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Friday, June 17, 2011 

Docs Overprescribing Antibiotics for Home-Care Patients: Study

HealthDay News

Friday, June 17, 2011

FRIDAY, June 17 (HealthDay News) -- Amid increased threats of drug-resistant infections, a new study reveals that doctors may overprescribe antibiotics to patients receiving ongoing medical care at home.

Researchers from McMaster University in Ontario, Canada, found that patients younger than 65 and those with poorer prognoses, in particular, are at greatest risk for misuse of the drugs.

"Taken together, our results reveal tremendous variability in how and why antibiotics are prescribed, and that overuse in the home-care population is likely," said one of the study's authors, Dr. Mark Loeb.

In conducting the study, published in the June issue of Infection Control and Hospital Epidemiology, researchers compiled medical information on more than 125,000 patients receiving home care for more than 60 days over the course of one year. The findings suggested that doctors may be more cautious with younger patients since those younger than 65 were more likely to receive a prescription for antibiotics.

They also found that patients with longer life expectancies were less likely to receive the drugs, even though they might benefit more from the treatment than other patients.

"Younger and sicker patients seem to be at added risk for misuse and should be the focus of further study to assess the appropriateness of antibiotic use at home," Loeb said in a journal news release.

The researchers noted that one of the most commonly prescribed classes of drugs was fluoroquinolones, which are often associated with increased rates of resistance. Since overuse could hinder their efficacy and lead to more drug-resistant infections, the study authors argued antibiotic use among home-care patients should be more closely tracked.

"Our results illustrate the importance of continuing to monitor antibiotic use in home-care patients, and the need for more effective methods of diagnosis that allow for appropriate antibiotic use," Loeb added.

More information

The U.S. Centers for Disease Control and Prevention provides more information on the proper use of antibiotics.

Cancer death rates continue drop: report

By Julie Steenhuysen

Reuters

Friday, June 17, 2011

CHICAGO (Reuters) – U.S. cancer death rates are continuing to fall, but not all segments of the population are benefiting, the American Cancer Society said Friday.

Overall, the group predicts 1,596,670 new cancer cases in the United States and 571,950 deaths in 2011.

Death rates for all cancer types fell by 1.9 percent a year from 2001 to 2007 in men and by 1.5 percent a year in women from 2002 through 2007.

Steady overall declines in cancer death rates have meant about 898,000 who would have died prematurely from cancer in the past 17 years did not, the organization said.

Americans with the least education are more than twice as likely to die from cancer as those with the most education, according to the group's annual cancer report.

Death rates for all cancer types have fallen in all racial and ethnic groups among both men and women since 1998 with the exception of American Indian/Alaska Native women, among whom rates were stable.

Black and Hispanic men have had the largest annual decreases in cancer death rates since 1998, falling by 2.6 percent among blacks and 2.5 percent among Hispanics.

New cases of lung cancer among women fell after rising steadily since the 1930s. The decline comes more than a decade after lung cancer rates in men started dropping and reflects differences in smoking trends among U.S. men and women, who took up smoking later in the last century than men.

Lung cancer is expected to account for 26 percent of all cancer deaths among women in 2011 and remains the No. 1 cancer killer of both men and women in the United States.

Breast cancer comes in No. 2 for women. Prostate cancer is the second most common killer of men, and colon cancer is the third-leading cause of cancer deaths for both sexes.

These four cancers account for almost half the total cancer deaths among men and women.

Cancer rates vary considerably among racial and ethnic groups. For all cancer types, black men have a 14 percent higher rate of new cases and a 33 percent higher death rate than white men, while black women have a 6 percent lower rate of new cancer cases and a 17 percent higher death rate than white women.

The report found cancer rates in the least educated were 2.6 times higher than in the most educated. This was most pronounced in lung cancer, reflecting higher smoking rates among those with less education.

Thirty-one percent of men with 12 or fewer years of education are smokers, compared with 12 percent of college graduates and 5 percent of men with advanced degrees.

(Editing by Todd Eastham)

Docs Overprescribing Antibiotics for Home-Care Patients: Study

HealthDay News

Friday, June 17, 2011

FRIDAY, June 17 (HealthDay News) -- Amid increased threats of drug-resistant infections, a new study reveals that doctors may overprescribe antibiotics to patients receiving ongoing medical care at home.

Researchers from McMaster University in Ontario, Canada, found that patients younger than 65 and those with poorer prognoses, in particular, are at greatest risk for misuse of the drugs.

"Taken together, our results reveal tremendous variability in how and why antibiotics are prescribed, and that overuse in the home-care population is likely," said one of the study's authors, Dr. Mark Loeb.

In conducting the study, published in the June issue of Infection Control and Hospital Epidemiology, researchers compiled medical information on more than 125,000 patients receiving home care for more than 60 days over the course of one year. The findings suggested that doctors may be more cautious with younger patients since those younger than 65 were more likely to receive a prescription for antibiotics.

They also found that patients with longer life expectancies were less likely to receive the drugs, even though they might benefit more from the treatment than other patients.

"Younger and sicker patients seem to be at added risk for misuse and should be the focus of further study to assess the appropriateness of antibiotic use at home," Loeb said in a journal news release.

The researchers noted that one of the most commonly prescribed classes of drugs was fluoroquinolones, which are often associated with increased rates of resistance. Since overuse could hinder their efficacy and lead to more drug-resistant infections, the study authors argued antibiotic use among home-care patients should be more closely tracked.

"Our results illustrate the importance of continuing to monitor antibiotic use in home-care patients, and the need for more effective methods of diagnosis that allow for appropriate antibiotic use," Loeb added.

More information

The U.S. Centers for Disease Control and Prevention provides more information on the proper use of antibiotics.

More Evidence Vitamin D Boosts Immune Response

ScienceDaily

Friday, June 17, 2011

ScienceDaily (June 17, 2011) — Laboratory-grown gingival cells treated with vitamin D boosted their production of an endogenous antibiotic, and killed more bacteria than untreated cells, according to a paper in the June 2011 issue of the journal Infection and Immunity. The research suggests that vitamin D can help protect the gums from bacterial infections that lead to gingivitis and periodontitis. Periodontitis affects up to 50 percent of the US population, is a major cause of tooth loss, and can also contribute to heart disease. Most Americans are deficient in vitamin D.

His interest piqued by another laboratory's discovery that vitamin D could stimulate white blood cells to produce natural proteins that have antibiotic activity, Gill Diamond of the UMDNJ -- New Jersey Dental School, Newark, showed that vitamin D could stimulate lung cells to produce LL-37, a natural antibiotic protein, and kill more bacteria. That suggested that , vitamin D might help cystic fibrosis patients. Next, in the new research, he showed that vitamin D has the same effct on gingival cells.

Then, Diamond found that vitamin D also stimulates gingival cells to produce another protein, called TREM-1, which had not been well-studied, but which was thought to be made by white blood cells. He found that it boosts production of pro-inflammatory cytokines.

The new research also showed that vitamin D coordinates expression of a number of genes not previously considered to be part of the vitamin D pathway. Those genes may be involved in additional infection-fighting pathways. A more comprehensive understanding of how vitamin D carries out this regulation at the molecular level -- something Diamond hopes to investigate -- will enable targeted therapies using vitamin D, he says.

Interestingly, Diamond also found that lung and gum cells appear to have the ability to activate inactive forms of vitamin D, says Diamond. "This means that we may even be able to use vitamin D therapy topically, if that proves true."

Vitamin D has become a hot area of research in recent years. In addition to infectious diseases, studies suggest that it has protective effects against autoimmune diseases, and certain cancers.

Diamond says that after he began conducting research on vitamin D, he began taking it as a supplement. Since then, "I have had only one cold in four years, and that one lasted only three days," he says. "Other people I've met who have done the same have seen similar results. We are trying to figure out how it's working, and what other infectious diseases can be mitigated by it."

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

L. McMahon, K. Schwartz, O. Yilmaz, E. Brown, L. K. Ryan, G. Diamond. Vitamin D-Mediated Induction of Innate Immunity in Gingival Epithelial Cells. Infection and Immunity, 2011; 79 (6): 2250 DOI: 10.1128/IAI.00099-11

Severe complications from cataract surgery decline

By Amy Norton

Reuters Health

Friday, June 17, 2011

NEW YORK (Reuters Health) – Serious, potentially blinding complications from cataract eye surgery are uncommon, and have been declining since the 1990s, a new U.S. study finds.

A cataract is a clouding of the eye's lens, usually caused when proteins in the lens start to clump up as a person ages. Cataract removal is the most common type of surgery in the U.S., with more than 3 million procedures done each year.

While the surgery is generally considered safe, there can be sight-threatening complications -- including severe inflammation in the eye, bleeding, and detachment of the retina, the light-sensing tissue in the back of the eye.

But those problems are uncommon and appear to be on the wane, according to new findings reported in the journal Ophthalmology.

Researchers found that for every 1000 Medicare patients who had cataract surgery in 2005 or 2006, four had at least one serious complication in the following year. That compared with six of every 1000 a decade earlier, in 1994 and 1995.

When the researchers took risk factors for complications into account -- including having other chronic health conditions -- people who had surgery in the mid-1990s were 21 percent more likely to have a serious complication than those who had surgery in recent years.

"Our analysis confirmed that cataract surgery is a safe surgical procedure with low risks of severe adverse events, and that the safety profile of this procedure has continued to improve over the past decade," said lead researcher Dr. Joshua D. Stein, of the University of Michigan in Ann Arbor, in an email to Reuters Health.

It's hard to tell why the improvement is happening, based on information from Medicare claims alone, Stein said.

But he and his colleagues suspect the credit should largely go to technical advances in how cataract surgery is done.

These days, cataract removal is usually done via a technique called "phacoemulsification." The surgeon makes a small incision in the eye's outer membrane, then inserts a tiny probe. The probe emits sound waves that break up the lens, which is then suctioned out and replaced with an artificial lens.

The same type of procedure was also done in the 1990s. But improved equipment and instruments may largely explain the decline in severe complications, according to Stein.

There are, though, certain patients at relatively higher risk of complications from cataract surgery, the study found.

They included patients with proliferative diabetic retinopathy -- an advanced stage of diabetes-related damage to the tiny blood vessels of the retina. While their risk of severe complications was still low, it was 62 percent higher than in patients without proliferative diabetic retinopathy.

That, Stein's team writes, suggests that when people with diabetic retinopathy have cataracts, it might be better to consider surgery sooner rather than later -- before the retinopathy gets worse.

Patients having certain other eye procedures at the same time as cataract surgery were also at increased risk of complications.

But Stein said it's tough to interpret that finding.

The researchers had no information on whether patients' additional procedures were pre-planned, or whether they were done to manage a complication during cataract surgery. So it's not clear that combination surgeries were a risk factor for complications.

"Before surgeons and patients jump to any conclusions about this specific finding," Stein said, "I think that additional studies are warranted, using other data sources which can help decipher some of the underlying reasons for this trend we are observing."

The researchers say future studies should also look into ways to further curb surgery complications in patients who remain at relatively greater risk, like those with advanced diabetic retinopathy.

In the U.S., it's estimated that half of people who live to the age of 80 will either have cataracts or have cataract surgery, at a cost of $1,500 to $3,000 per surgery.

Source: http://bit.ly/jC0LvA

 Ophthalmology, online June 2, 2011.

Shorter Sleep Durations May Increase Genetic Risks for Obesity

ScienceDaily

Friday, June 17, 2011

ScienceDaily (June 17, 2011) — Sleeping less at night may increase the expression of genetic risks for obesity, while getting plenty of sleep may suppress genetic influences on body weight, suggests an abstract being presented in Minneapolis, Minn., at SLEEP 2011, the 25th Anniversary Meeting of the Associated Professional Sleep Societies LLC (APSS).

