Monday, November 10, 2008

Influenza Vaccination can Help Cut Blood Clots in Veins

“Our study suggests for the first time that vaccination against influenza may reduce the risk of venous thrombotic embolism (VTE),” said Dr. Joseph Emmerich, lead author of the study and professor of vascular medicine at the University Paris Descartes and head of the INSERM Lab 765, which investigates thrombosis.

“This protective effect was more pronounced before the age of 52 years,” he said while presenting the findings at the American Heart Association’s Scientific Sessions 2008.

VTE, the formation of a blood clot in a vein, is dangerous because the blood clot can break loose and travel through the circulatory system to the right side of the heart. It can further travel to the lungs, where it may prove to be life-threatening or even fatal.

For their research, the team conducted a case-control study among 1,454 age- and sex-matched patients (average age 52 years) from 11 centers in France (the FARIVE study).

The researchers compared 727 patients without personal history of cancer within the last five years who had initial episodes of VTE to a control group of age- and sex-matched patients free of venous and arterial thrombotic disease.

They revealed that patients younger than 18 years old — or those who already had VTE, had a diagnosis of active cancer or a history of malignancy less than five years previously, or had a short life expectancy due to other causes — were ineligible to participate in the study.

MP3 Headphones can Hamper Defibrillators, Pacemakers

Research found that neodymium, a magnetic substance contained in the MP3 player headphones, appears to impede proper functioning of the technology, posing a potential grave risk to patients who rely on the devices.

"Exposure of a defibrillator to the headphones can temporarily deactivate the defibrillator," said William Maisel, senior author of the study and director of the Medical Device Safety Institute at Beth Israel Medical Center in Boston, Massachusetts.

The study, presented at an American Heart Association conference, concluded that in order to be operated safely, headphones accompanying the popular MP3 digital music players must be at least 1.2 inches (3 centimeters) from the implanted devices.

Scientists said patients using heart devices should not place MP3 player headphones in their pocket or drape them over their chest.

"For family members or friends of patients with implantable defibrillators," said Maisel, "they should avoid wearing headphones and resting their head right on top of someone's device."

Maisel and his research team determined that outside studies have found no adverse reactions to pacemakers and defibrillators from other portable electronic devices like iPods, Bluetooth headsets, iPhones, electric blankets or hand-held airport metal detectors.

Nine 'healthy towns' get £30m pot

Nine areas have been given the go-ahead to become "healthy towns" under a plan by ministers to combat obesity.

Dudley, Halifax, Sheffield, Tower Hamlets in London, Thetford in Norfolk, Middlesbrough, Manchester, Tewkesbury and Portsmouth will share a £30m pot.

The areas will all match the government funding to develop a host of schemes related to cycling, walking, healthy eating and green spaces.

It is part of a wider public health drive being rolled out in England.

Health Secretary Alan Johnson said: "Obesity is the biggest health challenge we face.

"For the first time we've given nine areas "healthy town" status.

"This means they must promote healthy living. Each town has come up with innovative ways - such as a loyalty schemes or cycling projects - to help their residents to be more active.

"Healthy towns is just the start. Our aim is to create a healthy England."

Among the measures put foward is a project called Points4Life in Manchester, which is a loyalty scheme to reward people with free activities or healthy food when they take exercise.

Thetford is planning a "cycle recycle" project which supports people to buy and maintain bikes.

Warning over untested web 'cures'

Leading medical experts are warning patients against using untested remedies advertised on the internet which, they say, sell "false hope".

The group, backed by charity Sense About Science, says vulnerable people are being increasingly exploited by the online promotion of such treatments.

Many untested remedies are expensive and do not work, and are often based on "unreliable" evidence, the experts say.

A new guide has been published to help patients recognise bogus treatments.

Sense About Science says there are now hundreds of websites offering hope to people who are desperate for a cure.

Many online adverts and chat-room conversations testify to the "incredible" benefits of new medicines and treatments, often selling the empty promise of curing the incurable, the charity says.

Some offer stem cell treatments for brain disorders for tens of thousands of pounds. Others sell cures for multiple sclerosis and cancers.

But the evidence behind the remedies is often unreliable, experts say, and patients are increasingly being exploited.

Experts and patient groups want to see tighter regulation to reduce unfounded claims.

Dr Kieran Breen, director of research at the Parkinson's Disease Society, said: "It can be tempting to believe personal stories of miracle cures, but only by using tried and tested methods can we move forward and provide people with Parkinson's with the best available advice and treatments."

Thursday, November 6, 2008

ADHD Affects Movement More in Boys Than in Girls

TUESDAY, Nov. 4 (HealthDay News) -- Girls with attention-deficit hyperactivity disorder (ADHD) appear to have better control of their movements than boys with the common mental disorder, a new study says.

The study, published in the Nov. 4 issue of Neurology, found that girls with ADHD and a control group of children without the disorder did twice as well as boys with ADHD in a test that compared their abilities to tap their toes, walk on their heels, maintain balance and keep a steady rhythm. The results of the children, aged 7 to 15, were compared by age as well as gender.

"Our findings suggest that the differences between boys and girls with ADHD show up not only in behavior and symptoms, but also in development of movement control, likely because girls' brains mature earlier than boys' brains," study author E. Mark Mahone, of Johns Hopkins University School of Medicine in Baltimore, said in an American Academy of Neurology news release.

Symptoms of ADHD include impulsiveness, hyperactivity, inattentiveness and constant daydreaming.

Mahone called for more ADHD movement studies that look at boys and girls separately and at younger ages.

Acupuncture may not help induce labor

NEW YORK (Reuters Health) - Acupuncture is promoted as alternative way to induce labor in women who go past their due date, but a new study finds no evidence that the tactic works.

About 5 percent to 10 percent of pregnant women go 2 weeks or more past their due date, a delay that raises the risk of complications during labor. Because of this, doctors routinely induce labor when a pregnancy lasts beyond 41 weeks.

During standard labor induction, the doctor uses an instrument to rupture the amniotic sac or gives synthetic forms of prostaglandins or oxytocin -- hormones that normally help trigger labor.

Acupuncture has been promoted as an alternative; in theory, it may work by stimulating the nervous system, which in turn could cause the uterus to contract.

But in the new study of 364 pregnant women who were past their due dates, Australian researchers found that 2 days of acupuncture therapy did not reduce the need for standard forms of labor induction.

Dr. Caroline A. Smith and colleagues at the University of Adelaide report the findings in the journal Obstetrics & Gynecology.

Acupuncture has been used for more than 2,000 years in Chinese medicine to treat a wide variety of ailments. According to traditional medicine, specific acupuncture points on the skin are connected to internal pathways that conduct energy, or qi ("chee"), and stimulating these points with a fine needle promotes the healthy flow of qi.

For their study, Smith and her colleagues randomly assigned patients to either undergo real acupuncture or a "sham" version where needles were inserted only superficially, into areas of the skin other than traditional acupuncture points.

Each woman had two sessions performed over the 2 days before her scheduled labor induction.

In the end, Smith's team found, women who had the real acupuncture were just as likely as the comparison group to need any of the standard forms of labor induction and did not have a shorter labor once it was induced.

Still, the researchers conclude, the findings do not prove that acupuncture has no use in inducing labor. They say larger studies should look at whether starting acupuncture sooner, or doing more sessions, aids labor induction.

In the meantime, acupuncture at least seems to do no harm.

"There is no evidence of harm from the administration of acupuncture in the postterm period to the mother or fetus," Smith and her colleagues write, "and women may still seek out the use of acupuncture to prepare for labor."

Monday, November 3, 2008

Obesity, Other Health Problems Delay MS Diagnosis

"Our study suggests that doctors who treat people with chronic diseases should not attribute new neurological symptoms such as numbness and tingling to existing conditions without careful consideration," said study author Ruth Ann Marrie, MD, PhD, of the University of Manitoba in Winnipeg, Canada, and member of the American Academy of Neurology.

For the study, researchers examined the records of 8,983 people who had been diagnosed with MS. Of those, 2,375 were further classified as having mild, moderate or severe disability within two years of diagnosis. This well-characterized group was asked about pre-existing health conditions, their smoking status and weight history.

The study found that it took one to 10 years longer for people who were obese, smoked, or had physical or mental health conditions to be diagnosed with MS compared to people without such conditions. The study also found that the more medical problems a person with MS had, the more severe the disease had become by the time they were diagnosed.

"People with vascular problems or who were obese were about one-and-a-half times more likely to be moderately disabled at the time of diagnosis compared with those who had MS but did not have any heart or weight problems," said Marrie. "We also found people who had a mental disorder or any muscle or joint problem along with MS were nearly two times more likely to be severely disabled at the time of diagnosis."

Marrie says pre-existing conditions are common in the United States and can mask symptoms of a new disease or affect access to patient care. "People with multiple medical problems on top of MS may need more healthcare resources or might respond differently to medication," Marrie said. "This needs more study."

Stem Cell Therapies For Heart Disease

Dr Nicolle Kränkel and colleagues at the Bristol Heart Institute have discovered how our bodies initiate DIY rescue and repair mechanisms when blood supply is inadequate, for example in diabetic limbs or in the heart muscle during heart attack. Their findings also provide a practical step to advance progress in stem cell therapies.

