanford University Medical School and provides a full range of patient care services with state-of-the-art technology, as well as education and research. Comprehensive health care is provided through primary care, tertiary care and long-term care in areas of medicine, surgery, psychiatry, physical medicine and rehabilitation, neurology, oncology, dentistry, geriatrics, and extended care. VAPAHCS has 897 operating beds, and is home to a variety of regional treatment centers, including a Spinal Cord Injury Center, a Polytrauma Rehabilitation Center, the Western Blind Rehabilitation Center, a Geriatric Research, Educational and Clinical Center and the National Center for PTSD.
The National Cancer Institute (NCI) leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

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

Childhood ADHD Linked to Criminal Behavior in Adults

More study needed to see if medical treatment cuts rates of illegal activities, researchers say
HealthDay

By Robert Preidt

Monday, October 19, 2009



MONDAY, Oct. 19 (HealthDay News) -- Children with attention-deficit/hyperactivity disorder (ADHD) are more likely than other children to engage in criminal activity when they grow older, a U.S. study has found.

The study included more than 10,000 adolescents who were later surveyed in adulthood. It found that youngsters with ADHD were twice as likely to commit theft later in life and were 50 percent more likely to sell drugs.

The findings, believed to be the first evidence of a link between ADHD and criminal activity, were published online Sept. 30 in the Journal of Mental Health Policy and Economics.
"While much research has shown links between ADHD and short-term educational outcomes, this research suggests significant longer-term consequences in other domains, such as criminal activities," study lead author Jason M. Fletcher, an assistant professor at the Yale School of Public Health, said in a university news release.

"We also found important differences in the association between adult crime and the type of childhood ADHD symptoms -- whether hyperactive or inattentive or both," he said.
Crimes where ADHD is a factor may cost the nation $2 billion to $4 billion a year, estimates have indicated.

Fletcher and colleagues plan to investigate whether drug treatments may reduce the illegal activities associated with ADHD in adulthood. The researchers also plan to study the associations between childhood ADHD symptoms and later employment and earnings.

ADHD, which affects between 2 percent to 10 percent of U.S. schoolchildren, is far more common in males than females. It's also more prevalent in people who have close relatives with the condition, suggesting a genetic origin, the study authors noted in the news release.

SOURCE: Yale University, news release, Oct. 19, 2009
HealthDay

Easy Way to Prevent Post-Op Nausea?

Administering dextrose right after surgery quells upset stomach, researchers say

HealthDay

By Randy Dotinga



Monday, October 19, 2009
MONDAY, Oct. 19 (HealthDay News) -- New research suggests that patients need not fear post-operative nausea and vomiting as much if they take dextrose, a form of glucose.
"As one of the most common post-operative complications, [vomiting and nausea] remains one of the main causes of decreased patient satisfaction following surgery," said Dr. Susan Dabu-Bondoc of Yale School of Medicine, one of the authors of a new study, in a statement. "Along with discomfort, the adverse effects can be extensive and may include aspiration, wound suture opening, prolonged hospital stays, unanticipated admission after outpatient surgery and delayed return of a patient's ability to function in daily activities."

The researchers, who were to release their findings Sunday at the annual meeting of the American Society of Anesthesiologists in New Orleans, report that they assigned half of 56 surgery patients to receive dextrose immediately after their operations. The other half got a placebo.

The patients were scheduled for gynecologic laparoscopic and hysteroscopic procedures. All patients were treated with general anesthesia and received a dose of a drug called an antiemetic, which can prevent some nausea and vomiting.

The researchers found that those who received the dextrose were at much lower risk of developing nausea and vomiting. They were also discharged from a post-operative care unit more quickly than the others.

"In light of the ease and low risk of administration of dextrose postoperatively and its apparent benefit to patient care and satisfaction, this therapeutic treatment should be considered in an attempt to prevent or reduce [vomiting and nausea] for patients in the immediate recovery period, " said Dabu-Bondoc.

She called for more research to understand exactly how administering dextrose prevents nausea and vomiting.

SOURCE: American Society of Anesthesiologists, news release, Oct. 18, 2009
HealthDay

Hangovers May Be Tougher for Migraine Sufferers

Rat study helps pinpoint cause of increased headache pain


HealthDay

By Robert Preidt

Monday, October 19, 2009



MONDAY, Oct. 19 (HealthDay News) -- As if migraine sufferers didn't already have enough pain, new research has found that they may also be more prone to hangover headaches.
U.S. researchers studied the effects of alcohol on a group of rats that experience recurrent migraines as well as a group of control rats that don't get the headaches. The study authors found that the rats with migraines experienced more pain four to six hours after ingesting alcohol than the control rats.

"Our results suggest that dehydration or impurities in alcohol are not responsible for hangover headache," Michael Oshinsky, an assistant professor of neurology at Jefferson Medical College of Thomas Jefferson University, and a member of the Jefferson Headache Center team, said in a university news release.

"Since these rats were sufficiently hydrated and the alcohol they received contained no impurities, the alcohol itself or a metabolite must be causing the hangover-like headache. These data confirm the clinical observation that people with migraine are more susceptible to alcohol-induced headaches," Oshinsky added.