Results of a study of 1,811 pairs of twins show that the heritability of sleep duration was 32 percent, and shared environmental influences on sleep duration were negligible. Longer sleep duration was associated with decreased body mass index, which is a measure of body fat based on height and weight.

Behavioral genetic modeling found significant interactions between self-reported, habitual sleep duration and both genetic and shared environmental influences on BMI. The heritability of BMI when sleep duration equaled seven hours was more than twice as large as the heritability of BMI when sleep duration equaled nine hours.

"The heritability of body weight decreased as sleep duration increased," said principal investigator Dr. Nathaniel Watson, associate professor of neurology at the University of Washington and co-director of the UW Medicine Sleep Center. "There appears to be something about short sleep that creates a permissive environment for expression of obesity-related genes."

The study involved a population-based sample of 1,811 pairs of identical and fraternal twins from the University of Washington Twin Registry. They had a mean age of about 37 years. Height, weight and habitual sleep duration were collected by self-report surveys. Participants were slightly overweight with a mean BMI of 25.4, and they had a mean sleep duration of about seven hours and 11 minutes per night. Data were analyzed using behavioral genetic interaction models.

According to Watson, the study is an important addition to the existing body of research on the relationship between sleep duration and BMI.

"Epidemiological and experimental studies have shown short sleep is associated with obesity," said Watson. "Our work takes this a step further, showing that short sleep facilitates expression of obesity-related genes."

The authors concluded that future research aiming to identify specific genotypes for BMI may benefit from considering the moderating role of sleep duration.

In a smaller study of 612 twin pairs published in the Journal of Clinical Sleep Medicine in 2010, Watson found that short sleep was associated with elevated BMI following careful adjustment for genetics and shared environment. In a study published in JAMA in 2010, the CDC estimated that 68 percent of U.S. adults were overweight or obese in 2007 -- 2008.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Thursday, June 16, 2011

Scientists find risk factor for tears in the aorta

By Julie Steenhuysen

Reuters

Thursday, June 16, 2011

CHICAGO (Reuters) – People who have too many copies of genes in a certain chromosome may have a 12-times greater risk of developing bulges and tears in their aorta, the main artery that carries blood from the heart to the rest of body, U.S. researchers said on Thursday.

The findings, published in the journal PLoS Genetics, could be used to help predict which patients are at risk for such bulges, known as aortic aneurysms, and related tears that kill 10,000 people each year in the United States, the team said.

They said people with too many copies of genes in a specific region of chromosome 16 may have an aggressive form of thoracic aortic disease that makes bulges in the artery called aneurysms more prone to tearing, an urgent condition that can lead to sudden death.

The findings are based on a new way of studying genetic variation that looks for extra copies or deletions in sections of DNA, referred to as copy number changes or variants.

These variants can cause people to have too many copies or not enough copies of a particular gene.

"We're just starting to understand copy number variants and their link to disease," said Dr. Dianna Milewicz of the University of Texas Medical School at Houston.

In the current study, Milewicz and colleagues zeroed in on a particular region of chromosome 16 known as 16p13.1. This region contains nine genes.

About one in every 1,000 people have duplications of genes in this area, and having these can raise a person's risk of schizophrenia and attention-deficit hyperactivity disorder.

One of the genes in this region known as MYH11 affects smooth muscle cell tissue in major arteries in the body, including the thoracic aorta.

Prior studies have shown that inherited mutations in this gene can causes weakness in the lining of the thoracic aorta.

Milewicz and colleagues decided to see if extra copies of genes in this region could raise the risk of aneurysms in people who do not have a family history of the disease.

They studied patients who had non-familial aneurysms and tears in the aorta and found duplications in this region in eight out of 765 patients, compared with just four in a group of nearly 5,000 control patients.

The findings suggest that people with duplications of this gene are 12 times more likely to develop aortic disease than people who do not.

"The results of this study could affect clinical care because it appears patients with 16p13.1 duplications have an aggressive form of the thoracic aortic disease that causes aneurysms to dissect at smaller diameters," Milewicz said in a statement.

Companies are developing powerful new machines that will be able to quickly and cheaply sequence the entire human genome, and some researchers predict these tools could soon be within patients' reach in the next two years.

Milewicz said once that was possible, doctors would be able to identify patients with duplications in this chromosome region and monitor them for aortic disease.

(Editing by Eric Walsh)

Migraines eased after ginger and herb treatment

By Kerry Grens

Reuters Health

Thursday, June 16, 2011

NEW YORK (Reuters Health) – Migraine sufferers treated with a homeopathic preparation of ginger and the herb feverfew may find some pain relief, according to a preliminary study. Feverfew, which is derived from a flowering plant, has long been thought to be a remedy for headaches. It might offer an alternative to standard migraine medications, which are costly, have side effects and don't always work, according the new report. About 12 percent of Americans get migraines, and the problem has been estimated to cost the U.S. some $20 billion annually in lost productivity and medical care.

In the new study, researchers funded by PuraMed Bioscience, which makes the feverfew/ginger treatment, randomly assigned patients to take a preparation containing miniscule amounts of the two plants or a dummy treatment. The patients were asked to treat themselves -- by putting a little sachet with the preparations under their tongue -- as soon as they recognized the signs of an approaching migraine. Forty five people took the homeopathic treatment and 15 took the placebo. About a third of those who took feverfew and ginger were pain-free after two hours, compared to only half as many in the placebo group.

Overall, 63 percent of those taking the homeopathic preparation saw some pain relief, while 39 percent did so among those taking the fake treatment. Because the study was small, it's possible that those randomly assigned to take the placebo simply experienced more severe migraines to begin with. But study researcher Dr. Roger Cady said that was unlikely. "I don't think that accounts for the differences in efficacy here," Cady, who directs the Headache Care Center in Springfield, Missouri, told Reuters Health. While he thinks the findings are real, it's still unclear how exactly the treatment would work, he added.

The homeopathic preparation, called LipiGesic, sells for $29.95 for several doses. Cady says people who experience migraines slowly, and therefore have the ability to treat them early and before they become severe, would be the best candidates to try the feverfew therapy. "The results are really intriguing, but definitely preliminary," said Dr. Rebecca Erwin Wells, an instructor at Beth Israel Deaconess Medical Center. Wells said the study had some flaws and noted that one of the authors is also the CEO and chairman of PuraMed Bioscience. Still, she said, it's important to have studies on complementary or alternative therapies, particularly for people who suffer migraines. A recent study by Wells and her colleagues, published along with the new results in the journal Headache, found that people who deal with migraines or severe headaches are more likely than others to seek out complementary or alternative remedies, such as meditation, yoga and herbal treatments. "We found that 50 percent of adults with migraine or severe headaches, which is 13.5 million Americans, used complementary and alternative medicine in the previous year," Wells told Reuters Health. Among people who don't have migraines or severe headaches, 35 percent used complementary or alternative approaches to wellness or diseases. "We need more research to understand the mechanisms, benefits, side effects and risks of complementary and alternative therapies," concluded Wells.

Source: Headache, online June 1, 2011. 

Study questions extra folic acid need for women

By Amy Norton

Reuters Health

Thursday, June 16, 2011

NEW YORK (Reuters Health) - Since 1998, the U.S. has required that grain products be fortified with the B vitamin folic acid to help prevent certain birth defects. Now a new study questions the need for women to get even more folic acid from a pill. Amy Norton New York (reuters Health) - Since 1998, The U.s. Has Required That Grain Products Be Fortified With The B Vitamin Folic Acid To Help Prevent Certain Birth Defects. Now A New Study Questions The Need For Women To Get Even More Folic Acid From A Pill. – 1 hr 34 mins ago

In a study of nearly 6,400 U.S. women who gave birth between 1998 and 2008, researchers found that as the women's intake of folic acid from food rose, there was a steady decline in their risk of having a baby with spina bifida -- a serious birth defect of the spine. However, there was no evidence of a further benefit when women took folic acid in pill form -- whether in a multivitamin or a single supplement -- around the time of conception. The findings "raise the possibility" that in the era of fortified grains, folic acid supplements offer no added protection against spina bifida, Dr. Martha M. Werler and her colleagues at Boston University report in the journal Epidemiology. That would stand in contrast to current recommendations for women of childbearing age. Experts advise them to get 400 micrograms of folic acid per day -- before conception, as spinal cord defects take shape very early, before many women know they are pregnant. And to get that much folic acid, they would need to take supplements as well as eat fortified foods.

The recommendation is aimed at preventing neural tube defects, severe malformations of the brain and spine. They include spina bifida, where the spine fails to close during early fetal development, and anencephaly, a usually fatal defect where much of the brain never forms. And the current findings should not deter women from taking supplements to get the recommended amount of folic acid, according to a researcher not involved in the study.

"I hope women realize that until more work is done, they should continue to follow this important recommendation to reduce their risk of having a baby with a neural tube defect," Dr. Deborah L. O'Connor, of the University of Toronto and Hospital for Sick Children in Ontario, Canada, said in an email.

In a recent study, O'Connor and her colleagues found that less than 1 percent of Canadian women were able to get the recommended 400 micrograms of folic acid from food alone. (Canada also requires that folic acid be added to grain products.) A number of studies have found that since the U.S. began requiring folic acid fortification of flours, breads, cereals, pasta and other grain products, rates of neural tube defects have waned. In 2005, according to the Centers for Disease Control and Prevention, about 18 per 100,000 live newborns had spina bifida, the lowest rate ever reported.

For the new study, Werler's team wanted to know whether, in the era of fortified grains, additional folic acid from supplements seems to further cut the risk. They compared 205 mothers who gave birth to a baby with spina bifida between 1998 and 2008, with 6,357 mothers who had a healthy baby. All of the women were asked whether they had used folic acid supplements in the two months before and after conception. They also completed questionnaires on what their diet habits had been before pregnancy. Overall, the researchers found that for every 100 micrograms of folic acid that women consumed from food each day, the risk of having a baby with spina bifida dipped by 13 percent. That included folic acid in fortified grains, as well as folate (the natural form of the B vitamin) in foods like spinach, asparagus, dried beans and peas, and orange juice. However, folic acid from pills was not linked to a benefit.

Overall, 41 percent of the women said they'd used folic acid supplements at least four days per week around the time of conception. But their risk of having a baby with spina bifida was the same as that of women who hadn't used supplements. "Our study findings raise the possibility that supplementation with folic acid during the months immediately preceding neural tube closure does not offer further benefit in reducing the risk of a spina-bifida-affected pregnancy," Werler and her colleagues conclude. There are major caveats, though, the researchers say. One issue is that women were asked to recall their diets and supplement use. It's possible that, knowing folic acid is linked to spina bifida, some women with affected infants said they took supplements when in fact they had not.

O'Connor agreed. "It is very possible that there was recall bias in the study among women who had a baby with a neural tube defect who felt uncomfortable acknowledging they did not regularly consume a folic acid supplement as recommended." It would also be difficult, she noted, for the mothers to accurately recall their pre-pregnancy diets. O'Connor also pointed out that in the early days of fortification, manufacturers added more folic acid to their products than they do now. "The amount of fortification has come down over the years and is likely to come down further as manufacturers become more comfortable with how much needs to be added to food to meet label claims," she said. The bottom line, according to O'Connor, is that women who might become pregnant should continue to follow current folic acid recommendations. "As a rule I hope women appreciate they should not discount well-established health recommendations based on a single study," she said. "More work in this area needs to be done."

Source: Epidemiology, online June 8, 2011. 

Diet tied to lower risk of vision loss in old age

By Kerry Grens

Reuters Health

Thursday, June 16, 2011

NEW YORK (Reuters Health) – For people at a higher risk of losing central vision as they age, eating sufficient levels of certain dietary nutrients could help protect their eyes. A new study finds that among people with a genetic susceptibility to macular degeneration -- vision loss caused by erosion of the retina - those who ate higher levels of zinc, antioxidants or omega-3 fatty acids cut their risk of developing the disease by as much as a third compared with those who ate lower levels of the nutrients.

