Lancet, BMJ studies sound concern over anti-obesity drug rimonabant
A woman stands outside a sandwich shop. Two overviews of trials of weight-loss drugs have added to concerns that the obesity treatment rimonabant may boost the risk of depression and anxiety.(AFP/File/Paul Ellis)PARIS (AFP) - Two overviews of trials of weight-loss drugs have added to concerns that the obesity treatment rimonabant may boost the risk of depression and anxiety.
The papers, published in Saturday's issue of The Lancet and online Friday by the British Medical Journal (BMJ), follow a decision in June by an advisory panel to the US Food and Drug Administration (FDA) that voted against marketing rimonabant in the United States on safety grounds.
Doctors led by Arne Astrup, a professor at the Faculty of Life Sciences at the University of Copenhagen, analysed four trials in which 4,105 patents were either given a 20mg daily dose of rimonabant or a dummy lookalike pill called a placebo.
Over one year, patients on rimonabant realised a weight loss that was 4.7 kilos (10.3 pounds) higher than counterparts in the placebo group.
But they were also 40 percent likelier to experience "adverse" or "serious adverse" events, according to Astrup's study, which appears in The Lancet.
Patients on rimonabant were two and a half times likelier to stop taking the drug because of depression than those on placebo, and three times likelier to discontinue the treatment because of anxiety.
The findings are significant because individuals with a history of depression -- a phenomenon common among the severely obese -- were specifically excluded from the trial, say the authors.
"We recommend increased alertness by physicians to these potentially severe psychiatric reactions," the Lancet paper says.
Meanwhile, a study published online Friday by the British Medical Journal (BMJ) said that rimonabant and two other anti-obesity drugs, orlistat and sibutramine, were of only limited effect in terms of weight loss over the long term.
Canadian researchers reviewed data from 30 trials in which obese volunteers -- average weight 100 kilos (220 pounds) -- took either anti-obesity drugs or a placebo for a year or more.
The three drugs reduced weight by less than five kilos (11 pounds), equivalent to a loss of less than five percent of total body weight.
The three drugs had various beneficial side effects but all had adverse effects, including, in rimonabant's case, an increase in depression and anxiety, they said.
The authors noted that no trials examined rates of death and disease as a result of taking anti-obesity pills and called for trials to looking into this aspect.
In June, all 14 experts on the FDA's Advisory Committee said rimonabant, which French maker Sanofi-Aventis had hoped would become a blockbuster drug under the brand name of Zimulti, voted against authorising the drug after they heard evidence that it was linked with an increased risk of suicide.
The European Union has approved rimonabant, locally marketed as Acomplia, as a support for diet and exercise for obese patients who have Type 2 diabetes and cardiovascular problems associated with obesity.
However, labelling of the drug has been stepped up to warn against prescribing it to European patients with depression or those taking anti-depressants.
A trial among 1,047 volunteers, published in The Lancet in October 2006, found ribonant improved control over blood glucose and blood fats among people with Type 2 diabetes.
The drug was "generally well tolerated," the study said. Among those volunteers who dropped out of the trial, depression, nausea and dizziness were the most cited reasons among the rimonabant group.Rimonabant blocks endocannabinoid receptors in the brain that cause hunger.Global sales of anti-obesity drugs reached 1.2 billion dollars in 2005, the BMJ said.
Tuesday, January 1, 2008
More Black Children Dying From Diabetes
More Black Children Dying From Diabetes
THURSDAY, Nov. 15 (HealthDay News) -- Black children withdiabetes face a death rate twice as high as that for white children, newU.S. government research shows.
While this racial disparity has been evident for more than two decades,the trend has been accelerating among children ages 1 to 19, according tothe study in the Nov. 16 issue of the Morbidity and Mortality WeeklyReport, published by the U.S. Centers for Disease Control andPrevention.
"Although the numbers are small, in absolute terms, these deaths arestill preventable, which is why it is important to examine thosedisparities and work toward eliminating them," said CDC epidemiologist Dr.Laura L. Polakowski, who co-authored the report.
Looking at death certificates from 1979 to 2004, the researchers foundthat between 2003 and 2004, there were 89 deaths among U.S. children andteens from diabetes. During that time, the annual diabetes death rate forblack children and teens was more than double that for white children.
From 2003 to 2004, the diabetes death rate per million for children andteens was 2.46 for blacks and 0.91 for whites, the report found.
In addition, the death rate among blacks has been increasing since1998, while for whites it decreased significantly from 1979 to 1994, andthen leveled off from 1994 to 2004, Polakowski's team found.
A complex interplay of factors seems to be driving the disparity,Polakowski said. "Possible explanations could be differences in access toor use of health-care services, or differences in quality of diseaseseducation and care," she said.
Polakowski's group did not distinguish between juvenile diabetes,commonly called type 1 diabetes, and adult onset diabetes, often calledtype 2 diabetes. However, most diabetes deaths among children are causedby short-term complications from type 1 diabetes, Polakowski said. "Weknow we see these deaths with type 1 diabetes, we don't know if we seethem with type 2 diabetes at this point," she said.
Many of these deaths are due to acute complications such as diabeticketoacidosis, in which insulin levels are too low. If untreated, it leadsto diabetic coma and eventually death, Polakowski said.
"These complications are readily recognizable in children and don'trequire a great deal of technology to treat them," Polakowski said. "Therate of death among black children can be lower, because there is a lowerrate among white children," she said.
Type 1 diabetes is typically diagnosed in children and young adults andresults when the body does not produce insulin, a hormone that convertsblood sugar to energy for the body's cells. With type 2 diabetes -- themost common form of the disease -- either the body doesn't produce enoughinsulin or cells ignore the insulin, according to the American DiabetesAssociation. The obesity epidemic plaguing American children and adults isbelieved responsible for much of the explosion in type 2 diabetescases.
One expert agrees that the pediatric deaths detailed in the new CDCreport are preventable.
"I am not surprised that there would be a disparity," said Dr. LarryDeeb, past president for medicine and science at the American DiabetesAssociation. "That just reflects America -- doesn't it?"
All these deaths are from diabetic ketoacidosis, Deeb said. "That'swhat kills children with diabetes, and most of these deaths arepreventable," he said.
Deeb thinks the racial disparity in diabetes deaths among childrenresults from too many black children not having easy access to healthcare. With improved access and better diabetes education, "we caneliminate the disparity," he said.
THURSDAY, Nov. 15 (HealthDay News) -- Black children withdiabetes face a death rate twice as high as that for white children, newU.S. government research shows.
While this racial disparity has been evident for more than two decades,the trend has been accelerating among children ages 1 to 19, according tothe study in the Nov. 16 issue of the Morbidity and Mortality WeeklyReport, published by the U.S. Centers for Disease Control andPrevention.
"Although the numbers are small, in absolute terms, these deaths arestill preventable, which is why it is important to examine thosedisparities and work toward eliminating them," said CDC epidemiologist Dr.Laura L. Polakowski, who co-authored the report.
Looking at death certificates from 1979 to 2004, the researchers foundthat between 2003 and 2004, there were 89 deaths among U.S. children andteens from diabetes. During that time, the annual diabetes death rate forblack children and teens was more than double that for white children.
From 2003 to 2004, the diabetes death rate per million for children andteens was 2.46 for blacks and 0.91 for whites, the report found.
In addition, the death rate among blacks has been increasing since1998, while for whites it decreased significantly from 1979 to 1994, andthen leveled off from 1994 to 2004, Polakowski's team found.
A complex interplay of factors seems to be driving the disparity,Polakowski said. "Possible explanations could be differences in access toor use of health-care services, or differences in quality of diseaseseducation and care," she said.
Polakowski's group did not distinguish between juvenile diabetes,commonly called type 1 diabetes, and adult onset diabetes, often calledtype 2 diabetes. However, most diabetes deaths among children are causedby short-term complications from type 1 diabetes, Polakowski said. "Weknow we see these deaths with type 1 diabetes, we don't know if we seethem with type 2 diabetes at this point," she said.
Many of these deaths are due to acute complications such as diabeticketoacidosis, in which insulin levels are too low. If untreated, it leadsto diabetic coma and eventually death, Polakowski said.
"These complications are readily recognizable in children and don'trequire a great deal of technology to treat them," Polakowski said. "Therate of death among black children can be lower, because there is a lowerrate among white children," she said.
Type 1 diabetes is typically diagnosed in children and young adults andresults when the body does not produce insulin, a hormone that convertsblood sugar to energy for the body's cells. With type 2 diabetes -- themost common form of the disease -- either the body doesn't produce enoughinsulin or cells ignore the insulin, according to the American DiabetesAssociation. The obesity epidemic plaguing American children and adults isbelieved responsible for much of the explosion in type 2 diabetescases.
One expert agrees that the pediatric deaths detailed in the new CDCreport are preventable.
"I am not surprised that there would be a disparity," said Dr. LarryDeeb, past president for medicine and science at the American DiabetesAssociation. "That just reflects America -- doesn't it?"
All these deaths are from diabetic ketoacidosis, Deeb said. "That'swhat kills children with diabetes, and most of these deaths arepreventable," he said.
Deeb thinks the racial disparity in diabetes deaths among childrenresults from too many black children not having easy access to healthcare. With improved access and better diabetes education, "we caneliminate the disparity," he said.
Fish, Fruits, Veggies May Cut Dementia Risk
Fish, Fruits, Veggies May Cut Dementia Risk
THURSDAY, Nov. 15 (HealthDay News) -- A diet that includes plentyof fish, omega-3 rich oils, fruits and vegetables may reduce the risk ofdementia and Alzheimer's disease, while high intake of omega-6 rich oilsmay boost the risk of developing memory problems, say French researchers.
They looked at the diets of 8,085 people older than 65 who did not havedementia at the start of the study. Over the following four years, 183 ofthe participants developed Alzheimer's disease, and 98 developed anotherform of dementia.
People who regularly consumed omega-3 rich oils, such as canola,flaxseed, and walnut oil, were 60 percent less likely to develop dementiathan those who did not regularly consume such oils. The study also foundthat regular consumption of fruits and vegetables lowered dementia risk by30 percent.
People who ate fish at least once a week were 40 percent less likely todevelop dementia and 35 percent less likely to develop Alzheimer's, butonly if they didn't carry a gene (ApoE4) known to increase the risk ofAlzheimer's.
"Given that most people do not carry the ApoE4 gene, these resultscould have considerable implications in terms of public health," studyauthor Pascale Barberger-Gateau, of the French National Institute forHealth and Medical Research, said in a prepared statement. "However, moreresearch is needed to identify the optimal quantity and combination ofnutrients which could be predictive before implementing nutritionalrecommendations."
The researchers also found that people without the ApoE4 gene whoregularly consumed omega-6 rich oils -- such as sunflower or grape seedoil -- but not omega-3 rish oils or fish were twice as likely to developdementia as people who didn't eat omega-6 rich oils.
The study is published in the Nov. 13 issue of the journalNeurology.
THURSDAY, Nov. 15 (HealthDay News) -- A diet that includes plentyof fish, omega-3 rich oils, fruits and vegetables may reduce the risk ofdementia and Alzheimer's disease, while high intake of omega-6 rich oilsmay boost the risk of developing memory problems, say French researchers.
They looked at the diets of 8,085 people older than 65 who did not havedementia at the start of the study. Over the following four years, 183 ofthe participants developed Alzheimer's disease, and 98 developed anotherform of dementia.
People who regularly consumed omega-3 rich oils, such as canola,flaxseed, and walnut oil, were 60 percent less likely to develop dementiathan those who did not regularly consume such oils. The study also foundthat regular consumption of fruits and vegetables lowered dementia risk by30 percent.
People who ate fish at least once a week were 40 percent less likely todevelop dementia and 35 percent less likely to develop Alzheimer's, butonly if they didn't carry a gene (ApoE4) known to increase the risk ofAlzheimer's.
"Given that most people do not carry the ApoE4 gene, these resultscould have considerable implications in terms of public health," studyauthor Pascale Barberger-Gateau, of the French National Institute forHealth and Medical Research, said in a prepared statement. "However, moreresearch is needed to identify the optimal quantity and combination ofnutrients which could be predictive before implementing nutritionalrecommendations."
The researchers also found that people without the ApoE4 gene whoregularly consumed omega-6 rich oils -- such as sunflower or grape seedoil -- but not omega-3 rish oils or fish were twice as likely to developdementia as people who didn't eat omega-6 rich oils.
The study is published in the Nov. 13 issue of the journalNeurology.
Ultrasound Beats Blood Test for Gauging Ovarian Cancers:Study
Ultrasound Beats Blood Test for Gauging Ovarian Cancers:Study
THURSDAY, Nov. 15 (HealthDay News) -- Ultrasound exams are betterthan blood tests at identifying whether ovarian tumors are benign ormalignant, a team of international researchers reports.
Ultrasound correctly identified 93 percent of tumors as benign orcancerous, while the blood test was correct 83 percent of the time.