In healthy people, reduced oxygen supply can occur in certain situations, e.g. after an injury. The affected tissues release chemical messengers that 'call' to a type of circulating stem cells (EPCs) for help to re-establish blood supply via the growth of new blood vessels. A group of Bristol researchers have found that kinins, for long time considered inflammatory substances, are among the messengers supporting blood vessel growth.

In this study, published in Circulation Research, Dr Kränkel and colleagues found that EPCs respond to kinins by travelling to the target tissue and invading it to assist healing. In patients with angina, EPCs cannot respond to the distress call because they lack a kinin sensor (the 'kinin receptor') on their surface. The oxygen-starved tissue is therefore left with reduced blood supply.

In heart attack patients they saw that a proportion of the circulating EPCs were able to sense the kinin signal and respond.

Dr Kränkel, Research Associate at the Bristol Heart Institute, said: "Our findings showed that heart attack patients possess the functional cells needed to repair blood supply to their heart, but they're hidden amongst a muddle of others."

The team purified the kinin-sensitive EPCs from the total stem cell population to create an enriched sample that has huge potential as a powerful regenerative therapy.

Dr Kränkel added: "In previous clinical stem cell trials, a mixture of different types of cells were used. We've used kinin like a magnet to attract and extract the most effective repair cells from the mass of different types. This enriched sample should increase the therapeutic potential, especially in heart attack patients where quick and efficient treatment is crucial for long term outcome."

Professor Jeremy Pearson, Associate Medical Director of the British Heart Foundation – one of the study's funders – said: "The team have made fascinating discoveries about our DIY repair systems and have translated them into practical use. They've intelligently employed the body's own strategies to develop a method that may take us a step closer to truly effective stem cell therapies for heart patients."

Dr Kränkel is a research fellow in the laboratory of Paolo Madeddu, Professor of Experimental Cardiovascluar Medicine at the Bristol Heart Institute, Bristol Royal Infirmary.

Kids With Parent in War Zone Face Behavior Risks

MONDAY, Nov. 3 (HealthDay News) -- Children of U.S. military personnel deployed to Iraq and Afghanistan are more likely to have behavioral problems than children whose parents aren't deployed, a new study shows.

Researchers studied 169 families with children aged 18 months to 5 years old enrolled in a day-care center at a Marine base.

Of those families, 55 (33 percent) had a deployed parent, with an average deployment length of 3.9 months. The researchers found that children aged three years and older with a deployed parent had significantly higher scores on measures of externalizing and overall behavior problems than children of the same age without a deployed parent.

"Such reported differences might be dismissed as distorted perceptions of the child by the distressed non-deployed parent; however, the association remained after controlling for parental stress and depressive symptoms," wrote Dr. Molinda M. Chartrand, of the Boston University School of Medicine and Boston Medical Center, and colleagues.

"Larger, longitudinal studies are needed to ascertain whether there are changes in children's behavior from the time before parental deployment, during parental deployment, and at the time of reunification," the researchers added.

"This information is necessary to provide clinicians serving military families with evidenced-based anticipatory guidance and clinical interventions. Finally, the needs of the children of deployed parents in the National Guard and Reserves also warrant urgent further education."

The study was published in the November issue of the Archives of Pediatrics & Adolescent Medicine.

"Findings from this study highlight the need for increased attention to mental health concerns of young children of deployed soldiers as well as the mental health concerns of the soldiers and non-deployed spouses," David J. Schonfeld and Robin Gurwitch, of the Cincinnati Children's Hospital Medical Center, wrote in an accompanying editorial. "[The study authors] raise questions of how to best determine deployment length and what preventive measures can be taken to reduce stress and distress to the non-deployed spouses and children left behind."

More than 2 million American children have had parents deployed to Iraq or Afghanistan, and about 40 percent of those children are younger than 5.

Scientists Make Clones of Mice Dead 16 Years

MONDAY, Nov. 3 (HealthDay News) -- Japanese scientists have succeeded in creating cloned mice from mouse bodies that had been frozen for up to 16 years.

While the feat may raise the specter of resurrecting lost species a la Jurassic Park, study senior author Teruhiko Wakayama said recreating woolly mammoths was "probably impossible."

He and his co-authors did acknowledge, however, the possibility of preserving endangered species and perhaps resurrecting other extinct species.

Other experts thought the implications of such technology could be more immediate -- and more human.

"Learning how to manipulate stem cells is an important enterprise, and scientists should be fully engaged in this. Whether we apply it toward bringing back dinosaurs or taking care of real needs on this planet is another question," said Richard Finnell, professor in the Center for Environmental and Genetic Medicine at the Texas A&M Health Science Center Institute of Biosciences and Technology.

"Stem cell biology offers tremendous upside, [but] the technology needs to be refined, and these scientists have come up with a way to manipulate these stem cells," Finnell continued. "Science is an interdisciplinary process. If we can grasp a technique that has been used for one approach, it really could be quite beneficial to how we deal with clinical problems today."

Scientists have cloned other species -- including celebrity sheep Dolly -- by using two live cells. Genetic material is taken from an unfertilized egg and then transferred to another live cell for "incubation," a process known as nuclear transfer.

Until now, researchers had believed that ice crystals formed in frozen cells would cause irreparable damage to the DNA, making cloning of long-dead animals impossible.

Wakayama, of the Laboratory for Genomic Reprogramming at the Center for Developmental Biology in Kobe, Japan, and his colleagues took brain tissue from a mouse strain frozen at minus 20 degrees Celsius for up to 16 years and transferred the nuclei (containing the genetic material) to empty egg cells.

These two-cell embryos were used to generate embryonic stem cell lines that resulted in 12 healthy cloned mice, which grew into normal adults.

The technique did not require nuclei from an intact donor cell. The cloning efficiency was about the same as using conventional cloning methods, the study authors stated.

Number Of American Kids Medicated For Chronic Conditions Increasing

The number of children on medication for chronic illnesses in the United States went up between 2002 and 2005 across a range of diseases, with a doubling of medication for type 2 diabetes, according to a new study.

The study was the work of lead author Dr Emily Cox of Express Scripts, Inc, St Louis, Missouri, and colleagues from other research centres in the US, and was published online on 31 October in the journal Pediatrics.

The researchers investigated commercial medical insurance claims made between 2002 and 2005 for a nationally representative sample of more than 3.5 million children aged from 5 to 19 years.

For each quarter of the three years covered by the study the researchers noted use of medication for the following chronic conditions: high blood pressure (antihypertensives), high blood fats (antihyperlipidemics), type 2 diabetes, antidepressants, asthma, attention deficit disorder and attention- deficit/hyperactivity disorder.

The results showed that:
  • The figures for medication use in the first quarter of the study period (first three monts of 2002, the baseline quarter) ranged from 29.5 per 1,000 child patients for asthma medication to 0.27 per 1,000 for antihyperlipidemics.

  • Except for asthma medication, the prevalence for older children, aged 15 to 19, was higher than for those who were younger than this.

  • The prevalence for type 2 diabetes medication doubled over the three years of the investigation.

  • This was driven mostly by a 166 per cent rise among females aged 10 to 14 and 135 per cent among females aged 15 to 19.

  • The highest rates of prevalence increase (in the double digits) were in medications for: asthma (46.5 per cent), attention-deficit disorder and attention-deficit/hyperactivity disorder medications (40.4 per cent), and antihyperlipidemics (15 per cent).

  • This compared with a more moderate growth in the use of antihypertensives and antidepressants (1.8 per cent).

  • The increase in prevalence rates for type 2 diabetes medication was far more dramatic for girls than for boys (147 versus 39 per cent).

  • There was a similar pattern for attention-deficit disorder and attention-deficit/hyperactivity disorder medications (63 versus 33 per cent), and antidepressants (7 versus 4 per cent).
In reporting their findings the authors commented that:

"Varying patterns were noted between males and females and across age groups. Particularly noteworthy are growing rates of use among female children, at times rates twice as great as among males."

"These findings hold important implications for children's health and health care costs in the United States," they added.

And they concluded that:

"Prevalence of chronic medication use in children increased across all therapy classes evaluated. "

Sunday, November 2, 2008

Bone-building find hold hope for improved osteoporosis treatment

The research from the University of Alabama at Birmingham (UAB) showed that parathyroid hormone (PTH) given intermittently enhances the body's own bone-building action through a specific "co-receptor" on the surface of bone cells.

While scientists have known for long that PTH stimulates bone formation, the exact mechanism underlying this effect has been unknown to date.

"Our study uncovers a novel mechanism for how parathyroid hormone signaling selectively stimulates bone formation. We have identified the protein co-receptor crucial to the whole process," said Dr. Xu Cao, UAB professor of pathology and senior author on the study.

During the study, the researchers focused on PTH signals in mice to see which cell receptors would actively recruit calcium from the blood.

Dr. Mei Wan, UAB associate professor of molecular and cellular pathology and first author on the study, said that the team's efforts helped uncover the one co-receptor responsible for turning on bone building.

