Personal Health

 

 

Friday, May 21, 2010

 

Irregular menstrual periods tied to heart disease

 

Reuters Health

Friday, May 21, 2010

NEW YORK (Reuters Health) – Women with a history of irregular menstrual periods may have a higher risk of developing heart disease than do other women, a new study suggests.

The study, which followed more than 23,000 Dutch women for a decade, found that those who said they'd typically had irregular periods in the past were 28 percent more likely than women who reported regular monthly periods to develop heart disease.

There was no increased risk seen among women who reported regularly long menstrual cycles (30 or more days between periods) or regularly short cycles (26 or fewer days between periods).

Despite their relatively higher risk, though, the large majority of women with irregular periods did not develop heart problems during the study period. Of the roughly 4,000 women who reported a history of irregular periods, 150 were diagnosed with coronary heart disease over the next 10 years.

Just over 17,000 study participants reported having either regular monthly periods (between 27 and 29 days) or regularly short cycles. Of those women, 530 developed coronary heart disease.

The women were 50 years old, on average, at the start of the study.

It's known that women with a condition called polycystic ovary syndrome (PCOS) have higher risks of heart disease and type 2 diabetes than other women their age. In that disorder, the ovaries produce higher-than-normal amounts of male hormones and menstrual periods are irregular or completely absent.

The new findings suggest that even in the absence of PCOS, less-extreme irregularities in the timing of menstrual periods may be related to heart disease risk, according to the researchers, led by Dr. Gerrie-Cor M. Gast of the University Medical Center Utrecht in the Netherlands.

The potential reasons, however, are unclear. Since estrogen is believed to have a generally protective effect on the heart and arteries -- and PCOS is marked by hormone imbalance -- Gast's team measured hormone levels in a subgroup of their study participants.

They found no evidence that altered hormone levels explained the association between irregular periods and heart disease risk. Nor did factors such as body weight, high blood pressure, or high cholesterol account for the link.

Both PCOS and very long menstrual cycles -- at least 40 days between periods -- have been linked to increased risks of type 2 diabetes, which is a heart disease risk factor.

In this study, women with irregular periods tended to have a higher risk of type 2 diabetes than those with monthly periods; however, the association was not statistically significant -- meaning the finding may have occurred by chance.

More research, according to Gast's team, is needed to confirm the current findings, and to uncover the underlying reasons for the link. The authors, who could not be reached for comment, do not address what, if anything, might lower the risk of heart disease among women with irregular cycles, should these results hold up in future studies.

Source: http://www.fertstert.org/article/S0015-0282(10)00505-4/abstract

Fertility and Sterility, online May 7, 2010.

Yogurt-Like Drink DanActive Reduced Rate of Common Infections in Daycare Children

 

ScienceDaily

Friday, May 21, 2010

 

ScienceDaily (May 21, 2010) — The probiotic yogurt-like drink DanActive reduced the rate of common sicknesses such as ear infections, sinusitis, the flu and diarrhea in daycare children, say researchers who studied the drink in the largest known probiotic clinical trial to be conducted in the United States. An additional finding, however, showed no reduction in the number school days missed.

 

The study led by Daniel Merenstein of Georgetown University School of Medicine (GUSOM), was funded by The Dannon Company, Inc., and published May 19 online in the European Journal of Clinical Nutrition.

 

Probiotic foods are continuing to increase in popularity and some are marketed for the potential benefits of probiotics such as Lactobacillus casei (L. casei) DN-114 001, the probiotic in DanActive. Studies in other countries have found that probiotics, which are live micro-organisms, produce positive health benefits in children, including the reduction of school days missed due to infections. However, most of the research was conducted outside the United States in structured conditions not comparable to normal everyday living.

 

"We were interested in a study that resembled how children in the U.S. consume drinks that are stored in home refrigerators and consumed without study personnel observation," says the study's lead author Daniel Merenstein, MD, director of research in the Department of Family Medicine at GUSOM.

 

"…To our knowledge this is the largest probiotic clinical trial conducted in the U.S. and provides much needed data," say the authors of the study. "We studied a functional food, not a medicinal product; parents will thus feed their children without any physician input and we felt it was best to assess [the drink] under similar conditions."

 

The study, titled DRINK (Decreasing the Rates of Illness in Kids), was a randomized, double-blind, placebo-controlled study -- the gold standard in clinical research design. It included 638 healthy children, aged three to six, who attended school five days a week. Parents were asked to give their child a daily strawberry yogurt-like drink. Some of the drinks were supplemented with the probiotic strain L. casei DN-114 001 (DanActive), while others had no probiotics (placebo). Neither the study coordinators, the children, nor the parents knew which drink was given to which participant until the study ended. In addition to phone interviews with researchers, parents kept daily diaries of their child's health and the number of drinks consumed.

 

Researchers found a 19 percent decrease of common infections among the children who drank the yogurt-like drink with L. casei DN-114 001 compared to those whose drink did not have the probiotic. More specifically, those who drank DanActive had 24 percent fewer gastrointestinal infections (such as diarrhea, nausea, and vomiting), and 18 percent fewer upper respiratory tract infections (such as ear infections, sinusitis and strep).

 

However, the reduction in infections did not result in fewer missed school days or activities -- also a primary outcome of the study.

 

"Our study had mixed results," says Merenstein. "Children in school or daycare are especially susceptible to these illnesses. We did find some differences in infection rates but this did not translate to fewer missed school days or change in daily activity. It is my hope that safe and tolerable ways to reduce illnesses could eventually result in fewer missed school days which means fewer work days missed by parents."

"It is important that more of these products are put under the microscope by independent academic researchers," he concludes.

 

In addition to Merenstein, the study's authors include Megan Murphy, GUMC; Ali Fokar, MPH, Medstar Research Institute; Rohini K. Hernandez MPH, MedStar Research Institute; Haewon Park, MPH, GUMC; Hala Nsouli, MPH, MedStar Research Institute; Mary Ellen Sanders, PhD, Dairy & Food Culture Technologies; Barbara A Davis, PhD, The Dannon Company, Inc.; Violeta Niborski, PhD, The Dannon Company, Inc.; Francoise Tondu, MSc, Danone Research; and Nawar M. Shara, PhD, MedStar Research Institute.

Davis was an employee of The Dannon Company, Inc. during the study. Niborski and Tondu were employees of Danone Research during the study. Sanders consults for numerous probiotic companies, including the The Dannon Company. No other authors report related financial interests.

 

Georgetown retains full academic freedom to publish all results. Statements made in this document are not endorsed by The Dannon Company.

Journal Reference:

D Merenstein, M Murphy, A Fokar, R K Hernandez, H Park, H Nsouli, M E Sanders, B A Davis, V Niborski, F Tondu and N M Shara. Use of a fermented dairy probiotic drink containing Lactobacillus casei (DN-114 001) to decrease the rate of illness in kids: the DRINK study A patient-oriented, double-blind, cluster-randomized, placebo-controlled, clinical trial. Eur J Clin Nutr, May 19, 2010 DOI: 10.1038/ejcn.2010.65


Sea sponge-derived drug treats several cancers

 

Reuters

Friday, May 21, 2010

WASHINGTON (Reuters) – An experimental new breast cancer drug made from sea sponges helped in a range of cancers, from breast cancer to sarcoma, researchers report.

Three studies show the drug, Eisai's eribulin, was effective and tolerated in patients with breast cancer, colon cancer and urinary cancer, according to brief data released on Thursday by the American Society of Clinical Oncology. Sarcomas are cancers that grow from muscle or bone.

A fourth study of patients with advanced breast cancer will be detailed in a "late-breaker" session at ASCO's annual meeting in June.

The drug is not yet approved, but Eisai has filed with relevant agencies in Japan, the United States and Europe.

The drug works on the same principle, but with a slightly different mechanism as older cancer drugs such as the taxanes and is infused intravenously.

Only a few details are available in the abstracts of the research published ahead of the meeting.

Researchers at Aichi Cancer Center in Nagoya, Japan and several other Japanese sites tested eribulin in 81 breast cancer patients whose cancer had come back despite several rounds of chemotherapy.

They said 21 percent of the patients had some response to the drug and side-effects were common -- 95 percent had low blood counts. Nonetheless they said the drug was effective and tolerable.

Researchers at the European Organization for Research and Treatment of Cancer tested eribulin in several types of advanced soft tissue sarcoma and found varying responses but said it deserved further study.

Up to 45 percent of the patients with one type of sarcoma saw three months before their tumors began growing again -- a significant result in advanced cancer.

And a team led by the California Cancer Consortium at the University of Southern California and elsewhere will report details of a mid-stage study of 40 patients with advanced urological cancer. They said 38 percent of the group had a response to eribulin.

An international team will report more details at the meeting itself in their trial of patients with breast cancer.

Common Diabetes Drug Linked to Vitamin B-12 Deficiency

 

HealthDay News

Friday, May 21, 2010

FRIDAY, May 21 (HealthDay News) -- Diabetics who take the drug metformin over the long term should get their vitamin B-12 levels checked regularly to see if they are developing a vitamin deficiency, a new report suggests.

Metformin, also known by several brand names including Glucophage, is a common treatment for people with type 2 diabetes, but it can cause vitamin B-12 deficiency, according to the report published online May 21 in the journal BMJ.

Failing to check patients' vitamin levels may lead doctors to improperly diagnose the symptoms of B-12 deficiency, which include fatigue, mental changes, anemia and neuropathy. Doctors may mistakenly think these symptoms are caused by diabetes or aging, the study authors noted.

Researchers in the Netherlands led by Coen Stehouwer studied the effects of metformin treatment on 390 patients with type 2 diabetes. They prescribed either the drug (196 patients) or a placebo (194 patients) to be taken three times a day for more than four years.

Patients who took the drug had a 19 percent reduction in their vitamin B-12 levels compared to the other participants, who had little change. The reduction in B-12 levels continued and became more apparent over time in those taking metformin, the investigators found.

Meanwhile, the number of patients taking metformin who developed vitamin B-12 deficiency grew from three to 19, the authors reported.

"Our study shows that it is reasonable to assume harm will eventually occur in some patients with metformin-induced low vitamin B-12 levels," Stehouwer's team concluded. "Our data provide a strong case for routine assessment of vitamin B-12 levels during long-term treatment with metformin."

More information

The U.S. National Library of Medicine has more about metformin.

Arsenic in Playgrounds Nothing to Worry About, Study Suggests

 

ScienceDaily

Friday, May 21, 2010

 

ScienceDaily (May 21, 2010) — Pressure treated wooden playground structures do not live up to the bad reputation they have earned as being harmful to children, according to the findings of a new University of Alberta study.

 

Chris Le, a scientist in the Faculty of Medicine & Dentistry, can put to rest any safety concerns regarding playgrounds made of chromated copper arsenate-treated wood. This is good news to parents planning to begin the summer ritual of taking their children to the local playground.

 

The study compared arsenic levels in urine and saliva samples of children playing in eight pressure treated wooden playgrounds and those in eight playgrounds made of other materials. The study found no significant difference in the concentration of arsenic species in children playing on playgrounds with or without the chemically-treated wood. The study suggests that contact with CCA treated wood in playgrounds is not likely to significantly contribute to the overall arsenic exposure in children.

 

Around 70 per cent of playgrounds in North America are made with pressure-treated wood. Le and his group want to encourage children to stay physically active, just make sure to wash their hands after play.

Le's findings are published in the May 15 edition of Environmental Science & Technology.

Journal Reference:

Kristi Lew, Jason P. Acker, Stephan Gabos, X. Chris Le. Biomonitoring of Arsenic in Urine and Saliva of Children Playing on Playgrounds Constructed from Chromated Copper Arsenate-Treated Wood. Environmental Science & Technology, 2010; 44 (10): 3986 DOI: 10.1021/es100128n


Thursday, May 20, 2010

 

Common diabetes drug linked to vitamin deficiency

 

By Kate Kelland

Reuters

Thursday, May 20, 2010

LONDON (Reuters) – Patients treated over long periods with metformin, a common drug for diabetes, are at risk of developing vitamin B-12 deficiency which is also likely to get worse over time, according to a study published Friday.

Dutch scientists who carried out the study said the findings suggest that regular checking of vitamin B-12 levels during long-term metformin treatment should be "strongly considered" to try to prevent deficiency and its effects.

Vitamin B-12 is essential to maintain healthy nerve cells and red blood cells. It is found in meat, dairy products, eggs, fish, shellfish and fortified breakfast cereals, and it also can be taken as a supplement.

Coen Stehouwer of Maastricht University Medical Center in the Netherlands, whose study was published in the British Medical Journal, said symptoms of B-12 deficiency include fatigue, mental changes, anemia and nerve damage known as neuropathy.

All these symptoms can easily be misdiagnosed as being due to diabetes and its complications, or to aging, he said, but checking B-12 levels could help doctors to assess the real cause and treat it if it was found to be B-12 deficiency.

"Our data provide a strong case for routine assessment of vitamin B-12 levels during long term treatment with metformin," Stehouwer wrote.

An estimated 246 million people around the world have diabetes and rates are expected to rise along with the number of people who are overweight or obese. Most sufferers have type 2 diabetes, the kind linked with poor diet and lack of exercise.