"Therefore, clinicians should provide dietary advice to young susceptible individuals to postpone or prevent the vision-disabling consequences of (age-related macular degeneration)," the researchers wrote in the journal Archives of Ophthalmology. Age-related macular degeneration is common, accounting for half of all cases of blindness in developed countries, they note.

In the United States, the condition occurs in more than six out of every 100 adults over age 40. Though patients can be treated with medications and surgery, none of these cures the disease. At least two gene variations are known to raise a person's risk for developing the condition compared to the general population. One of the variations (called CFH) increases a person's odds of macular degeneration up to 11-fold and another (called LOC387715S) raises them by up to 15-fold.

To see whether these especially susceptible people might reduce their risk, the researchers, based in the Netherlands, surveyed the eating habits of more than 2,000 participants over the age of 55. All were tested for the macular degeneration susceptibility genes. All the participants also had eye exams every three years for the next decade to determine who suffered vision loss. Among people with the CFH variation, greater amounts of either zinc, beta carotene, omega-3 fatty acids or lutein/zeaxanthin in the diet was linked to a smaller risk of macular degeneration.

For instance, 39 out of every 100 people who ate the lowest amounts of omega-3 fats (about 22 milligrams per day) developed vision loss, whereas 28 out of every 100 people who ate the largest amounts of omega-3s (268 mg per day) had vision loss. For those who had the LOC387715S variation, reduced risk of vision loss was seen among people who ate greater amounts of zinc or omega-3 fats. In their case, for example, 25 percent of people who ate 11.85 mg per day of zinc developed macular degeneration, compared to 33 percent of people who ate just 7.5 mg per day. "To achieve this benefit, it does not appear necessary to consume excessive amounts of these nutrients; the recommended dietary allowance will suffice," the authors note.

The recommended dietary allowance in the U.S. for zinc is 11 milligrams daily for men and 8 milligrams for women. Men are recommended to consume at least 1.6 grams of omega-3 fatty acids a day, and women 1.1 grams. Good sources for zinc include oysters, red meat, nuts and beans. Oily fish are some of the best food sources for omega-3 fats, while beta carotene is found in carrots, sweet potatoes and other vegetables and fruits. Lutein and zeaxanthin are abundant in eggs and green leafy vegetables. The authors did not work out whether or how these nutrients are responsible for the prevention of macular degeneration.

Source: Archives of Ophthalmology, June 2011.

Wednesday, June 15, 2011

Olive oil lovers show lower stroke risk

By Amy Norton

Reuters Health

Wednesday, June 15, 2011

NEW YORK (Reuters Health) - Older people who use olive oil in their cooking and on their salads may have a lower risk of suffering a stroke, researchers reported Wednesday. In a study that followed older French adults for five years, researchers found that those who regularly used olive oil were 41 percent less likely to have a stroke than those who never used the oil. The findings, reported in the journal Neurology, hint that the well-known connection between olive oil and heart disease might extend to stroke as well. Olive oil is a key ingredient in the so-called Mediterranean diet. And some clinical trials have suggested that the diet helps control risk factors for heart disease, like high blood pressure, abdominal obesity and elevated levels of "bad" LDL cholesterol. High olive oil intake is also linked to a lower risk of heart attack, and a longer lifespan among heart attack survivors. These latest findings support the general advice that people replace dubious dietary fats -- namely, saturated fats and "trans" fats -- with olive oil and other unsaturated fats, according to an expert not involved in the study. But he also stressed that the study does not prove that olive oil, per se, helps prevent strokes.

"We need to remember that this is an observational study," said Dr. Nikolaos Scarmeas, a neurologist at Columbia University Medical Center in New York who wrote an editorial published with the study. The study found a correlation between people's olive oil use and their stroke risk, he told Reuters Health -- but that doesn't necessarily translate into cause-and-effect. "People who use a lot of olive oil may be very different from people who don't," Scarmeas said. Olive oil users may, for example, have higher incomes, eat better overall or exercise more often than people who never use the oil. The researchers on the new study, led by Cιcilia Samieri of the French national research institute INSERM, tried to account for those differences. And after they did, olive oil was still linked to a lower stroke risk. But it's impossible to fully account for all those variables, Scarmeas noted. What's needed, he said, are clinical trials where people are randomly assigned to use olive oil or not, then followed over time to see who suffers a stroke. Such clinical trials are considered the "gold standard" of medical evidence.

The current study included 7,625 French adults age 65 and older who reported on their diets and other lifestyle factors. People who said they used olive oil for both cooking and as a dressing were considered "intensive users." Over the next five to six years, those intensive users suffered strokes at a rate of 0.3 percent per year. That compared with just over 0.5 percent among non-users, and 0.4 percent among moderate users. When the researchers factored in other diet habits, exercise levels and major risk factors for stroke -- like high blood pressure and diabetes -- heavy olive oil use was tied to 41 percent reduction in the odds of stroke. Samieri's team also took blood samples from another 1,245 older adults, measuring their levels of oleic acid -- a monounsaturated fat that accounts for most of the fatty acids in olive oil. The one-third of participants with the highest oleic acid levels were 73 percent less likely to suffer a stroke than the one-third with the lowest levels. The findings, according to Scarmeas, argue for more research into olive oil's potential benefits against not only heart disease, but stroke and other neurological diseases as well. For now, he suggested that people choose olive oil and other unsaturated fats over saturated fats (found largely in meat and dairy) and trans fats (found in some processed foods, like crackers, cookies and chips). "It's better to rely on this type of fat for your overall health," Scarmeas said. That said, no single food is consumed in isolation, he points out in his editorial. Olive oil is one part of the Mediterranean diet that has been tied to heart benefits. The diet also boasts plenty of fruits and vegetables, legumes, whole grains, fish and moderate amounts of red wine.

Source: http://bit.ly/SUxCM

Neurology, online June 15, 2011.

Most tumors not within cell phone radiation range

By Alison McCook

Reuters Health

Wednesday, June 15, 2011

NEW YORK (Reuters Health) – Brain tumors among cell phone users are not clustered within range of most of the radiation emitted from the devices, a new report finds - suggesting that mobile phones do not cause cancer.

Moreover, people who had used mobile phones for the longest amount of time, and spent the most time on the phones, were no more likely to experience tumors located within 5 centimeters of the phone, where "90 percent of the radiation" is emitted, study author Dr. Suvi Larjavaara from the University of Tampere in Finland told Reuters Health.

These findings appeared as the World Health Organization announced that, upon review of available scientific evidence, cell phones should be classified as "possibly carcinogenic."

Although the results of the Finnish study may be reassuring, they are certainly not conclusive, Larjavaara cautioned. Cancer can take a long time to develop, and only 5 percent of the people included in the study had been using mobile phones for at least 10 years, the authors note in the American Journal of Epidemiology.

Larjavaara acknowledged that these latest findings contradict the WHO's latest announcement, which placed cell phone use in the same cancer risk category as coffee and chloroform. The WHO had previously said there was no established evidence for a link between cell phone use and cancer.

"Our evidence does not support the connection, but obviously a majority does," she told Reuters Health by email.

Overall, the evidence remains conflicted: Last year, a study including 13,000 cell phone users over 10 years found no clear answer on whether the mobile devices cause brain tumors. Another study from last February suggested that using a mobile phone can change brain cell activity.

Use of mobile phones has increased hugely since their introduction in the early- to mid-1980s. About 5 billion mobile phones are currently in use worldwide.

One issue that arises when studying the risks of cell phone use is that people often don't recall how much time they spend on the phone. To approach the question more scientifically, Larjavaara and colleagues looked at the location of tumors, reasoning that an excess of tumors close to the phones would implicate the devices.

Ninety percent of the radiation released from phones is absorbed by the brain tissue located within 5 centimeters of the handset. So in 888 brain tumors diagnosed between 2000 and 2004, the researchers mapped the exact location of the tumor within the brain, relative to where people would place a cell phone while talking.

This study was one of the papers included in the WHO's recent analysis of cancer risk from cell phone use, along with two others by Dr. Elisabeth Cardis at the CREAL-Center for Research in Environmental Epidemiology in Barcelona, who reviewed the latest findings for Reuters Health. That analysis is scheduled to be released on July 1.

Cardis said that she and her team have also looked at tumor location in cell phone users, but instead developed a formula to calculate the amount of energy present at the actual tumor, factoring in the characteristics of the phone and network, among other variables.

In this analysis, they found that tumors in long-term cell phone users did occur more often in locations with higher exposure from cell phones, Cardis said.

The current study considered the entire phone as a source of exposure, since many phones have an integrated antenna, and therefore measured the distance of tumors from any point on the phone.

This definition of exposure "is overly simplistic, in my opinion," Cardis said in an email, because previous studies have found that the most exposed area is generally located around the ear.

"I expect there is substantial misclassification of exposure in the analyses published in the American Journal of Epidemiology, and hence it is not possible to draw conclusions about the presence or absence of a risk," she concluded.

Source: http://bit.ly/iE0l3x

American Journal of Epidemiology, online May 24, 2011.

Weighing cancer risks, from cellphones to coffee

By Marilynn Marchione

AP Medical Writer

The Associated Press

Wednesday, June 15, 2011

You're sitting in a freshly drywalled house, drinking coffee from a plastic foam cup and talking on a cellphone. Which of these is most likely to be a cancer risk?

It might be the sitting, especially if you do that a lot.

Despite all the recent news about possible cancer risks from cellphones, coffee, styrene, and formaldehyde in building materials, most of us probably face little if any danger from these things with ordinary use, health experts say. Inactivity and obesity may pose a greater cancer risk than chemicals for some people.

"We are being bombarded" with messages about the dangers posed by common things in our lives, yet most exposures "are not at a level that are going to cause cancer," said Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer.

Linda Birnbaum agrees. She is a toxicologist who heads the government agency that just declared styrene, an ingredient in fiberglass boats and Styrofoam, a likely cancer risk.

"Let me put your mind at ease right away about Styrofoam," she said. Levels of styrene that leach from food containers "are hundreds if not thousands of times lower than have occurred in the occupational setting," where the chemical in vapor form poses a possible risk to workers. "In finished products, certainly styrene is not an issue," and exposure to it from riding in a boat "is infinitesimal," she said.

Carcinogens are things that can cause cancer, but that label doesn't mean that they will or that they pose a risk to anyone exposed to them in any amount at any time.

They have been in the news because two groups that periodically convene scientists to decide whether something is a carcinogen issued new reports.

Last month, the International Agency for Research on Cancer, part of the World Health Organization, said there is a possibility cellphones raise the risk of brain tumors.

"The operative word is `possibility,'" said Lichtenfeld, who among others has pointed out the thin evidence for this and the fact that cancer rates have not risen since cellphones came out.

Last week, the National Toxicology Program, part of the National Institute of Environmental Health Sciences — both of which Birnbaum heads — issued its report.

It adds to the list of known carcinogens formaldehyde, which is in building materials and some hair-straightening products, though Birnbaum said on-the-job exposure is the main concern. The list also adds a plant substance in some "natural" arthritis remedies, aristolochic acid. Six other things were dubbed "reasonably anticipated" to be carcinogens, including styrene and another herbal medicine ingredient, riddelliine (rih-DELL-een).

Since 1971, the international cancer agency has evaluated more than 900 substances. Just over 100 have been deemed carcinogens, 59 are called probable carcinogens, and 266 others are possible ones.

In this last category of possibles — besides the electromagnetic energy from cellphones — are coffee, engine exhaust and talc-based body powder. Talc in its natural form may contain asbestos, though products sold for home use since the 1970s have been asbestos-free. Again, most risk is thought to involve occupational or unusual exposure to natural talc.