Dr. Jay McDonald, pathology professor and director of UAB's Center for Metabolic Bone Disease, pointed out that the exact mechanism of PTH-signalled bone formation was previously shrouded by the joint production of osteoblasts and osteoclasts, two types of cells that are instrumental in regulating a healthy skeleton.

While osteoblasts regulate a healthy skeleton by forming new bone, and osteoclasts do so by resorbing old and brittle bone.

McDonald highlighted the fact that many existing osteoporosis drugs target both osteoblasts and osteoclasts, which can lead to zero or minimal bone formation.

"The ideal would be to have one drug to shut down the osteoclasts and turn on the osteoblasts to effectively build bone. We don't have that yet, but this study shows us the path to get there," he said.

Doctors’ Body to Issue Guidelines for Treatment of Vertigo

The primary purposes of the new guideline, for patients 18 years and older, are to improve quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of the condition, reducing the inappropriate use of suppressant medications, decreasing the inappropriate use of ancillary tests such as radiographic imaging and vestibular testing, and to promote the use of effective repositioning maneuvers for treatment.

BPPV is a disorder that causes feelings of vertigo, dizziness, and nausea. Episodes of BPPV can be brought on by abrupt changes in movement, like standing up or turning the head suddenly. The condition usually begins to affect people after the age of 50, but it can affect younger patients.

"Approximately 5.6 million medical appointments per year in the United States can be attributed to complaints of dizziness," said Neil Bhattacharyya, chair of the multidisciplinary BPPV Guideline Panel. "We know now that anywhere from 17 to 42 percent of these patients will ultimately receive a diagnosis of BPPV. Unfortunately, proper diagnosis and treatment for those suffering is often delayed due to a lack of standardized diagnostic steps and relative unawareness of effective treatment options."

Expenses relating to the diagnosis and treatment of BPPV cost the U.S. healthcare system approximately $2 billion per year. Additionally, 86 percent of patients suffer some interrupted daily activities and lost days at work because of BPPV.

Wednesday, October 29, 2008

Workout for brain just a few clicks away

CHICAGO, Oct 14 (Reuters) - Searching the Internet may help middle-aged and older adults keep their memories sharp, U.S. researchers said on Tuesday.

Researchers at the University of California Los Angeles studied people doing Web searches while their brain activity was recorded with functional magnetic resonance imaging scans.

"What we saw was people who had Internet experience used more of their brain during the search," Dr. Gary Small, a UCLA expert on aging, said in a telephone interview.

"This suggests that just searching on the Internet may train the brain -- that it may keep it active and healthy," said Small, whose research appears in the American Journal of Geriatric Psychiatry.

Many studies have found that challenging mental activities such as puzzles can help preserve brain function, but few have looked at what role the Internet might play.

"This is the first time anyone has simulated an Internet search task while scanning the brain," Small said.

His team studied 24 normal volunteers between the ages of 55 and 76. Half were experienced at searching the Internet and the other half had no Web experience. Otherwise, the groups were similar in age, gender and education.

Both groups were asked to do Internet searches and book reading tasks while their brain activity was monitored.

"We found that in reading the book task, the visual cortex -- the part of the brain that controls reading and language -- was activated," Small said.

"In doing the Internet search task, there was much greater activity, but only in the Internet-savvy group."

He said it appears that people who are familiar with the Internet can engage in a much deeper level of brain activity.

"There is something about Internet searching where we can gauge it to a level that we find challenging," Small said.

In the aging brain, atrophy and reduced cell activity can take a toll on cognitive function. Activities that keep the brain engaged can preserve brain health and thinking ability.

Small thinks learning to do Internet searches may be one of those activities.

Old and new viruses spread by air travel, crowding

WASHINGTON, Oct 27 (Reuters) - Tourists traveling by plane and the growth of cities are combining to help new and old infections spread around the world, experts said on Monday.

Viruses such as Chikungunya and dengue fever are finding new homes or returning to places where they were eradicated, the researchers told an infectious diseases meeting.

And new methods of diagnosing infections have led to the discovery of dozens of viruses causing often-serious disease.

"As urbanization spread, so did the mosquito," Duane Gubler of the University of Hawaii told a news conference at a joint meeting of the American Society of Microbiology and the Infectious Diseases Society of America.

Researchers at the Pan American Health Organization told the meeting that dengue fever, which can cause mild illness or deadly hemorrhagic disease, has come back after decades of eradication successes in Latin America.

They said 1.03 million cases of dengue were reported in the 1980s and 2.7 million in the 1990s, but 4.6 million were reported from 2000 to 2007.

The "re-emergence of epidemic dengue is closely associated with global urbanization and global transportation," Gubler said. "Pathogens of all kinds -- many of them actually move in infected people but they also move in infected animals and mosquitoes."

New infections are a threat, as well.

Dr. Ian Lipkin of Columbia University in New York said his lab, using new genetic sequencing techniques, has identified 75 new pathogens -- including a new rhinovirus that has caused serious disease in "scores of children" around the world.


Rhinoviruses are spread person-to-person only and usually cause common colds but this version appears more like severe influenza, Lipkin told the news conference.

"It was literally under our noses and in our noses for a long time," Lipkin said. "It has been found in Asia, Africa, Oceania, North America and Europe," he added. "It clearly is an important pathogen."

Chikungunya virus, which causes painful and sometimes crippling or deadly symptoms, has spread to several new countries in the past two years. One traveler brought it to Italy last year, Gubler noted.

"The same virus was introduced into India and into Sri Lanka, most likely via infected travelers," Gubler said.

Outbreaks of Chikungunya, which originated in Tanzania in 1952 but did not spread much outside of Africa until 2005, have been helped by mutations that let it travel via the Asian tiger mosquito, Aedes albopictus.

In 2005 on tiny Reunion Island in the Indian Ocean, it infected more than a third of the population -- 266,000 people -- and killed 260 of them.

The virus has spread to Singapore and people who go to neighboring Malaysia to buy durian fruit may be helping to carry it, said Dr. Harold Townson of the Liverpool School of Tropical Medicine in Britain.

"Aedes albopictus is very common in the United States and Caribbean," Townson said. "There are risks it could be introduced here."

And Gubler noted that another species of mosquito, the dengue-carrying Aedes aegypti, is re-emerging in Latin America.

Aedes aegypti is the original carrier of Chikungunya -- whose name comes from a word in the Makonde language of Tanzania describing the stooped stance of victims.

Tuesday, October 28, 2008

Cash to boost cervical screening

The NHS is launching a £250,000 scheme to tackle falling numbers of young women in England being screened for cervical cancer.

The announcement comes as a report shows screening rates have declined across the country in the last decade, particularly among women under 35.

The sharpest drop, by 12.6%, was in the number of women aged 25-29 being screened, which now stands at 66.2%.

Apathy is believed to be one of the reasons for the decline.


The number of women aged 30-34 who had been screened in the past five years has also fallen - from 83.5% to 76.8% since 1998, according to the NHS Information Centre.

The number of deaths from cervical cancer has risen to 413 among women aged 25-64 in 2007, up from 388 in 2006.

This means the death rate from cervical cancer among these women is at its highest since 2001.

This was despite the number of women invited (aged 25-64) rising from 4.01m to 4.18m in the last year, an increase of 4.3%.

Improving uptake

A spokesman for the Department of Health said: "We are aware that coverage rates are declining across the country, particularly in young women.

"To tackle this, NHS Cancer Screening Programmes have commissioned the Improvement Foundation to undertake a project to look into ways in which cervical screening uptake can be improved in women aged under 35."

The NHSCSP and Improvement Foundation have identified 10 primary care trusts to work with.

Lessons learned from this project will be shared across the whole programme by the end of 2009.

If overall coverage of 80% can be achieved, the NHS predicts that a 95% reduction in death rates is possible in the long term.

Liberal Democrat health spokesperson Sandra Gidley said: "There are early warning signs in these new figures that suggest the number of deaths is rising.

"Trusts must make strenuous efforts to ensure their screening programmes reach as many women as possible.

"The government must pay more attention to screening or, quite simply, even more women will die unnecessarily."

Dr Anne Szarewski of Cancer Research UK said: "Cervical screening saves lives so it's a big worry if young women start to miss their smear tests. The peak age for cervical cancer to strike is while women are in their late-30s, but it can occur earlier.

"We're not sure exactly why there's been a drop in the numbers of women attending screening but these figures highlight just how important it is that all women - including those who will receive the HPV vaccine - are aware of cervical screening and attend when they receive their invitations."

Shadow Health Secretary Andrew Lansley said: "We already have one of the worst survival rates in Europe for cervical cancer. The decline in screening rates is unacceptable and needs to be reversed."

A Rise in Kidney Stones Is Seen in U.S. Children

To the great surprise of parents, kidney stones, once considered a disorder of middle age, are now showing up in children as young as 5 or 6.

While there are no reliable data on the number of cases, pediatric urologists and nephrologists across the country say they are seeing a steep rise in young patients. Some hospitals have opened pediatric kidney stone clinics.