Stehouwer's team studied 390 patients with type 2 diabetes, giving metformin to 196 of them three times a day for more than four years, and a placebo, or dummy pill, to the other 194.

They found that people who had taken the metformin had a 19 percent reduction in their vitamin B12 levels compared with people who had taken a placebo, who had almost no B-12 change.

The reduced levels of vitamin B-12 in the metformin group also persisted and became more apparent over time, they said.

"Our study shows that it is reasonable to assume harm will eventually occur in some patients with metformin-induced low vitamin B12 levels," Stehouwer wrote.

In a comment on the study, Josep Vidal-Alaball, a specialist in primary care and public health at Heath Park in Cardiff, Wales, said assessments should be carried out to see if giving patients advice on B12 in their diets would solve the problem.

"If it does not, a trial of screening for vitamin B-12 deficiency in patients taking metformin would be needed," he wrote.

Multivitamins Can Add Sparkle for Healthy Young People

 

ScienceDaily

Thursday, May 20, 2010

 

ScienceDaily (May 20, 2010) — The effects of multivitamins are most often researched in the elderly. This is one of very few studies to assess the relationship between supplementation with vitamins/minerals and psychological functioning in healthy groups of non-elderly adults. This study shows how a proprietary multivitamin and mineral supplement improves mood and mental performance while also reducing stress, mental tiredness and fatigue in healthy males.

 

Research into a vitamin and mineral supplement by academics at Northumbria University shows it improves mood and mental performance while also reducing stress, mental tiredness and fatigue in healthy males.

In a randomized, double-blind and placebo-controlled study, 215 men in full-time employment aged between 30 and 55 were given either a proprietary multivitamin or a placebo for a period of 33 days.

 

The two groups were tested at the beginning of the study and at the end with a battery of mood, stress and health questionnaires and with physical and mental tasks that included mental arithmetic (counting backwards in 3s or 7s from a random number).

 

The multivitamin was a B complex, vitamin C and minerals product known as Berocca® which is manufactured by Bayer Consumer Care, the sponsors of the study.

 

Prior to treatment, there were no significant differences between the placebo and multi-vitamin/minerals groups in performance or ratings for any of the study outcomes. However, after 33 days supplementation the multivitamin/minerals group reported significantly improved ratings of general mental health, reduced subjective stress and increased ratings of 'vigour', with a strong trend towards an overall improvement in mood. Task performance, in terms of the number of correct serial-3 subtractions throughout the six repetitions of the cognitive tasks, and serial-7s during the first repetition, was also improved. This was accompanied by reduced ratings of 'mental tiredness' before and after the intense mental processing and a trend towards reduced 'mental fatigue'. The placebo group showed no significant changes.

 

The effects of multivitamins are most often researched in the elderly, and very few studies have assessed the relationship between supplementation with vitamins/minerals and psychological functioning in healthy groups of non-elderly adults.

 

"Overall, these results suggest that improving nutritional status, by supplementation if necessary, may be beneficial to males within the general population as a whole," says Northumbria University's Professor David Kennedy, who led the study.

 

"The assumption was made here that the men tested enjoyed typical nutritional status. However, the very fact of being able to improve mood, ratings of mental health and vigour and aspects of task performance by simple supplementation with B vitamins, Vitamin C and minerals indicates that the cohort must have been suffering from less than optimal micronutrient status at the outset."

 

"We know that optimum functioning of the central nervous system is dependent on a wide range of micronutrients, and there is a wealth of evidence from epidemiological studies that clearly suggest a relationship between micro-nutrients and psychological functioning.

 

"Vitamin C for example is the brain's most prevalent antioxidant and is found at its greatest concentrations in neuron-rich areas."

 

Some Spices Cut Cancer Risk That Comes With Grilled Burgers

 

HealthDay News

Thursday, May 20, 2010

THURSDAY, May 20 (HealthDay News) --Researchers report that adding certain spices to your burgers before tossing them on the grill this summer will not only add to the flavor of the meat, but they can also cut the risk of cancer long associated with the cooking of beef.

Scientists at Kansas State University (KSU) found that three spices in particular -- fingerroot, rosemary and tumeric -- seem to direct the greatest amount of antioxidant activity towards preventing the formation of heterocyclic amines (HCAs). HCAs, they note, are the cancer-causing compounds that are produced when foods such as beef are barbecued, grilled, broiled or fried.

Specifically, the three spices appeared to cut back on HCA production by upwards of 40 percent, the team observed, thereby significantly reducing the HCA-associated risk for developing colorectal, stomach, lung, pancreatic, mammary and prostate cancers.

"Cooked beef tends to develop more HCAs than other kinds of cooked meats such as pork and chicken," KSU food chemistry professor J. Scott Smith noted in a news release. "Cooked beef patties appear to be the cooked meat with the highest mutagenic activity and may be the most important source of HCAs in the human diet."

Therefore Smith and his colleagues looked into the HCA-inhibiting potential of six spices: cumin, coriander seeds, galangal, fingerroot, rosemary and tumeric.

Of all those investigated, rosemary came out on top as the strongest protector against HCA.

The authors suggested that consumers integrate these spices into their menus when appropriate, noting that some, such as rosemary, come in an extract form that has demonstrated HCA inhibition of 61 percent to 79 percent.

They pointed out that spicing allows for the sort of high-temperature cooking (above 352 degrees Farenheit) that is typically recommended for safe grilling, while at the same time blocking the increased HCA production that is known to occur when the flames intensify.

Smith and his team plan further research to see what other marinades and powders might do by way of HCA curtailment -- they noted that earlier work has shown that marinating steaks with particular herbs and spices effectively lowers HCA production.

More information

For more grilling safety tips, visit the U.S. Department of Agriculture.

Is a high carbohydrate diet linked to pancreatic cancer?

 

By Lynne Peeples

Reuters Health

Thursday, May 20, 2010

NEW YORK (Reuters Health) – One of the first symptoms of pancreatic cancer -- often noticed even years before diagnosis -- is indigestion. A new study suggests that these timely tummy troubles may be enough to explain away previous links made between a high carbohydrate diet and an increased risk of the disease.

"We started out just aiming to replicate other studies that looked at the association between carbohydrates and pancreatic cancer," Rachael Stolzenberg-Solomon, from the National Cancer Institute, Bethesda, Maryland and an investigator on the new study, told Reuters Health. "But it turned out to be something more interesting."

It also turned out to be more complicated.

Like many of the prior studies, Stolzenberg-Solomon and her colleagues did initially find evidence of a link between a high carbohydrate diet and pancreatic cancer among more than 100,000 older men and women. The top 10 percent of the participants in rankings of carbohydrate consumption had an almost 50 percent greater risk of the cancer than the bottom 10 percent, the investigators report in the American Journal of Epidemiology.

It's important to note, however, that even with this increase in pancreatic cancer risk, the risk remained extremely low. Pancreatic cancer is rare: less than one-quarter of 1 percent of all participants were diagnosed over about a 7-year study period.

But what got the researchers' attention was how this apparent increase in risk was limited to carbohydrate consumers followed fewer than 4 years.

The researchers only collected information on food intake at the start of the study. And follow-up ended when a cancer diagnosis was made. So those participants diagnosed early on, explained Stolzenberg-Solomon, may have already been suffering cancer-related indigestion when they filled out the dietary questionnaire.

Further, since fatty foods can exacerbate indigestion, they may have replaced some of the fat in their diet with more easily digestible carbohydrates. Stolzenberg-Solomon recalled that a fat-carbohydrate swap was common among the pancreatic cancer patients she saw during her previous work as a dietitian.

In other words, carbohydrate intake may be a consequence rather than a cause of pancreatic cancer.

"It's all very complex," noted Stolzenberg-Solomon. "But it's one possible explanation for this change in risk between 3 and 4 years."

The finding could shed light on inconsistent results from previous studies that may not have been as careful or detailed in their data collection, Kristin Anderson, of the University of Minnesota and a co-author on other recent pancreatic cancer studies, told Reuters Health in an email: "You can't try to understand a puzzle by looking at one piece."

Source: http://aje.oxfordjournals.org/cgi/content/abstract/kwq061v1

American Journal of Epidemiology, online May 7, 2010.

A Protein Links Alzheimer's, Down Syndrome

 

HealthDay News

Thursday, May 20, 2010

THURSDAY, May 20 (HealthDay News) -- Researchers say a kind of protein that clogs the brain in Alzheimer's disease also accumulates in the eyes of Down syndrome patients and causes cataracts.

The finding is leading the researchers to develop an eye test for early signs of Alzheimer's in both disorders.

"People with Down syndrome develop symptoms of Alzheimer's-type dementia often by the age of 30," said study co-author Dr. Lee E. Goldstein, associate professor at Boston University School of Medicine, in a statement. "This is because they have an extra copy of a key Alzheimer's gene that leads to increased amyloid-beta accumulation in the brain. We discovered that this same protein starts to accumulate very early in the lens of the eye, even in children."

"The results are striking," added Dr. David G. Hunter, ophthalmologist-in-chief at Children's Hospital Boston and vice chairman of the department of ophthalmology at Harvard Medical School. "We have known that these cataracts are prevalent in people with Down syndrome and are sometimes seen at birth, but we never knew how they were related to the disorder. Now we know. These distinctive cataracts appear only in people with advanced Alzheimer's disease and much earlier in Down syndrome."

Goldstein said the team is developing an eye scanner to measure amyloid-beta, the protein in question, in the lens. "This approach may provide a way for early detection and monitoring of related pathology in the brain. Effective treatments for the brain disease in Down syndrome and Alzheimer's disease are on the horizon, and early detection is the key for successful intervention."

The findings were reported in the May 20 issue of the journal PLoS One and presented at the recent meeting of the Association for Research in Vision and Ophthalmology in Fort Lauderdale.

More information

For more about Alzheimer's disease, see the U.S. National Library of Medicine.

New approach to old test may detect ovarian cancer

 

By Julie Steenhuysen

Reuters

Thursday, May 20, 2010

CHICAGO (Reuters) – Researchers have found a new way to use an existing blood test that may provide a way to screen women for ovarian cancer, perhaps in time to cure more women of the deadly disease.

They said combining a test that measures levels of a certain protein along with a way of measuring risk of the disease helped spot early stage cancers in otherwise healthy women.

If detected early, ovarian cancer can be cured, but more than 70 percent of women have advanced disease by the time they are diagnosed, said Dr. Karen Lu, of the University of Texas M.D. Anderson Cancer Center, who led the study.

The findings were released on Thursday ahead of the American Society of Clinical Oncology meeting in June.

"This may be pointing the way toward developing a 'mammogram' if you will for ovary cancer," ASCO president Dr. Douglas Blayney, of the University of Michigan Medical School, said in a telephone interview.

Ovarian cancer kills 15,000 U.S. women each year.

"Clearly there is a need for coming up with an effective strategy to detect ovarian cancer early," Lu said in a telephone interview.

She and colleagues studied a new way to use the cancer antigen or CA-125 test, which measures levels of a protein that is elevated in ovarian cancer cells.

The CA-125 test can detect rising levels of this protein, and is typically used to see if ovarian cancer has come back. But it is less sensitive in early stage cancers because levels of CA-125 can also rise from non-cancerous conditions, especially in pre-menopausal women.

Lu's team used the CA-125 test in combination with the Risk of Ovarian Malignancy Algorithm, a mathematical formula that calculates a woman's risk of having ovarian cancer based on age, CA-125 level and CA-125 levels over time.

The team studied women over age 50 who had no significant family history of breast or ovarian cancer, and put them into three groups.

Those at low risk got annual blood tests. Women deemed at intermediate risk were called back for a repeat test in three months. If the risk appeared high, they were referred for a transvaginal ultrasound, which uses soundwaves to create a picture of the pelvis.

The team found three invasive cancers in 3,238 women who participated in the study -- all early stage and potentially curable.

"What's looking promising is the trend over time," Lu said. "You could have a very low value and all of a sudden it goes very high. That is a trigger," she said.

Lu said the findings are not enough to change practice. But researchers in Britain are evaluating the blood test and risk algorithm combination in a study of more than 200,000 women. Results of that study are due in 2015.

"We'll have the definitive answer in a short amount of time," she said.

(Editing by Maggie Fox and Vicki Allen)

Statin Use Tied to Eye, Kidney, Liver Troubles

 

By Steven Reinberg
HealthDay Reporter
HealthDay News

Thursday, May 20, 2010

THURSDAY, May 20 (HealthDay News) -- People taking cholesterol-lowering drugs called statins may be at heightened risk for liver dysfunction, acute kidney failure and cataracts, British researchers report.

Statins, which include the blockbuster drugs Lipitor, Pravachol, Crestor and Zocor, are recommended for patients with high cholesterol. Studies have shown that these drugs are effective in reducing the risk of heart disease and heart attack.

While the drugs have long been linked with a raised risk for muscle problems, the new study involving over 2 million patients found other "potential adverse effects of statins, namely myopathy [muscle problems], acute renal [kidney] failure, liver dysfunction and cataract, and shown that two of these have a dose-response effect," said lead researcher Dr. Julia Hippisley-Cox, professor of clinical epidemiology and general practice at the University of Nottingham.