The evidence on coffee has gone back and forth for years, with no clear sign of danger and some suggestions of benefit.

However, known carcinogens include alcoholic beverages, estrogen treatments for menopause symptoms, birth control pills, certain viruses and parasites, and even some drugs used to treat cancer, such as cyclophosphamide and tamoxifen.

"Most people would probably be shocked to see the number of things they interact with every day" on these lists, Lichtenfeld said.

Here's the problem: The agencies that pass judgment on a carcinogen don't regulate it or determine what levels or routes of exposure are a concern and for whom.

"People immediately assume it's going to cause cancer at any exposure level, and that's simply not true," said A. Wallace Hayes, editor of the scientific journal Food and Chemical Toxicology, and an industry consultant.

The rule is "RITE" — Risk Is equal to Toxicity times Exposure — and "they've left out half of the equation" by not saying how much exposure is a concern, Hayes said.

"The organizations that list these substances as possibly carcinogenic have to be conservative. That means if there's any reasonable evidence, way before it's a sure thing, they have to say, `Let's be cautious.' That's their job — to raise the flag," said David Ropeik, a consultant and author of "How Risky Is It Really? Why Our Fears Don't Always Match the Facts."

It's human nature to fear risks we didn't choose, such as hazardous chemicals, more than those we did, such as lack of exercise, poor diets or smoking, he said.

"A risk that is imposed on us scares us more than a risk we take voluntarily," especially if it comes from companies we don't trust, Ropeik said.

Styrene is an example: The government says it is a component of tobacco smoke and that is the biggest way most people are exposed to it. Smoking, of course, is the most easily preventable cancer risk.

To minimize risk, people can take reasonable measures to avoid exposure to possibly harmful things, experts say.

"If you walk into a room and you can smell formaldehyde, you probably want to vent the room before you spend a lot of time in it. That's just common sense," Birnbaum said.

If you're concerned about pesticides, you can peel fruit and vegetables or choose organics, though there is some evidence that organic products may be less safe in terms of germs like E. coli and salmonella.

People worried about cellphones can hold them farther from the head, text-message instead of talk, or use a headset or earpiece as Lichtenfeld does. He was returning from a major cancer conference in Chicago last week when a fellow traveler pointed at Lichtenfeld's Bluetooth earpiece and said, "Do you know that thing can cause cancer?"

"I said, `Yes, ma'am, I'm very familiar with the data and I choose to use Bluetooth,'" said Lichtenfeld, who didn't tell her he was one of the biggest cancer experts she'd ever meet.

"You can't live life in fear," he said. "You have to live life."

Online:

Carcinogens: http://bit.ly/aJI6ht

IARC: http://monographs.iarc.fr/index.php

NIH: http://ntp.niehs.nih.gov/go/roc12

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Study Hints at Antibiotic Overuse in Home-Care Patients

ScienceDaily

Wednesday, June 15, 2011

ScienceDaily (June 15, 2011) — A study of Canadian home-care patients suggests doctors may be over-prescribing antibiotics for patients receiving ongoing medical care at home. The study, published in the June issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, suggests that more should be done to monitor antibiotic use in home-care patients to avoid misuse that could decrease the efficacy of the drugs over time.

According to the study, led by researchers from McMaster University in Ontario, antibiotic prescriptions for home-care patients are quite common, with more than 6,800 patients receiving the drugs. Additionally, medical data on the patients reveal disturbing prescribing patterns, says Dr. Mark Loeb, one of the study's authors.

For instance, patients under the age of 65 were substantially more likely to receive antibiotics. That finding suggests that "physicians may be overly cautious with younger patients," Loeb said. In contrast, patients with longer life expectancies were less likely to receive antibiotics, despite the fact they would likely benefit more from the drugs compared to patients with poorer life expectancies.

"Taken together, our results reveal tremendous variability in how and why antibiotics are prescribed, and that overuse in the home-care population is likely," Loeb said. "Younger and sicker patients seem to be at added risk for misuse and should be the focus of further study to assess the appropriateness of antibiotic use at home."

Adding concern was the fact that the most common class of antibiotics prescribed in the study was fluoroquinolones, a class of drugs often associated with increased rates of resistance. Overuse of these drugs could weaken their efficacy, threatening their effectiveness against these and other emerging infections.

The researchers used data on more than 125,000 patients receiving home care for more than 60 days from 2006 to 2007. Medical data were collected by nurses through observation, client and family self-reports, and other medical records.

As the threat of drug resistant infections has increased in recent years, much work has been done to identify settings in which antibiotics may be over-prescribed. However, before this study very little was known about antibiotics in the home care population, the researchers say.

"Our results illustrate the importance of continuing to monitor antibiotic use in home-care patients, and the need for more effective methods of diagnosis that allow for appropriate antibiotic use," Loeb said. Antibiotic use studies are critical to understanding the basic science of how and why resistance is on the rise.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

Dominik Mertz, Erin Y. Tjam, Jeff Poss, John P. Hirdes, Bruce Arai, Jennie Johnstone, Micaela Jantzi, and Mark Loeb. Prevalence and predictors of antibiotic use in community-based elderly in Ontario, Canada. Infection Control and Hospital Epidemiology, 32:6

Proper Bowel Prep Key to Effective Colon Cancer Screening: Study

HealthDay News

Wednesday, June 15, 2011

WEDNESDAY, June 15 (HealthDay News) -- Inadequate bowel-cleansing before a colonoscopy can result in high miss rates for precancerous polyps (adenomas) and a need for earlier repeat tests, a new study finds.

"Our findings of a miss rate of 42 percent for all adenomas and 27 percent for advanced adenomas suggest that suboptimal bowel preparation has a substantial harmful impact on the effectiveness of colonoscopy, and follow-up examination within one year should be considered," said study lead author Dr. Benjamin Lebwohl of Columbia University Medical Center in New York City.

Since colorectal cancer develops slowly over time, effective screening and early detection of the disease is key to a patient's survival. Colonoscopy screening enables doctors to identify and remove precancerous polyps (small growths in the colon) before they turn into cancer. In order for this procedure to be effective, however, patients' bowels must be thoroughly cleansed so that doctors can spot any abnormalities.

The success of the bowel "prep" depends largely on individual patients, who have to carefully follow instructions about taking medication at home in liquid or tablet form that causes diarrhea, thereby emptying the colon.

This preparation takes an average of 16.5 hours, according to a Harvard Medical School guide to the procedure, and may involve consuming up to a gallon of an oral solution containing the medication the day before the colonoscopy (while consuming only clear liquids during that day), avoiding nuts, seeds and insoluble fiber up to three days before the procedure, and fasting for six hours or more in preparation for it.

In conducting the study, published in the June issue of GIE: Gastrointestinal Endoscopy, researchers reviewed the bowel preparation quality of 12,787 patients who underwent colonoscopy at Columbia over the course of roughly two years. They found preparation quality was either poor or fair for 24 percent, or about 3,000, of those patients.

Among those with inadequate bowel preparation, 17 percent needed a repeat colonoscopy within three years. The repeat procedures (with proper bowel preparation) uncovered 198 precancerous polyps. Of those polyps, 83 were only spotted during the follow-up colonoscopy -- revealing a miss rate of 42 percent.

For the colonoscopies repeated in less than one year, the miss rate for adenomas was 35 percent and for advanced adenomas, 36 percent, the researchers said.

The findings suggest that the success of colorectal cancer screening programs hinges on proper testing techniques, including bowel preparation, the researchers said in a news release from the American Society for Gastrointestinal Endoscopy.

Current guidelines that specify recommended intervals between colonoscopies presume optimal bowel preparation, the study authors said in the news release. In cases of insufficient bowel cleansing, the decision of when to repeat the test is left to the individual physicians doing the colonoscopies.

Repeating tests at more frequent intervals increases the overall cost of colonoscopy, they added.

More information

The U.S. National Digestive Diseases Information Clearinghouse provides more information on colonoscopy and how it is performed.

New Strategy to Attack Tumor-Feeding Blood Vessels

ScienceDaily

Wednesday, June 15, 2011

ScienceDaily (June 15, 2011) — Scientists at the Walter and Eliza Hall Institute have discovered a key molecule needed to kill the blood vessels that supply tumours.

The research team from the institute's Molecular Genetics of Cancer and Cancer and Haematology divisions found that for anti-cancer therapies that target tumour blood vessels to work the death- inducing molecule Bim is required. The finding could lead to improved anti-cancer treatments that are based on a two- or three-pronged attack on both the tumour and its blood supply. The research will be published online in the Journal of Experimental Medicine.

The growth of solid tumours, such as lung cancer, breast cancer and melanoma, depends on nutrients and oxygen being provided by the tumour blood supply. Cancer cells encourage the growth of blood vessels to feed a tumour by producing the hormone-like protein, vascular endothelial growth factor (VEGF). The research by Drs Edwina Naik, Leigh Coultas and Lorraine O'Reilly, and Professors Jerry Adams and Andreas Strasser showed that VEGF produced by tumours blocks production of Bim in the cells that line the tumour blood vessels.

New 'anti-angiogenic' medications that attack the blood vessels within tumours are showing promise in starving many types of cancers by reducing their blood supply.

In this study, in experimental melanoma, lung cancer and breast cancer models, Bim levels increased in the cells lining the blood vessels when VEGF was depleted by anti-angiogenic drugs, ultimately killing the blood vessel cells. VEGF depletion reduced the number of blood vessels in tumours, making the tumours shrink. However, in mice in which the blood vessels do not express Bim, VEGF depletion did not affect the number of tumour-associated blood vessels, and tumours grown in Bim-deficient mice did not respond to anti-angiogenic treatments.

Dr Strasser said this finding suggests that strategies for treating tumours by attacking the tumour blood supply could be optimised by incorporating drugs called BH3-mimetics that cause cell death by acting like Bim at a molecular level. "Similarly, therapies that increase the amount of Bim in tumour blood vessels could enhance the effects of anti-angiogenic agents," Dr Strasser said.

"BH3 mimetics may have two beneficial effects in cancer therapy. Our previous research had showed they can directly trigger death in tumour cells, particularly when the tumour is also attacked by chemotherapeutic drugs. We now think BH3-mimetics could also impact tumour cells indirectly by killing endothelial cells within tumours.

"This suggests that a promising new approach to the therapy of solid tumours may be to use a three-medication combination of a drug that specifically targets the tumour cell, an anti- angiogenic agent to impair the tumour blood vessels, plus a BH3 mimetic that will help the anti- tumour drug to directly kill the tumour cells and also will help the anti-angiogenic agent to kill the intra-tumoral endothelial cells, which in turn will starve the tumour, causing even more tumour cell death."

The research was supported by the Cancer Council Victoria, the National Health and Medical Research Council, the Australian Research Council, the US National Institutes of Health, the Leukemia and Lymphoma Society and Genentech.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

Edwina Naik, Lorraine A. O'Reilly, Marie-Liesse Asselin-Labat, Delphine Merino, Ann Lin, Michele Cook, Leigh Coultas, Philippe Bouillet, Jerry M. Adams, Andreas Strasser. Destruction of tumor vasculature and abated tumor growth upon VEGF blockade is driven by proapoptotic protein Bim in endothelial cells. Journal of Experimental Medicine, 2011; DOI: 10.1084/jem.20100951

Tuesday, June 14, 2011

Low-Carbohydrate, High-Protein Diets May Reduce Both Tumor Growth Rates and Cancer Risk

ScienceDaily

Tuesday, June 14, 2011

ScienceDaily (June 14, 2011) — Eating a low-carbohydrate, high-protein diet may reduce the risk of cancer and slow the growth of tumors already present, according to a study published in Cancer Research, a journal of the American Association for Cancer Research.