The study was scheduled to be presented at the annual meeting of the Society for Neuroscience, held Oct. 17 to 21 in Chicago.

The researchers are now studying the mechanism for causing a headache, along with the metabolites of alcohol that trigger hangover headaches.

SOURCE: Thomas Jefferson University, news release, Oct. 18, 2009
HealthDay

FDA Approves Seasonal Influenza Vaccine Fluarix for Pediatric Use

The U.S. Food and Drug Administration today approved use of the seasonal influenza vaccine Fluarix for children ages 3 years to 17 years. Previously, this vaccine, which contains inactivated (killed) influenza A and B viruses, had been approved for use in adults, ages 18 years and older.

The safety and effectiveness of Fluarix for use in children ages 3 years and older is documented by a U.S. study comparing 2,115 children who received Fluarix with 1,210 children who received Fluzone, a different influenza vaccine already licensed by the FDA for use in children ages 6 months and older. Study results showed that children 3 years and older vaccinated with Fluarix and Fluzone produced similar amounts of antibodies in the blood at levels considered likely to be protective against seasonal influenza.

Fluarix is a seasonal influenza vaccine not intended to protect against the 2009 H1N1 influenza virus.

"This approval of an additional seasonal influenza vaccine for children provides help in protecting them against influenza,” said Karen Midthun, M.D., acting director of the FDA’s Center for Biologics Evaluation and Research. “Children are very vulnerable to the influenza virus and are more likely to be hospitalized for associated problems.”

With today’s approval, there are now four companies approved by the FDA to manufacture seasonal influenza vaccine for use in children.

Influenza is far more dangerous than the common cold for children, who often require medical care, especially if they are younger than 5 years. It is best to vaccinate children each fall, but vaccination also can occur in the winter months when influenza season often peaks.
Common adverse events experienced after administration of Fluarix are typical of those for flu shots and include pain, redness, and swelling at the injection site as well as irritability, loss of appetite, and drowsiness.

Because Fluarix contains a small amount of egg protein, it should not be administered to anyone allergic to eggs or egg products.

Fluarix is manufactured by GlaxoSmithKline Biologicals of Dresden, Germany.

For more information:
FDA Web site on Influenza Virus Vaccine Safety and Availability
http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm110288.htm

Health Tip: Putting Baby to Bed

Suggestions for a safe night's rest

HealthDay

By Diana Kohnle

Monday, October 19, 2009

(HealthDay News) -- Newborn babies shouldn't be expected to sleep through the night. Their bodies are so tiny that they should be awakened if they haven't eaten for at least five hours, the Nemours Foundation says.

But there are things that new parents can do to help ensure a safe night's rest for their little one. The foundation offers these suggestions:

• Put baby to sleep on his or her back to reduce the risk of sudden infant death syndrome (SIDS).
• Don't let baby sleep with plush bedding, blankets or pillows.
• Remove stuffed animals from baby's crib when it's bedtime.
• Each night, alternate which side of his or her head your baby sleeps on, to prevent development of a "flat spot" on a favored side of the head.

HealthDay

Health Tip: The Importance of Folic Acid

It can help prevent birth defects

HealthDay

By Diana Kohnle

Monday, October 19, 2009

(HealthDay News) -- Folic acid is particularly important for pregnant women, and should be taken, if possible, beginning at least three months before they become pregnant.

The U.S. Centers for Disease Control and Prevention says this B vitamin can reduce the risk of major birth defects affecting the spine and brain by as much as 70 percent.

Women who are pregnant or planning to become pregnant should take 400 micrograms of folic acid daily. It can be contained within a multivitamin, or as a separate supplement.

Women also can get folic acid in fortified breakfast cereal. Just make sure the cereal has 100 percent of the recommended daily amount.

HealthDay

Hospital Workers May Trigger Dangerous Outbreaks

Study finds employees who see many patients daily may be key players in spreading germs

HealthDay

Monday, October 19, 2009



MONDAY, Oct. 19 (HealthDay News) -- Hospital workers who see many patients may play a disproportionate role in spreading dangerous hospital-acquired infections, a new study finds.
These so-called peripatetic workers, such as radiologists or physical therapists, visit many patients in the course of a day, said Laura Temime, a researcher at the Conservatoire National des Arts et Metiers in Paris, and lead author of a study published online Oct. 19 in the Proceedings of the National Academy of Sciences.

"Although to my knowledge, an increased super-spreading potential of 'peripatetic' health care workers has never really been formalized as a major hypothesis, there have been several reports of nosocomial outbreaks that have been traced back to such 'peripatetic' health-care workers," Temime said.

Her study adds to the evidence, she said. The study used a mathematical model of a hypothetical intensive care unit that was presumed free of the pathogen to see how easily hospital-based infections, such as methicillin-resistant Staphylococcus aureus (MRSA) spread.
Containing these outbreaks is of grave importance, public health officials agreed.

For the study, Temime divided workers into three groups -- a nurse-like group, which made frequent visits to a small number of patients assigned to them; a physician-like group, which made infrequent visits to a larger number of patients, and the peripatetic group, which visits all patients daily, such as physical therapists.