On the more positive side, the study found no link between statin use and risks for a wide range of cancers (including stomach, colon, lung, renal, breast or prostate malignancies), as well as no connection to Parkinson's disease, rheumatoid arthritis, blood clots, dementia or fractures.

And experts say that, given the drugs' well-known benefit in cutting heart disease risk, the new findings are no reason for patients to shy away from statins.

The report is published in the May 21 online edition of the BMJ.

For the study, Hippisley-Cox and her colleague Carol Coupland, an associate professor in medical statistics, collected data on more than 2 million people, including almost 226,000 patients who were new statin users. Among these patients, they looked for adverse outcomes from January 2002 through June 2008.

As noted in previous studies, statin use was also linked to a higher risk for moderate to serious muscle woes. And they found that the risk of acute kidney failure and liver dysfunction rose as the dose of statin increased.

But the popular pills had benefits, too. Hippisley-Cox and Coupland found that for every 10,000 high-risk women treated with statins, there were about 271 fewer cases of the number one killer, heart disease, and eight fewer cases of esophageal cancer.

However, among those same 10,000 women, statin use would be linked to 74 extra patients who would develop liver dysfunction, 23 who would go on to acute kidney failure, 307 who would develop cataracts and 39 patients who would develop muscle troubles. For men the findings were similar, except rates of muscle disease were higher.

These problems were similar for all the various statins taken, with the exception of Lescol, which seemed to bring a higher risk for liver dysfunction compared to the other medications.

The risk for adverse effects lasted as long as the drugs were being taken, but were highest during the year when treatment was initiated, the researchers found.

Dr. Alawi A. Alsheikh-Ali, a consultant cardiologist at the Institute of Cardiac Sciences at Sheikh Khalifa Medical City in Abu Dhabi, United Arab Emirates, and coauthor of an accompanying journal editorial said that, overall, "the findings of the study are reassuring."

The muscle and liver side effects are largely reversible, and statins do not appear linked to cancer, he said. "When the muscle and liver side effects are balanced against heart attacks and strokes, which are prevented by statins, the equation favors using statins in people who are at risk for heart attacks and strokes as recommended by current professional guidelines," Alsheikh-Ali said.

The study emphasizes that statins are generally safe, but like any intervention in medicine are not entirely free of side effects, he added. "This supports but does not change current practice."

And it is only wise that statins be prescribed in patients most likely to benefit from them, Alsheikh-Ali stated. "The present analysis should not be used to scare off current statin users or deny people at risk for heart attack or stroke the benefits of prevention with statins," he said.

Another expert, Dr. Gregg C. Fonarow, a professor of medicine, and director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, also pointed out that the study only found an association between statins and these side effects -- it did not prove that they caused the problem.

"Statin medications have been demonstrated in multiple, prospective, randomized placebo-controlled clinical trials involving tens of thousands of men and women with or at risk for cardiovascular disease to prevent heart attack, strokes and premature cardiovascular deaths," Fonarow said. "These well-controlled trials have also demonstrated that the benefits of statin therapy greatly outweigh the potential risks."

People with, and at risk for, cardiovascular disease that are being treated with statins "should continue statin treatment and those not treated should discuss with their physician whether statin therapy, together with lifestyle modifications, should be initiated," he said.

More information

For more on statins, visit the American Heart Association.

Heavy caffeine intake may mean smaller babies

 

By Amy Norton

Reuters Health

Thursday, May 20, 2010

NEW YORK (Reuters Health) – Pregnant women who down six coffee cups' worth of caffeine every day may have smaller babies than those who consume less caffeine, a new study finds.

Researchers found that among more than 7,300 Dutch women followed from early pregnancy onward, between 2 and 3 percent said they consumed the caffeine equivalent of six cups of coffee per day during any trimester. On average, their babies' length at birth was slightly shorter than that of newborns whose mothers had consumed less caffeine during pregnancy.

Heavy caffeine consumers also had an increased risk of having a baby who was small for gestational age -- smaller than the norm for the baby's sex and the week of pregnancy during which he or she was born.

That finding, however, was based on a small number of babies, and the significance is uncertain. Of 104 infants born to women with the highest caffeine intakes, seven were small for gestational age.

The findings, reported in the American Journal of Clinical Nutrition, add to the conflicting body of research into whether caffeine during pregnancy affects fetal growth.

Some studies, for instance, have linked regular caffeine consumption during pregnancy -- even a relatively modest one or two cups of coffee a day -- to an increased risk of low birth weight. But other studies have found no such effects. Researchers have also come to conflicting conclusions as to whether caffeine affects the risk of miscarriage.

In this latest study, Rachel Bakker and colleagues at Erasmus Medical Center in Rotterdam used ultrasound scans to monitor fetal growth over the course of pregnancy in 7,346 women.

At each trimester, the women reported on their usual intake of coffee and tea. Most women consumed less than the equivalent of four cups of coffee per day at any point in pregnancy, but between 2 and 3 percent downed six or more cups' worth of caffeine.

Overall, babies born to heavy caffeine consumers were slightly shorter, on average, at birth and during all three trimesters of fetal development, based on the ultrasound tests.

"Caffeine intake seems to affect length growth of the fetus from the first trimester onwards," Bakker told Reuters Health in an email.

The implication, she said, is that pregnant women should not consume more than six cups of coffee per day. However, the findings also do not mean that less coffee is generally "safe" during pregnancy.

"We only studied the effect of caffeine on fetal growth," Bakker said. "Future studies on possible other effects of maternal caffeine intake are therefore needed."

Given the uncertainty about whether and how caffeine might affect pregnancy and fetal development, experts generally recommend that to be safe, pregnant women limit their intake.

The March of Dimes, for example, suggests that, based on research into miscarriage risk, pregnant women get no more than 200 milligrams of caffeine per day -- roughly the amount in 12 ounces of coffee.

Source:  http://www.ajcn.org/cgi/content/abstract/ajcn.2009.28792v1

American Journal of Clinical Nutrition, online April 28, 2010.

Stroke Incidence Down, But Not for Blacks 

 

By Ed Edelson
HealthDay Reporter
HealthDay News

Thursday, May 20, 2010

THURSDAY, May 20 (HealthDay News) -- The incidence of the most common form of stroke has decreased significantly among whites but has increased slightly among blacks, according to a new regional survey designed to be representative of the United States as a whole.

Data from the Greater Cincinnati/Northern Kentucky Stroke Study showed an overall drop of 11.6 percent between 1999 and 2005 in the incidence of ischemic strokes, those caused by blood clots blocking a brain artery.

About 80 percent of strokes are ischemic. The others are hemorrhagic, caused by a burst blood vessel. The survey found no change in the incidence of hemorrhagic stroke.

A breakdown of the data showed a 14.4 percent decrease among white residents of the region, but a 4.6 percent increase among black residents, a rise that did not quite reach statistical significance.

The death rate for those who had ischemic strokes remained the same, about 10 percent, the survey found.

The good news from the survey is the overall decrease in incidence of stroke, said study author Dr. Dawn Kleindorfer, an associate professor of neurology at the University of Cincinnati. "This is the first time we've ever seen that," she said.

The bad news, of course, was the increase among blacks, who already had a significantly higher incidence of stroke.

There is no ready explanation for the findings, since the survey was designed just to measure incidence -- rather than underlying causes -- of stroke, Kleindorfer said. The most likely explanation for the overall decrease is better treatment of risk factors such as high blood pressure, obesity and high cholesterol levels, she said.

The reason for the difference between whites and blacks is also a matter of speculation, Kleindorfer said. "There are a lot of features that the survey cannot answer -- severity of the stroke, access to medical care, dietary differences," she said. "There are cultural differences, so completely teasing out the reasons would be challenging."

Blacks were more likely to have stroke risk factors, such as high blood pressure and diabetes, but were also more likely to be receiving treatment for them, the study found.

The survey findings, published in the May 20 online issue of Stroke, probably hold for the overall U.S. population, with one important exception, Kleindorfer said. "The [study] region is very representative of the United States as a whole in terms of income, education and percentage black," she said. "The big one missing is that there is no significant Hispanic population." Fewer than 3 percent of residents of the region studied were Hispanic.

Dr. Larry B. Goldstein, director of the Duke Stroke Center at Duke University, said the findings "are obviously concerning because they point out the differences between blacks and whites."

A study he did in collaboration with physicians at Yale University offers some clues to the racial disparity, Goldstein said. That study found no large differences in treatment for whites and blacks who had strokes, and no difference in hospital readmission rates for second strokes in the following year.

"What this is saying to me is that a lot of the difference has to do with overall risk factor control or treatment," he said.

More information

Learn more about stroke symptoms and treatment from the U.S. National Library of Medicine.

Daily Ginger Consumption Eases Muscle Pain by 25 Percent, Study Suggests 

 

ScienceDaily

Thursday, May 20, 2010

 

ScienceDaily (May 20, 2010) — For centuries, ginger root has been used as a folk remedy for a variety of ailments such as colds and upset stomachs. But now, researchers at the University of Georgia have found that daily ginger consumption also reduces muscle pain caused by exercise.

 

While ginger had been shown to exert anti-inflammatory effects in rodents, its effect on experimentally-induced human muscle pain was largely unexplored, said Patrick O'Connor, a professor in the College of Education's department of kinesiology. It was also believed that heating ginger, as occurs with cooking, might increase its pain-relieving effects.

 

O'Connor directed two studies examining the effects of 11 days of raw and heat-treated ginger supplementation on muscle pain. Collaborators included Chris Black, an assistant professor of kinesiology at Georgia College and State University in Milledgeville, UGA doctoral student Matt Herring and David Hurley, an associate professor of population health in UGA's College of Veterinary Medicine.

 

Participants in the studies, 34 and 40 volunteers, respectively, consumed capsules containing two grams of either raw or heat-treated ginger or a placebo for 11 consecutive days. On the eighth day they performed 18 extensions of the elbow flexors with a heavy weight to induce moderate muscle injury to the arm. Arm function, inflammation, pain and a biochemical involved in pain were assessed prior to and for three days after exercise.

 

The studies showed that daily ginger supplementation reduced the exercise-induced pain by 25 percent, and the effect was not enhanced by heat-treating the ginger.

 

"The economic and personal costs of pain are extremely high," said O'Connor. "Muscle pain generally is one of the most common types of pain and eccentric exercise-induced muscle pain specifically is a common type of injury related to sports and/or recreation (e.g., gardening). Anything that can truly relieve this type of pain will be greatly welcomed by the many people who are experiencing it."

 

The study is published in the September issue of The Journal of Pain.  It was funded by the McCormick Science Institute

Journal Reference:

Christopher D. Black, Matthew P. Herring, David J. Hurley, Patrick J. O'Connor. Ginger (Zingiber officinale) Reduces Muscle Pain Caused by Eccentric Exercise. The Journal of Pain, 2010; DOI: 10.1016/j.jpain.2009.12.013


Wednesday, May 19, 2010

 

Prescription drug use by U.S. children on the rise

 

By Bill Berkrot

Reuters

Wednesday, May 19, 2010

NEW YORK (Reuters) – Children were the leading growth demographic for the pharmaceutical industry in 2009, with the increase of prescription drug use among youngsters nearly four times higher than in the overall population, according to a report by Medco Health Solutions Inc.

More than one in four insured children in the United States and nearly 30 percent of adolescents aged 10 to 19 took at least one prescription medicine to treat a chronic condition in 2009, according to an analysis of pediatric medication use conducted as part of Medco's drug trend study issued on Wednesday.

Medco is forecasting overall pharmaceutical spending to rise up to 18 percent through 2012, driven by diabetes, cancer and rheumatology treatments. Spending is expected to rise 3 percent to 5 percent this year, and 4 percent to 6 percent the next two years.

Overall increases will be somewhat held down by some $46 billion in branded drug sales that will succumb to competition from cheap generic versions by the end of 2012.

But the increases in prescription drug use by children for chronic conditions could fuel significantly higher health care costs as those young patients enter adulthood, Medco said.

"Looking at children was the real shocker for us," Dr Robert Epstein, Medco's chief medical officer, said on a conference call from Medco's drug trend symposium in Orlando, Florida.

Over the past nine years, the most substantial increases in the medicating of children were seen in drugs for conditions not typically associated with them, such as for type 2 diabetes and antipsychotics, Medco said.

Some long-standing childhood maladies also saw large increases, such as asthma.

Obesity Link

"What's surprising is the type of drugs these kids are taking. All these adult drugs are popping up in children, which is really disturbing," Epstein said.

"The obesity problem is contributing not just to diabetes but to a lot of other problems," he said, noting a 50 percent increase since 2001 in use of cholesterol lowering drugs among those aged 10 to 19, a 24 percent increase in use of blood pressure medicines, and a whopping 147 percent jump in adolescents taking heart burn and acid reflux drugs.

Medco and other pharmacy benefit managers, or PBMs, administer prescription drug benefits for employers and health plans and also run large mail-order pharmacies. Data for the study was collected from Medco's top 200 clients, representing more than 40 million people.

Childhood use of medications for type 2 diabetes, a disease once referred to as adult onset diabetes, rose 5.3 percent in 2009 and is up more than 150 percent since 2001, the study found. Girls between the ages of 10 and 19 showed the greatest jump at nearly 200 percent over nine years.