The study was conducted in mice, but the scientists involved agree that the strong biological findings are definitive enough that an effect in humans can be considered.

"This shows that something as simple as a change in diet can have an impact on cancer risk," said lead researcher Gerald Krystal, Ph.D., a distinguished scientist at the British Columbia Cancer Research Centre.

Cancer Research editor-in-chief George Prendergast, Ph.D., CEO of the Lankenau Institute for Medical Research, agreed. "Many cancer patients are interested in making changes in areas that they can control, and this study definitely lends credence to the idea that a change in diet can be beneficial," said Prendergast, who was not involved with the study.

Krystal and his colleagues implanted various strains of mice with human tumor cells or with mouse tumor cells and assigned them to one of two diets. The first diet, a typical Western diet, contained about 55 percent carbohydrate, 23 percent protein and 22 percent fat. The second, which is somewhat like a South Beach diet but higher in protein, contained 15 percent carbohydrate, 58 percent protein and 26 percent fat. They found that the tumor cells grew consistently slower on the second diet.

As well, mice genetically predisposed to breast cancer were put on these two diets and almost half of them on the Western diet developed breast cancer within their first year of life while none on the low-carbohydrate, high-protein diet did. Interestingly, only one on the Western diet reached a normal life span (approximately 2 years), with 70 percent of them dying from cancer while only 30 percent of those on the low-carbohydrate diet developed cancer and more than half these mice reached or exceeded their normal life span.

Krystal and colleagues also tested the effect of an mTOR inhibitor, which inhibits cell growth, and a COX-2 inhibitor, which reduces inflammation, on tumor development, and found these agents had an additive effect in the mice fed the low-carbohydrate, high-protein diet.

When asked to speculate on the biological mechanism, Krystal said that tumor cells, unlike normal cells, need significantly more glucose to grow and thrive. Restricting carbohydrate intake can significantly limit blood glucose and insulin, a hormone that has been shown in many independent studies to promote tumor growth in both humans and mice.

Furthermore, a low-carbohydrate, high-protein diet has the potential to both boost the ability of the immune system to kill cancer cells and prevent obesity, which leads to chronic inflammation and cancer.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

V. W. Ho, K. Leung, A. Hsu, B. Luk, J. Lai, S. Y. Shen, A. I. Minchinton, D. Waterhouse, M. B. Bally, W. Lin, B. H. Nelson, L. M. Sly, G. Krystal. A Low Carbohydrate, High Protein Diet Slows Tumor Growth and Prevents Cancer Initiation. Cancer Research, 2011; DOI: 10.1158/0008-5472.CAN-10-3973

Prenatal pesticide exposure tied to birth size

Reuters Health

Tuesday, June 14, 2011

NEW YORK (Reuters Health) – Exposure to even moderate amounts of certain pesticides during pregnancy may affect infants' birth size, a new study suggests.

Researchers found that among nearly 500 newborns whose umbilical cord blood was tested for pesticide residues, those with higher levels tended to be smaller at birth.

The chemicals in question include DDT and three other organochlorines -- an older group of pesticides that are now banned or restricted in the U.S. and other developed countries, after research linked them to cancer and other potential health risks.

However, the pesticides persist in the environment for years. In the U.S., diet is the main potential source of exposure, according to the Centers for Disease Control and Prevention (CDC) -- with fatty foods, like dairy products and oily fish, topping the list.

In the new study, researchers found that for each 10-fold increase in any of the four pesticides in newborns' cord blood, birth weight dipped by roughly 2 to 4 ounces.

Higher levels of DDT were also linked to a decrease in head circumference, while another pesticide -- hexachlorobenzene (HCB), once used as a fungicide -- was tied to a shorter birth length.

The findings, reported in the journal Pediatrics, do not prove that the pesticides themselves hindered fetal growth.

One problem, the researchers say, is that people are exposed to a "huge variety of chemicals" -- in the environment, household products and food, for example.

So higher pesticide levels could simply be a marker of higher chemical exposures in general.

In addition, past studies on pesticides and birth size have come to conflicting conclusions, write the researchers, led by Maria-Jose Lopez-Espinosa of the Center for Public Health Research in Valencia, Spain.

Still, they say their findings raise concerns, especially since women in the study appeared to have relatively moderate exposure to pesticides during pregnancy. So the link between pesticides and infants' birth size does not reflect "extreme" exposures, the researchers write.

The findings are based on 494 infants born in Valencia between 2003 and 2006.

When the researchers looked at newborns whose DDT level was above the median, or midpoint, for the group, they found that the infants' head circumference was 0.1 inches smaller versus infants with DDT levels below the median.

When it came to HCB, each 10-fold increase in cord-blood levels was linked to a 0.2-inch decrease in birth length.

All four pesticides were tied to decreases in birth weight. The other two pesticides were DDE (a compound related to DDT) and beta-hexachlorocyclohexane.

While it's not clear that the pesticides are the cause of the birth size differences, it is plausible, according to Lopez-Espinosa's team. The chemicals are thought to interfere with thyroid hormones, which play an important role in growth and development.

According to the CDC, Americans' blood levels of organochlorine pesticides are much lower now than 30 years ago.

In a 2003-2004 government study, most Americans had no detectable amount of DDT and about half had no detectable beta-HCH. On the other hand, most did have detectable DDE -- which remains in the body longer than DDT -- as well as HCB.

Source: http://bit.ly/m7leXR

Pediatrics, online June 13, 2011. 

COPD mist inhaler may increase risk of death: study

By Julie Steenhuysen

Reuters

Tuesday, June 14, 2011

CHICAGO (Reuters) – A mist inhaler used to improve breathing in people with lung diseases including chronic bronchitis and emphysema may increase their risk of dying by 52 percent, U.S. and British researchers said on Tuesday.

The increased risk occurred in patients who used the Spiriva Respimat inhaler, a newer device made by privately held Boehringer Ingelheim. It delivers a soluble form of Spiriva, known generically as tiotropium.

The inhaler is used to treat Chronic Obstructive Pulmonary Disease or COPD, the fourth-leading cause of death worldwide, which includes the chronic lung diseases emphysema and bronchitis. COPD is usually due to decades of smoking.

"What we think is going on is that the mist inhaler is delivering a higher concentration of tiotropium than it should be and that may be increasing the risk of death," Dr. Sonal Singh of Johns Hopkins University School of Medicine, who led the study, said in a statement.

The inhaler recently won approval for use in Britain and Europe, but failed to win a nod from the U.S. Food and Drug Administration, which noted an excess number of deaths in a study of 17,000 patients. Instead, the FDA said it wanted more proof the inhaler was safe.

The new study, published in the British Medical Journal, is based on an analysis of data from five clinical trials involving 6,500 people.

It found that the risk of death in patients using the tiotropium Respimat inhaler was 52 percent higher than patients who used a placebo.

"We estimate that there will be one additional death for every 124 patients treated for a year with tiotropium Respimat," Dr. Yoon Loke of Norwich Medical School at the University of East Anglia, who worked on the study, said in a statement.

He said some of the added risk stems from patients dying of heart trouble, especially for those with existing heart problems that may be made worse with use of the product.

Most COPD sufferers use inhalers to help them breathe and more than half a million prescriptions for tiotropium inhalers were issued in the United Kingdom last year.

(Editing by Eric Walsh)

Seizure drugs tied to pregnancy risks

By Eric Schultz

Reuters Health

Tuesday, June 14, 2011

NEW YORK (Reuters Health) – New research on the links between seizure medication and pregnancy complications highlights the hard choices that pregnant women with epilepsy must make.

Scientists from the University of Bergen in Norway found that women with epilepsy are more likely to have pregnancy complications, and that the added risks were largely "associated with the use of anti-epileptic drugs in pregnancy."

Women who suffer from epilepsy, a brain disorder that involves periodic seizures, face especially difficult decisions about how to treat their condition while pregnant.

Previous research suggests that seizures during pregnancy can harm both mother and child. To prevent seizures, physicians often advise expectant mothers to continue taking their seizure medication.

To assess the range of risks to epileptic mothers and their babies, the authors compared medical records covering the pregnancies of nearly 200 women with epilepsy to those of the same number of women without epilepsy. They also looked at differences between the epileptic women who were taking seizure medications and those who were not.

Overall, epileptic women were more than twice as likely as women without epilepsy to experience preeclampsia -- and four times more likely to have a severe case.

Preeclampsia is characterized by high blood pressure and protein buildup in the urine, and severe preeclampsia is a serious condition that can lead to the death of both mother and child.

Women with epilepsy were also at higher risk for vaginal bleeding early in pregnancy (3.8 times more likely than non-epileptic women), of needing a Cesarean section or induced labor (1.8 times), of giving birth prematurely (nearly 6 times), and of having a baby with malformations (6.5 times the risk of women without epilepsy).

When the researchers analyzed pregnancy risks among just the women with epilepsy, those who were not taking seizure medications had similar risks for some complications -- bleeding and induced or cesarean birth -- as women without epilepsy.

Women taking seizure medications still had the raised risks for all complications.

Nearly 8 percent of women who took epilepsy medication suffered from severe preeclampsia, compared to just under 3 percent of women with epilepsy who did not take medication.

Women who took seizure drugs were also more than twice as likely to have labor induced and emergency Cesarean sections as epileptic women who did not take the medication.

The study does not prove that seizure medications caused the complications. Women who took medication could be different from the women who were not on medication in other ways, for instance.

These results don't mean women with epilepsy should stop taking their medications while pregnant, said the study's lead author, Dr. Ingrid Borthen. The apparent risks from taking epilepsy medication don't outweigh the known potential costs of suffering seizures during pregnancy, she told Reuters Health.

"The overall risk (of complications associated with medication) is low, and it is important to continue the medications during pregnancy to avoid seizures," Borthen said.

Dr. Autumn Klein, a neurologist at Brigham and Women's Hospital in Boston who was not involved in the study, agrees. "It's best to treat them with medications, because convulsions can be dangerous to the mom and the baby," Klein told Reuters Health.

Given the risks that women with epilepsy face during pregnancy, Klein believes that physicians "really need to pay close attention to these patients from an obstetric standpoint and an epilepsy standpoint. Problems come up when patients don't follow up with their physicians."

Klein advises that women with epilepsy visit their neurologists and obstetricians before and during pregnancy to minimize the risk of complications, and encourages specialists to cooperate and communicate in the care of these high-risk patients.

Source: http://bit.ly/jwca8i,

BJOG: An International Journal of Obstetrics and Gynaecology, July 2011.

Good Sleep Raises Quality of Life, Lowers Depression

HealthDay News

Tuesday, June 14, 2011 

TUESDAY, June 14 (HealthDay News) -- People who get six to nine hours of sleep each night rate their quality of life higher and are less likely to feel depressed than those who sleep less, according to a new study.

But, sleeping more than nine hours each night is ill-advised, the researchers found.

The study examined the records of 10,654 patients, who were about age 52 on average, over a two-year period. After accounting for differences in the participants' age, gender, race and marital status, researchers gathered information on their quality of life, feelings of depression and sleep duration.

Among the findings, slated for presentation Tuesday at a meeting of the Associated Professional Sleep Societies in Minneapolis, those with a "normal" night's sleep of six to nine hours reported high scores for quality of life and lower scores for depression severity, compared to short sleepers (fewer than six hours of sleep) and long sleepers (more than nine hours of sleep).

"These results are important because they provide more information about the importance of getting enough sleep, which is usually six to nine hours per night," the study's principal investigator, Dr. Charles Bae, neurologist at the Cleveland Clinic Sleep Disorders Center in Ohio, said in a news release from the American Academy of Sleep Medicine.

"People may already expect that their quality of life could be decreased when they do not get enough sleep, but they may not realize that sleeping too much can also have a negative impact," Bae said.