Next, using a complex mathematical model, the researchers assumed how long the patients would stay -- an average of 10 days -- and how much exposure they would have to each of the three categories of workers, plus how compliant the workers were with hand washing.

Then they computed the impact. They found infection rates increased by up to three times more when a peripatetic worker failed to wash his hands, compared to workers in the other groups.
The conclusions sound very logical, said Dr. Zachary Rubin, an epidemiologist at Santa Monica-UCLA Medical Center and Orthopaedic Hospital in Santa Monica. However, he added, "this is a mathematical model, and you have to do studies with human beings to see if the data is still true or not."

Temime said she and her colleagues are doing just that. They are involved in a European project called Mastering Hospital Antimicrobial Resistance (MOSAR), in which data on exposures and bacterial colonization will be collected on patients and health-care workers. "We are planning to use this data to validate our model," Temime said.

For now, many hospitals are stepping up efforts to promote hand washing among employees. Because the peripatetic workers have "major superspreading potential," the study authors recommend individual surveillance of these health-care workers.

Rubin said that hospitalized patients shouldn't be shy about asking the health-care workers who come in contact with them to follow infection control guidelines. Some hospitals have posted signs in patient rooms asking "Did your health-care worker wash his hands?" to make patients more aware of the importance of hand washing, he said.

"If a patient is concerned [about lack of hygiene from a health-care worker], he can always talk to the head nurse or charge nurse," Rubin said, as well as the hospital's patient advocate or his own physician.

SOURCE: Zachary Rubin, M.D., epidemiologist, Santa Monica-UCLA Medical Center and Orthopaedic Hospital, California, and assistant clinical professor, medicine, division of infectious diseases, David Geffen School of Medicine, UCLA; Laura Temime, Ph.D., researcher, Conservatoire National des Arts et Metiers, Paris, France; Oct. 19, 2009, Proceedinsg of National Academy of Sciences, online

HealthDay

Monday, October 19, 2009

FDA Approves New Indication for Gardasil to Prevent Genital Warts in Men and Boys

The U.S. Food and Drug Administration today approved use of the vaccine Gardasil for the prevention of genital warts (condyloma acuminata) due to human papillomavirus (HPV) types 6 and 11 in boys and men, ages 9 through 26.


Each year, about 2 out of every 1,000 men in the United States are newly diagnosed with genital warts.


Gardasil currently is approved for use in girls and women ages 9 through 26 for the prevention of cervical, vulvar and vaginal cancer caused by HPV types 16 and 18; precancerous lesions caused by types 6, 11, 16, and 18; and genital warts caused by types 6 and 11.


HPV is the most common sexually transmitted infection in the United States and most genital warts are caused by HPV infection.


“This vaccine is the first preventive therapy against genital warts in boys and men ages 9 through 26, and, as a result, fewer men will need to undergo treatment for genital warts,” said Karen Midthun, M.D., acting director of the FDA’s Center for Biologics Evaluation and Research.


Gardasil’s effectiveness was studied in a randomized trial of 4,055 males ages 16 through 26 years old. The results showed that in men who were not infected by HPV types 6 and 11 at the start of the study, Gardasil was nearly 90 percent effective in preventing genital warts caused by infection with HPV types 6 and 11.


Studies were conducted to measure the immune response to the vaccine in boys ages 9 through 15. The results showed that the immune response was as good as that found in the 16 through 26 years age group, indicating that the vaccine should have similar effectiveness.


The manufacturer will conduct postmarketing studies to obtain additional information on the safety and effectiveness of Gardasil in boys and men.


Gardasil is given as three injections over a 6-month period. Headache, fever and pain at the injection site, itching, redness, swelling and bruising, were the most common side effects observed.


Gardasil is manufactured by Merck and Company Inc. of Whitehouse Station, N.J.


Gardasil product information:
www.fda.gov/cber/products/gardasil.htm

Tylenol May Weaken Effectiveness of Kids' Vaccines

Giving analgesic to prevent fever at shot time could be counterproductive, researchers say

HealthDay

Friday, October 16, 2009



HealthDay news imageTHURSDAY, Oct. 15 (HealthDay News) -- Fever after a vaccination is a normal and essential part of building an immune response, and giving children acetaminophen -- best known in the U.S. as Tylenol -- after a shot could dampen that response, a new study finds.

With some vaccines, transient fever means that a child's immune system is processing the immunization, providing them with the best protection, explained Dr. Robert T. Chen, a blood safety specialist at the U.S. Centers for Disease Control and Prevention.

Therefore, "unless your doctor specifically recommends it, do not administer fever-reducing medicines at the same time as vaccination to prevent your child from developing a fever," said Chen, who wrote an editorial accompanying a report in the Oct. 17 issue of The Lancet.

"It is still okay to use antipyretics [acetaminophen or ibuprofen] to treat a fever, but just not recommended to prevent fever," he added. "High fevers can be serious, especially in infants. It is important to work with your doctor to provide the best care for your child."