"We've got to get our arms around some very fast lifestyle modification or we're going to have a real problem, having these adult illnesses show up in children who will have a changing life expectancy if they're going to be sick from a very young age," Epstein cautioned.

Antipsychotics

Among the trends was the rise in children taking antipsychotics -- powerful drugs traditionally used to treat schizophrenia, but increasingly prescribed for other conditions, such as depression and anxiety.

Use of such drugs has doubled since 2001 and more than doubled for girls, according to Medco's nine-year analysis.

Use of some antipsychotics has also been associated with significant weight gain and increased risk of developing type 2 diabetes, potentially compounding health problems.

There was a 23 percent drop since 2004 in use of antidepressants by youngsters. That decline followed U.S. Food and Drug Administration warnings of the increased risk of suicidal thoughts by children using those drugs.

Rates of childhood asthma are also on the rise, Medco found. Respiratory drug use grew 5 percent among children in 2009 and is up 42 percent since 2001.

Use of drugs for attention deficit hyperactivity disorder (ADHD), often cited in reports on the over-medication of children, is also on the rise. But surprisingly, the increase was more pronounced among young adults.

Overall ADHD drug use was up 9.1 percent last year, leading to a 23.8 percent rise in spending growth. But the utilization increase was 21.2 percent among those aged 20 to 34.

(Reporting by Bill Berkrot; Editing by Tim Dobbyn)

Breast-fed babies less feverish after immunization

By Anne Harding

Reuters Health

Wednesday, May 19, 2010

NEW YORK (Reuters Health) – Breastfeeding may protect babies from post-vaccine fevers, according to a new study in the journal Pediatrics.

It's not uncommon for an infant's temperature to climb soon after immunization, Dr. Alfredo Pisacane of Universita Federico II in Napoli, Italy, and his colleagues note.

"Immunization is something like a 'mild' disease," Pisacane explained via email, "and the immune system responds with local (pain, redness, swelling) and systemic (fever, decreased appetite) reactions."

Babies will receive three rounds of shots during their first year of life, he added. "Post-vaccination fever is usually mild and of short duration. Nonetheless, 1-2% of infants can have high fever, which can represent a stress for them and their families."

Breast and bottle-fed babies are known to respond differently to vaccines and to illness, Pisacane and his team explain, so they decided to investigate whether breastfeeding might protect against fever after a shot by having 450 moms keep track of their baby's temperature for a few days after immunization.

Once babies had received the first or second set of two combination vaccines (against diphtheria, tetanus, pertussis, hepatitis B, polio, Haemophilis influenzae type b, and pneumococcal infection), mothers took the infant's rectal temperature that evening and daily for three more days.

One hundred twenty infants were exclusively breastfed at the time of immunization, 154 were partially breastfed, and 176 were bottle-fed. Babies receiving the vaccine for the first time were about three months old, on average; those having their second set of shots were about six months old.

One-quarter of the exclusively breastfed babies, 31 percent of the partially breastfed babies, and 53 percent of the bottle-fed babies developed fevers of at least 38 degrees Celsius (100.4 degrees Fahrenheit) after being immunized, Pisacane and his team found.

For 90 percent of the entire group, fever occurred in the first day after immunization; three-quarters had fevers lasting just one day. Just eight of the infants - four partially breastfed, and four not breastfed - had fevers above 39 degrees Celsius (just above 102 degrees Fahrenheit).

Risk of fever for the breastfed babies was 54 percent lower than for the bottle-fed babies, while partially breastfed babies were at 42 percent lower risk. The apparent protective effect of breastfeeding remained even after the researchers accounted for factors like mother's education and the number of other children in the home.

Breast milk could reduce the production of inflammation-promoting proteins released after immunization, the researchers note, while breastfeeding itself could also comfort feverish children and encourage them to eat. Pisacane and his team point out that bottle-fed babies have been reported to consume fewer calories after immunization than breastfed babies do.

"When infants are sick and after a vaccination shot, they need not only water, food and a calm environment, but also to be protected," Pisacane told Reuters Health. "They need the warm body of their mothers. Breastfeeding provides all what an infant does need during illness."

He added, "Also, partial breastfeeding is useful to protect infant health and to ensure a warm relationship between a mother and her infant."

Source: http://pediatrics.aappublications.org/cgi/content/abstract/pe ds.2009-1911v1

Pediatrics, online May 17, 2010.

Fighting U.S. cancer: Diet, scant exercise problems

 

By Maggie Fox,

Health and Science Editor

Reuters

Wednesday, May 19, 2010

WASHINGTON (Reuters) – The United States does not produce or import anywhere near enough fruits and vegetables to provide Americans the right kind of diet to prevent cancer, government researchers said on Wednesday.

And Americans also overestimate how much they exercise, another barrier to fighting two of the biggest known cancer risks, researchers at the National Cancer Institute said.

"If everyone wanted to eat healthily, there would not be enough," Susan Krebs-Smith of the cancer institute told reporters.

Many studies have shown that people who keep a healthy weight, exercise regularly and eat plenty of fresh fruits and vegetables have a lower risk not only of cancer, but heart disease, diabetes and even Alzheimer's.

The administration of President Barack Obama is looking at ways to help Americans eat a healthier diet and exercise more to reduce obesity.

Krebs-Smith and colleagues knew Americans do not come even close to meeting those goals. They checked to see if the U.S. food supply could provide the recommended five servings a day of fresh fruit and vegetables to every American.

It cannot, Krebs-Smith told reporters.

"The fruit in the food supply is about half what it needs to be, but we have plenty of calories from fat and added sugars," she said.

The NCI team worked with the U.S. Department of Agriculture to calculate how much food the United States produces, imports and gets to retail outlets.

Fast-food outlets, junk food makers and snack companies are well supplied, they found.

"The food supply does supply enough meat and beans," Krebs-Smith said. But only half the vegetables needed for everyone to get what they should are grown or imported.

U.S. habits suggest demand may lie behind these shortages. "Our intakes of fruit are low. Our intake of vegetables is low but especially our intake of dark green and orange vegetables and legumes," Krebs-Smith said.

Empty Calories

Other studies have shown that Americans underestimate how many empty calories they take in. An average American can eat about 2,000 calories a day, she said -- and once the recommended foods are accounted for, this leaves just 270 "discretionary" calories a day, or just over 11 percent.

The average American actually gets 38 percent of calories from unneeded sugars and fats.

A second major factor in cancer is a lack of exercise and Dr. Rachel Ballard-Barbash found Americans come up far short there, too.

When asked, anywhere between 30 percent and 40 percent of Americans estimate they get enough exercise.

But a study of 6,329 people who wore a device called an accelerometer showed that in fact, fewer than 5 percent got the recommended minimum of about a half-hour of moderate exercise a day.

The cancer institute says obesity and physical inactivity account for 25 to 30 percent of colon, breast, endometrial, kidney, and esophageal cancers.

In 2002, about 41,000 new cases of cancer in the United States were due to obesity, or about 3.2 percent of all new cancers, the NCI says.

Diet and exercise can also help people survive cancer, Ballard-Barbash said.

Her team looked at breast cancer survivors and found women who ate the healthiest diets and exercised the most had a huge reduction in the risk their cancer would return.

"This suggests about an 89 percent reduction in the risk of death over a 1-year follow-up period," she told reporters.

The American Cancer Society estimates that nearly 1.5 million Americans got cancer in 2009 and 560,000 died of it.

(Editing by Cynthia Osterman)

Peanut, tree-nut allergies may be on the rise in kids

By Amy Norton

Reuters Health

Wednesday, May 19, 2010

NEW YORK (Reuters Health) – Between 1 and 2 percent of children in the U.S. and Canada may have allergies to peanuts or tree nuts, with the U.S. rates seemingly on the rise, two new studies suggest.

Peanuts and tree nuts such as almonds and walnuts are the most common causes of severe, sometimes life-threatening allergic reactions to food in the U.S. Recent research has suggested that while the percentage of children with these allergies remains relatively low, rates may be on the upswing.

In the new U.S. study, researchers found that among 5,800 households surveyed in 2008, 1.4 percent of children younger than 18 had a peanut allergy, based on parents' reports. That was triple the rate the same researchers found in a comparable survey done in 1997.

The Canadian study, of more than 3,600 households surveyed in 2008 and 2009, found a somewhat higher rate -- with 1.7 percent of children having a "probable" peanut allergy. Similar patterns were seen with allergies to tree nuts.

In the U.S. survey, 1 percent of children were reported to have tree-nut allergies -- up from 0.2 percent in 1997. Meanwhile, in the Canadian study, 1.6 percent of children were considered to have probable tree-nut allergies.

Allergies were considered "probable" when parents reported a "convincing" history of allergy symptoms -- such as a rash, hives, swelling or wheezing within 2 hours of their child having the suspect food -- or when they said a doctor had diagnosed the problem.

The Canadian researchers also tried to confirm the reported allergies by asking participants for permission to contact their doctors. However, many refused to give it, and even when they did, the doctors often failed to provide the test results.

As a consequence, the rates of "confirmed" allergies in the study were lower. Just 1 percent of children had a confirmed peanut allergy; among adults, the rate of probable peanut allergy was 0.7 percent, while the rate of confirmed cases was less than 0.3 percent.

"We think the 'probable' prevalence is probably more reflective of the true prevalence," lead researcher Dr. Moshe Ben-Shoshan, of McGill University in Montreal, told Reuters Health.

The study is the first to look at the national rate of potentially severe food allergies in Canada, according to Ben-Shoshan. So it is unclear whether, as in the U.S. study, some allergies might be on the rise there.

Both studies are published in the Journal of Allergy & Clinical Immunology.

The U.S. study adds to evidence that peanut allergies may be more common among kids now than a decade or two ago. But it also squares with a research review published last week in the Journal of the American Medical Association (JAMA) finding that estimates of the true rate of food allergies -- and whether they are increasing -- have been hampered by a "lack of uniformity for criteria" for diagnosing such allergies.

"The study is unique because we used the same (survey) methods three times over an 11-year period and assessed specific food allergies in the general U.S. population. Nothing like this has been done before," lead researcher Dr. Scott H. Sicherer, of Mount Sinai School of Medicine in New York, told Reuters Health in an email.

A limitation of the study, though, is that it relied on self-reports to estimate the prevalence of food allergies. However, Sicherer said that factors such as increased public awareness of peanut allergies would be unlikely to explain the increase between surveys. Peanut allergies, he pointed out, are "usually fairly evident" in that they lead to sudden reactions like swelling and trouble breathing.

Sicherer and his colleagues also found that self-reported peanut and tree-nut allergies did not increase over time among adults; in 2008, 1.3 percent reported an allergy to peanuts, tree nuts or both, versus 1.6 percent in 1997.

The "gold standard" for diagnosing the allergies is the food challenge -- where the patient consumes the suspect food under medical supervision to see if it triggers an allergic reaction. But doctors are often reluctant to perform food challenges, in part because they worry about the risk of setting off a serious allergic reaction. Other tests, such as skin-prick tests and blood tests, are less precise.

Relying on symptoms alone is also problematic. Ben-Shoshan pointed out that often what people think is a food allergy is actually a food intolerance. The difference is that allergies involve an immune system reaction that can, in some cases, cause severe symptoms. Food intolerance is not an immune system reaction, and people may be able to eat small amounts of the culprit food with no symptoms or only mild problems, like indigestion.

In their study, Ben-Shoshan and his colleagues found that none of those with possible food allergies said they had received a food-challenge test. Often, they had received no tests at all.

Of all adults and children who reported peanut allergies, for example, 79 percent either said they had undergone confirmatory testing or were not sure if they had.

No one is sure why peanut and tree-nut allergies may be on the rise among children. One hypothesis has to do with how peanuts are processed; in roasted form, Sicherer and his colleagues write, peanuts may be more likely to trigger allergies.

Some researchers also suspect that the so-called "hygiene hypothesis" may be contributing to allergies more generally. This theory holds that today's clean living -- creating less exposure to germs from early life on -- may in some people make the immune system more prone to attacking normally benign substances, like food proteins and pollen.

Sicherer noted that the JAMA review found little good evidence on how to prevent or best manage food allergies. "The current results highlight the need for more research on food allergy prevention and treatment strategies," he said.

Sources:

http://www.jacionline.org/article/S0091-6749(10)00575-0/abstract

http://www.jacionline.org/article/S0091-6749(10)00537-3/abstract

Journal of Allergy & Clinical Immunology, online May 10, 2010.

Is ageing a disease?

By Kate Kelland

Reuters

Wednesday, May 19, 2010

LONDON (Reuters) – Is aging a disease?

It's clear that the simple fact of growing older -- chronological aging -- is relentless and unstoppable. But experts studying the science of aging say it's time for a fresh look at the biological process -- one which recognizes it as a condition that can be manipulated, treated and delayed.

Taking this new approach would turn the search for drugs to fight age-related diseases on its head, they say, and could speed the path to market of drugs that treat multiple illnesses like diabetes, heart disease and Alzheimer's at the same time.

"If aging is seen as a disease, it changes how we respond to it. For example, it becomes the duty of doctors to treat it," said David Gems, a biogerontologist who spoke at a conference on aging in London last week called "Turning Back the Clock."