Although sleep needs vary from person to person, most people require seven to eight hours of sleep each night to feel alert and well-rested during the day, according to the news release.

Because the study is to be presented in a meeting, the findings should be considered preliminary until published in a peer-reviewed journal.

More information

The National Sleep Foundation provides more on sleep and depression.

TV time tied to diabetes, death

By Alison McCook

Reuters Health

Tuesday, June 14, 2011 

NEW YORK (Reuters Health) – People who log more hours in front of the television are at greater risk of dying, or developing diabetes and heart disease, a new study suggests.

"The message is simple," study author Dr. Frank Hu at the Harvard School of Public Health told Reuters Health. "Cutting back on TV watching is an important way to reduce sedentary behaviors and decrease risk of diabetes and heart disease."

Every day, Americans spend an average of 5 hours watching television while Australians and some Europeans log 3.5 to 4 hours a day, the researchers note.

People who sit in front of the TV are not only not exercising, they are likely eating unhealthy foods, Hu explained. "The combination of a sedentary lifestyle, unhealthy diet, and obesity creates a 'perfect breeding ground' for type 2 diabetes and heart disease."

This is not the first study to associate TV time with ill effects -- many studies have found a strong link to obesity, and one 2007 report found that more TV time was associated with higher blood pressure in obese children. Another study that same year found that overweight kids who watch food advertisements tend to double their food intake.

For the new study, published in the Journal of the American Medical Association, Hu and his team reviewed previous research that had examined the link between TV time and diseases such as type 2 diabetes, the form of the disease closely associated with obesity.

In the end, their analysis included 8 studies that followed more than 200,000 people for an average of 7 to 10 years.

Hu and his team found that for every 2 hours of daily television people watched, their risk of diabetes increased by 20 percent, while their risk of heart disease rose by 15 percent. Each 2 hours of television per day increased the risk of dying by 13 percent.

Based on those results, the researchers estimated that, among a group of 100,000 people, reducing daily TV time by 2 hours could prevent 176 new cases of diabetes, 38 cases of fatal cardiovascular disease, and 104 premature deaths -- every year.

All of the included studies ensured that participants did not have a chronic disease -- because people who were generally sicker might be more likely both to watch many hours of TV and to experience diabetes, heart disease, or premature death.

But, Hu and his colleagues caution, it remains possible that some people had undetected forms of disease at the outset of the studies, which could influence the findings.

The study cannot prove that TV watching, per se, causes the increased risk for disease. Nor can it identify what, exactly, about TV watching might influence disease risk.

"It's true that people who watch a lot of TV differ from those who watch less, especially in terms of diet and physical activity levels," Hu noted. People who watch a lot of TV are more likely to eat junk foods, he explained, but unhealthy diet and inactivity are also consequences of prolonged TV watching, so they explain some of the adverse effects of the sedentary behavior.

"'Couch potatoes' are more likely to get type 2 diabetes and heart disease, and more likely to die of chronic diseases," said Hu.

"I'm sure we've all unintentionally lost evenings slumped on the sofa in front of the TV snacking on crisps and biscuits and drinking sugary drinks or alcohol," said Maureen Talbot, a senior cardiac nurse with the British Heart Foundation who was not involved in the study. "But it's important that this doesn't become a regular activity."

"We should try to be selective in how much time we spend watching the TV, and try to be more physically active instead," said Talbot in a statement responding to the new findings. "We need 30 minutes of physical activity at least five days a week to keep our hearts healthy, so why not take a walk after work, join a sports team or even just get out for a bit of gardening in the evenings. It's bound to be a lot more rewarding than staring at the box."

Source: http://bit.ly/4HWZ7

Journal of the American Medical Association, June 15, 2011.

Ovarian Cancer Cells Bully Their Way Through Tissue

ScienceDaily

Tuesday, June 14, 2011

ScienceDaily (June 14, 2011) — A team led by Joan Brugge, the Louise Foote Pfeiffer Professor of Cell Biology at Harvard Medical School, recently shed light on how ovarian cancer spreads. In a paper published in the July edition of the journal Cancer Discovery, the newest journal of the American Association for Cancer Research, Brugge and colleagues found that ovarian cancer cells act like bullies, using brute force to plow their way through tissue and colonize additional organs.

"This is the first time that mechanical force has been implicated in the spread of ovarian cancer," says Brugge, who is also chair of the Department of Cell Biology. "While this research is still preliminary, we are building a foundation for the development of treatments based on a robust understanding of the disease."

According to the National Cancer Institute, ovarian cancer accounts for about three percent of all cancers among women in the United States. It caused nearly 14,000 deaths in 2010 alone.

The ovaries and many other organs, such as the liver, stomach and intestines, are located in an anatomical space called the peritoneal cavity. The lining of this cavity is called the peritoneum, and its top layer is called the mesothelium. After an ovarian tumor develops, clusters of cancer cells are released into the peritoneal cavity. Each cluster floats around until it encounters the lining of the cavity. It attaches to the lining, spreads out and launches an invasion into the mesothelium. Brugge's team determined how ovarian cancer cells get through the mesothelium to colonize organs on the other side.

When researchers placed ovarian cancer cells and mesothelial cells together in a dish, the cancer cells formed a hole in the mesothelial layer, mirroring behavior that would occur in the body as an invasion proceeds. The team interfered with molecular components of the cancer cells one by one and used time-lapse microscopy to watch the result. If the hole failed to form, the researchers knew that they'd discovered a critical player in the invasion process.

They identified three such players -- integrin, talin and myosin, which are all proteins known to play a role in cell movement. Integrin sticks out from the cancer cells and grabs hold of scaffolding surrounding the mesothelium. Myosin, which is a motor, pulls on integrin via talin. As a result, the protruding cancer cells gain traction and can now force mesothelial cells out of the way.

"The cancer cells act like bullies," says first author Marcin Iwanicki, a postdoctoral researcher in Brugge's lab. "Instead of relying on a sophisticated biochemical process to achieve their goal, they simply push mesothelial cells apart."

"Eventually, it might be possible to prevent or reverse the invasion process," says Brugge. "We hope that our work will inform such treatments in the future."

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Journal Reference:

Marcin P. Iwanicki, Rachel A. Davidowitz, Mei Rosa Ng, Achim Besser, Taru Muranen, Melissa Merritt, Gaudenz Danuser, Tan Ince, and Joan S. Brugge. Ovarian Cancer Spheroids Use Myosin-Generated Force to Clear the Mesothelium. Cancer Discovery, 2011; DOI: 10.1158/2159-8274.CD-11-0010

Monday, June 13, 2011

Breastfeeding linked to lower risk of SIDS

By Genevra Pittman

Reuters Health

Monday, June 13, 2011

NEW YORK (Reuters Health) - Babies who are breastfed – especially those only fed breast milk, and not formula as well - are less likely to die of sudden infant death syndrome, or SIDS, suggests a new analysis of past studies.

While the findings can't prove that breastfeeding causes the lower risk of SIDS, the authors write in Pediatrics that other explanations seem unlikely.

"Breastfeeding is the best method of feeding infants," said Dr. Fern Hauck, the study's lead author from the University of Virginia School of Medicine in Charlottesville.

SIDS, also known as "crib death," is defined as a sudden and unexplained death - usually during sleep -- in a baby less than one year old. It's most common in infants between two and four months old, according to the National Institutes of Health, and kills about 2,500 infants in the U.S. each year.

Researchers aren't sure what causes SIDS, but they known that African American and male babies are more likely to die from SIDS, and that parents can cut down on their baby's risk by making sure infants sleep on their backs and don't get too hot.

One theory for the cause of SIDS, said Hauck, is that it happens in babies sleeping with their faces down or heads covered who don't turn their heads or cry like most babies would, and slowly suffocate.

Breastfeeding could be linked to SIDS because it protects infants against minor infections that have also been shown to make sudden death more likely, the authors note. The World Health Organization, among other medical groups, recommends that mothers breastfeed their babies for the first six months of life.

In the new review, Hauck and her colleagues combined data from 18 studies that asked mothers of infants who had or hadn't died of SIDS about whether they breastfed the infants.

Combining the results, the researchers found that the rate of SIDS was 60 percent lower among infants who had any amount of breastfeeding compared to those who didn't breastfeed, and more than 70 percent lower in infants that been breastfed exclusively - without any formula - for any period of time.

That led the authors to conclude that any breastfeeding helps protect a baby against sudden death.

They note, however, that more research is needed to see if the duration of breastfeeding affects the risk of SIDS - specifically, if babies who are breastfed for longer get more protection that those who are only breastfed for a short time after birth.

The analysis doesn't definitively show that there's a cause and effect relationship between breastfeeding and SIDS risk, but Hauck said she is "fairly confident" that's the case.

"We found a protective effect even after controlling for factors that could explain the association," Hauck said. For example, the link remained even when the authors took into account the fact that women who smoke cigarettes are less likely to breastfeed, and also may be more likely to have an infant die from SIDS.

Hauck added that along with breastfeeding, babies who sleep in the same room as their parents - but not in the parents' bed - and those who use a pacifier while sleeping also have a smaller risk of sudden death.

The findings, the authors write, underscore the importance of promoting the positive effects of breastfeeding for both moms and babies.

Source: http://bit.ly/kSEGVh

Pediatrics, online June 13, 2011.

Medical Groups Update Heart, Blood Pressure Care Guidelines

HealthDay News

Monday, June 13, 2011

MONDAY, June 13 (HealthDay News) -- Patient-focused outcomes are emphasized in 10 updated performance measures for people with coronary artery disease and hypertension that were released Monday by a trio of major U.S. medical groups.

"These measures are primarily intended for the use of individual practitioners and group practices in their efforts to improve the care of patients with hypertension and those with stable coronary disease," Dr. Joseph Drozda Jr., director of outcomes research at Sisters of Mercy Health System in St. Louis, Mo., and co-chairman of the writing committee for the new measures, said in an American College of Cardiology news release.

"By adhering to the specifications called for in this measures set, entities operating such accountability programs can be assured of having high quality and clinically meaningful measures," he added.

The measures were released by the American College of Cardiology Foundation, the American Heart Association and the American Medical Association-convened Physician Consortium for Performance Improvement.

The coronary artery disease measures include:

Blood pressure control: Adults should obtain a blood pressure of less than 140/90 mm Hg. If that target cannot be reached, at least two antihypertensive medications should be prescribed.

Lipid control: Patients should achieve an LDL ("bad") cholesterol level of less than 100 mg/dL. If they can't reach that target, their doctor should document a plan of care to lower their LDL level, which includes at minimum the prescription of a statin.

Symptom and activity assessment: Doctors should evaluate patients' activity levels and the corresponding presence or absence of angina symptoms. Angina is chest pain or discomfort that occurs when the heart does not get enough blood.

Symptom management: For someone with angina, a doctor should document a plan of care to manage symptoms.

Tobacco use: Patients should be screened for tobacco use and should receive tobacco-cessation counseling, if needed.

Antiplatelet therapy: Physicians should prescribe aspirin or clopidogrel.

Beta-blocker therapy: It should be prescribed for people with prior myocardial infarction or a left ventricular ejection fraction of less than 40 percent.

ACE inhibitor/ARB therapy: This should be prescribed for people with diabetes or a left ventricular ejection fraction of less than 40 percent.

Cardiac rehabilitation referral: Early referrals should be made for people who've had an acute heart attack, coronary artery bypass graft surgery, stenting, cardiac valve surgery or a heart transplant.

In the area of hypertension, the new measures include:

Blood pressure control: Patients should have a blood pressure of less than 140/90 mm Hg. If their blood pressure is higher, at least two antihypertensive medications should be prescribed.