For the study, a research team led by Dr. Roman Prymula, from the University of Defence in Hradec Kralove, Czech Republic, did two studies, one when children received their first vaccination and another when they received their booster shot.

The vaccinations were routine for protection against pneumococcal disease, Haemophilus influenzae type b (Hib), diphtheria, tetanus, whooping cough, hepatitis B, polio and rotavirus.

The 459 infants in the studies were randomly assigned to get acetaminophen every six to eight hours for 24 hours after vaccination or no acetaminophen.

Prymula's team found that fewer infants who received acetaminophen had a fever, but these babies also had significantly fewer antibodies against pneumococcal disease, Haemophilus influenzae type b, diphtheria and tetanus toxoids, and for one of the whooping cough antibodies compared with infants who did not get acetaminophen.

They believe the pain reliever's anti-inflammatory activity might trigger "interference" to healthy immune system antibody responses, explaining the weakened immunization.

"Unless there are specific reasons for controlling fever, for example, in a child with history of febrile convulsions, Tylenol and other fever reducers should not be routinely given along with immunizations," Chen said.

Infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine in New York City, said that "the conclusion that Tylenol not only suppresses fever, but also decreases immune response is plausible. After all, what is an immune response? It's an inflammatory response."

Siegel agrees that acetaminophen should not be routinely given to infants to prevent fever after vaccination. "But, if the kid is sick, treat the sickness. If the kid is very sick, I would get the fever down," he said.

And what about the vaccine for the H1N1 flu? According to Siegel, "giving an infant Tylenol before an H1N1 flu vaccine shot may not be a problem, because the immune response to the vaccine has been so robust."

SOURCES: Robert T. Chen, M.D., blood safety specialist, U.S. Centers for Disease Control and Prevention, Atlanta; Marc Siegel, M.D., associate professor, medicine, New York University School of Medicine, New York City;Oct. 17, 2009, The Lancet
HealthDay

Thursday, October 15, 2009

FDA Warns Consumers About Buying H1N1 Vaccines On Internet

WASHINGTON (Dow Jones)--The U.S. Food and Drug Administration on Thursday said consumers should use "extreme care" when purchasing products online that purport to treat swine flu amid concerns they may be contaminated and not contain actual vaccines.

The FDA, in a press release, said it purchased and analyzed several products sold online that claimed to be Tamiflu, a flu vaccine made by Roche Holding AG (RHHBY). One product bought online came postmarked from India and consisted of unlabeled white pills that contained talc and a painkiller, but none of the ingredients in Tamiflu.

The agency said products in high demand are "vulnerable to counterfeiting and diversion because buyers may be desperate to stock the product, and criminals capitalize on the situation."

The agency urged consumers to only purchase products to treat the swine flu, formally called the H1N1 influenza virus, from licensed pharmacies in the U.S.
The H1N1 virus is now widespread in 37 states and about 76 children have died from the virus since April, according to the Center for Disease Control and Prevention. The U.S. has purchased 95 million H1N1 vaccines and more can be available if needed. The vaccines will be distributed across the country in the next few weeks.

Source:http://online.wsj.com/article/BT-CO-20091015-715327.html

Wednesday, October 14, 2009

Eye Problems Increasing in Preemies

As more pre-term infants survive, doctors see more babies with retinopathy of prematurity

HealthDay

By Robert Preidt

Tuesday, October 13, 2009


TUESDAY, Oct. 13 (HealthDay News) -- Increased survival of extremely pre-term infants has led to a greater number of babies with vision problems caused by abnormal development of blood vessels in the retina, a new study finds.

Swedish researchers looked at data on 506 extremely pre-term infants (born before 27 weeks of gestation) who survived until their first eye examination and found that 368 (72.7 percent) had retinopathy of prematurity -- 37.9 percent with mild cases and 34.8 percent with severe cases. Only 99 (19.6 percent) of the infants were treated for the condition.
Gestational age was a more significant risk factor for retinopathy of prematurity than birth weight.

"The incidence was reduced from 100 percent in the five infants born at 22 weeks' gestation to 56 percent in those born at 26 completed weeks. In addition, the risk of retinopathy of prematurity declined by 50 percent for each week of gestational age at birth in the cohort," wrote Dr. Dordi Austeng, of University Hospital in Uppsala, Sweden, and Trondheim University Hospital, Norway, and colleagues.

The study appears in the October issue of the Archives of Ophthalmology.
Previous research has found much lower rates of severe retinopathy of prematurity than the 34.8 percent noted in the new study: 25.5 percent in a Belgian study and 16 percent in an Austrian study.

"The higher incidence of retinopathy of prematurity in the present study may be because of the higher proportion of infants born in the earliest weeks of gestation [i.e., 11.5 percent of infants in weeks 22 to 23 vs. 0 to 6 percent in other studies]," Austeng and colleagues wrote. "These extremely premature infants, who previously did not survive, are probably especially vulnerable and prone to develop complications such as retinopathy of prematurity."