At the moment, drug companies and scientists keen to develop their research on aging into tangible results are hampered by regulators in the United States and Europe who will license medicines only for specific diseases, not for something as general as aging.

"Because aging is not viewed as a disease, the whole process of bringing drugs to market can't be applied to drugs that treat aging. This creates a disincentive to pharmaceutical companies to develop drugs to treat it," said Gems.

The ability of humans to live longer and longer lives is being demonstrated in abundance across the world.

Average life expectancies extended by as much as 30 years in developed countries during the 20th century and experts expect the same or more to happen again in this century.

A study published last year by Danish researchers estimated that more than half of all babies born in wealthy nations since the year 2000 will live to see their 100th birthdays.

"There’s  One Thing We’re All Missing”

But with greater age comes a heavier burden of age-related disease.

Cases of dementia and Alzheimer's, incurable brain-wasting conditions, are expected to almost double every 20 years to around 66 million in 2030 and over 115 million in 2050.

Diabetes, heart disease and cancer, and the cost of coping with them in aging populations, are also set to rise dramatically in coming decades in rich and poor countries alike.

Nir Barzilai of the Albert Einstein College of Medicine at Yeshiva University in New York, says one way of trying to face down this enormous burden of disease is to look at the biggest risk factor common to all of them -- aging.

"There's one thing everybody is missing," he said. "Aging is common for all of these diseases -- and yet we're not investigating the common mechanism for all of them. We are just looking at the specific diseases."

To try to reverse that, Barzilai and many other scientists around the world are studying the genes of the very old and starting to find the genetic mechanisms, or pathways, that help them beat off the dementias, cancers, heart diseases and other age-related illnesses that bring down others who die younger.

By finding the genes thought to help determine longevity, scientists think they may be able to mimic their action to not only extend life span, but, crucially, extend health span.

"It is ... looking increasingly likely that pharmacological manipulation of these ... pathways could form the basis of new preventative medicines for diseases aging, and aging itself," said Andrew Dillin of the Salk Institute in California and the Howard Hughes Medical Institute.

Gems says institutional and ideological barriers are standing in the way -- and a major one is the longstanding traditional view that aging is not a disease, but a natural, benign process that should not be interfered with.

Changing Attitudes?

All three experts say, however, that the ground is shifting in their direction.

There is now a "groundswell" of specialists in aging, says Dillin, who are lobbying the world's biggest drug regulator, the U.S. Food and Drug Administration, to consider redefining aging as a disease in its own right.

Major scientific research bodies like the U.S. National Institutes of Health and the Medical Research Council in Britain are also under pressure to put more emphasis -- and funding -- into studying how aging increases disease risk.

For biogerontologists, as scientists who study the biology of aging are known, the struggle is to convince people that their goal in unpicking the science behind aging is no longer life, but healthier life.

"The whole reason that we study the aging process is not actually to make people live a lot longer, it's to get people to have a more healthy lifespan," said Dillin.

He sees it as a matter of re-educating the public and health authorities to see biological aging in a new light.

"When we are in the public arena we tell people we're working on the aging process, the first thing they think is that we want to make a 100-year-old person live to be 250 -- and that's actually the furthest from the truth," he said.

"What I want is for a 60-year-old person who is predisposed to have Alzheimer's to be able to delay that, live to be 80, and get to know their grandchildren." 

FDA may disclose more details on drug, food safety

 

By Matthew Perrone

AP Business Writer

The Associated Press

Wednesday, May 19, 2010

WASHINGTON – The nation's top drug regulator proposed Wednesday to disclose more information about safety problems with the drugs and devices it rejects.

The effort is part of a broader plan to remake the public image of the Food and Drug Administration, which has come under fire for being too secretive.

An agency taskforce is suggesting 21 ways the FDA could release more information to the public in areas like drug evaluation and in food manufacturing inspections, another area in which it has oversight responsibility.

Agency leaders stressed that the FDA is merely considering the changes and that some would require legal changes by Congress to implement.

The FDA has long operated under strict confidentiality rules because its scientists handle reams of proprietary information from food, drug and device companies.

However, that operating style has come under fire in recent years from critics who have charged that the agency is too slow to disclose drug safety issues.

The changes suggested in the 67-page report would mark an about-face from current policies that allow manufacturers to control most public information about products in development.

Deputy Commissioner Dr. Joshua Sharfstein said greater transparency would benefit both consumers and companies, who will be able to learn from the success and failures of competitors.

"The more people see how the agency approaches this the more they'll understand the kind of data they need and the more rapid and efficient approvals could be," Sharfstein said during a call with reporters.

Problems with FDA transparency were highlighted in 2004 when the popular painkiller Vioxx was pulled from the market five years after its approval, because of links to heart attack and stroke. Critics said lives could have been saved if the agency had opened up more to outside researchers and health advocates.

Half of the new suggestions are designed to give more information about experimental drugs and devices under review at the agency. Under current FDA regulations, communication about such products is extremely limited. In the initial months of review FDA spokespersons will not even confirm the existence of a new drug application. Additionally, when the FDA declines to approve a treatment, it allows the manufacturer to make the announcement — usually in the most vague terms possible.

Under the proposals posted online, the FDA would begin publishing rejection letters to drug and device manufacturers, including any safety concerns that led to the decision.

The Pharmaceutical Research and Manufacturers Association said Wednesday it is reviewing FDA's proposal and generally supports increased transparency.

But the group's senior vice president, Ken Johnson, added that FDA must "ensure that the competitive development process remains intact to serve patients and the public."

The medical device industry's lobbying group AdvaMed took a more critical stance, suggesting some of FDA's proposals could needlessly disclose proprietary company information.

"Weakening intellectual property protections is a dangerous recipe for stifling investment in breakthrough products and could significantly impede medical progress and ultimately impede public health," the group said in a statement.

Other recommendations from the FDA task force include:

·         publishing inspection reports of drug and food manufacturing plants online

·         publicizing criminal cases against companies regulated by the FDA

·         putting more documents online to relieve a massive backlog of document requests

One of the agency's toughest critics questioned that last strategy, pointing out that the FDA would actually need more time and money to redact thousands of documents to be posted online.

"There are some important steps forward here, but you can talk about transparency from here to eternity and if you don't have an actual mechanism to make that data available it becomes less meaningful," said Dr. Sidney Wolfe, of the consumer advocacy group Public Citizen.

The FDA's task force will take comments on the recommendations for 60 days and then submit a final list of changes for implementation.

Milk, wheat-free diet may not help autism: U.S. study

 

By Maggie Fox,

Health and Science Editor

Reuters

Wednesday, May 19, 2010

WASHINGTON (Reuters) – A popular diet that eliminates wheat and milk protein does not appear to help children with autism, but early behavioral treatments do, researchers reported on Wednesday.

The findings are sure to disappoint many parents who have been trying to manage autism, which affects as many as 1 in 100 U.S. children.

"It would have been wonderful for children with autism and their families if we found that the gluten-free, casein-free diet could really help, but this small study didn't show significant benefits," said Dr. Susan Hyman of the University of Rochester in New York, who led the study.

Gluten is the protein found in wheat, rye and other grains, while casein is a milk protein.

"The removal of gluten and casein from the diet of a controlled group of young children with autism, all of whom were screened for celiac disease ... did not demonstrate a change in sleep habits, bowel habits, activity or core symptoms of autism," Hyman said.

Autism includes a range of conditions, from the social awkwardness seen in Asperger's syndrome to profound and severe disabilities. There is no cure and little information about treatments that work.

Hyman's team studied the diet after seeing Internet reports from parents who believed they saw effects in their children. There is some evidence linking autism with some potential abnormality or activity in the intestines and theories suggest proteins absorbed in the bowels may affect autism symptoms.

They tested 14 children aged 2 to 5, making sure they did not eat gluten or casein.

Intense Study

After at least four weeks on the strict diet, the children were randomly given snacks containing either gluten, casein, both or placebo in randomized order. The snacks were disguised so neither the child nor the caregiver knew they contained a "hidden" ingredient.

Parents, teachers and a research assistant filled out standardized surveys about each child's behavior the day before they received the snack, two hours after and 24 hours later, and the parents kept a diary throughout the experiment about eating, sleep and bowel habits.

The children were videotaped to assess social interaction.

There were no differences after the challenge, the researchers told the International Meeting for Autism Research in Philadelphia.

Hyman said other diets may work. "We only eliminated food containing gluten and casein," she said.

While on the special diet, the children took part in early childhood education programs, and those seemed to help their symptoms, Hyman said.

"All got the same early education care," Hyman said. "Early childhood education appears to work in helping symptoms of autism."

She also said it is possible that children with lactose intolerance or celiac disease -- an allergy to wheat protein -- may be helped by the diet.

"This is really just the tip of the iceberg. There are many possible effects of diet, including over- and under-nutrition, on behavior in children with autism spectrum disorders that need to be scientifically investigated so families can make informed decisions about the therapies they choose for their children," Hyman said.

(Editing by Julie Steenhuysen and Stacey Joyce)

Moderate drinkers have better health, study finds

 

By Kate Kelland

Reuters

Wednesday, May 19, 2010

LONDON (Reuters) – People who drink moderate amounts of alcohol have better health on average than those who are teetotalers, French scientists said on Wednesday.

Researchers found that most of the health benefits in drinkers were not a direct result of the alcohol, but due to indirect links such as being less stressed, engaging in more physical activity and enjoying a better social status.

"Moderate alcohol intake is a powerful marker of a higher social level, superior general health status and lower cardiovascular risk," said Boris Hansel, of the Hospital of Pitie-Salpetriere in Paris, who led the study.

He stressed, however, that the study did not show any causal links, and should not be used as evidence to promote alcohol.

Previous studies have shown that moderate drinking may be tied to lower risks of heart disease. At the same time, excessive drinking is associated with chronic liver disease, many cancers, alcohol poisoning, fetal alcohol syndrome and heart disease, and alcohol is to blame for 2.3 million deaths globally each year, according to the World Health Organization.

Hansel and colleagues studied almost 150,000 French people and split them into four groups -- those who never drank, low level drinkers (less than 10 grams of alcohol a day) moderate drinkers (10g - 30g a day) and heavy drinkers (more than 30g).

Their findings were published in the European Journal of Clinical Nutrition.

They found that low and moderate drinking groups of both men and women had better general health than those who never drank or drank large amounts.

Men who drank moderately were more likely to have lower cardiovascular risk, heart rate, stress, depression and body mass index. They also scored higher on subjective health measures such the amount of exercise they did.

In Britain, 8g of alcohol is classed as one unit, or one standard drink.

The scientists found similar trends in moderate female drinkers, who had lower blood pressure and slimmer waists.

For both sexes, moderate drinkers were also found to have higher amounts of so-called "good cholesterol," or high density lipoprotein (HDL), in their blood.

But Hansel said this did not mean alcohol had an influence on good cholesterol or could protect against heart disease.

He said the key findings was that moderate alcohol drinking was a very good indicator of "optimal social status" and this may be a key reason for better health in this group.

"These findings suggest that it is not appropriate to promote alcohol consumption as a basis for cardiovascular protection," he said, adding that "pleasure" was the best justification for moderate drinking.

Source: http://www.nature.com/ejcn/journal/vaop/ncurrent/abs/ejcn201061a.html

 European Journal of Clinical Nutrition, online May 19, 2010.

Surprising Infection Inducing Mechanism Found in Bacteria

 

ScienceDaily

Wednesday, May 19, 2010

 

ScienceDaily (May 19, 2010) — A study appearing in Nature, with the participation of doctors Susana Campoy and Jordi Barbé from the Department of Genetics and Microbiology at UAB, demonstrates that bacteria have a surprising mechanism to transfer virulent genes causing infections. The researchers describe an unprecedented evolutionary adaptation and could contribute to finding new ways of treating and preventing bacterial infections.

 

Pathogenic genes are responsible for making bacteria capable of causing diseases. These genes cause bacteria to produce specific types of toxins and determine whether or not a disease will later develop in an individual. These virulent genes can be passed from one bacteria to another if the genome segments containing them, known as pathogenicity islands, are transferred from one to another.

 

A team of researchers from Universitat Autònoma de Barcelona, together with members of the CSIC Institute for Agrobiotechnology, Public University of Navarre, Virginia Commonwealth University, and New York University Medical Center, coordinated by the Valencian Institute for Agronomic Research (IVIA) and CEU-Cardenal Herrera University, have studied the mechanisms producing virulence in staphylococcus bacteria and causing Toxic Shock Syndrome, a rare but potentially fatal illness in 50% of the cases.

 

Researchers observed how pathogenicity islands underwent an unprecedented evolutionary adaptation to be able to transfer pathogens to other innocuous bacteria and thus transform them into virulent bacteria.

Under normal conditions, pathogenicity islands produce the protein Stl, which binds to the DNA segment containing virulent genes and represses the transfer of the island. However, sometimes bacteria become infected with a virus which packages and transfers these virulent genes to other bacteria.

 

Scientists have discovered that these islands can detect the presences of a virus, eliminate the repression produced by Stl, and thus commence a replication and packaging cycle. The island is then capable of transference and of making other harmless bacteria turn virulent.

 

The new mechanism discovered by scientists is of great importance for the development of new treatments for diseases caused by bacterial toxins. The pathogenicity island studied is a prototype of a new family of virulent DNA recently discovered which also can be transferred to other species of bacteria such as Listeria monocytogenes, responsible for a large number of intoxications.