Results of the study, by the International Ovarian Tumor Analysiscollaboration group (IOTA), were published online Nov. 13 in theJournal of the National Cancer Institute.
"To my knowledge, the IOTA study is the first study that clearlydemonstrated that in experienced hands, ultrasound is significantly betterthan blood tests,'" said study leader Dr. Dirk Timmerman, a researcher atKatholieke Universiteit Leuven in Belgium.
An estimated 22,430 new cases of ovarian cancer are expected to bediagnosed in 2007 in the United States, according to the American CancerSociety, with about 15,280 deaths. The disease typically strikes womenover age 55. Symptoms include bloating, pelvic or abdominal pain,difficulty eating or feeling full quickly, or urinary symptoms such as afrequent need to urinate.
Because the symptoms are often similar to less serious conditions, onlyabout 20 percent of ovarian cancers are found at an early stage, thecancer society estimates. This makes the quest for the best techniques todetect the cancer early even more important.
For the IOTA study, Timmerman and his colleagues compared ultrasoundwith blood tests to decide if the ovarian masses discovered in 1,066 womenwere benign or malignant.
Experts examined patterns in ultrasound images, and then compared thoseresults with blood tests that detect an elevated level of the proteinCA-125, considered an indicator of whether an ovarian tumor is cancerousor benign.
The ultrasound exams, including transvaginal gray-scale and colorDoppler ultrasound exams, were given within 120 days of surgery to removethe tumors. Before surgery, 809 of the women gave blood, and the sampleswere analyzed later for CA-125 levels.
When the results from both methods were compared with the findings atsurgery, the researchers found that ultrasound correctly classified 93percent of tumors as cancerous or not, while the blood test was correct inonly 83 percent of cases.
"The IOTA study not only demonstrated that ultrasound is better thanblood tests but also that the blood tests do not give additional benefitin mathematical models developed to distinguish between benign andmalignant masses," Timmerman said.
Timmerman emphasized that the study only looked at the best method todecide if a tumor was cancerous after the mass had already beendiscovered. "Of course, this is different from screening," he said. "Inscreening studies, a healthy population is screened for a specificdisease, for example, ovarian cancer. In that setting, a blood test mightprove to be useful in the future." He noted that two large studiesexploring that issue are expected to conclude in about five years.
Dr. Robert Morgan, co-director of the gynecologic oncology/peritonealmalignancy program at the City of Hope Cancer Center in Duarte, Calif.,said the study results confirm what doctors have known for a long time."CA-125 is only elevated in about 50 percent of early stage ovariancancer, and the data in this paper confirms that," he said.
The study's bottom line: Most of these cancers are being picked up withultrasound, not the blood test, Morgan said. "And, most of the time, when[the ultrasound] says it's not malignant, it's not," he said.
''C-125 tests are not cheap and, particularly when you do them in ahuge number of patients, the costs add up. And, apparently, they don'tseem to be adding anything to the diagnostic accuracy," he added.
Sherry Salway Black, executive director of the Ovarian Cancer NationalAlliance, called the new study results exciting. "It gives moreinformation, more evidence that a transvaginal ultrasound can be effectiveunder these circumstances."
Still, she said, the blood test might prove to have some benefit. "Itmay not be the best stand-alone diagnostic tool. This [study] appears tosay transvaginal ultrasound is definitely better." But the study authorsdid find that CA-125 levels in women found to have cancer were higher forpostmenopausal women than premenopausal women, for instance. And suchdetails, Black said, might prove valuable.
Meanwhile, a study from Boston's Brigham and Women's Hospital has foundthat regular consumption of foods containing the flavonoid kaempferol,including nonherbal tea and broccoli, was associated with a reduced riskof ovarian cancer. The study, funded by the National Cancer Institute andpublished in the Nov. 15 issue of the International Journal ofCancer, also found a decreased risk in women who consumed largeamounts of the flavonoid luteolin, found in carrots, peppers and cabbage.
"This is good news, because there are few lifestyle factors known toreduce a woman's risk of ovarian cancer," first author Margaret Gates, aresearch fellow at the hospital, said in a prepared statement. "Althoughadditional research is needed, these findings suggest that consuming adiet rich in flavonoids may be protective."
"Other flavonoid-rich foods, such as onions, beans and kale, may alsodecrease ovarian cancer risk, but the number of women who frequentlyconsumed these foods was not large enough to clearly evaluate theseassociations. More research is needed," concluded Gates, who is also aresearch fellow at the Harvard School of Public Health.
THURSDAY, Nov. 15 (HealthDay News) -- Ultrasound exams are betterthan blood tests at identifying whether ovarian tumors are benign ormalignant, a team of international researchers reports.
Ultrasound correctly identified 93 percent of tumors as benign orcancerous, while the blood test was correct 83 percent of the time.
Results of the study, by the International Ovarian Tumor Analysiscollaboration group (IOTA), were published online Nov. 13 in theJournal of the National Cancer Institute.
"To my knowledge, the IOTA study is the first study that clearlydemonstrated that in experienced hands, ultrasound is significantly betterthan blood tests,'" said study leader Dr. Dirk Timmerman, a researcher atKatholieke Universiteit Leuven in Belgium.
An estimated 22,430 new cases of ovarian cancer are expected to bediagnosed in 2007 in the United States, according to the American CancerSociety, with about 15,280 deaths. The disease typically strikes womenover age 55. Symptoms include bloating, pelvic or abdominal pain,difficulty eating or feeling full quickly, or urinary symptoms such as afrequent need to urinate.
Because the symptoms are often similar to less serious conditions, onlyabout 20 percent of ovarian cancers are found at an early stage, thecancer society estimates. This makes the quest for the best techniques todetect the cancer early even more important.
For the IOTA study, Timmerman and his colleagues compared ultrasoundwith blood tests to decide if the ovarian masses discovered in 1,066 womenwere benign or malignant.
Experts examined patterns in ultrasound images, and then compared thoseresults with blood tests that detect an elevated level of the proteinCA-125, considered an indicator of whether an ovarian tumor is cancerousor benign.
The ultrasound exams, including transvaginal gray-scale and colorDoppler ultrasound exams, were given within 120 days of surgery to removethe tumors. Before surgery, 809 of the women gave blood, and the sampleswere analyzed later for CA-125 levels.
When the results from both methods were compared with the findings atsurgery, the researchers found that ultrasound correctly classified 93percent of tumors as cancerous or not, while the blood test was correct inonly 83 percent of cases.
"The IOTA study not only demonstrated that ultrasound is better thanblood tests but also that the blood tests do not give additional benefitin mathematical models developed to distinguish between benign andmalignant masses," Timmerman said.
Timmerman emphasized that the study only looked at the best method todecide if a tumor was cancerous after the mass had already beendiscovered. "Of course, this is different from screening," he said. "Inscreening studies, a healthy population is screened for a specificdisease, for example, ovarian cancer. In that setting, a blood test mightprove to be useful in the future." He noted that two large studiesexploring that issue are expected to conclude in about five years.
Dr. Robert Morgan, co-director of the gynecologic oncology/peritonealmalignancy program at the City of Hope Cancer Center in Duarte, Calif.,said the study results confirm what doctors have known for a long time."CA-125 is only elevated in about 50 percent of early stage ovariancancer, and the data in this paper confirms that," he said.
The study's bottom line: Most of these cancers are being picked up withultrasound, not the blood test, Morgan said. "And, most of the time, when[the ultrasound] says it's not malignant, it's not," he said.
''C-125 tests are not cheap and, particularly when you do them in ahuge number of patients, the costs add up. And, apparently, they don'tseem to be adding anything to the diagnostic accuracy," he added.
Sherry Salway Black, executive director of the Ovarian Cancer NationalAlliance, called the new study results exciting. "It gives moreinformation, more evidence that a transvaginal ultrasound can be effectiveunder these circumstances."
Still, she said, the blood test might prove to have some benefit. "Itmay not be the best stand-alone diagnostic tool. This [study] appears tosay transvaginal ultrasound is definitely better." But the study authorsdid find that CA-125 levels in women found to have cancer were higher forpostmenopausal women than premenopausal women, for instance. And suchdetails, Black said, might prove valuable.
Meanwhile, a study from Boston's Brigham and Women's Hospital has foundthat regular consumption of foods containing the flavonoid kaempferol,including nonherbal tea and broccoli, was associated with a reduced riskof ovarian cancer. The study, funded by the National Cancer Institute andpublished in the Nov. 15 issue of the International Journal ofCancer, also found a decreased risk in women who consumed largeamounts of the flavonoid luteolin, found in carrots, peppers and cabbage.
"This is good news, because there are few lifestyle factors known toreduce a woman's risk of ovarian cancer," first author Margaret Gates, aresearch fellow at the hospital, said in a prepared statement. "Althoughadditional research is needed, these findings suggest that consuming adiet rich in flavonoids may be protective."
"Other flavonoid-rich foods, such as onions, beans and kale, may alsodecrease ovarian cancer risk, but the number of women who frequentlyconsumed these foods was not large enough to clearly evaluate theseassociations. More research is needed," concluded Gates, who is also aresearch fellow at the Harvard School of Public Health.
Inflammation Can't Explain Depression's Link to HeartDisease
Inflammation Can't Explain Depression's Link to HeartDisease
THURSDAY, Nov. 15 (HealthDay News) -- Depression is known to hikethe risk of cardiovascular disease, but don't put all the blame on anyconcurrent rise in inflammation.
So concludes a study led by Dr. Viola Vaccarino, a professor ofmedicine at Emory University, in Atlanta.
That means that it's back to the drawing board in terms of unravelingthe depression-heart disease link, according to Vaccarino.
"That depression is a factor in cardiovascular disease is clear. Whatis not clear is what kind of mechanism is involved," she said.
The Emory group, as well as researchers from five other medicalinstitutions, studied the possible role of inflammation in a group of 559women who were referred for heart tests because of blockage in a coronaryartery. All the women had a standard test for depression at the start ofthe study and were followed for an average of about six years.
They were divided into three groups on the basis of those tests: thosewho clearly were depressed by diagnosis and previous treatment; those whomight be depressed because of either a diagnosis or treatment; and thosewho had no indicator of depression.
The researchers made frequent measurements of two molecules linked tothe inflammatory response -- C-reactive protein (CRP) andinterleukin-6.
There were 79 major events of cardiovascular disease during the study,23 of them fatal.
As expected, the incidence of such events was 2.5 times higher in womenwith depression. There was no comparable increase in women classified aspossibly depressed.
The team found that women diagnosed as depressed had a 70 percenthigher level of C-reactive protein and a 25 percent higher level ofinterleukin-6 compared to women who were not depressed. Women classifiedas possibly depressed had elevated levels of both markers, but to a lesserextent.
The bottom line, according to the researchers, was that whileinflammation was tied to heart risk, it failed to explain most of thecardiovascular danger posed by depression.
"Despite being associated with each other, depression and inflammationpredicted future events for the large part independently," the researcherswrote. "Thus, despite a clear relationship between depression andinflammation, the latter plays only a minor role in the higher risk ofadverse outcomes for women with depression."
The finding is something of as surprise, said Dr. David S. Sheps,professor of medicine at the University of Florida at Gainesville, amember of the research team.
"We know from other studies that there is a relationship betweendepression and elevation of certain inflammatory molecules, but no oneknows for sure what the mechanism is," Sheps said.
"What is clear is that inflammation does not play a substantial role,"Vaccarino said. "We need to look at other things. Perhaps there is achange in the ability of platelets to aggregate." Platelets are bloodcells that can form clots to block arteries. "And there could be otherpathways," she said.
THURSDAY, Nov. 15 (HealthDay News) -- Depression is known to hikethe risk of cardiovascular disease, but don't put all the blame on anyconcurrent rise in inflammation.
So concludes a study led by Dr. Viola Vaccarino, a professor ofmedicine at Emory University, in Atlanta.
That means that it's back to the drawing board in terms of unravelingthe depression-heart disease link, according to Vaccarino.
"That depression is a factor in cardiovascular disease is clear. Whatis not clear is what kind of mechanism is involved," she said.
The Emory group, as well as researchers from five other medicalinstitutions, studied the possible role of inflammation in a group of 559women who were referred for heart tests because of blockage in a coronaryartery. All the women had a standard test for depression at the start ofthe study and were followed for an average of about six years.
They were divided into three groups on the basis of those tests: thosewho clearly were depressed by diagnosis and previous treatment; those whomight be depressed because of either a diagnosis or treatment; and thosewho had no indicator of depression.
The researchers made frequent measurements of two molecules linked tothe inflammatory response -- C-reactive protein (CRP) andinterleukin-6.
There were 79 major events of cardiovascular disease during the study,23 of them fatal.
As expected, the incidence of such events was 2.5 times higher in womenwith depression. There was no comparable increase in women classified aspossibly depressed.
The team found that women diagnosed as depressed had a 70 percenthigher level of C-reactive protein and a 25 percent higher level ofinterleukin-6 compared to women who were not depressed. Women classifiedas possibly depressed had elevated levels of both markers, but to a lesserextent.