SOURCE: JAMA/Archives journals, news release, Oct. 12, 2009
HealthDay

Common Antioxidant Might Slow Parkinson's


But too much urate can also cause trouble, so more study is needed, experts say


HealthDay

Tuesday, October 13, 2009



TUESDAY, Oct. 13 (HealthDay News) -- A new look at some old data adds convincing evidence that high body fluid levels of the antioxidant urate slow the progressive nerve damage of Parkinson's disease.

However, the researchers also warned of the potential danger of putting that information to immediate use.

"The study doesn't prove that urate is slowing down the disease, and we need clinical trials to see if progression is based on levels of urate," explained study senior author Dr. Michael A. Schwarzschild, associate professor of neurology at Harvard Medical School and director of the MassGeneral Institute for Neurodegenerative Diseases. He and his colleagues reported the finding online Oct. 12 in the Archives of Neurology.

A clinical trial assessing the impact of urate on Parkinson's is beginning, funded by the Michael J. Fox Foundation. It is recruiting 90 people with Parkinson's disease at 10 U.S. medical centers to study whether regular intake of inosine, a widely available dietary supplement that is a precursor of urate, slows Parkinson's-related deterioration of nerves. Results are expected to be available in about two years, but more definitive studies will take five years or longer, Schwarzschild said.

Meanwhile, what should people with Parkinson's disease do? "They should be very cautious," Schwarzschild said. "There may be a temptation, but one should be careful because there are clear safety concerns."

The major dangers of overdosing with urate are kidney stones and gout, but there are other possible risks, such as an increased incidence of cardiovascular disease, he said.
"There is a lot of vice associated with it, and because we don't know if the case is proven, it would be bad advice to take such measures," Schwarzschild said.

Another expert agreed. "I would not at this point recommend to any Parkinson's patients that they take inosine as a supplement," said Dr. Ira Shoulson, professor of neurology at the University of Rochester in New York and a member of the research team. "I would not for several reasons, mostly to do with safety but also about whether it is beneficial. These are things we have to sort out in future years."

As for natural sources of urate, they are mostly things that people are told to avoid for other reasons, Schwarzschild said -- fructose, the sugar often blamed for an epidemic of obesity; alcohol; and even smoking. "There is a lot of it in liver, but who wants to eat that much liver?" Shoulson added.

Parkinson's disease is a degenerative neurological illness in which deterioration of brain cells causes steadily worsening symptoms such as trembling and slowed motion. Indications that urate might affect the course of Parkinson's began to emerge from epidemiological studies decades ago, Schwarzschild said. More solid evidence came from a study reported last year, which led the researchers of the new study to look back at a two-decades-old study of 800 people with Parkinson's disease.

"They had donated spinal fluid as well as blood, so we were able to test for urate levels in spinal fluid, which surrounds the brain cells," Schwarzschild said.

Analysis showed that the one-fifth of participants with the highest urate levels had a 36 percent lower risk of disease progression compared to the one-fifth with the lowest levels.
"Urate is actually one of the major antioxidants that circulates in humans," Schwarzschild said. "Brain cell degeneration in Parkinson's, Alzheimer's disease or ALS [amyotrophic lateral sclerosis, Lou Gehrig's disease], is caused by oxidative damage."

But another expert agreed it's too early for dietary or treatment recommendations.
"This finding is very exciting, but not yet ready for applicability to individual patients," said Dr. Melissa Nirenberg, assistant professor of neurology and neuroscience at Weil Cornell Medical College in New York City, who was not involved in the study.

She said that the previous report had not generated many queries about urate from her patients. "This one may generate more buzz, but it is very, very concerning that uric acid is a risk factor for cardiovascular disease and other diseases," she said.

If she were asked about inosine, "I would never recommend it to a patient at this stage because we don't know whether it is cause-and-effect rather than just a relationship and whether the potential benefits outweigh the risks," Nirenberg said.

SOURCES: Michael A. Schwarzschild, M.D., Ph.D, associate professor, neurology, Harvard Medical School, director, MassGeneral Institute for Neurodegenerative Diseases, Boston; Ira Shoulson, M.D., professor, neurology, University of Rochester, N.Y.; Melissa Nirenberg, M.D., Ph.D., assistant professor, neurology and neuroscience, Weil Cornell Medical College in New York City; online Oct. 12, 2009, and December 2009 print edition of Archives of Neurology
HealthDay

Tuesday, October 13, 2009

Poor Education May Lead to Poor Health


Navigating a complex health system takes a more literate consumer, experts say


HealthDay

Saturday, October 10, 2009



SATURDAY, Oct. 10 (HealthDay News) -- Adults with a poor education are also likely to have poor health, a growing body of evidence suggests.

Study after study has confirmed the link, and now experts are zeroing in on the reasons for it and what can be done.

"Persons with a higher education tend to have better jobs, and better income, better benefits," said David R. Williams, a professor of public health at the Harvard School of Public Health and staff director for the Robert Wood Johnson Foundation's Commission to Build a Healthier America.

Those benefits, he said, go beyond health benefits to include such other factors as having the leeway to take a day off or part of a day to see a doctor. People with higher levels of education "tend to have more resources to cope with stress and life, to live in better neighborhoods," Williams said. They have stress, of course, but also more resources to cope with it -- such as access to a health club to exercise away the stress -- than do people with less education, he said.