 

Less than a year ago, the research group led by Dr Jordi Barbé from the Department of Genetics and Microbiology at UAB published an article in Science on the antibiotic resistance mechanism in bacteria. "With the two articles in Nature and Science we have basic knowledge of the mechanisms used by bacteria to cause infections. This "doublet" in science not only demonstrates the quality of research being carried out at universities in our country, but also the possibility of creating applications for the treatment and prevention of bacterial infections," says Dr Jordi Barbé.

 

The research was led by professor José R. Penadés of the CEU-Cardenal Herrera University and members of the Valencian Institute for Agronomic Research (CITA-IVIA). In addition to doctors Susana Campoy and Jordi Barbé of the Department of Genetics and Microbiology at UAB, participating in the study were researchers Maria Ángeles Tormo Más and Ignacio Mir Sanchis from CITA-IVIA and scientists from CSIC Institute for Agrobiotechnology, Public University of Navarre, Virginia Commonwealth University and New York University Medical Center.

Journal References:

1.    María Ángeles Tormo-Más, Ignacio Mir, Archana Shrestha, Sandra M. Tallent, Susana Campoy, Íñigo Lasa, Jordi Barbé, Richard P. Novick, Gail E. Christie, José R. Penadés. Moonlighting bacteriophage proteins derepress staphylococcal pathogenicity islands. Nature, 2010; DOI: 10.1038/nature09065

2.    E. Guerin, G. Cambray, N. Sanchez-Alberola, S. Campoy, I. Erill, S. Da Re, B. Gonzalez-Zorn, J. Barbe, M.-C. Ploy, D. Mazel. The SOS Response Controls Integron Recombination. Science, 2009; 324 (5930): 1034 DOI: 10.1126/science.1172914

Tuesday, May 18, 2010

 

Antibiotic Resistance Can Last a Year, Review Finds

 

HealthDay News

Tuesday, May 18, 2010

TUESDAY, May 18 (HealthDay News) -- Some patients who take antibiotics may become resistant to them and stay that way for as long as a year, a new review finds.

The researchers analyzed 24 studies of antibiotic resistance, in which people develop a partial or full immunity to the powers of a medication. The studies looked at use of the drugs in primary care, most often for respiratory or urinary tract infections.

Antibiotic resistance is at its height in the month after a drug is prescribed, but the effect may last for a year, according to the findings published online May 18 in BMJ.

"Primary care clinicians and patients may wish to consider this evidence when discussing the benefits and risks of prescribing and consuming antibiotics," study author Alastair Hay, consultant senior lecturer in primary health care at the University of Bristol in England, and colleagues concluded.

In an accompanying commentary, two economics and health policy specialists wrote that new drugs are needed to help combat the antibiotic resistance problem.

Another commentary warns that "nothing less than the future of medicine, from organ transplants to chemotherapy, is at stake, and there will be no second chances."

More information

The American Academy of Family Physicians has more on antibiotic resistance.

Drug-resistant TB risk demands push for new drugs

 

By Kate Kelland

Reuters

Tuesday, May 18, 2010

LONDON (Reuters) – Multi-drug resistant strains of tuberculosis (TB) could become dominant forms of the disease in the next few decades, adding heavy financial and medical burdens to already struggling health systems, doctors said on Wednesday.

In a series of studies into TB, scientists said "superbug" strains of the disease were already gaining ground in some countries and called for greater investment into research and development of new drugs and possible vaccines.

Multidrug-resistant tuberculosis, known as MDR-TB, has much lower cure rates, higher death rates, and costs far more to treat than normal TB, they warned.

An estimated 440,000 MDR-TB infections occurred around the world in 2008, accounting for 3.6 percent of known cases.

Neel Gandhi of New York's Yeshiva University and Paul Nunn of the World Health Organization in Geneva, who conducted one of the studies, found that India and China had around 50 percent of the global MDR-TB burden, followed by Russia with 9 percent.

"Unless countries invest substantially in management of MDR TB, the possibility remains that MDR strains could become the dominant form," they wrote.

"The future possibility of strains that are totally resistant to all anti-tuberculosis drugs is not inconceivable."

TB -- which causes around 1.8 million deaths worldwide every year, or nearly 5,000 people a day -- is often associated with poverty and is one of the leading causes of death among people in economically productive age-groups in developing nations.

Of a 11 million active cases of TB recording in 2008, 95 percent of cases were in low- and middle-income countries.

It is caused by the Mycobacterium tuberculosis bacteria and can be cured with antibiotics, but they must be taken daily for months to be effective and public health funding cuts in some countries may mean fewer drugs are available.

Because people do not always take the drugs properly, MDR-TB strains are starting to take hold and the WHO says there is an urgent need for countries to set up laboratories to fight it.

Gandhi and Nunn said MDR-TB treatment is less effective, requiring 24 months of treatment rather than the usual 6 months, and far more expensive -- costing an average of $3,500 in drugs per patient versus around $20 per patient for normal cases.

"Even though there are fewer cases of drug-resistant TB, the cost and complexity of their management place a significantly greater burden on the health system," they said.

In other studies in the series, which was published by The Lancet on Wednesday, scientists said the combined impact of new drugs, vaccines, and diagnostic tests could cut worldwide incidence of TB by 94 percent by 2050, but the investment needed to bring this about it falling way too short.

Only around a quarter of the funding needed is being put into TB drug research and development, they said, and called for new ways of encouraging pharmaceutical firms into the field.

"Development of new drugs for TB is lengthy, expensive, and risky, and the expected revenues are too small to justify commercial investment," wrote Zhenkun Ma of the Global Alliance for TB Drug Development. "New financing and market incentive mechanisms are needed."

According to the studies, there are 11 potential TB vaccines being tested in human trials and up to 10 experimental medicines in the TB drug "pipeline." Since many drugs fail in late-stage trials, this handful of possibilities is unlikely to be enough.

"To eliminate TB as a public health concern by 2050, all responsible parties need to work together to strengthen the global anti-tuberculosis drug pipeline," the scientists said.

(Editing by Charles Dick)

More bran tied to longer life in diabetic women

 

By Amy Norton

Reuters Health

Tuesday, May 18, 2010

NEW YORK (Reuters Health) – Among women with diabetes, those who bulk up their diets with plenty of bran may live longer and be less likely to die of heart disease, a new study hints.

A number of studies have linked higher consumption of whole grains to lower risks of developing type 2 diabetes and heart disease. The new study extends those findings by suggesting that even among people with type 2 diabetes -- which raises the risk of heart disease -- whole grains may help protect the heart.

They also suggest a particularly important role for the fiber-rich bran found in whole grains, Dr. Lu Qi, one of the researchers on the study, told Reuters Health.

Grains consist of three layers: the fiber- and nutrient-containing bran and germ layers and the starchy kernel layer. Refined grains, like white flour, are largely stripped of the bran and germ; whole grains -- such as oatmeal, brown rice, barley and breads made from whole wheat -- retain more of those components.

Studies suggest that the fiber, antioxidants and other nutrients in whole grains may help lower cholesterol, blood sugar and insulin levels, as well as improve blood vessel functioning and reduce inflammation in the circulatory system.

In the new study, Qi and his colleagues at Harvard Medical School in Boston found that among 7,800 U.S. women followed for 26 years, those with the highest bran intake were 28 percent less likely to die during the study period than those who consumed the least bran.

Similarly, they were 35 percent less likely to die of cardiovascular disease (heart disease or stroke) specifically.

The findings, published in the journal Circulation, do not prove that bran-heavy diets were the reason for the lower risks.

However, the connection was not explained by generally healthier lifestyles among the bran lovers. When the researchers accounted for other diet habits -- like fat intake and total calories -- as well as the women's weight, exercise levels, smoking history and drinking habits, the link between higher bran intake and lower death rates remained.

This suggests that bran intake itself may help lower diabetics' risk of premature death, according to Qi.

He suggested that women and men with diabetes try to replace refined grains in their diets with bran-rich whole grains.

That said, the researcher pointed out that the risk reductions in this study were seen across a large population -- with bran lovers showing a relatively lower risk of death than those who ate little bran. That does not mean that for any one person with diabetes, boosting bran intake would have a substantial effect on longevity.

The findings are based on 7,822 women with type 2 diabetes who were part of the Nurses' Health Study, a long-term study of U.S. female nurses begun in 1976. Every two years, the women answered the questions about their lifestyle, medical history and any disease diagnoses.

Over 26 years of follow-up, 852 study participants died, including 295 women who died of heart disease or stroke.

Overall, Qi's team found, women in the top 20 percent for bran intake had a 28 percent lower risk of dying from any cause during the study period, compared with women in the lowest 20 percent. Their risk of death from cardiovascular disease was 35 percent lower.

The group with the highest bran intake typically consumed 9 grams of bran per day -- about 10 times more than the lowest-intake group. In general, experts recommend that adults get at least 3 to 4 "ounce equivalents" of whole grains each day; a slice of whole-grain bread or a cup of whole-grain cereal are examples of one ounce equivalent.

Source: http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.109.907360v1 Circulation, online May 10, 2010.

Exercise Can Spur Wheezing, Even in Healthy Kids

 

HealthDay News

Tuesday, May 18, 2010

TUESDAY, May 18 (HealthDay News) -- Intense exercise can provoke the onset of temporary lung problems and other symptoms typically associated with asthma in children who are not actually asthmatic, new research reveals.

The findings -- based on an analysis of 56 healthy children with no prior history of asthma -- builds on prior research that suggested that adults can similarly develop bouts of wheezing and reduced pulmonary function following vigorous exercise.

"The results of this study indicate that short bouts of heavy exercise do cause a decrease in lung function testing in healthy children without a history of asthma or allergies," Dr. Alladin Abosaida, study lead author and hospital clinician at the University of California's Irvine and Miller Children's Hospital, said in a news release.

Abosaida and his colleagues were slated to report their findings Monday at the American Thoracic Society conference in New Orleans.

The authors engaged the participating children in exercise regimens designed to evaluate exercise-induced asthma as well as general aerobic capacity.

The research team found that after exercising almost half the children displayed at least one abnormal pulmonary function result. They noted that such abnormalities were typically the result of bronchoconstriction -- a tightening of the primary airways through which air passes into and out of the lungs.

Abosaida expressed surprise at the findings. "We did not expect to see pulmonary function abnormalities after short periods of heavy exercise in such a large number of healthy children in our subject population," he said.

The team indicated that more research is needed to ascertain the exact mechanism driving the exercise-related lung dysfunction they observed.

More information

For more on asthma and children, visit the National Institutes of Health.

Suicide a risk in retirement, nursing communities

 

Reuters

Tuesday, May 18, 2010

CHICAGO (Reuters) – Seniors who move into residential homes are often at risk for suicide, yet these communities are ill equipped to deal with these problems, U.S. researchers said on Tuesday.

Older adults typically move to residential homes because of failing health, loss of a spouse or financial insecurity, all factors that can raise the risk of suicide, they said.

"These adjustments, coupled with an array of risk factors commonly found among seniors -- such as depression, hopelessness, and functional impairment -- can result in suicidal behaviors," Carol Podgorski of the University of Rochester in New York and colleagues wrote in the Public Library of Science journal PLoS Medicine.

Widowing, divorce, substance abuse, loss and family discord also can push an older adult toward suicide, Podgorski said in a statement.

Yet policies regarding the best way to deal with suicide prevention in these settings are sparse, she said.

That may become more important as the first baby boomers start turning 65 in 2011.

According to Alliance for Aging Research, by 2030 almost one out of every five Americans, or 72 million people, will be 65 or older, and about 80 percent of seniors have at least one chronic health condition.

Currently, adults over 65 make up 12.4 percent of the U.S. population, yet they account for 14 percent of all suicides, the team reported.

Suicides are highest among white men over 85. Methods vary by gender. Women are more likely to use suffocation or poisoning, including prescription drugs, while men are more likely to use firearms, Podgorski said.

"About 75 percent of older adults who die by suicide have never made a prior attempt, but because they tend to use more lethal means, they are more likely to die in an attempt," Podgorski and colleagues wrote.

They said public health systems and residential communities can counter suicidal behavior in residential communities by:

·         Identifying at risk seniors who are depressed;

·         Increasing access to mental health and substance abuse services;

·         Treating medical conditions and chronic pain;

·          Promoting social networks and support;

·         Decreasing access to firearms, drugs and other lethal means of suicide.

The full study appears at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000254

(Reporting by Julie Steenhuysen; Editing by Cynthia Osterman) 

Major Depression Often Follows Brain Injury

 

By Amanda Gardner
HealthDay Reporter

HealthDay News

Tuesday, May 18, 2010

TUESDAY, May 18 (HealthDay News) -- People who are hospitalized for a traumatic brain injury face an almost eight-fold higher risk of also suffering major depression.

That's the finding of a team led by Charles H. Bombardier, professor of rehabilitation medicine at the University of Washington School of Medicine in Seattle and first author of a study published in the May 19 issue of the Journal of the American Medical Association.

Bombardier spoke Tuesday at a special JAMA teleconference, held to present findings from a number of studies focused on mental health.