“The older doctors would say in the ’70s and ’80s, they’d see a kid with a stone once every few months,” said Dr. Caleb P. Nelson, a urology instructor at Harvard Medical School who is co-director of the new kidney stone center at Children’s Hospital Boston. “Now we see kids once a week or less.”

Dr. John C. Pope IV, an associate professor of urologic surgery and pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, said, “When we tell parents, most say they’ve never heard of a kid with a kidney stone and think something is terribly wrong with their child.”

In China recently, many children who drank milk tainted with melamine — a toxic chemical illegally added to watered-down milk to inflate the protein count — developed kidney stones.

The increase in the United States is attributed to a host of factors, including a food additive that is both legal and ubiquitous: salt.

Though most of the research on kidney stones comes from adult studies, experts believe it can be applied to children. Those studies have found that dietary factors are the leading cause of kidney stones, which are crystallizations of several substances in the urine. Stones form when these substances become too concentrated.

Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.

Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.

“What we’ve really seen is an increase in the salt load in children’s diet,” said Dr. Bruce L. Slaughenhoupt, co-director of pediatric urology and of the pediatric kidney stone clinic at the University of Wisconsin. He and other experts mentioned not just salty chips and French fries, but also processed foods like sandwich meats; canned soups; packaged meals; and even sports drinks like Gatorade, which are so popular among schoolchildren they are now sold in child-friendly juice boxes.

Children also tend not to drink enough water. “They don’t want to go to the bathroom at school; they don’t have time, so they drink less,” said Dr. Alicia Neu, medical director of pediatric nephrology and the pediatric stone clinic at Johns Hopkins Children’s Center in Baltimore. Instead, they are likely to drink only once they’re thirsty — but that may be too little, too late, especially for children who play sports or are just active.

“Drinking more water is the most important step in the prevention of kidney stones,” Dr. Neu said.

The incidence of kidney stones in adults has also been rising, especially in women, and experts say they see more adults in their 20s and 30s with stones; in the past, it was more common in adults in their 40s and 50s.

“It’s no longer a middle-aged disease,” Dr. Nelson said. “Most of us suspect what we’re seeing in children is the spillover of the overall increase in the whole population.”

The median age of children with stones is about 10.

Many experts say the rise in obesity is contributing to kidney stones in children as well as adults. But not all stone centers are seeing overweight children, and having a healthy weight does not preclude kidney stones. “Of the school-age and adolescent kids we’ve seen, most of them appear to be reasonably fit, active kids,” Dr. Nelson said. “We’re not seeing a parade of overweight Nintendo players.”

Dr. Slaughenhoupt has seen more overweight children at his clinic. “We haven’t compared our data yet,” he said, “but my sense is that children with stones are bigger, and some of them are morbidly obese.”

Dr. Pope, in Nashville, agreed. His hospital lies in the so-called stone belt, a swath of Southern states with a higher incidence of kidney stones, and he said doctors there saw two to three new pediatric cases a week.

“There’s no question in my mind that it is largely dietary and directly related to the childhood obesity epidemic,” he said.

Fifty to 60 percent of children with kidney stones have a family history of the disease. “If you have a family history, it’s important to recognize your kids are at risk at some point in their life,” Dr. Nelson said. “That means instilling lifelong habits of good hydration, balanced diet, and avoiding processed high-salt, high-fat foods.”

There is also evidence that sucrose, found in sodas, can also increase risk of stones, as can high-protein weight-loss diets, which are growing in popularity among teenagers.

A common misconception is that people with kidney stones should avoid calcium. In fact, dairy products have been shown to reduce the risk of stones, because the dietary calcium binds with oxalate before it is absorbed by the body, preventing it from getting into the kidneys.

Children with kidney stones can experience severe pain in their side or stomach when a stone is passing through the narrow ureter through which urine travels from the kidneys to the bladder. Younger children may have a more vague pain or stomachache, making the condition harder to diagnose. Children may feel sick to their stomach, and often there is blood in the urine.

One Saturday last February, 11-year-old Tessa Cesario of Frederick, Md., began having back pains. An aspiring ballerina who dances en pointe five nights a week, she was used to occasional aches and strains. But this one was so intense that her parents took her to the doctor.

The pediatrician ordered an X-ray, and when he phoned with the results, her parents were astonished.

“I was afraid he was calling to say she pulled something and wouldn’t be able to dance,” said her mother, Theresa Cesario. Instead, they were told that Tessa had a kidney stone.

“I thought older men get kidney stones, not kids,” Ms. Cesario said.

The treatment for kidney stones is similar in children and adults. Doctors try to let the stone pass, but if it is too large, if it blocks the flow of urine or if there is a sign of infection, it is removed through one of two types of minimally invasive surgery.

Shock-wave lithotripsy is a noninvasive procedure that uses high-energy sound waves to blast the stones into fragments that are then more easily passed. In ureteroscopy, an endoscope is inserted through the ureter to retrieve or obliterate the stone.

Simple Test To Predict Pre-Eclampsia In Sight

A team of UK researchers has found that women who develop pre-eclampsia in pregnancy have lower than normal levels of a marker protein in their blood at the three-month stage and this could open the door to developing a simple blood test for this potentially life-threatening condition.

The research, which was funded by the British Heart Foundation (BHF), was led by Professor Dave Bates from the Department of Physiology and Pharmacology at the University of Bristol and is published in the journal Clinical Science.

Pre-eclampsia is a common pregnancy-related condition characterized by high blood pressure, protein in the urine, fluid retention, and dysfunction in the lining of blood vessels of the pregnant woman. Up to 1,000 babies and 10 women die every year in the UK as a result of the condition.

Bates and colleagues found that women in their 12th week of pregnancy who went on to develop pre-eclampsia had lower than expected levels of the protein VEGF165b compared to counterparts who did not develop the condition.

They suggested VEGF165b could be used as a biomarker to assess a woman's risk of developing pre-eclampsia and a test based on it could be used to monitor and care for vulnerable pregnancies.

The researchers built on previous studies that suggested links between pre-eclampsia and the VEGF group of proteins. They decided to track the level of VEGF165b in particular.

For the study, Bates and colleagues measured levels of VEGF165b in non-pregnant women, women who did not develop pre-eclampsia and women who did. In the pregnant women they measured levels of VEGF165b at 12 weeks of gestation and intervals through the rest of the pregnancy.

The results showed there was a 10-fold increase in VEGF165b in normal pregnancies at 12 weeks compared to non-pregnancy, while women who went on to develop pre-eclampsia hardly showed any increase at week 12.

Yet at full term, there was no statistically significant difference in the levels of VEGF165b between the women with pre-eclampsia and the women with normal pregnancies. The researchers suggested that VEGF165b increase is delayed in women who go on to develop pre-eclampsia.

43-year-old Karen Partridge from Bristol had severe pre-eclampsia in her first two pregnancies. She said she had to spend 21 days in hospital in her first pregnancy and that it was "a scary time".

She had the classic symptoms, she said:

"Protein in my urine, and high blood pressure and I swelled up like the Michelin man putting on four stone."

Partridge said she had no choice but to have her first baby delivered as quickly as possible and this meant her daughter had a low birthweight of only 5lb 2 oz (2.3 kg) and had to be fed through a tube for her first 10 days of life.

Again, Partridge found herself with pre-eclampsia and very similar symptoms during her second pregnancy, and again it was a very anxious time for her and her family.

"Early detection would have prepared me for the symptoms of this condition and my pregnancy would have been more closely monitored," she said in a statement from Bristol University.

Dr Victoria Bills, the obstetrician who conducted the study and who is also a Clinical Research Fellow at the University said:

"Although there is currently no medicine to cure pre-eclampsia, a VEGF test could guide the prescription of aspirin -- which decreases the incidence of pre-eclampsia by 15 per cent -- and identify women that should be particular mindful of the symptoms, and who should be monitored closely by their doctor and midwife with regular fetal growth scans and blood pressure measurement."

"As this change occurs so early we still need to know whether the VEGF165b contributes to development of the condition, or is a consequence of early changes," she added.

Professor Jeremy Pearson, Associate Medical Director at the BHF likened the medical research quest to develop a test to predict pre-eclampsia to a "holy grail".

"These researchers have made a vital finding that, if confirmed by other studies, has the potential to translate into a simple test that could potentially save many lives," said Pearson.

Prostate Cancer Risk Did Not Reduce With Vitamin E And Selenium

An initial independent review of data from a study looking at whether selenium and vitamin E supplements prevented prostate cancer found they had no benefit, taken either together or alone.

The review of data from the Selenium and Vitamin E Cancer Prevention Trial (SELECT) was funded by the National Cancer Institute (NCI) in the US and other institutes from the National Institutes of Health in the US.

SELECT was started to corroborate findings from studies on other primary cancer outcomes that found significantly fewer prostate cancers in men who took either Vitamin E or selenium supplements.

SELECT started in 2001 and eventually recruited more than 35,000 male volunteers over 50 years The men were randomly assigned to one of four groups: (1) real selenium and real vitamin E, (2) real selenium and vitamin E placebo , (3) selenium placebo and real vitamin E, and (4) placebo selenium and placebo vitamin E.