Being better educated also means that a person is more likely to understand the world of modern medicine, said Erik Angner, an assistant professor of philosophy and economics at the University of Alabama at Birmingham, who has researched the link between literacy and happiness.

"Modern medicine is incredibly complex," Angner said, "and if you lack the constellation of skills -- including basic reading and numerical tasks -- required to function adequately in the health-care environment, you might find it harder to effectively request, receive and understand your [medical] care."

A report issued in May by Williams's commission found that, compared with college graduates, adults who did not graduate from high school were 2.5 times as likely to be in less than very good health. High school graduates, it found, were nearly twice as likely as college graduates to be in less than very good health.

The report suggested that factors outside of the medical system play an important role in determining people's health, including how long they will live. Access to medical care is crucial, the report authors said, but it isn't enough to improve health.

What's needed, they suggested, is increased focus on schools and education -- encouraging people to obtain more education -- as well as more promotion of healthy living in the home, community and workplace.

From a "big picture" perspective, Williams said, health promotion should be emphasized and taught more -- and earlier -- in schools. Health habits in adulthood, he said, are built during childhood. It's also crucial, he said, to have a healthy neighborhood and workplace.
Angner said that he's found in his recent research that the older adults he has studied who could read and answer questions on medical forms without assistance were likely to be happier than those who could not.

Improving literacy -- and thus improving the ability to read and understand medical forms -- could boost health among adults, he said.
For adults whose education was stopped early, returning to school might help their health as well as their job prospects, the experts say. And if that's not an option, Angner said, simply trying to improve reading skills should make a difference.

SOURCES: David R. Williams, Ph.D., professor, public health, Harvard School of Public Health, Boston; Erik Angner, Ph.D., assistant professor, philosophy and economics, University of Alabama at Birmingham; "Reaching America's Health Potential Among Adults: A State-by-State Look at Adult Health," May 2009, Robert Wood Johnson Foundation

HealthDay

Want Leaner Kids? Parents May Need to Toe the Line

Health experts say much can be done to keep weight in check

HealthDay

Sunday, October 11, 2009



SUNDAY, Oct. 11 (HealthDay News) -- It's a trend that has health experts worried: Young kids are becoming increasingly oversized -- leading, they fear, to overweight teens and, ultimately, overweight adults with health problems.

But parents could be poised to do something about this. After all, some experts contend, parents are part of the problem.

"Parents might be contributing to the overweight epidemic," said Dr. Elsie Taveras, an assistant professor of pediatrics at Harvard Pilgrim Health Care and Harvard Medical School, who has researched the issue.

They do so unwittingly, of course, Taveras said. And the point is not to make parents feel guilty about contributing to their children's weight problems, she said, but to get the word out because the trend is headed in the wrong direction.

Today in the United States, infants up to 6 months old are 59 percent more likely to be overweight than were babies 20 years ago, according to a study published in Obesity.
In her research, Taveras discovered that infants who gain weight quickly early in life face weight problems by the time they're toddlers.

"What we found was, those children who gained more weight and gained it more quickly in the first six months of life had a higher risk of obesity when they were 3 years old," Taveras said. Her study was reported in Pediatrics.

The way parents feed their infants might play a role in this weight gain, another study found.
John Worobey, a professor and chairman of the nutritional sciences department at Rutgers University in New Jersey, evaluated the behavior of mothers as they fed their babies. His team followed 96 mother-child pairs, asking the mothers questions -- such as what they did when their babies got fussy -- and watching them feed their children formula.

Mothers who fed their babies eight times a day, on average, rather than seven and "who were less sensitive in reading their baby's satiety cues," Worobey said, had babies who gained more weight between ages 6 and 12 months. The findings were reported in the Journal of Nutrition Education and Behavior.

One solution, he said, is for parents to pay closer attention to their baby's cues, asking their pediatrician for help if they aren't certain how to read those cues.

"Pulling the head away from the bottle is the infant's way to signal, 'Hey, I don't want to do this anymore,'" Worobey said. But the cue is often not noticed.

One way to remedy that, he suggests, is for parents to avoid feeding their infants while watching television. "You may be paying more attention to the TV," he said. "It's better to make it one-on-one time."

There could be cultural myths at work, too, he said, with some cultures still believing that a chubby baby is a healthy baby.

Taveras urged parents to check in often about weight with their infant's pediatrician. With about four "well-baby" visits in the first six months, parents should remember to ask each time about their child's weight. "They should discuss with their clinician how their child is growing," she said.

But the parental link to youngsters' weight might start well before birth, perhaps even before pregnancy.

Reporting in the Maternal and Child Health Journal, researchers found that women who start pregnancy at a normal weight but gain more than 25 to 35 pounds increase their child's risk for being overweight at age 3.