Other studies in the same issue of the journal describe a treatment method for anxiety disorders that may provide help in primary-care settings, and a Detroit depression-care program that has dramatically reduced the number of suicides among patients at one hospital.

According to Bombardier, some 6 million people in the United States are living with a traumatic brain injury (TBI) and have significant disability as a result. Major causes of traumatic brain injury include vehicle accidents, blunt injuries to the head and penetrating wounds such as gun shots. It is also a "signature injury" among soldiers serving in Afghanistan and Iraq, the study stated.

In this study of 559 patients with traumatic brain injury, more than half (53.1 percent) also endured major depressive disorder at some point during the study follow-up.

In terms of risk factors, patients with major depression at the time of their injury or before their injury, as well as those who were younger and those who reported alcohol dependence, were most likely to suffer depression after head trauma. Those who were diagnosed with major depression were also more likely to have anxiety disorders, the researchers found.

Unfortunately, there seems to be a troubling shortfall when it comes to depression care -- only 44 percent of traumatic brain injury patients with depression had been treated with medications or counseling for their depression, significantly affecting their quality of life, the study found.

"Often the depression appeared in the first three months but the risk persisted for one year and probably beyond," Bombardier said. "We need to improve recognition of major depression after traumatic brain injury and identify individuals at risk early on."

A second study in the journal found that a strategy that gave patients with anxiety disorders a choice of medication, cognitive behavioral therapy or both, along with professional monitoring in a primary-care setting, had better results than "usual care."

Approximately 1,000 patients participated in the study, which compared usual care or with a program called Coordinated Anxiety Learning and Management (CALM).

CALM also incorporated "non-expert" professionals to help doctors with treatment.

Volunteers in the CALM group, who suffered from panic disorder, generalized anxiety disorder, social anxiety disorder and/or post traumatic stress disorder (PTSD), reported greater alleviation of symptoms and better life functioning.

If reimbursement issues are worked out, the model could become an alternative to the current referral system, the study authors stated.

"This addresses one of the major public health problems in this country, which is that although we do have some fairly effective though not ideal treatments, very, very few people end up having access to them," said lead author Dr. Peter Roy-Byrne, professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. "We need to move available treatments from controlled research settings into real-world practice settings that have much greater variability in patients' characteristics and skill levels of physicians. The majority of people with anxiety and depression are seen in primary-care and not mental health settings."

A third study found that an individualized program to treat depressed patients reduced to zero the number of suicides at Henry Ford Health System in Detroit, with not one depressed patient committing suicide over a two-and-a-half-year time span.

"The encouraging results of the initiative suggest that this care model can be highly effective for achieving and sustaining breakthrough quality improvement in mental health care," Dr. C. Edward Coffey, Henry Ford's vice president Behavioral Health Services, said in a news release.

More information

There's more on a range of mental health topics at the U.S. National Institute of Mental Health.

Overuse of antibiotics spurs vicious cycle

 

By Kate Kelland

Reuters

Tuesday, May 18, 2010

LONDON (Reuters) – Patients whose doctors over-prescribe antibiotics may develop drug resistance that lasts up to a year, putting them and the population at risk when more serious treatment is needed, scientists said on Wednesday.

The more antibiotics are prescribed for coughs and flu-like illnesses, or urine infections, the more bacteria become resistant in a vicious cycle, said British researchers who analyzed 24 previous studies of antibiotic resistance.

"The effect is greatest in the month immediately after treatment, but may last for up to a year, and this residual effect may be a driver for high levels of resistance in the community," said Alastair Hay, a consultant senior lecturer in primary health care at Bristol University, who led the research.

Medical experts say overuse of antibiotics in Europe, the United States and other wealthy regions is building widespread resistance in and threatening vital medical treatments from hip replacements and cancer therapies, to intensive care.

Hay said his study showed how individual resistance was building up, and how that then translated into community- or population-wide problems.

Antibiotics are needed in all these treatments to prevent bacterial infection, but can be rendered useless if they are used so widely that bugs develop ways to outwit them.

Multi drug-resistant bacteria are a growing problem in hospitals worldwide, marked by the rise of "superbug" infections like methicillin-resistant Staphyloccus aureus (MRSA).

Worth Fixing

But Hay, whose study was published in the British Medical Journal, said the problem of antibiotic resistance is often ignored in doctors' clinics, despite the fact that some 80 percent of antibiotic prescriptions come from family doctors.

"Up until now, the majority of the evidence has been at a population level, so it was very easy -- both for clinicians and patients -- to say 'this isn't my problem' or say 'just one more antibiotic isn't going to make a difference'," Hay said.

"But the more we prescribe, the more the bacteria become resistant. And really the only way of turning that vicious cycle into a virtuous circle is to only prescribe when it is absolutely necessary in the first place."

Experts say the annual cost in the United States of treating infections traceable to just six drug-resistant bacteria is more than $1.87 billion -- more than the yearly cost of treating flu.

In the European Union, added costs and loss of productivity as a result of antibiotic resistance are estimated at around 1.5 billion euros ($1.85 billion) a year.

In a commentary on the study, Chantal Morel and Elias Mossialos, specialists in economics and health policy from the London School of Economics, said it showed how great the need was for new classes antibiotics to be developed.

Morel and Mossialos said financial incentives should be used to persuade drug companies to invest in research to find, test and develop new antibiotics.

"In view of the rapid growth of antibiotic resistance...the intricacies of the antibiotics market, and the cost savings from improved treatment, there is a public health well as economic justification for intervention," they wrote.

($1=.8114 Euro)

(Editing by Reed Stevenson)

Cholesterol Crystals Incite Inflammation in Coronary Arteries, Research Finds

 

ScienceDaily

Tuesday, May 18, 2010

 

ScienceDaily (May 18, 2010) — Cholesterol crystals, known to be a catalyst for heart attacks and strokes, also cause cells to send out danger signals that can lead to the inflammation and hardening of arteries, according to a Michigan State University cardiologist.

 

The discovery by George Abela, chief of the cardiology division in MSU's College of Human Medicine, and a team of researchers provides new insights into how arteries harden -- a process called atherosclerosis -- and gives hope for new and early treatments of cardiovascular disease.

 

The findings are published in the most recent edition of the journal Nature.

 

Past research has shown that as cholesterol builds up along the wall of an artery, it crystallizes from a liquid to a solid state and expands, said Abela, who has been studying cholesterol crystals for nearly a decade. As the crystals expand, they can disrupt plaque and cause clotting, leading to cardiac attacks. That research also was recently highlighted recently in the Journal of Clinical Lipidology.

 

In a new discovery, Abela and the team -- while looking at causes of inflammation during atherosclerosis in mice -- found that the once cholesterol crystals form in the arterial wall, they activate a biomarker called NLRP3 that induces inflammation.

 

"What we have found now, at the cellular level, is that the crystals are an early cause rather than a late consequence of inflammation," Abela said.

 

The discovery could lead to new treatments for heart disease.

 

"Since cholesterol crystals form very early in the process of heart disease, with great potential to aggravate atherosclerosis, we can target them early on," Abela said. "We can target new therapies by reducing cholesterol crystal deposits early on or use an inhibitor to block the inflammatory biomarker."

Abela added that the biomarker activated by the crystals could be a better indicator of potential cardiovascular disease than others, such as serum cholesterol, or the amount of cholesterol found in the bloodstream.

"Now we treat atherosclerosis on the systematic level; with this discovery we can also treat it the cellular level," he said.

Journal References:

1.    Peter Duewell, Hajime Kono, Katey J. Rayner, Cherilyn M. Sirois, Gregory Vladimer, Franz G. Bauernfeind, George S. Abela, Luigi Franchi, Gabriel Nuñez, Max Schnurr, Terje Espevik, Egil Lien, Katherine A. Fitzgerald, Kenneth L. Rock, Kathryn J. Moore, Samuel D. Wright, Veit Hornung, Eicke Latz. NLRP3 inflammasomes are required for atherogenesis and activated by cholesterol crystals. Nature, 2010; 464 (7293): 1357 DOI: 10.1038/nature08938

2.    George S. Abela. Cholesterol crystals piercing the arterial plaque and intima trigger local and systemic inflammation. Journal of Clinical Lipidology, 2010; 4 (3): 156 DOI: 10.1016/j.jacl.2010.03.003

 

Monday, May 17, 2010

 

Caffeine May Slow Alzheimer's Disease and Other Dementias, Restore Cognitive Function, According to New Evidence

 

ScienceDaily

Monday, May 17, 2010

 

ScienceDaily (May 17, 2010) — Although caffeine is the most widely consumed psychoactive drug worldwide, its potential beneficial effect for maintenance of proper brain functioning has only recently begun to be adequately appreciated. Substantial evidence from epidemiological studies and fundamental research in animal models suggests that caffeine may be protective against the cognitive decline seen in dementia and Alzheimer's disease (AD).

A special supplement to the Journal of Alzheimer's Disease, "Therapeutic Opportunities for Caffeine in Alzheimer's Disease and Other Neurodegenerative Diseases," sheds new light on this topic and presents key findings.

Guest editors Alexandre de Mendonça, Institute of Molecular Medicine and Faculty of Medicine, University of Lisbon, Portugal, and Rodrigo A. Cunha, Center for Neuroscience and Cell Biology of Coimbra and Faculty of Medicine, University of Coimbra, Portugal, have assembled a group of international experts to explore the effects of caffeine on the brain. The resulting collection of original studies conveys multiple perspectives on topics ranging from molecular targets of caffeine, neurophysiological modifications and adaptations, to the potential mechanisms underlying the behavioral and neuroprotective actions of caffeine in distinct brain pathologies.

"Epidemiological studies first revealed an inverse association between the chronic consumption of caffeine and the incidence of Parkinson's disease," according to Mendonça and Cunha. "This was paralleled by animal studies of Parkinson's disease showing that caffeine prevented motor deficits as well as neurodegeneration "Later a few epidemiological studies showed that the consumption of moderate amounts of caffeine was inversely associated with the cognitive decline associated with aging as well as the incidence of Alzheimer's disease. Again, this was paralleled by animal studies showing that chronic caffeine administration prevented memory deterioration and neurodegeneration in animal models of aging and of Alzheimer's disease."

Key findings presented in "Therapeutic Opportunities for Caffeine in Alzheimer's Disease and Other Neurodegenerative Diseases":

·         Multiple beneficial effects of caffeine to normalize brain function and prevent its degeneration

·         Caffeine's neuroprotective profile and its ability to reduce amyloid-beta production

·         Caffeine as a candidate disease-modifying agent for Alzheimer's disease

·         Positive impact of caffeine on cognition and memory performance

·         Identification of adenosine A2A receptors as the main target for neuroprotection afforded by caffeine consumption

·         Confirmation of data through valuable meta-analyses presented

·         Epidemiological studies corroborated by meta-analysis suggesting that caffeine may be protective against Parkinson's disease

*                   Several methodological issues must be solved before advancing to decisive clinical trials

Mendonça and Cunha also observe that "the daily follow-up of patients with AD has taught us that improvement of daily living may be a more significant indicator of amelioration than slight improvements in objective measures of memory performance. One of the most prevalent complications of AD is depression of mood, and the recent observations that caffeine might be a mood normalizer are of particular interest."

The supplement was funded by the Associação Industrial e Comercial do Café, while leaving full scientific independence to all contributors. The entire issue has been made available on a no-fee basis at http://iospress.metapress.com/content/t13614762731/.

Pesticides on Produce Tied to ADHD in Children

 

By Amanda Gardner
HealthDay Reporter
HealthDay News

Monday, May 17, 2010

MONDAY, May 17 (HealthDay News) -- New research suggests that exposure to high levels of organophosphate pesticides, commonly found on berries, celery and other produce, could raise the odds for attention-deficit/hyperactivity disorder (ADHD) in children.

At this point, though, there is no evidence that pesticide exposure can actually cause ADHD, stated the authors of a paper appearing in the June issue of Pediatrics.

Certainly parents and children shouldn't swear off fruits and veggies, said study lead author Maryse Bouchard, an adjunct researcher in the department of environmental and occupational health at the University of Montreal and at Sainte-Justine University Hospital Centre. However, "I think it's safe to say that we should as much as possible reduce our exposure to pesticides," she said.

That would meaning going organic, buying at farmers' markets and washing fruits and vegetables thoroughly before consuming them, she said.

"I always encourage my families to embrace healthy lifestyles in general," agreed Dr. Nakia Scott, clinical assistant professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine and a child psychiatrist with Lone Star Circle of Care. "I think it's much more important that they're eating fruits, vegetables, nuts and grains instead of sodas and fast foods and I'm not saying that they're not going to eat any produce because it might contain pesticides."

Previous research has shown an association between both prenatal and postnatal organophosphate exposure and developmental problems in young children.

But most prior studies have focused on excessive rather than average exposure to organophosphates.

"Organophosphates are one of the most widely used pesticides in agriculture to protect crops and fruits and vegetables," Bouchard noted. "For children, the major source of exposure would be the diet -- fruits and vegetables in particular."

In their study, Bouchard and her colleagues analyzed data on pesticide exposure and ADHD in more than 1,100 American children aged 8 to 15.

Children with higher pesticide levels in their urine were more likely to have ADHD, the team found.