The bottom line, according to the researchers, was that whileinflammation was tied to heart risk, it failed to explain most of thecardiovascular danger posed by depression.
"Despite being associated with each other, depression and inflammationpredicted future events for the large part independently," the researcherswrote. "Thus, despite a clear relationship between depression andinflammation, the latter plays only a minor role in the higher risk ofadverse outcomes for women with depression."
The finding is something of as surprise, said Dr. David S. Sheps,professor of medicine at the University of Florida at Gainesville, amember of the research team.
"We know from other studies that there is a relationship betweendepression and elevation of certain inflammatory molecules, but no oneknows for sure what the mechanism is," Sheps said.
"What is clear is that inflammation does not play a substantial role,"Vaccarino said. "We need to look at other things. Perhaps there is achange in the ability of platelets to aggregate." Platelets are bloodcells that can form clots to block arteries. "And there could be otherpathways," she said.
Drug Fights Medication-Linked Bone Loss
Drug Fights Medication-Linked Bone Loss
WEDNESDAY, Nov. 14 (HealthDay News) -- An osteoporosis drug has provensuperior to standard therapy at slowing bone loss caused by asthmatreatment, researchers say.
Glucocorticoid medicines such as prednisone are often given to treatasthma, autoimmune disorders, skin allergies and other conditions,researchers note. But the drugs can also cause osteoporosis.
The drug, an anabolic agent called teriparatide, probably will be thepreferable treatment "for patients who have particularly bad disease tostart with or are on glucocorticoids for a long time," said Dr. Kenneth G.Saag, professor of medicine and epidemiology at the University of Alabamaat Birmingham.
The study, which was funded by teriparatide's maker, Eli Lilly &Co., is published in the Nov. 15 issue of the New England Journal ofMedicine.
One million Americans are taking glucocorticoids for one condition oranother, Saag said, and many are at higher risk of fractures, because themedications weaken their bones. Current treatment for medication-linkedosteoporosis centers on use of bisphosphonates, medications designed toprevent bone breakdown.
The 18-month trial included 428 men and women with drug-causedosteoporosis who had been taking glucocorticoids for at least threemonths. Half were assigned to take alendronate, a bisphosphonate, whilethe other half took teriparatide.
After three months, the increase in bone density at the lumbar (lower)spine was double for those taking teriparatide -- an average 7.2 percentrise versus 3.4 percent in the alendronate group. The teriparatide groupalso experienced fewer fractures of the vertebral bones compared withthose on the bisphosphonate.
But teriparatide's much higher cost will limit its use, Saag said. "Useof therapy is driven by insurance as well as by appropriate bone densityand fracture rate," he said. "We would like to be able to single out thosepatients whose minimal bone density puts them at higher risk forfracture," Saag said. "Those patients are the ones we want to target moreaggressively."
That group would include 30 percent to 50 percent of those withdrug-caused osteoporosis, he said. The U.S. Food and Drug Administrationalready has approved use of teriparatide for the treatment of osteoporosisin postmenopausal women at high risk for fracture and to increase bonemass in men at high risk of fracture with primary or hypogonadalosteoporosis.
The anabolic agent is a better treatment, because bisphosphonates donot actually promote bone growth, added Dr. Robert R. Recker, professor ofmedicine at Creighton University and a member of the Osteoporosis ResearchCenter there. Rather, they prevent bone destruction by natural processessuch as apoptosis (natural cell death), he said
"There is a greater need for a bone-forming agent, one that interfereswith the apoptosis of bone cells," Recker said. "The condition is not somuch a low bone mass disease but a disease of bone cells that results intoo much remodeling. Bisphosphonates lower remodeling. [Teriparatide]increases new bone formation."
But longer-term studies are still needed to assess teriparatide'seffects over prolonged periods, Recker said.
"Not one study has gone long enough to see if you get more benefits byusing it for a long time," he said. "It may be good for 24 months. Thatremains to be seen."
More information
WEDNESDAY, Nov. 14 (HealthDay News) -- An osteoporosis drug has provensuperior to standard therapy at slowing bone loss caused by asthmatreatment, researchers say.
Glucocorticoid medicines such as prednisone are often given to treatasthma, autoimmune disorders, skin allergies and other conditions,researchers note. But the drugs can also cause osteoporosis.
The drug, an anabolic agent called teriparatide, probably will be thepreferable treatment "for patients who have particularly bad disease tostart with or are on glucocorticoids for a long time," said Dr. Kenneth G.Saag, professor of medicine and epidemiology at the University of Alabamaat Birmingham.
The study, which was funded by teriparatide's maker, Eli Lilly &Co., is published in the Nov. 15 issue of the New England Journal ofMedicine.
One million Americans are taking glucocorticoids for one condition oranother, Saag said, and many are at higher risk of fractures, because themedications weaken their bones. Current treatment for medication-linkedosteoporosis centers on use of bisphosphonates, medications designed toprevent bone breakdown.
The 18-month trial included 428 men and women with drug-causedosteoporosis who had been taking glucocorticoids for at least threemonths. Half were assigned to take alendronate, a bisphosphonate, whilethe other half took teriparatide.
After three months, the increase in bone density at the lumbar (lower)spine was double for those taking teriparatide -- an average 7.2 percentrise versus 3.4 percent in the alendronate group. The teriparatide groupalso experienced fewer fractures of the vertebral bones compared withthose on the bisphosphonate.
But teriparatide's much higher cost will limit its use, Saag said. "Useof therapy is driven by insurance as well as by appropriate bone densityand fracture rate," he said. "We would like to be able to single out thosepatients whose minimal bone density puts them at higher risk forfracture," Saag said. "Those patients are the ones we want to target moreaggressively."
That group would include 30 percent to 50 percent of those withdrug-caused osteoporosis, he said. The U.S. Food and Drug Administrationalready has approved use of teriparatide for the treatment of osteoporosisin postmenopausal women at high risk for fracture and to increase bonemass in men at high risk of fracture with primary or hypogonadalosteoporosis.
The anabolic agent is a better treatment, because bisphosphonates donot actually promote bone growth, added Dr. Robert R. Recker, professor ofmedicine at Creighton University and a member of the Osteoporosis ResearchCenter there. Rather, they prevent bone destruction by natural processessuch as apoptosis (natural cell death), he said
"There is a greater need for a bone-forming agent, one that interfereswith the apoptosis of bone cells," Recker said. "The condition is not somuch a low bone mass disease but a disease of bone cells that results intoo much remodeling. Bisphosphonates lower remodeling. [Teriparatide]increases new bone formation."
But longer-term studies are still needed to assess teriparatide'seffects over prolonged periods, Recker said.
"Not one study has gone long enough to see if you get more benefits byusing it for a long time," he said. "It may be good for 24 months. Thatremains to be seen."
More information
Clinical Trials Update: Nov. 15, 2007
Clinical Trials Update: Nov. 15, 2007
(HealthDay News) -- Here are the latest clinical trials, courtesyof Thomson CenterWatch:
Carotid Artery Disease
If you are at least 18 years old, have a narrowing orblockage in a carotid artery, and are at high risk for complications fromsurgery, you may be eligible for this study.
The research site is inManhasset, N.Y.
More information
Please see http://www.centerwatch.com/patient/studies/cat635.html.
-----
Parkinson's Disease
If you are 30 or older and have been diagnosed withidiopathic Parkinson's disease within the last five years, you may beeligible to participate in this study.
The research site is in SunCity, Ariz.
More information
Please see http://www.centerwatch.com/patient/studies/cat117.html.
-----
Breast Cancer
If you are 18 or older, have breast cancer, and haveadequate bone marrow, liver, and renal function, you may be eligible forthis study.
The research site is in Memphis, Tenn.
More information
Please see http://www.centerwatch.com/patient/studies/cat29.html.
-----
Copyright 2007 Thomson CenterWatch. All rights reserved.
(HealthDay News) -- Here are the latest clinical trials, courtesyof Thomson CenterWatch:
Carotid Artery Disease
If you are at least 18 years old, have a narrowing orblockage in a carotid artery, and are at high risk for complications fromsurgery, you may be eligible for this study.
The research site is inManhasset, N.Y.
More information
Please see http://www.centerwatch.com/patient/studies/cat635.html.
-----
Parkinson's Disease
If you are 30 or older and have been diagnosed withidiopathic Parkinson's disease within the last five years, you may beeligible to participate in this study.
The research site is in SunCity, Ariz.
More information
Please see http://www.centerwatch.com/patient/studies/cat117.html.
-----
Breast Cancer
If you are 18 or older, have breast cancer, and haveadequate bone marrow, liver, and renal function, you may be eligible forthis study.
The research site is in Memphis, Tenn.
More information
Please see http://www.centerwatch.com/patient/studies/cat29.html.
-----
Copyright 2007 Thomson CenterWatch. All rights reserved.
Vietnam Vets Study Links Asthma and PTSD
Vietnam Vets Study Links Asthma and PTSD
THURSDAY, Nov. 15 (HealthDay News) -- A study of male twins who servedin Vietnam has uncovered a strong link between asthma and post-traumaticstress disorder (PTSD).
Columbia University researchers, reporting in the Nov. 15 issue of theAmerican Journal of Respiratory and Critical Care Medicine, foundthat those who suffered the most from PTSD were more than twice as likelyto have asthma.
"This is very good data," said Keith A. Young, co-director of theCentral Texas Veterans Health Care System Neuropsychiatry ResearchProgram. "One of the things that is very clearly delineated by this studyis that there truly is an association. This association has been seen withother anxiety disorders before, and there were some hints with PTSD, butthis is the best. This kind of sets it in stone."
The challenge now is to find out whether this is a cause-and-effectrelationship.
Previous studies have indicated a more general link between anxietydisorders and asthma, but this study focused specifically on PTSD, adisorder that involves nightmares, flashbacks and panic attacks linked to"triggers" that develop after exposure to combat or other extremelydisturbing events.
This study looked at 3,065 male twin pairs listed in the Vietnam EraTwin Registry.
The twins were either identical (meaning they shared all the samegenetic material) or fraternal (sharing only half their genetic material).Such twin studies are useful to science, because they can help tease outgenetic and environmental influences.
The twins in this study had all lived together as children and had allserved on active military duty in Vietnam. There were no significantdifferences in history of combat exposure or cigarette smoking. Theoverall prevalence of asthma was 6 percent and was about the same inidentical and fraternal twins.
Twins who suffered from the most PTSD symptoms were 2.3 times morelikely to have asthma when compared with those who suffered from the leastPTSD symptoms. The increased risk was about the same for both fraternaland identical twins, suggesting an environmental underpinning rather thana genetic one.
"If there had been a strong genetic component to the link betweenasthma and PTSD, the results between these two types of twins would havebeen different, but we didn't find any substantial differences between thetwo," lead researcher Renee D. Goodwin, an assistant professor ofepidemiology at the Mailman School of Public Health at Columbia Universityin New York City, said in a statement.
No one knows what the mechanisms are behind the association. It'spossible that some sort of traumatic stress could trigger both PTSD andasthma, or one condition could contribute to the other.
"In my mind, the most likely thing that would relate these two ischildhood stress," Young said. "It's very well-known that children who area under a lot of stresses can grow up to have a different mental healthoutcome than their twin."
According to the study authors, understanding the association bettermay help PTSD prevention efforts by suggesting ways to modifyenvironmental risk factors.
THURSDAY, Nov. 15 (HealthDay News) -- A study of male twins who servedin Vietnam has uncovered a strong link between asthma and post-traumaticstress disorder (PTSD).
Columbia University researchers, reporting in the Nov. 15 issue of theAmerican Journal of Respiratory and Critical Care Medicine, foundthat those who suffered the most from PTSD were more than twice as likelyto have asthma.
"This is very good data," said Keith A. Young, co-director of theCentral Texas Veterans Health Care System Neuropsychiatry ResearchProgram. "One of the things that is very clearly delineated by this studyis that there truly is an association. This association has been seen withother anxiety disorders before, and there were some hints with PTSD, butthis is the best. This kind of sets it in stone."
The challenge now is to find out whether this is a cause-and-effectrelationship.
Previous studies have indicated a more general link between anxietydisorders and asthma, but this study focused specifically on PTSD, adisorder that involves nightmares, flashbacks and panic attacks linked to"triggers" that develop after exposure to combat or other extremelydisturbing events.
This study looked at 3,065 male twin pairs listed in the Vietnam EraTwin Registry.
The twins were either identical (meaning they shared all the samegenetic material) or fraternal (sharing only half their genetic material).Such twin studies are useful to science, because they can help tease outgenetic and environmental influences.
The twins in this study had all lived together as children and had allserved on active military duty in Vietnam. There were no significantdifferences in history of combat exposure or cigarette smoking. Theoverall prevalence of asthma was 6 percent and was about the same inidentical and fraternal twins.