SOURCES: Elsie Taveras, M.D., M.P.H., assistant professor, pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care and Harvard Medical School, Boston; John Worobey, Ph.D., professor and chairman, Department of Nutritional Sciences, Rutgers University, New Brunswick, N.J.; May/June 2009, Journal of Nutrition Education and Behavior; April 2009, Pediatrics; Sept. 26, 2008, Maternal and Child Health Journal; July 2006, Obesity

HealthDay

Friday, October 9, 2009

Statement from Paul A. Sieving, M.D., Ph.D., Director of the National Eye Institute, National Institutes of Health, on World Sight Day, Oct. 8, 2009

On World Sight Day 2009, the National Eye Institute (NEI), part of the National Institutes of Health, joins with groups around the globe to recognize vision as a public health priority. We at the NEI reaffirm our commitment to preventing and treating blinding eye conditions through scientific research and educational programs.

World Sight Day this year is dedicated to raising awareness of women and eye health. Worldwide, 314 million people are visually impaired, of whom 45 million are blind. Nearly two-thirds of people affected by vision loss are female.

Gender disparities in vision loss in the United States are partly related to the fact that women live longer than men, and are thus more susceptible to age-related eye diseases. In addition, females are at a higher risk for dry eye syndrome as well as several autoimmune diseases that affect the eyes, such as lupus, rheumatoid arthritis and multiple sclerosis.

Women around the world also may be at a greater risk for blinding eye conditions because social or economic factors prevent them from receiving equal access to eye care. This inaccessibility to eye health care is particularly detrimental in communities where a condition known as trachoma is prevalent. This eye disease is a leading cause of blindness worldwide, but it can be avoided and treated through health education, antibiotics and surgery.

Currently available treatments and educational strategies could be used to prevent or cure an estimated 75 percent of blindness worldwide. These include lifestyle factors such as stopping smoking, which is a risk factor for cataract and age-related macular degeneration, or reducing obesity, which is a risk factor for diabetic eye disease. Vision health could also be maintained through improved access to health care, including regular, comprehensive dilated eye exams, which would facilitate early detection and treatment of eye diseases.

On World Sight Day 2009, we at the NEI acknowledge the impact of blinding eye conditions on women, men and children throughout the world. Through the National Eye Health Education Program and our support of scientific research, we will continue to work to reduce the impact of vision disorders worldwide, especially those that can be prevented and treated.

The National Eye Institute, part of the National Institutes of Health, leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sight-saving treatments. For more information, visit www.nei.nih.gov.

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

Stem Cell Research Offers Hope for Colon Cancer Vaccine

Mouse study suggests it may be possible to generate an immune response to cancer
HealthDay


By Robert Preidt



Thursday, October 8, 2009
WEDNESDAY, Oct. 7 (HealthDay News) -- Human stem cells may provide a means of creating a vaccine against colon cancer and other types of cancers, say American and Chinese scientists.
"Cancer and stem cells share many molecular and biological features. By immunizing the host with stem cells, we are able to 'fool' the immune system to believe that cancer cells are present and thus to initiate a tumor-combating immune program," Dr. Zihai Li, of the University of Connecticut Stem Cell Institute, said in a news release.

The research by Li and colleagues is the first to make the connection between human stem cells and colon cancer vaccination.

It has long been believed that immunizing people with embryonic materials may trigger an anti-tumor response by the immune system, but this theory has never advanced beyond animal research. The finding that human stem cells may help immunize against colon cancer is new and unexpected, the study authors pointed out.

In this study, the researchers vaccinated mice with human embryonic stem cells and found that the mice developed a consistent immune response against colon cancer cells. The vaccinated mice showed a dramatic decline in tumor growth, compared with non-vaccinated mice.

While human embryonic stem cells triggered an immune response, artificially induced pluripotent stem cells did not, a finding that challenges the theory that induced pluripotent stem cells are the same as human embryonic stem cells and may replace them at the forefront of stem cell research, Li and colleagues said.

The study was published online Oct. 7 in the journal Stem Cells.

"Although we have only tested the protection against colon cancer, we believe that stem cells might be useful for generating an immune response against a broad spectrum of cancers, thus serving as a universal cancer vaccine," co-author Dr. Bei Liu said in the news release.

SOURCE: Stem Cells, news release, Oct. 7, 2009
HealthDay

HIV Patients More Prone to 7 Kinds of Cancer

Study found early treatment of infection could slow start of malignancies

HealthDay

By Robert Preidt

Thursday, October 8, 2009


WEDNESDAY, Oct. 7 (HealthDay News) -- The weakened immune systems of people with HIV puts them at increased risk for at least seven types of cancer, but early diagnosis and treatment of HIV infection could help delay the onset of some of these cancers, a new study suggests.

French researchers examined the incidence of three AIDS-defining cancers (Kaposi's sarcoma, non-Hodgkin's lymphoma and cervical cancer) and four non-AIDS-defining cancers (Hodgkin's lymphoma, lung cancer, liver cancer and anal cancer) in 52,278 HIV-infected people.

The study authors also analyzed the association between immunodeficiency, viral load, antiretroviral treatment and the onset of the seven cancers. Overall, immunodeficiency increased the risk of all the cancers, and CD4 cell count was the most predictive risk factor for all the cancers except anal cancer. The cancer risk associated with viral load was lower than that associated with immunodeficiency, the researchers noted.