"This report represents an update and revision of guidelines last published in 2005" and "clearly outlines what is appropriate care for patients with coronary artery disease and/or hypertension," said Dr. Louis Evan Teichholz, chief of cardiology and medical director of cardiac services at Hackensack University Medical Center in New Jersey. "A significant change is the addition of cardiac rehabilitation referral from an outpatient setting."

Although the blood pressure and lipid guidelines have not changed much, he said, both are "in the midst of revision and new recommendations will be available late in 2011 or early 2012."

More information

The U.S. National Heart, Lung, and Blood Institute has more about coronary heart disease.

Protein linked with rare disease plays role in aging

By Julie Steenhuysen

Reuters

Monday, June 13, 2011

CHICAGO (Reuters) – The same mechanism that causes children with a rare genetic disease called progeria to age at seven times the normal rate may play a role in normal aging as well, government researchers said on Monday.

The study led by Dr. Francis Collins, director of the National Institutes of Health, suggests aging may not simply be a gradual wearing out of cells.

Instead, it may be an active biological mechanism -- one that might be tinkered with to address age-related diseases.

"I think a lot of people in the past have assumed that the aging of cells and of individuals was just a matter of everything running down," Collins told Reuters in a telephone interview.

"What we are learning at the cellular level ... is that is not right," said Collins, whose study appears in the Journal of Clinical Investigation.

Scientists for several years have been working to understand the key biological processes that trigger aging in hopes of discovering new drugs that could delay or prevent age-related diseases such as cancer, heart disease and Alzheimer's disease.

Much of that has been focused on studying protective caps on the tips of chromosomes called telomeres, which Collins likens to "the aglets on shoelaces that keep the laces from them from getting ratty."

When telomeres become too short and frayed through cell division, the cell eventually dies. But it has not been entirely clear how this comes about.

Based on the study by Collins and colleagues at the National Human Genome Research Institute, it now appears that the same toxic protein that drives the premature aging disorder progeria plays a key role in normal cell aging, Collins said.

Formally known as known as Hutchinson-Gilford Progeria Syndrome, progeria is an extremely rare disease in which children experience symptoms normally linked with old age -- hair loss, wrinkled skin, clogged arteries and arthritis.

Children with the disease often die by the age of 13.

Insight Into Aging

In a 2003 study, Collins and colleagues found the disease is caused by mutations in a gene called LMNA that makes the toxic protein progerin.

"What this paper does is show the process that is happening in those children is clearly an important process in normal aging," Collins said.

"That same toxic protein that we call progerin, which is made in large quantities in those kids, is also made in your cells and mine" as the cells start to die.

"And it shows the telomeres and progerin are connected," Collins said. "They have been on parallel scientific pathways and we have now found they are actually linked together."

He said when telomeres become too short and frayed, this triggers the production of progerin, signaling to the body that the cell is at the end of its useful life.

Collins says the study shows that instead of being a passive wearing out of cells, aging is an active biological mechanism that is programed into cells.

And understanding this mechanism could lead to new kinds of treatments. Already, a study is underway in children with progeria to see if researchers could block the excess production of progerin.

Collins says more work is needed to understand the biological mechanism of aging.

"We clearly don't have the whole picture," he said.

But understanding the aging process could lead to new ways to slow normal aging, and it underscores the need to continue funding research on rare diseases.

"It is often the insights that come from the rare diseases that teach us something about more common ones," he said.

(Editing by Eric Beech)

Could a Diet Help Prevent Alzheimer's?

By Amanda Gardner
HealthDay Reporter

HealthDay News

Monday, June 13, 2011

MONDAY, June 13 (HealthDay News) -- The low-fat, low-glycemic diet often promoted for general health and well-being may lower the risk of developing Alzheimer's disease if adopted early in life, researchers say.

But starting such an eating plan after symptoms surface doesn't seem to help prevent deterioration of brain function, according to new research published online June 13 in Archives of Neurology.

"This is not the first time this concept has emerged, that things you do in midlife or earlier on may have effects later on," said Dr. Marc L. Gordon, chief of neurology at Zucker Hillside Hospital and an Alzheimer's researcher at the Feinstein Institute for Medical Research in Manhasset, N.Y.

"For example, we know that midlife obesity is associated epidemiologically with a higher risk of late-life dementia," he continued. "Whether that's causal or an effect of the disease is open to speculation, but it suggests that there may be periods of vulnerability that are different in different times in the life span."

Although numerous studies have probed connections between lifestyle factors and cognitive ability, no solid proof yet exists that diet (or much else) can prevent Alzheimer's, the most common form of dementia among the elderly.

A low-glycemic diet, which focuses on eating fruits and vegetables, whole grains and lean meats, avoids spikes in blood sugar and is said to promote feelings of fullness.

A U.S. National Institutes of Health conference convened last spring concluded that, for now, older age is the leading known risk factor for Alzheimer's disease. A gene variation is also tied to increased risk for the brain disorder, the NIH review said. Experts at the conference stressed that the general public should still focus on avoiding behaviors already linked to other chronic diseases.

This new study looked at the effect of different diets on biomarkers associated with Alzheimer's, such as blood sugar levels, cholesterol and blood lipid levels. The researchers also tested memory after participants followed the assigned diets.

Twenty healthy adults and 29 with mild memory problems that could be predictive of Alzheimer's followed either a high-fat, high simple-carbohydrate diet ("HIGH" diet) or a diet lower in fat and simple carbohydrates ("LOW" diet).

After four weeks, healthy participants on the LOW diet had changes in biomarkers, including insulin and lipid levels in the blood, which were moving away from those normally associated with dementia.

In participants with mild cognitive impairment, this diet had the opposite effect.

Commenting on the study, Dr. Suzanne de la Monte, professor of neurosurgery and pathology at Brown University and Rhode Island Hospital in Providence, said it remains to be seen if the changes noted in this study actually translate, over the longer term, into differences in risk for developing Alzheimer's disease.

The bottom line, though, is the same as it's been for eons: A healthy diet lowers your risk of type 2 diabetes, heart disease, cancer and maybe even Alzheimer's.

That means staying away as much as possible from processed foods, de la Monte advised.

A second study, in the same issue of the journal, also looked at biomarkers and found that different levels were associated with different measures of cognitive function associated with Alzheimer's disease.

This finding could help improve diagnosis of Alzheimer's, which now relies mostly on clinical observation.

More information

The Alzheimer's Association has more on this condition.

Study recommends against autism screening

By Frederik Joelving

Reuters Health

Monday, June 13, 2011

NEW YORK (Reuters Health) – There is no solid evidence to support screening toddlers for autism, a new study concludes.

It's estimated that autism spectrum disorders, which range from mild Asperger's Syndrome to severe mental retardation and social disability, affect nearly one percent of kids in the U.S., putting a significant burden on families and society at large.

Both the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention encourage routine screening for the disorders.

But the new report, a review of the medical literature, suggests those recommendations are premature.

"We don't have research evidence to show how well screening works and whether we do more good than harm," Dr. Jan Willem Gorter, a pediatrician at McMaster University in Hamilton, Canada, told Reuters Health.

While many screening tests exist -- usually based on simple questions about the child's use of eye contact and gestures -- none of them are very accurate, Gorter and colleagues report in the journal Pediatrics.

Often the tests will misdiagnose healthy kids, such as one recent test that yielded false positives a quarter of the time, or they will fail to detect autism.

"The potential burdens on families of receiving a misdiagnosis (either a false-positive or a false-negative) may be enormous," the researchers write, "and there might be labeling effects that can be hard to remove."

They found other reasons to avoid screening, too.

For instance, there is no cure for autism, and interventions to help the kids function better on a daily basis often have shaky underpinnings and cost a lot.

Such treatment programs may not be easily available either, the researchers note, adding that offering screening without providing helpful services would be "pointless, and almost certainly unethical."

"The reality is there are already waitlists of up to a year, or over a year," Gorter said.

At this point, he added, the best way to help children with autism is probably to make parents understand how their kids communicate and make sure they meet other children.

Source: http://bit.ly/cxXOG

Pediatrics, online June 13, 2011.

Diabetics May Be at Greater Risk for Second Stroke

By Steven Reinberg
HealthDay Reporter

HealthDay News

Monday, June 13, 2011

MONDAY, June 13 (HealthDay News) -- After suffering a first stroke or transient ischemic attack (TIA), people with diabetes are at greater risk of having another stroke or a heart attack, a new study confirms.

But, aggressively lowering cholesterol can help reduce that risk, the researchers report.

"Patients who had a stroke or TIA and who have diabetes are at higher risk of having another stroke as compared to patients who have no diabetes or those who have metabolic syndrome," said study researcher Dr. Larry B. Goldstein, director of the Duke Stroke Center at Duke University Medical Center in Durham, N.C.

"Moreover, statin treatment was similarly effective in reducing risk in patients with and without type 2 diabetes or metabolic syndrome," he said.

The report was published in the June 13 online edition of the Archives of Neurology.

For the study, the research team analyzed data from the Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) Trial. This trial was designed to look at whether taking high doses of cholesterol-lowering drugs called statins (in this case, Lipitor) would reduce the risk of having a second stroke or TIA.

The trial did find that lowering cholesterol reduced the likelihood of another cardiovascular event in patients with recent stroke or TIA.

In their analysis, the researchers also looked at the risk of having another stroke, TIA or a heart attack among diabetics and people with metabolic syndrome and whether statin treatment could reduce that risk.

Of the 4,731 people in the trial who had had a stroke or TIA, the researchers identified 794 diabetics and 642 with metabolic syndrome. Metabolic syndrome is a group of conditions, including high blood pressure, high blood sugar and high cholesterol, that increase the odds of developing diabetes and heart disease.

Compared with non-diabetics, people with diabetes were more likely than others to have another stroke, TIA or other cardiovascular event. They were also more likely to need an angioplasty to open blocked arteries.

However, people with metabolic syndrome were not at greater risk of another stroke or TIA or cardiovascular event than those without the syndrome. But they also were at higher risk of needing an angioplasty, the researchers found.

"The main point of the paper is that intensive lipid-lowering in patients with prior stroke or TIA and without known heart disease provides global benefit of risk reduction," said lead researcher Dr. Alfred Callahan, from Vanderbilt University Medical Center in Nashville, Tenn.

Dr. Ralph Sacco, president of the American Heart Association/American Stroke Association, said the study is largely confirmatory. But it did show that "even among diabetics, statins are still making a difference in terms of reducing risk," he said.

Controlling diabetes is important after a serious cardiovascular event, added Sacco, who is also chairman of the department of neurology at Miller School of Medicine of the University of Miami. "We want people to control their diabetes and also treat their blood pressure and treat their cholesterol," he said.

More information

For more information on diabetes, visit the U.S. National Library of Medicine.

One in Five Heart-Attack Deaths Could Be Prevented With New Drug, Findings Show

ScienceDaily

Monday, June 13, 2011

ScienceDaily (June 13, 2011) — Robert Storey, Professor of Cardiology at the University of Sheffield's Department of Cardiovascular Science, has presented findings that show that one in five deaths in the year following a heart attack could be prevented if a new drug, ticagrelor, was used instead of the standard treatment, clopidogrel.

Professor Storey's latest findings were presented at the British Cardiovascular Society annual scientific conference in Manchester on June 13, 2011.

Professor Storey has led UK investigations of ticagrelor and was a member of the international committee that conducted the PLATO study, a trial of over 18 thousand patients in over 40 countries around the world. The results of the PLATO study were first presented at the European Society of Cardiology congress in 2009, showing that ticagrelor was more effective for heart attack patients than clopidogrel in reducing death and recurrent heart attack.

A new analysis of the PLATO study presented this year at the American College of Cardiology showed that ticagrelor is just as effective at reducing deaths in patients over the age of 75 as in younger patients. Professor Storey commented: "Our new findings really highlight the universal applicability of the treatment."