Twins who suffered from the most PTSD symptoms were 2.3 times morelikely to have asthma when compared with those who suffered from the leastPTSD symptoms. The increased risk was about the same for both fraternaland identical twins, suggesting an environmental underpinning rather thana genetic one.
"If there had been a strong genetic component to the link betweenasthma and PTSD, the results between these two types of twins would havebeen different, but we didn't find any substantial differences between thetwo," lead researcher Renee D. Goodwin, an assistant professor ofepidemiology at the Mailman School of Public Health at Columbia Universityin New York City, said in a statement.
No one knows what the mechanisms are behind the association. It'spossible that some sort of traumatic stress could trigger both PTSD andasthma, or one condition could contribute to the other.
"In my mind, the most likely thing that would relate these two ischildhood stress," Young said. "It's very well-known that children who area under a lot of stresses can grow up to have a different mental healthoutcome than their twin."
According to the study authors, understanding the association bettermay help PTSD prevention efforts by suggesting ways to modifyenvironmental risk factors.
Study warns on safety of Sanofi's Acomplia
Study warns on safety of Sanofi's Acomplia
A logo of pharmaceutical company Sanofi Aventis is seen in Ambares near Bordeaux, southwestern France, September 20, 2006. Patients taking the Sanofi-Aventis (Regis Duvignau/Reuters)LONDON (Reuters) - Patients taking the Sanofi-Aventisanti-obesity drug Acomplia have well over double the risk ofdepression and anxiety, researchers said, adding to the badnews for a drug already linked to suicidal thoughts.
Danish researchers reviewed four studies featuring 4,105patients and found that people taking 20 milligrams per day ofthe drug were 2.5 times more likely to discontinue treatmentdue to depressive disorders and three times more likely to stopbecause of anxiety than those who received a placebo.
The findings published in the Lancet journal follow a U.S.advisory panel decision in June that the drug should not beapproved in the world's largest drugs market because it mayincrease suicidal thoughts and depression.
"Taken together with the recent U.S. Food and DrugAdministration finding of increased risk of suicide duringtreatment with rimonabant, we recommend increased alertness byphysicians to these potentially severe psychiatric reactions,"Arne Astrup of the University of Copenhagen and colleagueswrote.
A study in the British Medical Journal on Friday also foundthat people taking anti-obesity drugs -- including Acomplia --would only see "modest" weight loss with many remainingsignificantly obese or overweight.
Salah Mahyahou, Sanofi's head of product communication,said caution raised about who should get Acomplia was in linewith the firm's efforts' to ensure the medicine is notprescribed to patients with severe depression or onanti-depressive treatment.
"We believe the meta analysis does not reveal any new dataor any new evidence beyond what is already known by physiciansor health authorities," he said by telephone.
SIDE EFFECTS
The researchers did not conduct the studies themselves butdid what is called a meta-analysis by reviewing four separatetrials of patients who received 20 gram doses of Acomplia andothers who took a placebo.
They also found that while patients given Sanofi's druglost nearly 5 kilograms more over a one-year period, the riskof serious side effects -- ranging from dry mouth to headachesto depression -- rose 40 percent.
Acomplia -- also known by the brand name Zimulti in theUnited States and generically as rimonabant -- is the first ina new class of drugs that switch off the same brain circuitsthat make people hungry when they smoke cannabis.
Its unique biochemical effect and ability to reduce severalrisk factors for cardiovascular disease initially led topredictions it would become a multibillion-dollar-a-yearblockbuster. It recorded sales of just 21 million euros ($31million) in the third quarter.
But the latest findings are bad news for the world's thirdbiggest drug maker after it announced in September it plannedto begin new clinical trials of the medicine as a treatment fortype 2 diabetes, which is linked to obesity.
Other researchers called the Danish findings especiallystriking given that people with a history of serious depressionor other psychiatric illnesses had been excluded from thestudies.
"Their meta-analysis has raised major questions about thesafety of rimonabant in obese people, who are already at anincreased risk of depression," Philip Mitchell and MargaretMorris of the University of New South Wales in Australia wrotein a Lancet commentary.
(Editing by Matthew Tostevin)
A logo of pharmaceutical company Sanofi Aventis is seen in Ambares near Bordeaux, southwestern France, September 20, 2006. Patients taking the Sanofi-Aventis (Regis Duvignau/Reuters)LONDON (Reuters) - Patients taking the Sanofi-Aventisanti-obesity drug Acomplia have well over double the risk ofdepression and anxiety, researchers said, adding to the badnews for a drug already linked to suicidal thoughts.
Danish researchers reviewed four studies featuring 4,105patients and found that people taking 20 milligrams per day ofthe drug were 2.5 times more likely to discontinue treatmentdue to depressive disorders and three times more likely to stopbecause of anxiety than those who received a placebo.
The findings published in the Lancet journal follow a U.S.advisory panel decision in June that the drug should not beapproved in the world's largest drugs market because it mayincrease suicidal thoughts and depression.
"Taken together with the recent U.S. Food and DrugAdministration finding of increased risk of suicide duringtreatment with rimonabant, we recommend increased alertness byphysicians to these potentially severe psychiatric reactions,"Arne Astrup of the University of Copenhagen and colleagueswrote.
A study in the British Medical Journal on Friday also foundthat people taking anti-obesity drugs -- including Acomplia --would only see "modest" weight loss with many remainingsignificantly obese or overweight.
Salah Mahyahou, Sanofi's head of product communication,said caution raised about who should get Acomplia was in linewith the firm's efforts' to ensure the medicine is notprescribed to patients with severe depression or onanti-depressive treatment.
"We believe the meta analysis does not reveal any new dataor any new evidence beyond what is already known by physiciansor health authorities," he said by telephone.
SIDE EFFECTS
The researchers did not conduct the studies themselves butdid what is called a meta-analysis by reviewing four separatetrials of patients who received 20 gram doses of Acomplia andothers who took a placebo.
They also found that while patients given Sanofi's druglost nearly 5 kilograms more over a one-year period, the riskof serious side effects -- ranging from dry mouth to headachesto depression -- rose 40 percent.
Acomplia -- also known by the brand name Zimulti in theUnited States and generically as rimonabant -- is the first ina new class of drugs that switch off the same brain circuitsthat make people hungry when they smoke cannabis.
Its unique biochemical effect and ability to reduce severalrisk factors for cardiovascular disease initially led topredictions it would become a multibillion-dollar-a-yearblockbuster. It recorded sales of just 21 million euros ($31million) in the third quarter.
But the latest findings are bad news for the world's thirdbiggest drug maker after it announced in September it plannedto begin new clinical trials of the medicine as a treatment fortype 2 diabetes, which is linked to obesity.
Other researchers called the Danish findings especiallystriking given that people with a history of serious depressionor other psychiatric illnesses had been excluded from thestudies.
"Their meta-analysis has raised major questions about thesafety of rimonabant in obese people, who are already at anincreased risk of depression," Philip Mitchell and MargaretMorris of the University of New South Wales in Australia wrotein a Lancet commentary.
(Editing by Matthew Tostevin)
Former sub-Sahara Africa leaders meet to discuss AIDS crisis
Former sub-Sahara Africa leaders meet to discuss AIDS crisis
A group of Zambian HIV-positive children. Veteran statesmen in Africa's sub-Sahara region are expected to gather in Zambia next week to discuss how to combat the deadly HIV/AIDS pandemic ravaging the continent, an official has said.(AFP/File/Alexander Joe)LUSAKA (AFP) - Veteran statesmen in Africa's sub-Sahara region are expected to gather in Zambia next week to discuss how to combat the deadly HIV/AIDS pandemic ravaging the continent, an official said Friday.
The meeting will bring together more than 10 former leaders in sub-Saharan Africa, including former South African President Nelson Mandela and his Mozambican counter-part Joaquim Chissano.
The former secretary general of the African Union, Salim Ahmed Salim, will also attend the meeting, at Zambia's tourist resort town of Livingstone, between November 21 and 23.
"The purpose is to work with former African leaders in building a stronger regional voice and action-oriented programme aimed at defeating HIV and AIDS", said Munyaradzi Hwengwere, coordinator of the meeting.
The meeting is sponsored by the aid agency Oxfam and organised by AIDSCOM, an organisation founded by Zambia's first president Kenneth Kaunda who active in the fight against AIDS.
UNAIDS put HIV/AIDS sufferers in the region, which makes just over 10% of the world's population, at 25.8 million.
A group of Zambian HIV-positive children. Veteran statesmen in Africa's sub-Sahara region are expected to gather in Zambia next week to discuss how to combat the deadly HIV/AIDS pandemic ravaging the continent, an official has said.(AFP/File/Alexander Joe)LUSAKA (AFP) - Veteran statesmen in Africa's sub-Sahara region are expected to gather in Zambia next week to discuss how to combat the deadly HIV/AIDS pandemic ravaging the continent, an official said Friday.
The meeting will bring together more than 10 former leaders in sub-Saharan Africa, including former South African President Nelson Mandela and his Mozambican counter-part Joaquim Chissano.
The former secretary general of the African Union, Salim Ahmed Salim, will also attend the meeting, at Zambia's tourist resort town of Livingstone, between November 21 and 23.
"The purpose is to work with former African leaders in building a stronger regional voice and action-oriented programme aimed at defeating HIV and AIDS", said Munyaradzi Hwengwere, coordinator of the meeting.
The meeting is sponsored by the aid agency Oxfam and organised by AIDSCOM, an organisation founded by Zambia's first president Kenneth Kaunda who active in the fight against AIDS.
UNAIDS put HIV/AIDS sufferers in the region, which makes just over 10% of the world's population, at 25.8 million.
Experts call for vaccine to fight severe diarrhea
Experts call for vaccine to fight severe diarrhea
HONG KONG (Reuters) - Pediatricians are urging governmentsin Asia to bolster national immunization programs with vaccinesagainst the rotavirus, the most common cause of severe diarrheain young children.
Rotavirus kills about 611,000 children worldwide a year, ora child every minute. Africa and Asia account for 90 percent ofthese deaths, with more than 180,000 occurring in Asia.
Experts said the high costs of rotavirus vaccines (US$50for each of 3 doses) should not be an obstacle.
"In Mexico and Chile, they decided it would be costeffective (to have all children vaccinated against rotavirus)and data show a decrease in mortality and morbidity," said UsaThisyakorn, president of the Pediatric Society in Thailand.
The World Health Organization said it recommended theinclusion of rotavirus vaccination into national immunizationprograms in places where its efficacy has been proven, but itgave a word of caution.
"To date, the clinical efficacy of rotavirus vaccines hasbeen demonstrated mainly in the United States, Europe and LatinAmerica. Experience with several other oral vaccines hasdemonstrated that in terms of vaccine safety and efficacy,considerable regional differences may exist," it said.
"Clinical trials are currently ongoing in Africa and Asia,where rotavirus disease burden is very high and where the needfor more data on vaccine efficacy is particularly urgent."
The Global Alliance for Vaccine and Immunization (GAVI) hasfunded the use of rotavirus vaccines in some countries inEurope and Latin America with a gross national income of underUS$1,000 per capita.
"To further expand new vaccine use in other countries suchas Philippines not currently covered by GAVI, other donors andfoundations should also come forward," the WHO said.
GAVI is backed by governments and the private sector.
INFANTS MOST AT RISK
Rotavirus affects nearly all children before they turn 5and 70 percent are 11 months old or younger. Highly contagious,it can survive in the environment for hours on hands, and fordays on solid surfaces. Excreted in stools, it is transmittedorally person-to-person very easily via toys and other objects.
Between 25 percent and 60 percent of diarrhea patients inAsia who end up in hospital suffer from rotavirus.
Without proper fluid replacement, a child can be dehydratedwithin 24 hours and develop serious complications such aselectrolyte imbalance, organ failure, shock, and even die.
"For an infant, any loss of fluid that is more than 10percent of body weight is crucial, and at 15 percent it can gointo organ failure," said Lulu Bravo, pediatric professor andexecutive director of the National Institute of Health at theUniversity of the Philippines.
One way to counter diarrhea is to replace water loss withoral rehydration fluids. But that is difficult becauserotavirus causes vomiting, making it difficult for anyone tohold down water, let alone an infant or young child.
(Editing by Jeremy Laurence)
HONG KONG (Reuters) - Pediatricians are urging governmentsin Asia to bolster national immunization programs with vaccinesagainst the rotavirus, the most common cause of severe diarrheain young children.
Rotavirus kills about 611,000 children worldwide a year, ora child every minute. Africa and Asia account for 90 percent ofthese deaths, with more than 180,000 occurring in Asia.
Experts said the high costs of rotavirus vaccines (US$50for each of 3 doses) should not be an obstacle.
"In Mexico and Chile, they decided it would be costeffective (to have all children vaccinated against rotavirus)and data show a decrease in mortality and morbidity," said UsaThisyakorn, president of the Pediatric Society in Thailand.
The World Health Organization said it recommended theinclusion of rotavirus vaccination into national immunizationprograms in places where its efficacy has been proven, but itgave a word of caution.