The study was set up as a double blind trial; that is neither the participants nor the doctors administering the treatment knew which group they were in.

The initial analysis also found two small but disturbing trends, neither of which is statistically significant, but all the men are being told to come off the supplements and continue to be monitored.

There was a small and statistically insignificant rise in the number of prostate cancer cases among the men taking only vitamin E, and a small and statistically insignificant rise in number of type 2 diabetes cases among men taking only selenium.

The researchers said in a statement that:

"Because this is an early analysis of the data from the study, neither of these findings proves an increased risk from the supplements and both may be due to chance."

Letters are being sent to the participants explaining these initial findings and telling them to stop taking their supplements. Study staff will continue to monitor the participants' health for three years of follow up and this may include regular digital rectal exams and tests for PSA (prostate-specific antigen).

The men continue to be blinded to prevent potential bias, but if a participant wishes to know which group he was in and which supplements he received he will be told.

An international network of research institutions called the Southwest Oncology Group (SWOG) coordinates SELECT at more than 400 clinical sites in the United States, Puerto Rico, and Canada.

During the follow up the researchers will also collect blood samples to put in a biorepository. This is another important objective of the study and will provide a bank of samples that researchers can analyse to better understand prostate and other cancers and other diseases of older men.

While the SELECT study was recruiting participants in 2003, another SWOG-sponsored study found that the drug finasteride reduced the incidence of prostate cancer by 25 per cent. The men on the SELECT study were told about this and offered the option to take finasteride, which has not been approved in the US as a prostate cancer prevention drug.

Dr Eric Klein, a study co-chair for SELECT, and a physician at the Cleveland Clinic, said:

"SELECT was always designed as a study that would answer more than a single question about prostate cancer."

"As we continue to monitor the health of these 35,000 men, this information may help us understand why two nutrients that showed strong initial evidence to be able to prevent prostate cancer did not do so," he added.

Prostate cancer is second only to skin cancer as the most common form of cancer among men in the US where in 2008 estimates suggest over 186,000 new cases will be diagnosed and over 28,600 men will die of the disease.

NCI director Dr John E Niederhuber said:

"Finding methods to prevent and treat prostate cancer remains a priority for the NCI, and with the aid of new molecular diagnostic tools and applications, we hope to continue to make headway in reducing deaths and new cases of this disease."

"The science of cancer prevention is also leading toward individualized, molecular prevention, in which we will calculate risk and design preventive steps based on an individual's genome," he added.

The SELECT investigators are continuing with the data analysis and intend to publish the final results in a peer-reviewed medical journal.

Dr Laurence H Baker, chairman of the Southwest Oncology Group, said:

"The SELECT trial owes a tremendous debt to our volunteers, the thousands of men who offered their time and enthusiastic participation, all in the interest of a future when prostate cancer can be prevented."

Statins May Prevent Some Miscarriages

Pregnancy loss associated with antiphospholipid antibodies might be prevented with statin drugs, said researchers here. In a mouse model of antiphospholipid syndrome, treatment with simvastatin (Zocor) and pravastatin (Pravachol) reduced miscarriage by approximately 70%, reported Guillermina Girardi, Ph.D., of the Hospital for Special Surgery, and colleagues in the October issue of the Journal of Clinical Investigation. "We postulate that statins may be a good treatment for women with antiphospholipid-induced pregnancy complications," they wrote. In an interview, Dr. Girardi said her institution is planning to begin clinical trials of statins in women with antiphospholipid antibodies. But she urged clinicians to await the outcome of clinical studies before prescribing them for this purpose.
Antiphospholipid antibodies are seen in 3% to 7% of women of child-bearing age. They have traditionally been associated with excessive blood coagulation and thrombosis, and treatment has typically involved anti-coagulants such as warfarin.
Excessive clotting has been thought to trigger miscarriages by creating placental infarctions, killing the fetus.
But recent studies have suggested that the coagulation dysfunction may be secondary to an inflammatory process and is not the true cause of fetal loss.
In particular, antiphospholipid antibodies appear to activate the C5a complement pathway, inducing expression of tissue factor, which has both pro-coagulant and pro-inflammatory properties.

Cost of diabetes care doubled over last 6 years

CHICAGO, Illinois (AP) -- Americans with diabetes nearly doubled their spending on drugs for the disease in just six years, with the bill last year climbing to an eye-popping $12.5 billion.

Newer, more costly drugs are driving the increase, said researchers, despite a lack of strong evidence for the new drugs' greater benefits and safety. And there are more people being treated for diabetes.
The new study follows updated treatment advice for Type 2 diabetes, issued last week. In those recommendations, an expert panel told doctors to use older, cheaper drugs first.
And a second study, also out Monday, adds to evidence that metformin -- an inexpensive generic used reliably for decades -- may prevent deaths from heart disease while the newer, more expensive Avandia didn't show that benefit.
"We need to pay attention to this," said Dr. David Nathan, diabetes chief at Boston's Massachusetts General Hospital, who wrote an editorial but wasn't involved in the new studies. "If you can achieve the same glucose control at lower cost and lower side effects, that's what you want to do."
The studies, appearing in Monday's Archives of Internal Medicine, were both funded by federal grants.
In one, researchers from University of Chicago and Stanford University looked at which pills and insulin doctors prescribed and total medication costs. Diabetes drug spending rose from $6.7 billion in 2001 to $12.5 billion in 2007, a period when costs dropped for metformin.
More patients got multiple prescriptions as new classes of drugs came on the market. And more patients with diabetes were seeing doctors, increasing from 14 million patients in 2000 to 19 million in 2007.
"There's been a remarkable change in diabetes treatments and remarkable increases in the cost of treatments over the past several years," said study co-author Dr. Caleb Alexander, assistant professor of medicine at the University of Chicago. "We were surprised by the magnitude of the changes and the rapid increase in the cost of diabetes care."
Nearly 24 million Americans, 8 percent of the population, have Type 2 diabetes, which can lead to kidney failure, blindness and heart disease.
Current guidelines say doctors should prescribe metformin (about $30 a month) to lower blood sugar in newly diagnosed patients and urge them to eat healthy food and get more exercise. Other drugs can be added later, on top of metformin, to help patients who don't meet blood sugar goals. The updated guidelines don't include Avandia, which costs about $225 a month.
Dr. Susan Spratt, an endocrinologist at Duke University Medical Center, said she prescribes whatever it takes to lower her patients' future risk of blindness and amputations. That can mean coupling more costly drugs with metformin to hit blood sugar goals.
"I think cost-analysis is important from a public health standpoint," Spratt said. "But when you're sitting across from a patient, you want to use whatever is going to help them get control of their diabetes."

For every 1.1-pound decrease in birth weight, the risk of the birthmark increased nine-fold, Beth Drolet, M.D., of the Medical College of Wisconsin, a

MONROE, Georgia -- It's just after dawn on a chilly Monday morning. The leaves crunch under Van Lewis' feet as he treks through the woods in rural Monroe, Georgia, clutching a hunting rifle.
Lewis is breathing heavily as he makes his way to a ladder leaning next to an old pine tree. He then climbs 20 feet to a custom-built enclosed hunting stand and waits for a deer.
"Ninety percent of the time, it is relaxation therapy," said Lewis, 52, a university police officer in Atlanta, Georgia. "The other 10 percent of the time, it is a workout."
That workout, according to some medical experts, may be too much for some hunters to handle.
"I think it's a very significant problem," said Dr. Eric Good, a cardiologist at the University of Michigan Health System in Ann Arbor.
The biggest danger that some hunters face isn't getting hit by a stray bullet or falling out of a tree stand, Good said. It's heart disease.
"Heart attacks are three times more likely to take a life than a gunshot injury," Good said.

Increase in Hemangiomas Linked to Increasing Rate of Low Birth Weight

For every 1.1-pound decrease in birth weight, the risk of the birthmark increased nine-fold, Beth Drolet, M.D., of the Medical College of Wisconsin, and colleagues reported in the November issue of the Journal of Pediatrics.
"Based on low birth weight statistics, we estimate that the incidence of infantile hemangiomas has increased by 40% in the last 20 years," Dr. Drolet said.
According to the researchers, there's been an increase in the number of U.S. infants who are born at less than 5.5 pounds. The 8.2% below that weight in 2005 was the highest percentage since 1968, and a rate higher than in most industrialized countries, the researchers said.
Dr. Drolet said her institution has also seen a "dramatic increase" in the number of babies with hemangiomas, a common birthmark caused by a conglomeration of blood vessels.
Previous studies have found that other risk factors for hemangiomas include premature birth, female sex, white race, increased maternal age, maternal history of infertility, using assisted reproductive technologies, and having a prior miscarriage.
But the results of this study, Dr. Drolet said, might explain why more infants are developing hemangiomas.
"This study reaffirms several known risk factors for infantile hemangiomas, … but for the first time demonstrates that low birth weight rather than prematurity per se is the most significant risk factor for developing hemangiomas," the authors said.
Their case-control study compared 420 children who had been diagnosed with a hemangioma at the Children's Hospital of Wisconsin and the University of California San Francisco Medical Center with 353 children under age two who had been diagnosed with skin anomalies other than the birthmark.
Infants with hemangiomas were more likely to be female (P<0.0001), non-Hispanic white (P<0.0001), premature (P<0.0001), and of low birth weight (P<0.0001).
Compared with the control group, the odds ratio for hemangiomas in preterm infants was 1.53 (95% CI 0.86 to 2.7) for birth weight below 2,500 g, and the odds ratio was 2.8 (95% CI 1.46 to 5.6).
In the control group, 4.8% of infants were the product of multiple gestation, compared with 10% of infants with hemangiomas (P=0.0064). Of controls, 2.8% were the product of in vitro fertilization compared with 4.2% of the hemangioma patients (P=0.336).
The multivariate analysis also showed that 33% of infants with hemangiomas had a positive family history of the birthmark compared with 15% of the control group (P<0.001).
"The finding that a significantly higher percentage of children with infantile hemangiomas had a positive family history suggests at least some genetic predisposition," Dr. Drolet said.
Even in the regression model, low birth weight was still the most statistically significant risk factor for hemangiomas, the researchers said.
They called for further research into medications used to treat hemangiomas, because there are no FDA-approved medications to treat the condition.