Ticagrelor was made available in the UK in December 2010 but has not yet been adopted across most of the UK due to cost concerns. Clopidogrel has a very low cost as it is available in generic forms, whereas ticagrelor is more expensive at around £55 per month. However, the excess drug cost of ticagrelor is offset to some extent by its greater effectiveness which reduces the need for heart operations.

Professor Storey commented: "Many people are dying avoidably in the year after having a heart attack due to delays introducing this new treatment. These new findings provide yet further evidence in support of making the drug available to patients in the UK. We're pleased that the Scottish Medicine Consortium recently approved ticagrelor, on the basis that the initial expense of the drug is offset to a significant extent by the resultant savings, such as reduced need for procedures. In England, a verdict from NICE is awaited but final guidance is not expected until October."

One of the problems with clopidogrel is that about a quarter of people in the UK have a genetic variant that reduces the effect of the drug and are at greater risk. A sub-study of the PLATO trial was published in the Lancet confirming that patients treated with clopidogrel, who have such a genetic variant, have a slightly higher risk in the first month following heart attack but ticagrelor is not affected by this variant and is still more effective than clopidogrel, regardless of a patient's genetic make-up.

A common side-effect of ticagrelor is a sense of breathlessness which is usually mild and well-tolerated. Professor Storey presented data at the European Society of Cardiology meeting in 2010 showing that even patients who develop this side-effect still seem to have the reduced mortality risk compared to clopidogrel-treated patients. Another analysis led by Professor Storey showed that patients who develop breathlessness on ticagrelor do not show any problems on heart or lung tests, providing reassurance about the benign nature of ticagrelor-related breathlessness.

Professor Storey has been involved with the development of ticagrelor and related drugs for the past 15 years. 90 patients from Sheffield, with acute coronary syndrome, were recruited for the PLATO trial, which involved over 18,000 cardiac patients worldwide. One of the questions that is currently unanswered is whether continuing ticagrelor beyond 1 year after a heart attack will lead to continued benefit. This question will be addressed by the PEGASUS study which has recently started in the UK and many other countries, recruiting patients who are within 2 years of completing their one year course of treatment following a heart attack.

Professor Storey commented: "PEGASUS is an exciting study that will recruit 21,000 patients around the world, looking at whether ticagrelor added to aspirin is more effective at preventing problems related to clotting in the arteries than the standard anti-clotting treatment of aspirin only. Another study (ATLANTIC) planned to start in the next few months will also assess whether it is more effective to treat patients with full-blown heart attack with ticagrelor in the ambulance rather than wait until patients arrive at the hospital to have the blocked artery opened by balloon angioplasty."

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Few Anesthesiologists Monitor Key Heart Signal

HealthDay News

Monday, June 13, 2011

MONDAY, June 13 (HealthDay News) -- During high-risk surgery, only about one-third of anesthesiologists measure oxygen flow throughout their patient's body, even though this heart function can significantly affect recovery, according to a new survey.

Researchers in Amsterdam surveyed 463 European and American anesthesiologists and found that 95 percent knew it was critically important that enough oxygen reach all parts of a patient's body during high-risk surgery, but only 35 percent were actually monitoring their patients' cardiac output.

"If cardiac output is not measured there is no way to know whether oxygen is delivered appropriately to the tissues or not," said the study's lead author, Dr. Maxime Cannesson, associate professor of anesthesiology at the University of California, Irvine, in a news release from the European Anaesthesiology Congress.

Roughly 30 million patients around the world undergo high-risk surgery every year, according to the news release.

The anesthesiologists surveyed said they didn't monitor cardiac output mainly because the procedure was too invasive or they used other methods for monitoring the heart's performance.

In response, the study's authors argued current cardiac output monitoring is less invasive than it used to be, and alternate means of monitoring cardiac output, such as pulse pressure variations, are an ineffective substitute.

The study, which was presented Sunday at the European Anaesthesiology Congress in Amsterdam, noted previous research has shown that when anesthesiologists measure and set goals for cardiac output during high-risk surgery, survival rates increase and the number of complications drop. Surgical patients can also go home sooner.

"The idea is very simple: Since oxygen is of major importance to the body when it is experiencing stress, as in the case of high-risk surgery, it seems logical that setting goals for maximizing the delivery of oxygen to the tissues would improve patients' care," said Cannesson. "If the cells and tissues do not receive oxygen during the surgery, they are going to produce toxins, which will eventually worsen the situation and increase postoperative complications such as infection, kidney failure, pneumonia, and so forth," he added.

Based on their findings, the study's authors called for the creation of national and international guidelines to ensure that cardiac output monitoring is carried out during and after all high-risk surgeries.

Research presented at medical meetings is considered preliminary until it is published in a peer-reviewed medical journal.

More information

The American Society of Anesthesiologists provides more information on the role of anesthesiologists in the operating room.

Black heart patients less often go to top hospitals

By Amy Norton

Reuters Health

Monday, June 13, 2011

NEW YORK (Reuters Health) – When older African Americans suffer a heart attack, they are less likely than their white counterparts to go to a hospital that performs potentially life-saving heart procedures, a new study suggests.

Researchers say the findings point to one potential reason why African Americans are less likely than whites to receive guideline-recommended treatments for heart attacks.

The study, which looked at Medicare records for more than 65,000 heart attack patients, found that black patients were 12 percent less likely than whites to go to a "high-quality" hospital and 17 percent more likely to arrive at a "low-quality" hospital.

What's more, blacks were less likely than white patients to go to a hospital that performed angioplasty and bypass surgery -- two procedures commonly used to clear the artery blockages causing the heart attack.

The reasons for the findings, reported in the journal Circulation, are not clear.

But the specific neighborhoods in which people live may be key, according to lead researcher Dr. Ioana Popescu of the University of California, Los Angeles.

That's because when she and her colleagues compared only patients living within the same zip code, the racial discrepancy disappeared.

In raw numbers, in fact, a slightly higher percentage of black patients were seen at the hospitals offering the best heart attack treatments: 61 percent, versus 59 percent of white patients.

But when the researchers adjusted their statistical analysis to account for the fact that African Americans, on average, lived closer to the best hospitals, it turned out that black patients were 13 percent less likely than whites to be admitted to those hospitals.

The issue may not be race, per se, Popescu told Reuters Health, but the "context" of the neighborhood in which people live -- like income and education levels, and people's general access to more-routine healthcare.

"I think this really points to the importance of location, and what kinds of choices people have in their local healthcare market," Popescu said.

"As far as research," she added, "we really have to look at the relationship between where people live and what kind of care they get."

A limitation of this study, Popescu said, is that it had no information on how patients got to the hospital -- on their own, or by ambulance. So it's not clear whether, for example, black patients were less likely to call an ambulance.

Nor is it clear, the authors note, whether among heart attack sufferers who choose which hospital to go to, preferences for specific doctors or institutions are among the sociological factors that influence those choices.

But if you are suffering potential heart attack symptoms, Popescu said, it's always wise to call 911 -- in part, because paramedics should know whether a particular nearby hospital is best equipped to handle heart attacks.

"But that means that people also need to be educated about the signs of a heart attack," Popescu said.

Potential signs of a heart attack include feelings of pain, pressure or squeezing in the chest, shortness of breath, light-headedness, nausea, or pain in the arms, back, neck or jaw.

The current findings are based on 65,633 Medicare patients who were treated for heart attacks in 2005, in any of 63 hospital referral regions across the country.

Popescu's team gave each hospital a quality score, based on the center's 30-day death rate and whether it met certain standards for treating heart attacks -- like getting patients started on aspirin and heart drugs called beta-blockers within 24 hours.

Overall, 25 percent of white patients were admitted to a hospital that scored in the top 20 percent for quality. That compared with 21 percent of black patients.

On the other hand, 11 percent of black patients and 9 percent of whites were taken to a hospital in the bottom 20 percent.

The findings, according to Popescu, offer one possible reason for the race gap in heart attack treatment.

Past studies have found that African Americans are less likely than whites to receive generally recommended heart attack therapies -- particularly ones that are newer or expensive. Those include prescriptions for cholesterol-lowering statin drugs, as well as invasive procedures like angioplasty.

In one study of U.S. hospitals, black patients were about 30 percent less likely than whites to receive angioplasty within 48 hours. That was with age, overall health and insurance coverage taken into account.

Source: http://bit.ly/jf8Oo4

Circulation, online May 31, 2011.

Early Exposure to Pets Won't Up Kids' Allergy Risk: Study

By Serena Gordon
HealthDay Reporter

HealthDay News

Monday, June 13, 2011

MONDAY, June 13 (HealthDay News) -- Exposure to pets in infancy and childhood probably won't increase a child's risk of developing an allergy to cats and dogs, and may actually protect against such allergies, new research suggests.

The first year of life appears to offer the greatest protection, the researchers said. Living with a dog before age 1 year was associated with about half the risk of developing a dog allergy in boys. Exposure to cats before turning 1 was associated with about a 48 percent reduction in risk for girls and boys, the new study reported.

"Exposing children to cats and dogs in the home is not going to increase the risk of sensitization to these animals. It might even decrease the risk," said the study's lead author, Ganesa Wegienka, an epidemiologist in the department of public health at Henry Ford Hospital in Detroit.

Results of the study are published online June 13 in the journal Clinical & Experimental Allergy.

As many as 70 percent of U.S. households have pets, according to estimates from the American Academy of Allergy, Asthma and Immunology. For those who are allergic to these animals, symptoms can range from watery eyes, a runny nose and sneezing to a full-blown asthma attack.

But experts haven't been sure if early exposure to animals might contribute to the development of those allergies. Some experts think that early exposure could trigger the development of allergies, while others suspect that early exposure could increase the immune system's exposure to a diverse array of bacteria, making it less likely to overreact to normally harmless substances, such as animal dander. This theory is commonly referred to as the hygiene hypothesis.

To see what effect, if any, childhood exposure to cats and dogs has on the development of pet allergies in children, the researchers tested blood samples gathered as part of the Detroit Childhood Allergy Study for the presence of a substance known as animal-specific IgE. The presence of this antibody would indicate that an individual was "sensitized" to that animal, which indicates an allergy. The study began in 1987.

At age 18, about 560 of the study's participants agreed to participate in this follow-up study. They provided additional blood samples and pet histories.

During their first year of life, 184 teens had an indoor dog and 110 had an indoor cat.

In males, the risk of having a dog allergy was decreased by 50 percent in those who had a dog during their first year. This association wasn't found in females, however. But when the researchers looked at teens born via cesarean-section delivery, they found that both males and females had a 67 percent decreased risk of dog allergy when they lived with a dog during their first year of life.

Wegienka noted that babies born via C-section aren't exposed to the diverse microflora that babies born vaginally are, which might make their immune systems more susceptible to allergies.

The researchers said that exposure to animals at other times in childhood didn't appear to be as significant as the first year. But, Wegienka cautioned that this study doesn't prove a cause-and-effect relationship between having a pet and avoiding allergies, just an association between those two factors.

"We don't want to say that everyone should go out and get a dog or cat to prevent allergies," she said, adding that the current study only found an association between a reduced risk and exposure to cats and dogs. "More research is needed, though we think this is a worthwhile avenue to pursue. How does having a dog or a cat change the home environment? And, how does that affect allergy risk?"

The authors said it would be logical to look at smaller and smaller windows of time, such as the first month or first three months of life.

Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital and Medical Center in Detroit, said the development of allergies is very complicated. It's significant that this study found that early life exposure wasn't associated with an increased risk, she said.

"We're not likely to find one simple answer to avoid them [allergies], but this study suggests that maybe having pets -- whether or not it's protective -- maybe having them isn't so bad," Appleyard said.

More information

For more on pet allergies, visit the American Academy of Allergy, Asthma & Immunology.