"To date, the clinical efficacy of rotavirus vaccines hasbeen demonstrated mainly in the United States, Europe and LatinAmerica. Experience with several other oral vaccines hasdemonstrated that in terms of vaccine safety and efficacy,considerable regional differences may exist," it said.
"Clinical trials are currently ongoing in Africa and Asia,where rotavirus disease burden is very high and where the needfor more data on vaccine efficacy is particularly urgent."
The Global Alliance for Vaccine and Immunization (GAVI) hasfunded the use of rotavirus vaccines in some countries inEurope and Latin America with a gross national income of underUS$1,000 per capita.
"To further expand new vaccine use in other countries suchas Philippines not currently covered by GAVI, other donors andfoundations should also come forward," the WHO said.
GAVI is backed by governments and the private sector.
INFANTS MOST AT RISK
Rotavirus affects nearly all children before they turn 5and 70 percent are 11 months old or younger. Highly contagious,it can survive in the environment for hours on hands, and fordays on solid surfaces. Excreted in stools, it is transmittedorally person-to-person very easily via toys and other objects.
Between 25 percent and 60 percent of diarrhea patients inAsia who end up in hospital suffer from rotavirus.
Without proper fluid replacement, a child can be dehydratedwithin 24 hours and develop serious complications such aselectrolyte imbalance, organ failure, shock, and even die.
"For an infant, any loss of fluid that is more than 10percent of body weight is crucial, and at 15 percent it can gointo organ failure," said Lulu Bravo, pediatric professor andexecutive director of the National Institute of Health at theUniversity of the Philippines.
One way to counter diarrhea is to replace water loss withoral rehydration fluids. But that is difficult becauserotavirus causes vomiting, making it difficult for anyone tohold down water, let alone an infant or young child.
(Editing by Jeremy Laurence)
Child health fight grim sign for broader U.S. reforms
Child health fight grim sign for broader U.S. reforms
Wagons filled with petitions protesting President Bush's veto of the State Children's Health Insurance Program sit in front of the White House, October 1, 2007. Washington is abuzz with predictions of health care system reforms after the 2008 presidential elections but an unexpectedly bitter impasse over insuring poor children is a telling reminder that few things stir up partisan passions like health care. (Jim Young/Reuters)WASHINGTON (Reuters) - Washington is abuzz with predictionsof health care system reforms after the 2008 presidentialelections but an unexpectedly bitter impasse over insuring poorchildren is a telling reminder that few things stir up partisanpassions like health care.
And when Democrats and Republicans feud, the outcome isoften ... nothing.
The State Children's Health Insurance Program is a popular10-year-old program backed by both parties, but lawmakers andPresident George W. Bush have deadlocked over extending andexpanding it. The U.S. Congress was leaving for a two-weekThanksgiving break on Friday without a solution.
Some policy experts predict that if politicians cannotagree on insuring poor kids, it is going to be challenging evenfor a new president and a new Congress to move ahead in 2009 onfar broader changes to the health care system.
"We have a big dysfunctional sector of the economy withlots of money floating around," said Michael Cannon, a healthanalyst at the libertarian Cato Institute.
Shaking up that system inevitably creates winners andlosers, he said, "so most of the time we're at this stalematewhere everyone's second best option is the same: Do nothing."
And any debate over health coverage, whether for childrenor larger populations, means a highly ideological fight aboutthe appropriate role of government, said Ed Howard of thenonpartisan Alliance for Health Reform, a veteran of manyWashington health care battles.
Reformers have been trying to overhaul the U.S. system fordecades. The last big legislative push came in the early 1990sunder Democratic President Bill Clinton and first lady HillaryClinton. Now a senator from New York, a revamped healthcoverage plan is a key theme in her 2008 presidential bid.
PROBLEMS HAVE DEEPENED
In the last decade, many U.S. health care problems havedeepened. Health spending has soared and now makes up one-sixthof the U.S. economy. The number of uninsured has reached 47million. Researchers have identified troubling levels ofmedical errors and lapses in quality.
"We had a big attempt (at reform) 13 years ago. It didn'twork. Then we decided to work incrementally and that's been apretty spectacular failure. The problems are getting worse,"said Karen Pollitz, of Georgetown University's Health PolicyInstitute.
Bush vetoed the children's health coverage bill and hasvowed to kill future versions unless it shrinks to hisspecifications.
He said the plan, which would increase funding to $60billion from the current $25 billion over five years, was toocostly and could shift middle-income kids from privateinsurance to government-run care. He also objected to raisingtobacco taxes to pay for the program.
Democrats say the extra money is needed to continuecoverage for the roughly 6.6 million children currentlyenrolled and provide coverage to about 3.4 million more.
Conservatives call the children's health program"socialized medicine" or a "government-takeover" of healthcare, rhetoric that echoes previous debates and may foreshadowRepublican attacks on coverage proposals if a Democrat wins theWhite House next year.
"Name calling is a tried and true weapon," said Pollitz.
Republican candidates have their own health proposals, manyrelying on tax credits and changes to private insurancemarkets. Democrats often dismiss them as fig leafs that mayhelp businesses with a stake in health care but do little forpeople who cannot afford coverage.
(Editing by Lori Santos and Vicki Allen)
Wagons filled with petitions protesting President Bush's veto of the State Children's Health Insurance Program sit in front of the White House, October 1, 2007. Washington is abuzz with predictions of health care system reforms after the 2008 presidential elections but an unexpectedly bitter impasse over insuring poor children is a telling reminder that few things stir up partisan passions like health care. (Jim Young/Reuters)WASHINGTON (Reuters) - Washington is abuzz with predictionsof health care system reforms after the 2008 presidentialelections but an unexpectedly bitter impasse over insuring poorchildren is a telling reminder that few things stir up partisanpassions like health care.
And when Democrats and Republicans feud, the outcome isoften ... nothing.
The State Children's Health Insurance Program is a popular10-year-old program backed by both parties, but lawmakers andPresident George W. Bush have deadlocked over extending andexpanding it. The U.S. Congress was leaving for a two-weekThanksgiving break on Friday without a solution.
Some policy experts predict that if politicians cannotagree on insuring poor kids, it is going to be challenging evenfor a new president and a new Congress to move ahead in 2009 onfar broader changes to the health care system.
"We have a big dysfunctional sector of the economy withlots of money floating around," said Michael Cannon, a healthanalyst at the libertarian Cato Institute.
Shaking up that system inevitably creates winners andlosers, he said, "so most of the time we're at this stalematewhere everyone's second best option is the same: Do nothing."
And any debate over health coverage, whether for childrenor larger populations, means a highly ideological fight aboutthe appropriate role of government, said Ed Howard of thenonpartisan Alliance for Health Reform, a veteran of manyWashington health care battles.
Reformers have been trying to overhaul the U.S. system fordecades. The last big legislative push came in the early 1990sunder Democratic President Bill Clinton and first lady HillaryClinton. Now a senator from New York, a revamped healthcoverage plan is a key theme in her 2008 presidential bid.
PROBLEMS HAVE DEEPENED
In the last decade, many U.S. health care problems havedeepened. Health spending has soared and now makes up one-sixthof the U.S. economy. The number of uninsured has reached 47million. Researchers have identified troubling levels ofmedical errors and lapses in quality.
"We had a big attempt (at reform) 13 years ago. It didn'twork. Then we decided to work incrementally and that's been apretty spectacular failure. The problems are getting worse,"said Karen Pollitz, of Georgetown University's Health PolicyInstitute.
Bush vetoed the children's health coverage bill and hasvowed to kill future versions unless it shrinks to hisspecifications.
He said the plan, which would increase funding to $60billion from the current $25 billion over five years, was toocostly and could shift middle-income kids from privateinsurance to government-run care. He also objected to raisingtobacco taxes to pay for the program.
Democrats say the extra money is needed to continuecoverage for the roughly 6.6 million children currentlyenrolled and provide coverage to about 3.4 million more.
Conservatives call the children's health program"socialized medicine" or a "government-takeover" of healthcare, rhetoric that echoes previous debates and may foreshadowRepublican attacks on coverage proposals if a Democrat wins theWhite House next year.
"Name calling is a tried and true weapon," said Pollitz.
Republican candidates have their own health proposals, manyrelying on tax credits and changes to private insurancemarkets. Democrats often dismiss them as fig leafs that mayhelp businesses with a stake in health care but do little forpeople who cannot afford coverage.
(Editing by Lori Santos and Vicki Allen)
Some OBs unclear on HIV testing requirements
Some OBs unclear on HIV testing requirements
NEW YORK (Reuters Health) - Although virtually allobstetrician-gynecologists recommend HIV testing to all theirpregnant patients, some are unaware of their state requirementsfor recommending such testing, according to a report in theObstetrics & Gynecology.
Several organizations, including the Centers for DiseaseControl and Prevention, have recommended that all pregnantwomen be screened for HIV, using an opt-out approach, as partof routine prenatal care, the authors explain.
With the opt-out testing strategy, the woman tested unlessshe explicitly refuses. She is provided information on HIV andtold that a test will be performed as part of a battery ofstandard tests. She is also informed that she has the right todecline testing.
The opt-in testing approach requires an explicit requestfor an HIV test. After a woman has received HIV information,she is asked if she wants an HIV test. She is tested only ifshe specifically agrees and, in most cases, signs and aninformed consent form.
Dr. Jay Schulkin and colleagues from the American Collegeof Obstetricians and Gynecologists, Washington, DC surveyedobstetrician-gynecologists regarding HIV knowledge. A total of1,032 questionnaires were sent out and 582 were returned.
All but 3 percent of obstetrician-gynecologists reportedthat they recommend HIV testing to all of their pregnantpatients, the authors report, though nearly three quarters ofobstetrician-gynecologists considered 5 percent or fewer oftheir pregnant patients to be at high risk for HIV infection.
Obstetrician-gynecologists were fairly evenly divided as towhether they tested their pregnant patients for HIV using theopt-in approach (52 percent) or the opt-out approach (48percent).
Just over half the obstetrician-gynecologists (57 percent)reported using the HIV testing approach required in theirstates, the researchers note, while 43 percent reported usingan approach not consistent with their state's regulation.
Nearly one third of obstetrician-gynecologists said theydid not know if their state required HIV testing duringpregnancy.
Most obstetrician-gynecologists responding to the surveyreported that they provide pretest counseling before HIVtesting (73.7 percent) and post-test counseling (84.6 percent).
"The results of this study suggest thatobstetrician-gynecologists may benefit from additionalinformation that could improve their knowledge and practiceregarding HIV screening," the investigators write.
"Although most respondents report being at least moderatelyknowledgeable about HIV during pregnancy and reportrecommending HIV testing to all pregnant patients, they mayneed to be more aggressive in following up with patients whodecline HIV testing."
SOURCE: Obstetrics & Gynecology, November 2007
NEW YORK (Reuters Health) - Although virtually allobstetrician-gynecologists recommend HIV testing to all theirpregnant patients, some are unaware of their state requirementsfor recommending such testing, according to a report in theObstetrics & Gynecology.
Several organizations, including the Centers for DiseaseControl and Prevention, have recommended that all pregnantwomen be screened for HIV, using an opt-out approach, as partof routine prenatal care, the authors explain.
With the opt-out testing strategy, the woman tested unlessshe explicitly refuses. She is provided information on HIV andtold that a test will be performed as part of a battery ofstandard tests. She is also informed that she has the right todecline testing.
The opt-in testing approach requires an explicit requestfor an HIV test. After a woman has received HIV information,she is asked if she wants an HIV test. She is tested only ifshe specifically agrees and, in most cases, signs and aninformed consent form.
Dr. Jay Schulkin and colleagues from the American Collegeof Obstetricians and Gynecologists, Washington, DC surveyedobstetrician-gynecologists regarding HIV knowledge. A total of1,032 questionnaires were sent out and 582 were returned.
All but 3 percent of obstetrician-gynecologists reportedthat they recommend HIV testing to all of their pregnantpatients, the authors report, though nearly three quarters ofobstetrician-gynecologists considered 5 percent or fewer oftheir pregnant patients to be at high risk for HIV infection.
Obstetrician-gynecologists were fairly evenly divided as towhether they tested their pregnant patients for HIV using theopt-in approach (52 percent) or the opt-out approach (48percent).
Just over half the obstetrician-gynecologists (57 percent)reported using the HIV testing approach required in theirstates, the researchers note, while 43 percent reported usingan approach not consistent with their state's regulation.
Nearly one third of obstetrician-gynecologists said theydid not know if their state required HIV testing duringpregnancy.
Most obstetrician-gynecologists responding to the surveyreported that they provide pretest counseling before HIVtesting (73.7 percent) and post-test counseling (84.6 percent).
"The results of this study suggest thatobstetrician-gynecologists may benefit from additionalinformation that could improve their knowledge and practiceregarding HIV screening," the investigators write.