CD4 count was the only risk factor for Hodgkin's lymphoma, lung cancer and liver cancer, the study found. Increased risk of Kaposi's sarcoma and non-Hodgkin's lymphoma was associated with lower CD4 count, higher HIV viral load and a lack of combination antiretroviral therapy (cART).
A higher CD4 count was associated with a lower risk of cervical cancer, and patients taking cART were half as likely to develop cervical cancer. Anal cancer risk increased with the time during which CD4 count was less than 200 cells per microliter and viral load was greater than 100,000 copies per milliliter, according to the report.

The study appears online Oct. 7 in advance of publication in the November print issue of The Lancet Oncology.

"Our results suggest that cART would be most beneficial if it restores or maintains the CD4 count above 500 cells per microliter, thereby indicating an earlier diagnosis of HIV infection and earlier treatment initiation," the researchers wrote.

The study authors called for effective cancer-specific screening programs for HIV patients and said all HIV-positive women should be regularly offered cervical cancer screening.

SOURCE: The Lancet Oncology, news release, Oct. 7, 2009
HealthDay

Consortium of Researchers Discover Retroviral Link to Chronic Fatigue Syndrome

Scientists have discovered a potential retroviral link to chronic fatigue syndrome, known as CFS, a debilitating disease that affects millions of people in the United States. Researchers from the Whittemore Peterson Institute (WPI), located at the University of Nevada, Reno, the National Cancer Institute (NCI), part of the National Institutes of Health, and the Cleveland Clinic, report this finding online Oct. 8, 2009, issue of Science.

"We now have evidence that a retrovirus named XMRV is frequently present in the blood of patients with CFS. This discovery could be a major step in the discovery of vital treatment options for millions of patients," said Judy Mikovits, Ph.D., director of research for WPI and leader of the team that discovered this association.


Researchers cautioned however, that this finding shows there is an association between XMRV and CFS but does not prove that XMRV causes CFS.


The scientists provide a new hypothesis for a retrovirus link with CFS. The virus, XMRV, was first identified by Robert H. Silverman, Ph.D., professor in the Department of Cancer Biology at the Cleveland Clinic Lerner Research Institute, in men who had a specific immune system defect that reduced their ability to fight viral infections.


"The discovery of XMRV in two major diseases, prostate cancer and now chronic fatigue syndrome, is very exciting. If cause-and-effect is established, there would be a new opportunity for prevention and treatment of these diseases," said Silverman, a co-author on the CFS paper.


Commonality of an immune system defect in patients with CFS and prostate cancer led researchers to look for the virus in their blood samples. In this study, WPI scientists identified XMRV in the blood of 68 of 101 (67 percent) CFS patients. In contrast, they found that eight of 218 healthy people (3.7 percent) contained XMRV DNA. The research team not only found that blood cells contained XMRV but also expressed XMRV proteins at high levels and produced infectious viral particles. A clinically validated test to detect XMRV antibodies in patients' plasma is currently under development.


These results were also supported by the observation of retrovirus particles in patient samples when examined using transmission electron microscopy. The data demonstrate the first direct isolation of infectious XMRV from humans.


"These compelling data allow the development of a hypothesis concerning a cause of this complex and misunderstood disease, since retroviruses are a known cause of neurodegenerative diseases and cancer in man," said Francis Ruscetti, Ph.D., Laboratory of Experimental Immunology, NCI.


Retroviruses like XMRV have also been shown to activate a number of other latent viruses. This could explain why so many different viruses, such as Epstein-Barr virus, which was causally linked to Burkitt's and other lymphomas in the 1970s, have been associated with CFS. It is important to note that retroviruses, like XMRV, are not airborne.


"The scientific evidence that a retrovirus is implicated in CFS opens a new world of possibilities for so many people," said Annette Whittemore, founder and president of WPI and mother of a CFS patient. "Scientists can now begin the important work of translating this discovery into medical care for individuals with XMRV related diseases."


Dan Peterson, M.D., medical director of WPI added, "Patients with CFS deal with a myriad of health issues as their quality of life declines. I'm excited about the possibility of providing patients, who are positive for XMRV, a definitive diagnosis, and hopefully very soon, a range of effective treatments options."


The Whittemore Peterson Institute for Neuro Immune Disease exists to bring discovery, knowledge, and effective treatments to patients with illnesses that are caused by acquired dysregulation of both the immune system and the nervous system, often resulting in lifelong disease and disability. www.wpinstitute.org.


The Lerner Research Institute is home to Cleveland Clinic's laboratory, translational and clinical research. Its mission: to promote human health by investigating in the laboratory and the clinic the causes of disease and discovering novel approaches to prevention and treatments; to train the next generation of biomedical researchers; and to foster productive collaborations with those providing clinical care. More than 1,200 people in 11 departments work in research programs focusing on cardiovascular, cancer, neurologic, musculoskeletal, allergic and immunologic, eye, metabolic, and infectious disease. The Institute also is an integral part of the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.


The National Cancer Institute (NCI) leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).


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