Can Cholesterol-Lowering Drugs Fight Pneumonia Too?

People who take statins and end up in the hospital with pneumonia are more likely to survive than those who are not taking a cholesterol-lowering drug, according to a study in Archives of Internal Medicine.
It’s possible that statins, some of the most commonly prescribed medications in the world, may help fight lung infections. On the other hand, people who take them may be in better health to begin with, which could explain their ability to survive a serious infection.
If statins are shown to fight infection, they could prove to be “a cheap and effective way of treating pneumonia, which would be wonderful,” says Reimar W. Thomsen, MD, PhD, of Aarhus University and Aalborg Hospital in Aalborg, Denmark, who led the study. “We really need new treatment options for pneumonia because it’s a great burden on health-care systems.”
Animal research has shown that statins reduce inflammation and fight blood clotting, so it’s scientifically plausible that they could help treat infections too. There have been studies showing benefits of statins in patients with sepsis, a life-threatening blood infection, as well as pneumonia.
However, the study could also be picking up on a so-called healthy-user effect. Healthy users tend to see their doctors regularly, take their medications as prescribed, exercise, eat their fruits and veggies, and avoid smoking.
Such people also tend to be prescribed medications like statins—or, if they were menopausal women a few years ago, estrogen. In that case, the healthy-user effect made it look like these women were getting benefits like stronger bones and healthier hearts from the hormone—until the Women’s Health Initiative study demonstrated that estrogen was actually harmful.

Pregnancy Normalizes Immunity in Women with Rheumatoid Arthritis

BERLIN, When women with rheumatoid arthritis become pregnant, their immune systems appear to normalize, possibly explaining why they go into remission, researchers But after delivery a suite of genes involved in the innate and adaptive immune systems is over-expressed, compared with healthy women post-partum, according to Thomas Haupl, M.D., of Charité-University Medicine, and colleagues.
The changes appear to correspond to the remission in rheumatoid arthritis commonly seen during pregnancy, Dr. Haupl and colleagues reported in the October issue of Arthritis & Rheumatism.
In six pregnant women with rheumatoid arthritis and eight healthy pregnant controls, the researchers tested gene expression in peripheral blood mononuclear cells during the third trimester of pregnancy and 24 weeks after delivery.
All of the women had uncomplicated pregnancies and delivered healthy children after 36 weeks of gestation, the researchers said, and for all but one patient, disease activity was low during pregnancy. Accordingly, four of the six received no drugs during pregnancy.
Using microarray technology, the researchers looked for genes whose expression differed by at least 1.5 times in at least half of all pairwise comparisons among the participants.
Analysis found the fewest differences were among the healthy women, with 10 genes increased and 50 decreased in activity after delivery, compared with during pregnancy.
But notably, the researchers said, there were also few differences between pregnant rheumatoid arthritis patients and the pregnant healthy volunteers -- with 39 genes increased and 48 decreased in activity.
In contrast to what Dr. Haupl and colleagues called "subtle differences" during pregnancy, many more genes whose activity changed were found when comparing either patients and controls after delivery, or patients before and after delivery.
In the first case, the researchers found, the patients had 155 genes whose activity increased compared with the controls and 30 whose activity decreased.
In the second case, after delivery the patients had 997 genes whose activity increased, compared with levels during pregnancy, and 48 whose activity fell.
The researchers said analysis of 32 "immunologically relevant cellular pathways" showed additional activation of genes related to adhesion, migration, defense against pathogens, and cell activation, including Notch, phosphatidylinositol, mTOR, Wnt, and MAPK signaling.
Dr. Haupl and colleagues found that -- in both patients and controls -- monocyte gene activity increased during pregnancy, while lymphocyte activity was lower.
Monocyte activity fell after delivery in the controls, they found, but persisted in the patients, implying that "innate immune functions play an important role" in reactivation of disease after delivery.
But among the patients, lymphocyte gene activity was also increased after delivery, the researchers said, suggesting that adaptive immune system functions serve as "cofactors in the relapse."

Parents in Greater Numbers Reporting Childhood Food Allergies

HYATTSVILLE, Md., Oct. 23 -- Reports by parents that their children have food allergies have increased sharply in the past decade, CDC researchers reported.
Whether the surging reports represent a true rise in food allergies or an increase in awareness of the condition is not clear, said Amy Branum, M.S.P.H., of the CDC's National Center for Health Statistics, who reported with Susan L. Lukacs, D.O., M.S.P.H., that in the years 1997 to 2007 there has been an 18% increase.
Yet in an NCHS Data Brief they said that more than three million children -- or four of every 100 younger than 18 -- had reported a food or digestive allergy in the previous 12 months.
These data came from a National Health Interview Survey of parents of 9,500 children in 2007 and the National Hospital Discharge Survey. The latter is a sample of 270,000 inpatient records from about 500 hospitals, and it gave an estimate the number of hospital discharges among children attributable to food allergies.
Both the survey results and hospital discharge data showed the same trend -- a growing number of children with food allergies.
"Food allergy has certainly received quite a bit of attention in the news and other outlets in past few years," said Branum. "There's always the possibility that kids are getting in to see doctors more, and parents are taking some of the signs and symptoms more seriously."
She added that she thinks diagnostic tools used to assess allergies have improved over the past decade leading to more frequent diagnosis.
But Ann Munoz-Furlong, founder and CEO of the nonprofit Food Allergy and Anaphylaxis Network, disagreed and said that all allergies, including food allergies, are on the rise.
"We are becoming more allergic as a population," Munoz-Furlong said. "And we need to find out why, so we can stop it."
The study also found that children with food allergies were two to four times more likely than those with no food allergies to have asthma and other allergies.
"I think that it's important for physicians and parents to realize this because these food allergies obviously do not occur in isolation from other problems," Branum said.

Staph germs harder than ever to treat, studies say

WASHINGTON – Drug-resistant staph bacteria picked up in ordinary community settings are increasingly acquiring "superbug" powers and causing far more serious illnesses than they have in the past, doctors reported Monday. These widespread germs used to be easier to treat than the dangerous forms of staph found in hospitals and nursing homes.
"Until recently we rarely thought of it as a problem among healthy people in the community," said Dr. Rachel Gorwitz of the federal Centers for Disease Control and Prevention.
Now, the germs causing outbreaks in schools, on sports teams and in other social situations are posing a growing threat. A CDC study found that at least 10 percent of cases involving the most common community strain were able to evade the antibiotics typically used to treat them.
"They're becoming more resistant and they're coming into the hospitals," where they swap gene components with other bacteria and grow even more dangerous, said Dr. Keith Klugman, an infectious disease expert at Emory University. "It's really a major epidemic."
The germ is methicillin-resistant Staphylococcus aureus, or MRSA. People can carry it on their skin or in their noses with no symptoms and still infect others — the reason many hospitals isolate and test new patients to see if they harbor the bug.
MRSA mostly causes skin infections. Cleveland Browns tight end Kellen Winslow was just hospitalized for a staph infection, his second in recent years, and the team reportedly has had at least six cases in the past three years.
But the germ can be life-threatening if it gets into the bloodstream, lungs or organs. Pneumonia, sinus infections and even "flesh-eating" wounds due to MRSA are on the rise, doctors reported Monday at an infectious diseases conference in Washington.
About 95,000 serious infections and 20,000 deaths due to drug-resistant staph bacteria occur in the United States each year.
To treat them, "we've had to dust off antibiotics so old that they've lost their patent," said Dr. Robert Daum, a pediatrician at the University of Chicago.
The CDC used a network of hospitals in nine cities and states to test samples of the most common community MRSA strain, USA300, over the last few years.
MRSA usually is resistant only to penicillin-type drugs. But 10 percent of the 824 samples checked also could evade clindamycin, tetracycline, Bactrim or other antibiotics.
"The drugs that doctors have typically used to treat staph infections are not effective against MRSA," and family doctors increasingly are seeing a problem only hospital infection specialists once did, Gorwitz said.
Even more worrisome: many of these community strains had features allowing them to easily swap genes and become even hardier.