"Although most respondents report being at least moderatelyknowledgeable about HIV during pregnancy and reportrecommending HIV testing to all pregnant patients, they mayneed to be more aggressive in following up with patients whodecline HIV testing."
SOURCE: Obstetrics & Gynecology, November 2007
U.S. regulators join HIV transplant probe
U.S. regulators join HIV transplant probe
CHICAGO (Reuters) - The Centers for Medicare and MedicaidServices has joined an investigation into how four Chicagotransplant recipients contracted HIV and hepatitis C from asingle organ donor, U.S. officials said on Friday.
CMS, a federal agency that regulates organ procurement, ischecking whether three Chicago hospitals fully informedtransplant recipients that the organ donor was at high risk ofbeing infected with the human immunodeficiency virus, whichcauses AIDS.
A Chicago attorney has asked the Cook County Circuit Courtto order one hospital to preserve all records related to itsorgan donation procedures.
Thomas Demetrio said his client, one of the organrecipients, was not told the kidney she received was from ahigh-risk donor until this week.
Tests of the organs initially showed them to be free ofinfection, but a more sophisticated test done later detectedHIV and hepatitis C, health officials said.
"We are still doing an investigation of the organprocurement organization and we also are looking at thehospitals to make sure information was shared with both thetransplant programs and the recipients," said Jan Tarantino,director of the division of continuing care providers at CMS, apart of the U.S. Department of Health and Human Services.
SERIOUS SITUATION
"This is a serious situation," Tarantino said in atelephone interview.
Typically, CMS contracts with the state health department,but she said CMS has sent its own investigator to accompanystate officials. "We've never gotten a report of this beforeand the consequences are very serious for the patientsinvolved," she said.
Hospital officials have confirmed that two patients fromthe University of Chicago Medical Center, one from NorthwesternMemorial Hospital and one at Rush University Medical Centertested positive for HIV and hepatitis C.
If the hospitals are found to have violated procedures,they could face sanctions and ultimately could be dropped fromparticipation in Medicare, Tarantino said.
The U.S. Centers for Disease Control and Prevention hassaid the cases mark the first incidence of HIV infectioncontracted from organ donation since 1986.
Dave Bosch of the Gift of Hope Organ and Tissue DonorNetwork, the regional organ procurement agency that handled thedonor organs, this week confirmed the organs came from ahigh-risk donor. He said standard tests failed to pick up theinfections, likely because they occurred within three weeks ofthe donor's death -- too soon for the tests to detect.
Demetrio said in a telephone interview his client, a womanin her early 30s, had been on the transplant list for more thanfive years before receiving a kidney from the University ofChicago Medical Center. "Right now she's a wreck. She's stillin shock," he said.
Demetrio said his client had been undergoing kidneydialysis and could have waited for another organ.
A University of Chicago Medical Center spokesman confirmedthat the hospital received a petition from Cook County CircuitCourt and said the hospital will provide necessary records withthe patient's consent.
A spokeswoman for Rush said the hospital has been contactedby CMS and is cooperating with the investigation.
Bosch said about 9 percent of the 22,000 organ transplantsin the United States involve high-risk organs.(Editing by Will Dunham and Vicki Allen)
CHICAGO (Reuters) - The Centers for Medicare and MedicaidServices has joined an investigation into how four Chicagotransplant recipients contracted HIV and hepatitis C from asingle organ donor, U.S. officials said on Friday.
CMS, a federal agency that regulates organ procurement, ischecking whether three Chicago hospitals fully informedtransplant recipients that the organ donor was at high risk ofbeing infected with the human immunodeficiency virus, whichcauses AIDS.
A Chicago attorney has asked the Cook County Circuit Courtto order one hospital to preserve all records related to itsorgan donation procedures.
Thomas Demetrio said his client, one of the organrecipients, was not told the kidney she received was from ahigh-risk donor until this week.
Tests of the organs initially showed them to be free ofinfection, but a more sophisticated test done later detectedHIV and hepatitis C, health officials said.
"We are still doing an investigation of the organprocurement organization and we also are looking at thehospitals to make sure information was shared with both thetransplant programs and the recipients," said Jan Tarantino,director of the division of continuing care providers at CMS, apart of the U.S. Department of Health and Human Services.
SERIOUS SITUATION
"This is a serious situation," Tarantino said in atelephone interview.
Typically, CMS contracts with the state health department,but she said CMS has sent its own investigator to accompanystate officials. "We've never gotten a report of this beforeand the consequences are very serious for the patientsinvolved," she said.
Hospital officials have confirmed that two patients fromthe University of Chicago Medical Center, one from NorthwesternMemorial Hospital and one at Rush University Medical Centertested positive for HIV and hepatitis C.
If the hospitals are found to have violated procedures,they could face sanctions and ultimately could be dropped fromparticipation in Medicare, Tarantino said.
The U.S. Centers for Disease Control and Prevention hassaid the cases mark the first incidence of HIV infectioncontracted from organ donation since 1986.
Dave Bosch of the Gift of Hope Organ and Tissue DonorNetwork, the regional organ procurement agency that handled thedonor organs, this week confirmed the organs came from ahigh-risk donor. He said standard tests failed to pick up theinfections, likely because they occurred within three weeks ofthe donor's death -- too soon for the tests to detect.
Demetrio said in a telephone interview his client, a womanin her early 30s, had been on the transplant list for more thanfive years before receiving a kidney from the University ofChicago Medical Center. "Right now she's a wreck. She's stillin shock," he said.
Demetrio said his client had been undergoing kidneydialysis and could have waited for another organ.
A University of Chicago Medical Center spokesman confirmedthat the hospital received a petition from Cook County CircuitCourt and said the hospital will provide necessary records withthe patient's consent.
A spokeswoman for Rush said the hospital has been contactedby CMS and is cooperating with the investigation.
Bosch said about 9 percent of the 22,000 organ transplantsin the United States involve high-risk organs.(Editing by Will Dunham and Vicki Allen)
Few overweight people trim down after heart attack
Few overweight people trim down after heart attack
Two audience members watch the 2007 'Farm Aid' concert in New York September 9, 2007. Overweight people lose virtually no weight after suffering a heart attack, according to the first study to evaluate factors associated with post-heart attack weight changes. (Lucas Jackson/Reuters)NEW YORK (Reuters Health) - Overweight people losevirtually no weight after suffering a heart attack, accordingto the first study to evaluate factors associated withpost-heart attack weight changes.
"On average less than a half of a percent change in bodyweight occurred, and that's really small," Dr. John A. Spertusof the Mid America Heart Institute of Saint Luke's Hospital inKansas City, Missouri, one of the study's authors, told ReutersHealth. People need to lose at least 5 percent of their bodyweight to significantly improve their heart health, he added.
Spertus and his team followed up with 1,253 overweight orobese individuals one year after they had experienced a heartattack. On average, they had lost 0.2 percent of their bodyweight. Overweight people actually gained an average of 0.4percent of their body weight, while obese people lost 0.5percent and morbidly obese individuals lost nearly 4 percent.
People who were depressed put on more weight, as did peoplewho quit smoking after their heart attack. Individuals withouthealth insurance were also more likely to put on pounds.
"People who stopped smoking tended to increase their weightby about 2.5 to 3 percent," Spertus noted. "That's a challengebecause you want people to both stop smoking and lose weight."
Just 18 percent to 25 percent of the study patientsparticipated in a certified cardiac rehabilitation program inthe first month after their heart attack, Spertus noted in aninterview. These programs, which focus on helping peopleincrease activity, eat better, quit smoking and make otherlifestyle changes to improve cardiovascular health, areconsidered the gold standard of post-heart attack care, headded, but not everyone has access to them.
When this is the case, Spertus said, "doctors and officestaff need to fill the role" of encouraging patients to loseweight and quit smoking. When certified cardiac rehabilitationprograms are available, he added, they're often underused. "Wearen't doing as well as we need to be doing."
SOURCE: American Heart Journal, October 2007.
Two audience members watch the 2007 'Farm Aid' concert in New York September 9, 2007. Overweight people lose virtually no weight after suffering a heart attack, according to the first study to evaluate factors associated with post-heart attack weight changes. (Lucas Jackson/Reuters)NEW YORK (Reuters Health) - Overweight people losevirtually no weight after suffering a heart attack, accordingto the first study to evaluate factors associated withpost-heart attack weight changes.
"On average less than a half of a percent change in bodyweight occurred, and that's really small," Dr. John A. Spertusof the Mid America Heart Institute of Saint Luke's Hospital inKansas City, Missouri, one of the study's authors, told ReutersHealth. People need to lose at least 5 percent of their bodyweight to significantly improve their heart health, he added.
Spertus and his team followed up with 1,253 overweight orobese individuals one year after they had experienced a heartattack. On average, they had lost 0.2 percent of their bodyweight. Overweight people actually gained an average of 0.4percent of their body weight, while obese people lost 0.5percent and morbidly obese individuals lost nearly 4 percent.
People who were depressed put on more weight, as did peoplewho quit smoking after their heart attack. Individuals withouthealth insurance were also more likely to put on pounds.
"People who stopped smoking tended to increase their weightby about 2.5 to 3 percent," Spertus noted. "That's a challengebecause you want people to both stop smoking and lose weight."
Just 18 percent to 25 percent of the study patientsparticipated in a certified cardiac rehabilitation program inthe first month after their heart attack, Spertus noted in aninterview. These programs, which focus on helping peopleincrease activity, eat better, quit smoking and make otherlifestyle changes to improve cardiovascular health, areconsidered the gold standard of post-heart attack care, headded, but not everyone has access to them.
When this is the case, Spertus said, "doctors and officestaff need to fill the role" of encouraging patients to loseweight and quit smoking. When certified cardiac rehabilitationprograms are available, he added, they're often underused. "Wearen't doing as well as we need to be doing."
SOURCE: American Heart Journal, October 2007.
Study shows how some AIDS vaccines may harm
Study shows how some AIDS vaccines may harm
A Chinese woman checks her mobile phone while passing an anti-AIDS poster in Beijing November 28, 2004. Some viruses being used in experimental AIDS vaccines may damage the immune system by exhausting key cells, researchers reported on Thursday in a finding that may further cloud the field of HIV vaccines. (Claro Cortes/Reuters)WASHINGTON (Reuters) - Some viruses being used inexperimental AIDS vaccines may damage the immune system byexhausting key cells, researchers reported on Thursday in afinding that may further cloud the field of HIV vaccines.
They said vaccines using the viruses should not be testedon people until more studies are done. But other vaccineexperts said the findings, while scientifically interesting,were not a cause for immediate alarm.
The usually harmless viruses are used as so-called vectorsto carry genetic material from the AIDS virus into the body sothat the immune system can recognize and rally against it.
But the viruses, called adeno-associated viruses, maythemselves be doing harm, said Dr. Hildegund Ertl, director ofthe Wistar Institute Vaccine Center in Philadelphia.
In mice, the adeno-associated virus, or AAV vaccines,directly interfered with immune cells called CD8 T-cells,Ertl's team reported in the Journal of Clinical Investigation.These are the "killer" T-cells that a vaccine is supposed tomuster to fight HIV.
"The immune cells become exhausted," Ertl said in atelephone interview.
"It is simply a defense mechanism of T-cells -- if there istoo much antigen for too long a time they simply turnthemselves off."
Antigens are the proteins the immune system uses torecognize enemies such as bacteria and viruses. In the case ofHIV, turned-off T-cells could leave a person more vulnerablethan usual to infection.
"AAVs do not cause disease," Ertl's team wrote. They cannoteven replicate on their own, instead piggybacking ontoadenoviruses, which cause colds, or herpes viruses.
But they do persist in the body.
VULNERABLE TO HIV
Ertl said it was unclear whether her findings might castlight on the troubling developments in a trial of an AIDSvaccine that used another virus, an adenovirus.
Vaccine maker Merck & Co stopped that trial in Septemberand said last week it appeared that the adenovirus used in thevaccine may have somehow made patients more vulnerable to HIVinfections.
The International AIDS Vaccine Initiative or IAVI used anadeno-associated virus in a trial of an AIDS vaccine thatwrapped up in January in Belgium, Germany and India, andanother in South Africa, Uganda and Zambia.
IAVI's Pat Fast said the group was not testing AAV vaccinesany more.
"While we find the AAV study by Dr. Ertl and her group ...very interesting and we'll consider whether it can inform ourfuture studies, their study was conducted in mice and there arefundamental differences between mice and humans in theirrespective immune responses, particularly with regard to theimmune response against HIV," Fast said in a statement.
"The dose given to these mice was equivalent, on the basisof body weight, to 3,000 to 4,000 times the highest dose givento humans in the ... study in India."