"The analysis showed that the higher the level of exposure [as measured by metabolites in the urine], the higher the odds of having ADHD," Bouchard added.

Just how might pesticides harm brain development? According to the authors, high doses of organophosphates may inhibit acetylcholinesterase, a nervous system enzyme. Lower doses of the pesticide may affect different growth factors and neurotransmitters.

The findings, if replicated, may provide another clue into the causes of ADHD, a condition which affects three to seven percent of school-aged children, according to the U.S. Centers for Disease Control and Prevention.

"We do have a fair amount of evidence about other causes of ADHD," Scott said. "We know that ADHD is a highly heritable disorder. At least one-third of fathers who have had ADHD in their youth have a child with ADHD."

"There are also prenatal risks such as tobacco exposure and alcohol exposure," she added. "There's also a possibility that children who are exposed to high levels of lead prior to the age of six may develop ADHD."

More information

There's more on shielding kids from pesticides at the U.S. Environmental Protection Agency.

Study suggests processed meat a real health risk

 

By Julie Steenhuysen

Reuters

Monday, May 17, 2010

CHICAGO (Reuters) – Eating bacon, sausage, hot dogs and other processed meats can raise the risk of heart disease and diabetes, U.S. researchers said on Monday in a study that identifies the real bad boys of the meat counter.

Eating unprocessed beef, pork or lamb appeared not to raise risks of heart attacks and diabetes, they said, suggesting that salt and chemical preservatives may be the real cause of these two health problems associated with eating meat.

The study, an analysis of other research called a meta-analysis, did not look at high blood pressure or cancer, which are also linked with high meat consumption.

"To lower risk of heart attacks and diabetes, people should consider which types of meats they are eating," said Renata Micha of the Harvard School of Public Health, whose study appears in the journal Circulation.

"Processed meats such as bacon, salami, sausages, hot dogs and processed deli meats may be the most important to avoid," Micha said in a statement.

Based on her findings, she said people who eat one serving per week or less of processed meats have less of a risk.

The American Meat Institute objected to the findings, saying it was only one study and that it stands in contrast to other studies and the U.S. Dietary Guidelines for Americans.

"At best, this hypothesis merits further study. It is certainly no reason for dietary changes," James Hodges, president of the American Meat Institute, said in a statement.

Most dietary guidelines recommend eating less meat. Individual studies looking at relationships between eating meat and cardiovascular diseases and diabetes have had mixed results.

But studies rarely look for differences in risk between processed and unprocessed red meats, Micha said.

She and colleagues did a systematic review of nearly 1,600 studies from around the world looking for evidence of a link between eating processed and unprocessed red meat and the risk of heart disease and diabetes.

They defined processed meat as any meat preserved by smoking, curing or salting, or with the addition of chemical preservatives. Meats in this category included bacon, salami, sausages, hot dogs or processed deli or luncheon meats.

Unprocessed red meat included beef, lamb or pork but not poultry.

They found that on average, each 1.8 oz (50 grams) daily serving of processed meat a day -- one to two slices of deli meats or one hot dog -- was associated with a 42 percent higher risk of heart disease and a 19 percent higher risk of developing diabetes.

They found no higher heart or diabetes risk in people who ate only unprocessed red meats.

The team adjusted for a number of factors, including how much meat people ate. They said lifestyle factors were similar between those who ate processed and unprocessed meats.

"When we looked at average nutrients in unprocessed red and processed meats eaten in the United States, we found that they contained similar average amounts of saturated fat and cholesterol," Micha said.

"In contrast, processed meats contained, on average, four times more sodium and 50 percent more nitrate preservatives," Micha added.

Last month, the Institute of Medicine urged the U.S. Food and Drug Administration to regulate the amount of salt added to foods to help Americans cut their high sodium intake.

The FDA has not yet said whether it will regulate salt in foods, but it is looking at the issue.

(Editing by Eric Walsh)

Acne, Psoriasis Meds Don't Raise Fracture Risk

HealthDay News

Monday, May 17, 2010

MONDAY, May 17 (HealthDay News) -- Patients who take drugs like Accutane and Soriatane for acne and psoriasis don't seem to be at higher risk of breaking bones, a new study finds, even though similar dietary supplements have been linked to fractures.

Accutane and Soriatane -- known generically as isotretinoin and acitretin -- are similar to vitamin A, which has been linked to broken bones when taken in high doses. The drugs themselves, which are used to treat acne and psoriasis, have been connected to lower levels of bone density.

In the new study, researchers at Aarhus University Hospital in Denmark studied 124,655 patients with broken bones from the year 2000. They compared them to people of the same age and sex who didn't have broken bones.

The researchers found that the drugs didn't boost the risk of broken bones, even at high doses.

The study appears in the May issue of the Archives of Dermatology.

More information

For more about acne, try the U.S. National Library of Medicine.

High-Fat Meals a No-No for Asthma Patients, Researchers Find

 

ScienceDaily

Monday, May 17, 2010

 

ScienceDaily (May 17, 2010) — People with asthma may be well-advised to avoid heavy, high-fat meals, according to new research. Individuals with asthma who consumed a high-fat meal showed increased airway inflammation just hours after the binge, according to Australian researchers who conducted the study. The high fat meal also appeared to inhibit the response to the asthma reliever medication Ventolin (albuterol).

 

"Subjects who had consumed the high-fat meal had an increase in airway neutrophils and TLR4 mRNA gene expression from sputum cells, that didn't occur following the low fat meal," said Dr. Lisa Wood, Ph.D., research fellow of the University of Newcastle. "The high fat meal impaired the asthmatic response to albuterol. In subjects who had consumed a high fat meal, the post-albuterol improvement in lung function at three and four hours was suppressed."

 

The research are being presented at the ATS 2010 International Conference in New Orleans.

 

Asthma prevalence has increased dramatically in westernized countries in recent decades, suggesting that environmental factors such as dietary intake may play a role in the onset and development of the disease. Westernized diets are known to be relatively higher in fat than more traditional diets.

 

High dietary fat intake has previously been shown to activate the immune response, leading to an increase in blood markers of inflammation. However, the effect of a high fat meal on airway inflammation, which contributes to asthma, had not been investigated.

 

Researchers recruited 40 asthmatic subjects who were randomized to receive either a high-fat, high-calorie "food challenge," consisting of fast food burgers and hash browns containing about 1,000 calories, 52 percent of which were from fat; or a low-fat, low-calorie meal consisting of reduced fat yogurt, containing about 200 calories, and 13 percent fat.

 

Sputum samples were collected before the meal and four hours afterward, and analyzed for inflammatory markers.

 

Subjects who had consumed the high-fat meal had a marked increase in airway neutrophils and TLR4 mRNA gene expression. TLR4 is a cell surface receptor that is activated by nutritional fatty acids: TLR4 'senses' the presence of saturated fatty acids, and prompts the cell to respond to the fatty acids as if they were an invading pathogen, releasing inflammatory mediators. While the study didn't definitively distinguish between high fat and high energy, this increase in TLR4 activity suggests that dietary fat is important to the effects.

 

Subjects who had consumed the high fat meal also had reduced bronchodilator response as measured by FEV1% predicted and FEV1/FVC%, when compared to those had consumed the low-fat meal.

 

"This is the first study to show that a high fat meal increases airway inflammation, so this is a very important finding," said Dr. Wood. "The observation that a high fat meal changes the asthmatic response to albuterol was unexpected as we hadn't considered the possibility that this would occur."

 

The mechanism by which a high fat meal could change the bronchodilator response requires further investigation.

 

"We are designing more studies to investigate this effect. We are also investigating whether drugs that modify fat metabolism could suppress the negative effects of a high fat meal in the airways," said Dr. Wood. "If these results can be confirmed by further research, this suggests that strategies aimed at reducing dietary fat intake may be useful in managing asthma."

Dramatic surge seen in kids hospitalized with MRSA

By Lindsey Tanner

AP Medical Writer

The Associated Press

Monday, May 17, 2010

CHICAGO – The number of children hospitalized with dangerous drug-resistant staph infections surged 10-fold in recent years, a study found.

Disease incidence increased from 2 cases to 21 cases per 1,000 hospital admissions from 1999 to 2008. Most infections were caught in the community, not in the hospital.

The study involved methicillin-resistant staph infections, called MRSA. These used to occur mostly in hospitals and nursing homes but they are increasingly showing up in other settings in children and adults. Recent evidence suggests hospital-acquired MRSA cases may be declining while community-acquired cases are becoming more common.

The results are "a good example of how something that is not unexpected remains alarming," said Dr. Buddy Creech, an infectious disease specialist at Vanderbilt University. He was not involved in the study.

The study involved 25 children's hospitals; the 10-fold increase in hospitalizations likely occurred nationwide, said Dr. Jason Newland, the lead author and an infectious disease physician at Children's Mercy Hospitals and Clinics and the University of Missouri-Kansas City.

Almost 30,000 children were hospitalized with MRSA infections at the hospitals studied during the 10-year period. Most had skin or muscle infections, and 374 youngsters with MRSA died. While Newland said it isn't clear if MRSA caused those deaths, it can be deadly and is blamed for more than 18,000 deaths in children and adults nationwide each year.

The study didn't examine whether deaths or the severity of infections increased.

The results were published Monday in the journal Pediatrics.

MRSA often begins as a pimple or boil on the skin. It can also spread to other parts of the body, including the bones or lungs, where it can cause pneumonia.

The study also found a coinciding increase in use of clindamycin, an antibiotic that comes in easy-to-use pills and liquid, and smaller increases for two other antibiotics. Another drug effective against MRSA, vancomycin, is only available intravenously and its use decreased during the study.

Newland said the increasing use of clindamycin is concerning because in some regions MRSA is already becoming resistant to the drug. Doctors need to use the antibiotic judiciously, he said.

Dr. Kenneth Alexander, the University of Chicago's pediatric infectious disease chief, said he agrees.

"Staph are incredibly cagey, and will ultimately find their way around any antibiotic in use," he said.

Research is needed to find other drugs that will work against MRSA, he said.

On the Net:

Pediatrics: http://www.pediatrics.org

MRSA: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_data.html

Do c-sections increase the risk of celiac disease?

 

By Nancy Lapid

Reuters Health

Monday, May 17, 2010

NEW YORK (Reuters Health) – Children who develop celiac disease appear to be more likely to be born by cesarean section, German researchers say.

Celiac disease is a disorder in which eating gluten -- a type of protein found in wheat, barley, and rye -- causes the body's immune system to attack and damage the small intestine. In the U.S., researchers think nearly 1 out of every 100 people has celiac disease.

Dr. Mathias Hornef, from Hannover Medical School in Germany, and his colleagues knew that people with certain inflammatory bowel diseases - such as celiac disease, Crohn's disease, and ulcerative colitis - have a different mix of bacteria in their intestines.

How a child is delivered can affect that mix, so the researchers wondered if children with those diseases would have a higher rate of cesarean birth.

The team studied children and adolescents with Crohn's disease, ulcerative colitis, or celiac disease. They also studied some children with other gastrointestinal problems, as well as a "control" group of children who were visiting local eye doctors and dentists for unrelated conditions.

The celiac children clearly had a higher rate of cesarean births compared to the other four groups. Twenty-eight percent of the celiac children were born by cesarean section, compared to no more than 19 percent of all the other groups. The celiac children were also diagnosed at a younger age, on average, than the other patients.

Hornef and colleagues are not sure why cesarean delivery might be associated with celiac disease but not Crohn's disease or ulcerative colitis, because the three disorders develop in some similar ways. They say one explanation might be that celiac disease can be triggered much earlier in life, so the newborns with abnormal intestinal bacteria might be particularly vulnerable.

Hornef and his group note in their report that this is the first time anyone has found a link between cesarean delivery and children with celiac disease.

Researchers who were not involved in the study called the results intriguing, but said there may be explanations that don't involve the way babies were born.

For example, Dr. Daniel Leffler, director of clinical research at the Celiac Disease Center at Boston's Beth Israel Deaconess Medical Center, said many of the children's mothers may have had undiagnosed celiac disease. Given that celiac disease can be inherited, and that undiagnosed celiac disease increases the risk of cesarean section, undiagnosed disease "would be more than enough to explain the increased number of cesareans," he told Reuters Health.

"It may well be that celiac disease is showing up in the children, rather than in the mothers, because people are more alert to the possibility in kids," he added.

Dr. Joseph Murray, a gastroenterologist who specializes in celiac disease at the Mayo Clinic in Rochester, Minnesota, said it would also be good to study whether there's a similar link between cesarean birth and diabetes, which is closely related to celiac disease.

Hornef is quick to emphasize that cesarean sections can be lifesaving. Much larger studies, and far more data, would be needed "before we recommend something like trying to avoid c-section" as a way to avoid celiac disease, he told Reuters Health by e-mail.

If anything, the results "may mean we need to be looking for celiac disease in young women who want to become pregnant," Leffler said. He noted that when celiac disease is treated with a gluten-free diet, the risk for cesarean section is no higher than for the average woman.

Untreated celiac disease, Leffler added, can have effects on the fetus as well, including slowing its growth and a higher risk of premature birth.

Source: www.pediatrics.org/cgi/doi/10.1542/peds.2009-2260 Pediatrics, online May 17, 2010.