Family Flu Shots Protect Babies Before Leaving Hospital

New mothers and their immediate family should receive flu shots before their newborns leave the hospital. This will create a "cocooning effect" that will help protect the infants from life-threatening influenza, a new study says.
Researchers at Duke Children's Hospital said they found boosting immunization rates in parents -- especially new fathers -- and siblings is especially effective. They were to present their findings Sunday at the annual ICAAC/IDSA meeting, in Washington, D.C.
"The Centers for Disease Control and Prevention does not recommend vaccinating newborns for flu because they're too young; however, they're a part of the population that is at highest risk," Dr. Emmanuel "Chip" Walter, a pediatric infectious disease specialist at Duke Children's Hospital, said in a university news release.
"Newborns have the highest rate of hospitalizations due to influenza when compared to any other age group of children. Their rates of influenza-related hospitalization are similar to people age 80 and older. And, in some seasons, the influenza-associated mortality rate is highest among infants. We want to protect the newborn by vaccinating the entire family, and send parents home with one less thing to worry about," Walter said.
The study, done at Durham Regional Hospital during the last flu season, included distributing flu education materials to new mothers and setting up a flu vaccine clinic to facilitate getting the shots to other family members around the time of a newborn's birth.
Vaccination of new mothers and other family members increased 16 percent when compared to another hospital in the area, Walter said. The campaign resulted in an additional 45 percent of new mothers -- who had not received a flu shot during pregnancy -- choosing to be vaccinated. There was an equally notable number of new fathers and siblings also getting the flu vaccine when compared to the comparison hospital site, the release said.
"Our study shows that offering the flu vaccine to new mothers during their baby's stay in the hospital is an effective way to assure that all women have the opportunity to get vaccinated and thereby protect their own health and the health of their baby," Walter said. "It also proved to be a convenient, and possibly the most effective, way for fathers to be vaccinated. Protection of the newborn from the dangers of influenza is maximized when those who have the closest contact are vaccinated."

Drug Improves Outcomes for Gout Patients

The drug pegloticase (Puricase) may help gout patients who've had no luck with other treatments, according to researchers who studied 212 patients who'd run out of treatment options.
They were randomly assigned to receive six months of intravenous treatment with either pegloticase or a placebo. One group of patients received 8 milligrams of pegloticase every two weeks, another group received 8 milligrams of pegloticase every four weeks, and a third group received the placebo.
The patients -- mostly men with an average age of 55 years -- had a significantly better response to pegloticase than to the placebo. While there wasn't a significant difference in number of gout flares, more of the patients who took the drug had more complete resolution of tophi, which are chalky deposits or uric acid. The patients who took pegloticase also noticed improved physical function.
Overall, pegloticase was successful in treating 40 percent of patients. Successful treatment was defined as having uric acid readings within the normal range at least 80 percent of the time in months three and six.
Patients who took pegloticase had more serious adverse side effects than those who took the placebo.
"Patients with treatment failure gout suffer from severe pain, increased disability, and reduced quality of life," lead investigator Dr. John S. Sundy, an associate professor of medicine at Duke University Medical Center, said in an American College of Rheumatology news release. "Therefore, these findings are exciting, because they show that pegloticase was able to reduce urate levels and improve clinical outcomes in subjects with gout who had exhausted all available treatment options."
The findings were expected to be presented Sunday at the American College of Rheumatology annual meeting, in San Francisco

Healing Process Found to Backfire in Lung Patients

A mechanism in the body which typically helps a person heal from an injury, may actually be causing patients with idiopathic pulmonary fibrosis (IPF) to get worse, researchers at the National Institute of Environmental Health Sciences (NIEHS), a part of the National Institutes of Health (NIH), and their collaborators have found.
"We identified a new mechanism that explains why some patients with IPF get more short of breath than others, in spite of similar levels of lung scarring," said Stavros Garantziotis, M.D., an NIEHS staff clinician and lead author on the new paper highlighted on the cover of the Nov. 1 issue of the American Journal of Respiratory and Critical Care Medicine.
Idiopathic pulmonary fibrosis is an incurable lung disease that affects approximately 50,000 people in the United States. In IPF, the lung tissue becomes scarred and patients have difficulty breathing, often resulting in death. The cause is unknown, though genes as well as environmental factors such as smoking and exposure to metal dust particles, are thought to raise the risk.
In healthy individuals, the body has a way of forming new blood vessels that can help heal an injury. For example, if you cut your finger, the body knows to deliver nutrients and cells to the injury site to promote wound healing. However, in patients with IPF, although there is a healing process that occurs, researchers say the process backfires or is disrupted and may be doing the patients more harm than good. Garantziotis explains that this involves a blood protein called inter-alpha-trypsin inhibitor (IaI), which binds with a connective tissue molecule called hyaluronan to make new blood vessels.
In people without IPF, this produces a healing process in the lungs. But Garantziotis says something different happens in people with IPF.
"Instead of building healthy new tissue to heal the scarring in the lungs, patients with higher IaI levels develop vessels that are far away from where they should be, pushing the blood away from the lung and bypassing the area where the body gets its oxygen, thus causing more shortness of breath," Garantziotis explains. Patients with IPF may suffer from low oxygen levels and shortness of breath beyond the actual effects of lung scarring itself.
The researchers applied a true bench-to-bedside approach for this study. Starting with basic research findings from in vitro cell and experimental animal studies, they were then able to demonstrate, in patients with IPF, that higher IaI serum levels were associated with less ability to take up oxygen, thus worsening the patients’ condition.
The researchers say there are at least two reasons why this study is important. First, it demonstrates for the first time the important role that a blood circulating protein plays in lung function. Secondly, it identifies a potential new therapeutic target for IPF.

Scientists try to stop hunger with retooled foods

LONDON - Want to lose weight? Try eating. That's one of the strategies being developed by scientists experimenting with foods that trick the body into feeling full.
At the Institute of Food Research in Norwich, England, food expert Peter Wilde and colleagues are developing foods that slow down the digestive system, which then triggers a signal to the brain that suppresses appetite.
"That fools you into thinking you've eaten far too much when you really haven't," said Wilde. From his studies on fat digestion, he said it should be possible to make foods, from bread to yogurts, that make it easier to diet.
While the research is preliminary, Wilde's approach to curbing appetite is one that some doctors say could be key in combating the obesity epidemic.
"Being able to switch off appetite would be a big help for people having trouble losing weight," said Steve Bloom, a professor of investigative medicine at London's Imperial College, who is not connected to Wilde's research.
Scientists in North America and elsewhere in Europe are also trying to control appetite, including through chemical injections or implantable devices that interfere with the digestive system.
Bloom said that regulating appetite through modified foods is theoretically possible. Other mechanisms in the body, like cholesterol production, are already routinely tweaked with medicines.
But Bloom warned that controlling appetite may be more challenging. "The body has lots of things to prevent its regulatory mechanisms from being tricked," he said.
For instance, while certain hormones regulate appetite, the brain also relies on nerve receptors in the stomach to detect the presence of food and tell it when the stomach is full.
Wilde's research hinges on the body's mechanisms for digesting fat.
Fat normally gets broken down in the first part of the small intestines. When you eat a high-fat meal, however, the body can only digest the fat entirely further down in the intestines. That sparks a release of hormones that suppress appetite.
Wilde's approach copies what happens with a high-fat meal: He coats fat droplets in foods with modified proteins from plants, so it takes longer for the enzymes that break down fat to reach it.
That means that the fat isn't digested until it hits the far reaches of the intestines. At that point, intestinal cells send a signal telling the brain it's full.
Even though the body hasn't had a high-fat meal, it suppresses the appetite as if it has. If the fat had been digested earlier in the intestines, no such signal would be sent.
Wilde said the technique should work with any foods that contain fat, like dairy products, precooked sauces, mayonnaise, breads and pastries, and that taste would probably not be affected.
If all goes well, products could be on shelves within a few years, he said.
In another technique, scientists at the University of Newcastle have been testing a seaweed extract called alginate that reduces fat absorption by cutting the level of glucose digested by the body before it gets broken down in the large intestine.

Red-Cell Transfusion After Heart Attack Called Potentially Lethal

PHILADELPHIA, Oct. 27 -- Packed red cell transfusions in patients after myocardial infarction may increase the risk of serious arrhythmic events, often leading to death, said a researcher here.

Lethal cardiac events including ventricular tachycardia and cardiac arrest were more than twice as common in patients given the infusions, reported M. Kamran Athar, M.D., of Cooper University Hospital in Camden, N.J. The data emerged in a retrospective analysis, after adjusting for several risk factors known to affect MI outcomes.
Non-lethal events were increased nearly five-fold in transfused versus non-transfused patients. In-hospital mortality and duration of stay were also substantially greater in the transfused patients, he said.
Speaking at the American College of Chest Physicians meeting here, Dr. Athar said the findings supported "a more restrictive transfusion strategy in the setting of acute MI."
The practice of giving transfusions to patients following a heart attack is long-standing but has become controversial in recent years. Several studies have suggested that it increases mortality.
Dr. Athar said that atrial fibrillation related to packed red cell transfusions has been documented in cardiac surgical patients, but whether it also occurs in the context of acute MI had not been studied.
He and his colleagues reviewed records of 1,496 patients treated at Cooper University Hospital from 2003 to 2007, 148 of them given packed red cell transfusions.