Dr. Anthony Fauci, director of the National Institute ofAllergy and Infectious Diseases, said the study should be taken"with a very heavy dose of caution."He noted that adenoviruses and adeno-associated viruses arevery different microbes, despite the similarity of their names."We may be dealing with apples and oranges," Fauci said ina telephone interview.(Editing by Mohammad Zargham)
A Chinese woman checks her mobile phone while passing an anti-AIDS poster in Beijing November 28, 2004. Some viruses being used in experimental AIDS vaccines may damage the immune system by exhausting key cells, researchers reported on Thursday in a finding that may further cloud the field of HIV vaccines. (Claro Cortes/Reuters)WASHINGTON (Reuters) - Some viruses being used inexperimental AIDS vaccines may damage the immune system byexhausting key cells, researchers reported on Thursday in afinding that may further cloud the field of HIV vaccines.
They said vaccines using the viruses should not be testedon people until more studies are done. But other vaccineexperts said the findings, while scientifically interesting,were not a cause for immediate alarm.
The usually harmless viruses are used as so-called vectorsto carry genetic material from the AIDS virus into the body sothat the immune system can recognize and rally against it.
But the viruses, called adeno-associated viruses, maythemselves be doing harm, said Dr. Hildegund Ertl, director ofthe Wistar Institute Vaccine Center in Philadelphia.
In mice, the adeno-associated virus, or AAV vaccines,directly interfered with immune cells called CD8 T-cells,Ertl's team reported in the Journal of Clinical Investigation.These are the "killer" T-cells that a vaccine is supposed tomuster to fight HIV.
"The immune cells become exhausted," Ertl said in atelephone interview.
"It is simply a defense mechanism of T-cells -- if there istoo much antigen for too long a time they simply turnthemselves off."
Antigens are the proteins the immune system uses torecognize enemies such as bacteria and viruses. In the case ofHIV, turned-off T-cells could leave a person more vulnerablethan usual to infection.
"AAVs do not cause disease," Ertl's team wrote. They cannoteven replicate on their own, instead piggybacking ontoadenoviruses, which cause colds, or herpes viruses.
But they do persist in the body.
VULNERABLE TO HIV
Ertl said it was unclear whether her findings might castlight on the troubling developments in a trial of an AIDSvaccine that used another virus, an adenovirus.
Vaccine maker Merck & Co stopped that trial in Septemberand said last week it appeared that the adenovirus used in thevaccine may have somehow made patients more vulnerable to HIVinfections.
The International AIDS Vaccine Initiative or IAVI used anadeno-associated virus in a trial of an AIDS vaccine thatwrapped up in January in Belgium, Germany and India, andanother in South Africa, Uganda and Zambia.
IAVI's Pat Fast said the group was not testing AAV vaccinesany more.
"While we find the AAV study by Dr. Ertl and her group ...very interesting and we'll consider whether it can inform ourfuture studies, their study was conducted in mice and there arefundamental differences between mice and humans in theirrespective immune responses, particularly with regard to theimmune response against HIV," Fast said in a statement.
"The dose given to these mice was equivalent, on the basisof body weight, to 3,000 to 4,000 times the highest dose givento humans in the ... study in India."
Dr. Anthony Fauci, director of the National Institute ofAllergy and Infectious Diseases, said the study should be taken"with a very heavy dose of caution."He noted that adenoviruses and adeno-associated viruses arevery different microbes, despite the similarity of their names."We may be dealing with apples and oranges," Fauci said ina telephone interview.(Editing by Mohammad Zargham)
Infants of obese mothers have higher mortality risk
Infants of obese mothers have higher mortality risk
A newborn baby is put on a scale at a hospital in Suining, southwest China's Sichuan province September 14, 2007. Obese women are at increased risk of having their infant die soon after birth, especially if premature rupture of membranes (PROM) occurs before full-term, according to a report in the journal Obstetrics and Gynecology. (Stringer/Reuters)NEW YORK (Reuters Health) - Obese women are at increasedrisk of having their infant die soon after birth, especially ifpremature rupture of membranes (PROM) occurs before full-term,according to a report in the journal Obstetrics & Gynecology.
These findings may indicate there is a problem in how obesewomen with preterm PROM births are treated, Dr. Ellen A. Nohrfrom University of Aarhus, Denmark told Reuters Health. It isalso possible that "preterm infants of obese mothers may bemore susceptible when they are not protected by the membranes."
PROM occurs when the membranes rupture before labor begins,which is usually followed by labor and delivery. Umbilical cordcompression is the primary risk for the fetus, while infectionwithin the uterus is the major complication in the woman.
Nohr and colleagues used the Danish National Birth Cohortto investigate the association between prepregnancy obesity andinfant mortality, with focus upon different types of pretermbirths.
The infant mortality rate was higher in infants ofoverweight and obese mothers than in infants of normal-weightmothers, the authors report, even after consideration of othermaternal and infant risk factors.
Mortality in infants born after preterm PROM was more thantripled in infants of overweight women and was increased nearlysix-fold in infants of obese women, the report indicates.
High body mass index was not, however, associated withmortality in infants born after spontaneous preterm birthswithout preterm PROM.
The results were similar in infants with or withoutmalformations and after exclusion of infants born to women withobesity-related diseases or infants born to subfertile women,the researchers note.
"This is the first study indicating an elevated mortalityin infants of obese mothers after preterm PROM, and it istherefore too early to suggest changes in the management ofpregnancies in obese women," Nohr said.
"However, if these findings are causal and we understandthe mechanisms behind them, it may be possible to suggestpreventive measures," she added.
SOURCE: Obstetrics & Gynecology, November 2007.
A newborn baby is put on a scale at a hospital in Suining, southwest China's Sichuan province September 14, 2007. Obese women are at increased risk of having their infant die soon after birth, especially if premature rupture of membranes (PROM) occurs before full-term, according to a report in the journal Obstetrics and Gynecology. (Stringer/Reuters)NEW YORK (Reuters Health) - Obese women are at increasedrisk of having their infant die soon after birth, especially ifpremature rupture of membranes (PROM) occurs before full-term,according to a report in the journal Obstetrics & Gynecology.
These findings may indicate there is a problem in how obesewomen with preterm PROM births are treated, Dr. Ellen A. Nohrfrom University of Aarhus, Denmark told Reuters Health. It isalso possible that "preterm infants of obese mothers may bemore susceptible when they are not protected by the membranes."
PROM occurs when the membranes rupture before labor begins,which is usually followed by labor and delivery. Umbilical cordcompression is the primary risk for the fetus, while infectionwithin the uterus is the major complication in the woman.
Nohr and colleagues used the Danish National Birth Cohortto investigate the association between prepregnancy obesity andinfant mortality, with focus upon different types of pretermbirths.
The infant mortality rate was higher in infants ofoverweight and obese mothers than in infants of normal-weightmothers, the authors report, even after consideration of othermaternal and infant risk factors.
Mortality in infants born after preterm PROM was more thantripled in infants of overweight women and was increased nearlysix-fold in infants of obese women, the report indicates.
High body mass index was not, however, associated withmortality in infants born after spontaneous preterm birthswithout preterm PROM.
The results were similar in infants with or withoutmalformations and after exclusion of infants born to women withobesity-related diseases or infants born to subfertile women,the researchers note.
"This is the first study indicating an elevated mortalityin infants of obese mothers after preterm PROM, and it istherefore too early to suggest changes in the management ofpregnancies in obese women," Nohr said.
"However, if these findings are causal and we understandthe mechanisms behind them, it may be possible to suggestpreventive measures," she added.
SOURCE: Obstetrics & Gynecology, November 2007.
Fetal Heart Rate Points to Later Child Development
Fetal Heart Rate Points to Later Child Development
FRIDAY, Nov. 16 (HealthDay News) -- Checking on fetal heart-ratepatterns can offer insight into how a child's nervous system will developthrough its toddler years, a U.S. study finds.
Johns Hopkins and U.S. National Institutes of Health researcherschecked fetal heart rate and variability -- the degree to which heart rateincreases and decreases within a specific time period -- six times from 20weeks through 38 weeks of gestation in 137 women with normalpregnancies.
When the children born to the women were between 24 months and 36months old, the researchers assessed their mental, motor and languageabilities.
Greater variation in fetal heart rate at about 28 weeks gestationpredicted better performance on a standardized developmental exam at agetwo, and better language skills at 30 months, said the study, which ispublished in the November/December issue of the journal ChildDevelopment.
Fetuses that had more rapid gains in heart rate variation beginning at20 weeks gestation had quicker progression through childhood mental, motorand language milestones than children who had slower fetal gains inheart-rate variations.
According to the researchers, the findings suggest that the basis ofindividual differences in children's development begins duringgestation.
"Further demonstration that these and other indicators of fetalfunctioning supply important information about the developing nervoussystem will enrich our understanding of the importance of the prenatalperiod of life," study lead author Janet DiPietro, a professor in thedepartment of population, family and reproductive health, and associatedean for research at Johns Hopkins Bloomberg School of Public Health, saidin a prepared statement.
"In turn, such knowledge can contribute to the formation of strategiesfocused on improving prenatal functioning in these arenas by facilitatingpregnancy well-being. However, since current obstetric care alreadyroutinely evaluates heart rate patterning as an indicator of fetaldistress, pregnant women do not need to seek out additional informationabout their baby's heart rate from their providers," DiPietro said.
FRIDAY, Nov. 16 (HealthDay News) -- Checking on fetal heart-ratepatterns can offer insight into how a child's nervous system will developthrough its toddler years, a U.S. study finds.
Johns Hopkins and U.S. National Institutes of Health researcherschecked fetal heart rate and variability -- the degree to which heart rateincreases and decreases within a specific time period -- six times from 20weeks through 38 weeks of gestation in 137 women with normalpregnancies.
When the children born to the women were between 24 months and 36months old, the researchers assessed their mental, motor and languageabilities.
Greater variation in fetal heart rate at about 28 weeks gestationpredicted better performance on a standardized developmental exam at agetwo, and better language skills at 30 months, said the study, which ispublished in the November/December issue of the journal ChildDevelopment.
Fetuses that had more rapid gains in heart rate variation beginning at20 weeks gestation had quicker progression through childhood mental, motorand language milestones than children who had slower fetal gains inheart-rate variations.
According to the researchers, the findings suggest that the basis ofindividual differences in children's development begins duringgestation.
"Further demonstration that these and other indicators of fetalfunctioning supply important information about the developing nervoussystem will enrich our understanding of the importance of the prenatalperiod of life," study lead author Janet DiPietro, a professor in thedepartment of population, family and reproductive health, and associatedean for research at Johns Hopkins Bloomberg School of Public Health, saidin a prepared statement.
"In turn, such knowledge can contribute to the formation of strategiesfocused on improving prenatal functioning in these arenas by facilitatingpregnancy well-being. However, since current obstetric care alreadyroutinely evaluates heart rate patterning as an indicator of fetaldistress, pregnant women do not need to seek out additional informationabout their baby's heart rate from their providers," DiPietro said.
Major U.S. Autism Study Gets Under Way
Major U.S. Autism Study Gets Under Way
FRIDAY, Nov. 16 (HealthDay News) -- A large, five-year studylooking at the genetic and environmental factors that may cause autism, aswell as other developmental delays, has started enrolling 2,700 childrenand their families from six areas in the United States.
The Study to Explore Early Development -- which researchers called thelargest of its kind -- will include children with autism and otherdevelopmental delays, as well as children with normal development.
Family medical history, genetics, and sociodemographic, lifestyle andenvironmental factors will be among the areas of focus in the study.Information will be gathered through interviews, physical examinations,medical records and cheek swab, blood and hair samples.
"We hope this will help us learn more about the factors that may leadto autism and other developmental disabilities, and how genes and theenvironment may affect child development," Lisa A. Croen, principalinvestigator at a site in California, said in a prepared statement.
"The results may also contribute to better services and treatments foraffected children and to prevention strategies," said Croen, anepidemiologist with Kaiser Permanente's Division of Research in Oakland,Calif.
It's not understood why, but the incidence of autism is increasing andnow affects about one in 150 children born in the U.S. The chronicdisorder affects the normal functioning of the brain and affectsdevelopment of communication and social skills.
FRIDAY, Nov. 16 (HealthDay News) -- A large, five-year studylooking at the genetic and environmental factors that may cause autism, aswell as other developmental delays, has started enrolling 2,700 childrenand their families from six areas in the United States.
The Study to Explore Early Development -- which researchers called thelargest of its kind -- will include children with autism and otherdevelopmental delays, as well as children with normal development.
Family medical history, genetics, and sociodemographic, lifestyle andenvironmental factors will be among the areas of focus in the study.Information will be gathered through interviews, physical examinations,medical records and cheek swab, blood and hair samples.
"We hope this will help us learn more about the factors that may leadto autism and other developmental disabilities, and how genes and theenvironment may affect child development," Lisa A. Croen, principalinvestigator at a site in California, said in a prepared statement.
"The results may also contribute to better services and treatments foraffected children and to prevention strategies," said Croen, anepidemiologist with Kaiser Permanente's Division of Research in Oakland,Calif.
It's not understood why, but the incidence of autism is increasing andnow affects about one in 150 children born in the U.S. The chronicdisorder affects the normal functioning of the brain and affectsdevelopment of communication and social skills.