US Doctors Use Placebo Treatments But Don't Always Inform Patients

"Placebo treatments" are regularly prescribed by rheumatologists and internal medicine physicians, often without admitting the intention to the patients, according to a study released on October 24, 2008 on BMJ Online. Placebo treatments are highly criticized because they require some deception on the part of the doctor, which ethically violates patients' rights to autonomy. However, many placebo treatment advocates have pointed out that the effect can still be harnessed, offering effective treatment for many chronic conditions, without deceiving patients. Presently, only limited research has been performed to elucidate the attitudes of doctors towards placebos and magnitude of placebos' use. To investigate these issues, Dr Jon Tilburt of the National Institutes of Health and his colleagues conducted a confidential survey to 1,200 randomly selected, practicing physicians. All of the physicians had specialized in general internal medicine or rheumatology, which are both practices that often come into contact with patients with serious chronic, difficult to manage conditions. Of the 679 responding physicians, half indicated that they prescribed "placebo treatments" on a regular basis. Most of them (62%) believed that this practice was acceptable from an ethical standpoint, and were happy to recommend or prescribe placebos. Most commonly, these placebo treatments were over the counter painkillers (41%) or vitamins (38%). Some physicians also had used antibiotics (13%) and sedatives (13%) for this purpose, while a few had used sugar pills (3%.)Among those respondents who did prescribe placebos, most also reported that they described placebo treatments as "a potentially beneficial medicine or treatment not typically used for their condition,” but very rarely referred to them as “placebos.”The authors note that the study was limited by its relatively low survey response rate (57%), but that even with the most conservative analysis, this is still a remarkably common practice. While placebo use is controversial, they say, the doctors who responded to the survey did not indicate that they felt unethical about either the behavior or the lack of disclosure. The authors note the ethical complexity of placebos in contemporary medicine. In conclusion they determine that harmless treatments like vitamins or over the counter painkillers to promote positive expectations may not create panic. However, the prescription of antibiotics or sedatives without clear medical justification could be harmful for individual patients and for the health of the public. "Whether, or under what circumstances, recommending or prescribing placebo treatments is appropriate remains a topic for ethical and policy debate,." they say.

Flu Vaccination Investigated In PLoS Medicine

With the new flu season beginning, the open-access journal PLoS Medicine has released two studies related to influenza vaccination, each showing that the population burden of the flu can be decreased overall by increasing the number of people vaccinated. The flu vaccine is often recommended for specific groups of people who are at a higher risk of spreading or suffering from influenza in targeted vaccination programs. However, in 2000, the province of Ontario, Canada began a universal immunization program, promoting vaccination in and providing vaccination free of charge to all people over 6 months old. Jeff Kwong from the Institute for Clinical Evaluative Sciences in Toronto and colleagues examined this program's effects on influenza-related health outcomes. To do this, they examined data from both national and provincial records between 1997 and 2004 in order to compare Ontario's flu outcomes before and after the introduction of the universal vaccination program, as well as to compare Ontario's outcomes to those of other provinces which continued their targeted vaccination programs. In the analysis the group found that the universal vaccination program was associated with reductions in influenza outcomes, such as flu-related deaths, hospitalizations, and emergency room and doctor visits. The results also indicated that increasing immunization rates was not as clearly associated with a reduction in mortality and health care need in older people, especially older than 75 years, in comparison with younger people. Additionally, even with the better access to free flu vaccines in Ontario, a modest average of 38% of the overall household population reported that they had received the vaccinations. This suggests that immunizing younger people who come in contact with older people may still be useful in prevention of influenza-related outcomes. .The second study investigated this idea mathematically, capitalizing on a concept known as heard immunity, in which immunization of a few individuals in the population contributes to reduce overall exposure to people who are not immunized. Carline van den Dool and colleagues at the University Medical Center, Utrecht, the Netherlands created a mathematical model simulating the spread of influenza in nursing homes. Specifically, they found that by increasing the proportion of vaccinated health care workers from zero to 100% in a 30 bed nursing home department could reduce infections in patients approximately 60%. On average, vaccinating seven health care workers prevented one patient from influenza. Unfortunately, they found that even full health care worker vaccination does not guarantee complete herd immunity. This suggests that even when immunization rates are high, health care workers should be vaccinated each year to reduce risk to patients. The authors point out that one of the major drawbacks of the study was random variation which limits the abilities of small vaccine trials to assess the real relationship between vaccination and influenza. As a result, further studies should be performed to confirm these results. Cécile Viboud and Mark Miller of the Fogarty International Center, US National Institutes of Health, contributed an accompanying comment in which they discuss the merits and drawbacks of the observational study design for evaluation of influenza vaccination.

Covert Promotion Of Off-Label Drug Use

Several techniques are often employed by drug companies to secretly promote off-label use, according to a piece released on October 27, 2008 in the open-access journal PLoS Medicine. For most drugs, it is legal to prescribe them for off-label uses, which are not specified in the original approval of the drug. These uses are sometimes unavoidable -- for instance, most approvals do not include pregnant women, who may need medication. However, it is illegal for a drug manufacturer to promote these off-label uses, because they have not necessarily been proven effective and may have serious side effects. Adriane Fugh-Berman, of Georgetown University Medical Center, and Douglas Melnick, a preventive medicine physician in North Hollywood, California emphasize that these off-label drug use, though “sometimes unavoidable” and sometimes “demonstrably beneficial," they add that this "should be undertaken with care and caution due to the uncontrolled experiment to which a patient is being subjected.” Even so, drug companies have a potential benefit from promoting off-label use thanks to “larger revenues from larger user populations, especially for products with narrow indications.”They subsequently describe the techniques that are employed by these drug companies to covertly promote the off-label use of their drugs. One such technique is "decoy indication." Int his process, drugs may be initially promising for many different uses, but companies choose a limited number of conditions on which they focus research for efficient approval of the drug. By pursuing a narrower indication, the drug may be sent to market more quickly, but this "decoy indication" simply masks the other uses from drug regulators. Drug representatives may also pass on the information. In the United States, drug representatives are not permitted to inform doctors of off-label uses. The authors quote a pharmaceutical industry attorney in a second paper from Medical Marketing and Media: “Before engaging in off-label promotion, companies should ascertain the risk profile, safety, efficacy, and potential commercial benefits of the use--without committing that last bit to print.” That is, if the potential profits of the action overcome the potential fines, it may be worth a company's consideration. Thus, doctors and patients are often encouraged to engage in off-label use, as pharmaceutical marketing has “distorted the discourse on off-label uses and encouraged the unmonitored, potentially dangerous use of drugs by patients for whom risks and benefits are unknown.”

Monday, October 27, 2008

On Emergency Plan Communication, Nearly Half Of US States Fail

Seven years after Sept. 11, and in the wake of many major natural disasters such as forest fires, hurricanes and flooding, nearly half of U.S. states either have no state-level emergency plan or do not provide it readily to the public, reveals a new study by George Mason University Communication Professor Carl Botan. Despite federal laws that require a state emergency operations plan (EOP) as a prerequisite to some federal funding, 22 states were unable to provide Botan with an EOP, withheld the plan on security grounds or made it difficult for even trained researchers to gain access. Residents of these states, Botan says, may question their state's preparedness because they are unable to find out how the highest authorities in their state coordinate responses to major disasters or how to have a say in those plans. "While most Americans will have access to some important state-level information during emergencies, many may not. When minutes may make the difference between life and death in an emergency situation, the population should not have to waste precious time looking for answers or who to turn to," says Botan. The study, "Using Sense-Making and Co-orientation to Rank Strategic Public Communication in State Emergency Operations Plans," graded and ranked the state emergency operations plans of the 50 U.S. states and the District of Columbia on their communication components. Botan analyzed the accessible state EOPs for three criteria: if the plans had a two-way communication component, if they addressed the communication needs of vulnerable populations and if they treated public communication as important enough to specifically address it in the plan. He found that the 29 jurisdictions that do have plans available make provisions for public communication - including news releases and public broadcasts, but only 16 of them make explicit or implicit provisions for two-way public communication such as community forums and focus groups. Botan feels that two-way public communication is essential in the plans, for that will allow the state to understand what its residents feel they need in emergency situations. Of the 29 plans obtained, only two - Washington, D.C. [which is treated as a state-level entity for this purpose] and New Mexico - received a perfect score of eight for communication. In addition, while 16 states mentioned vulnerable publics, only 13 of these discussed specific communication strategies for these vulnerable publics in their plans. For example, California mentions specific strategies such as dispatching special teams targeting vulnerable populations like the aged and the disabled, while Arizona simply mentions that emergency managers must pay attention to "special needs" people like residents of nursing homes and the hearing impaired, but does not outline specific strategies to communicate with them.