Cell Insights May Predict Breast Cancer's Spread
Cell Insights May Predict Breast Cancer's Spread
FRIDAY, Nov. 16 (HealthDay News) -- U.S. researchers believethey're on the way to solving a major question about breast cancer: Whichwomen have a type of lesion in their breast duct that will progress toinvasive disease?
"It's an exciting step forward -- people have been trying to gettraction on this big clinical problem for about 40 years, and this is abig crack in the door," said lead researcher Thea Tlsty, a professor ofpathology at the University of California, San Francisco.
Ductal carcinoma in situ (DCIS), as this type of lesion is officiallyknown, is diagnosed in about 47,000 American women every year, accordingto the U.S. National Cancer Institute. To prevent its recurrence asinvasive breast cancer, DCIS generally is treated by lumpectomy alone(approximately 25 percent of cases) or lumpectomy with adjunctivetreatments such as radiation, chemotherapy, and/or hormones (approximately40 percent).
In about 25 percent of cases, complete mastectomies are performed. Lessthan an estimated 5 percent of women choose "watchful waiting" in lieu ofa surgical intervention, Tlsty said.
But doctors are still confronted with a guessing game when it comes topredicting those patients at highest risk for recurrence, Tlsty said."Only about 12 to 15 percent of women diagnosed with DCIS are going tohave a future invasive cancer, and all the others won't. Up until now, theproblem was that we couldn't distinguish the 12 to 15 percent from thosewho were not [at risk]," explained Tlsty.
Consequently, some women unknowingly are overtreated by having amastectomy, and others are undertreated if they chose a course of watchfulwaiting rather than surgical intervention, Tlsty added.
In their pilot study, published in the November issue of CancerCell, the UCSF team looked at how a collection of biomarkers,including molecules called p16 and ki67, interact to predict invasivetumors, she explained.
Because this initial study was done on tissue samples from 70 women, alarger retrospective study is under way at UCSF to validate the initialresults, Tlsty said.
Further research, including a large prospective trial, is also neededbefore the findings can be ready for clinical use, she added. If that workupholds the results of the pilot study, the biomarkers could be ready forclinical use within four to five years, Tlsty said.
Dr. Joseph Geradts, a professor of pathology at Duke University inDurham, N.C., said that finding biomarkers that predict the conversion ofDCIS into invasive cancer is "the holy grail of breast cancer research."He said there have been a number of previous studies that have beenpublished, but, so far, they've been "mostly a fruitless effort."
According to Geradts, the UCSF study "is valuable," because "theauthors propose two new biomarkers that in the past have not been lookedat." The UCSF team's findings "are intriguing preliminary data" that"merit confirmation and subsequent studies," he added.
Geradts said his own lab currently is researching whether changes inDNA may identify a tumor's capacity to metastasize or become invasive.Other researchers are looking at other DCIS biomarkers, he said.
"DCIS itself is a non-life threatening condition" with rare exceptions,noted Dr. Eric Winer, director of breast oncology at the Dana-FarberCancer Institute in Boston, and women are usually treated to help preventinvasive cancer. If the findings of the initial UCSF study are confirmed,then with "careful investigation, we may get to the point where we don'thave to treat all women with DCIS, and we may be able to tailor it so somewomen get less, and some women get more" depending upon their risk forinvasive breast cancer, Winer said.
"It's a very complex and interesting study" added Dr. Richard Bleicher,a surgical oncologist at Fox Chase Cancer Center in Philadelphia. "We needto be cautiously optimistic."
Bleicher added that while the findings have "significant potential,"women at this point shouldn't "pin all your hopes on it," because the p16assay is not something they can ask their doctors for at this point intime.
FRIDAY, Nov. 16 (HealthDay News) -- U.S. researchers believethey're on the way to solving a major question about breast cancer: Whichwomen have a type of lesion in their breast duct that will progress toinvasive disease?
"It's an exciting step forward -- people have been trying to gettraction on this big clinical problem for about 40 years, and this is abig crack in the door," said lead researcher Thea Tlsty, a professor ofpathology at the University of California, San Francisco.
Ductal carcinoma in situ (DCIS), as this type of lesion is officiallyknown, is diagnosed in about 47,000 American women every year, accordingto the U.S. National Cancer Institute. To prevent its recurrence asinvasive breast cancer, DCIS generally is treated by lumpectomy alone(approximately 25 percent of cases) or lumpectomy with adjunctivetreatments such as radiation, chemotherapy, and/or hormones (approximately40 percent).
In about 25 percent of cases, complete mastectomies are performed. Lessthan an estimated 5 percent of women choose "watchful waiting" in lieu ofa surgical intervention, Tlsty said.
But doctors are still confronted with a guessing game when it comes topredicting those patients at highest risk for recurrence, Tlsty said."Only about 12 to 15 percent of women diagnosed with DCIS are going tohave a future invasive cancer, and all the others won't. Up until now, theproblem was that we couldn't distinguish the 12 to 15 percent from thosewho were not [at risk]," explained Tlsty.
Consequently, some women unknowingly are overtreated by having amastectomy, and others are undertreated if they chose a course of watchfulwaiting rather than surgical intervention, Tlsty added.
In their pilot study, published in the November issue of CancerCell, the UCSF team looked at how a collection of biomarkers,including molecules called p16 and ki67, interact to predict invasivetumors, she explained.
Because this initial study was done on tissue samples from 70 women, alarger retrospective study is under way at UCSF to validate the initialresults, Tlsty said.
Further research, including a large prospective trial, is also neededbefore the findings can be ready for clinical use, she added. If that workupholds the results of the pilot study, the biomarkers could be ready forclinical use within four to five years, Tlsty said.
Dr. Joseph Geradts, a professor of pathology at Duke University inDurham, N.C., said that finding biomarkers that predict the conversion ofDCIS into invasive cancer is "the holy grail of breast cancer research."He said there have been a number of previous studies that have beenpublished, but, so far, they've been "mostly a fruitless effort."
According to Geradts, the UCSF study "is valuable," because "theauthors propose two new biomarkers that in the past have not been lookedat." The UCSF team's findings "are intriguing preliminary data" that"merit confirmation and subsequent studies," he added.
Geradts said his own lab currently is researching whether changes inDNA may identify a tumor's capacity to metastasize or become invasive.Other researchers are looking at other DCIS biomarkers, he said.
"DCIS itself is a non-life threatening condition" with rare exceptions,noted Dr. Eric Winer, director of breast oncology at the Dana-FarberCancer Institute in Boston, and women are usually treated to help preventinvasive cancer. If the findings of the initial UCSF study are confirmed,then with "careful investigation, we may get to the point where we don'thave to treat all women with DCIS, and we may be able to tailor it so somewomen get less, and some women get more" depending upon their risk forinvasive breast cancer, Winer said.
"It's a very complex and interesting study" added Dr. Richard Bleicher,a surgical oncologist at Fox Chase Cancer Center in Philadelphia. "We needto be cautiously optimistic."
Bleicher added that while the findings have "significant potential,"women at this point shouldn't "pin all your hopes on it," because the p16assay is not something they can ask their doctors for at this point intime.
Live Christmas Trees Can Trigger Mold Allergies
Live Christmas Trees Can Trigger Mold Allergies
FRIDAY, Nov. 16 (HealthDay News) -- While bringing home a liveChristmas tree marks the beginning of the holiday season for many, themold that thrives on its branches can trigger weeks of suffering for some,a new study shows.
Connecticut researchers have found that the mold count from a liveChristmas tree rose to five times the normal level two weeks after thetree was brought indoors, and that can prove problematic for people withmold allergies. Their research was presented this week at the AmericanCollege of Allergy, Asthma & Immunology annual meeting, in Dallas.
"Christmas trees are another possible source of mold exposure duringthe holiday season," said study co-author Philip Hemmers, an allergist andimmunologist with St. Vincent's Medical Center in Bridgeport, Conn. "Moldallergies peak in the fall, and we see a second peak with a lot of ourmold-sensitive patients during the holiday season. Our finding correlateswith this second peak of mold sensitivity."
The researchers studied the mold growth of a live Christmas tree in ahouse in Connecticut. Mold reproduce by releasing spores into the air, soafter the live Christmas tree was brought inside the house and decorated,the researchers measured mold spore counts. These counts were taken 12times over a two-week period between Dec. 24 and Jan. 6. The researchersdid not assess the types of mold or whether these molds triggered allergicsymptoms in people living in the house.
The study found that the mold spore count was 800 spores per squaremeter (m3) for the first three days. Normal spore counts are less than1,000 spores/m3, said Hemmers. However, the spore count rose after dayfour, reaching a maximum of 5,000 spores/m3 by day 14.
"This mold spore count is five times above normal. These high levelshave been correlated with allergic rhinitis and an increased rate ofasthma symptoms and asthma-related hospitalization in other studies," saidHemmers. "So if you don't feel well during the holidays, consider theChristmas tree as a possible source of allergies."
Hemmers recommended that people with mold sensitivity keep a liveChristmas tree in the house for only four to seven days. An artificialtree may be a better option for people with mold allergies, he added, butthey carry their own set of problems, especially if they've been stored inthe attic or basement where they can collect dust and mold.
Although Christmas trees are not a problem for most people withallergies, said Dr. David Khan, an associate professor of internalmedicine at the University of Texas Southwestern Medical Center in Dallas,there are things you can do to minimize their impact.
"If one is mold-allergic, running an air cleaner in the same room asthe tree could theoretically reduce the mold exposure, but this has notbeen studied," he said. "For some people who are sensitive to odors, thearoma from the tree, which most people like, could irritate their nose andcause symptoms. For these people, avoiding live trees may be best."
Before people start avoiding live Christmas trees because of their moldgrowth, more research needs to be done, said Dr. Dennis Ownby, a professorof pediatrics and medicine at the Medical College of Georgia, in Augusta.Since this study only looked at a single tree in one home, more homes withtrees should be investigated, as well as the types of mold found andwhether those molds trigger allergies. He added that the researchersshould also measure mold counts outside the home and correlate those toindoor mold counts.
Hemmers said that the outdoor mold count was likely low, since thestudy was done during the winter. The research team does plan to dofurther work this Christmas season by looking at more homes and the typesof mold found.
In addition to Christmas trees, there are other potential holidayallergens, said Dr. James Sublett, section chief of Pediatric Allergy atthe University of Louisville School of Medicine in Kentucky. These caninclude foods consumed at holiday parties, such as nuts and shellfish, andChristmas ornaments and lights that have been contaminated with dust ormold.
"Store Christmas decorations in plastic containers that you can wipeoff, since cardboard can potentially have mold," he advised. "Also wear aN95 dust mask when bringing stuff out of storage."
FRIDAY, Nov. 16 (HealthDay News) -- While bringing home a liveChristmas tree marks the beginning of the holiday season for many, themold that thrives on its branches can trigger weeks of suffering for some,a new study shows.
Connecticut researchers have found that the mold count from a liveChristmas tree rose to five times the normal level two weeks after thetree was brought indoors, and that can prove problematic for people withmold allergies. Their research was presented this week at the AmericanCollege of Allergy, Asthma & Immunology annual meeting, in Dallas.
"Christmas trees are another possible source of mold exposure duringthe holiday season," said study co-author Philip Hemmers, an allergist andimmunologist with St. Vincent's Medical Center in Bridgeport, Conn. "Moldallergies peak in the fall, and we see a second peak with a lot of ourmold-sensitive patients during the holiday season. Our finding correlateswith this second peak of mold sensitivity."
The researchers studied the mold growth of a live Christmas tree in ahouse in Connecticut. Mold reproduce by releasing spores into the air, soafter the live Christmas tree was brought inside the house and decorated,the researchers measured mold spore counts. These counts were taken 12times over a two-week period between Dec. 24 and Jan. 6. The researchersdid not assess the types of mold or whether these molds triggered allergicsymptoms in people living in the house.
The study found that the mold spore count was 800 spores per squaremeter (m3) for the first three days. Normal spore counts are less than1,000 spores/m3, said Hemmers. However, the spore count rose after dayfour, reaching a maximum of 5,000 spores/m3 by day 14.
"This mold spore count is five times above normal. These high levelshave been correlated with allergic rhinitis and an increased rate ofasthma symptoms and asthma-related hospitalization in other studies," saidHemmers. "So if you don't feel well during the holidays, consider theChristmas tree as a possible source of allergies."
Hemmers recommended that people with mold sensitivity keep a liveChristmas tree in the house for only four to seven days. An artificialtree may be a better option for people with mold allergies, he added, butthey carry their own set of problems, especially if they've been stored inthe attic or basement where they can collect dust and mold.
Although Christmas trees are not a problem for most people withallergies, said Dr. David Khan, an associate professor of internalmedicine at the University of Texas Southwestern Medical Center in Dallas,there are things you can do to minimize their impact.
"If one is mold-allergic, running an air cleaner in the same room asthe tree could theoretically reduce the mold exposure, but this has notbeen studied," he said. "For some people who are sensitive to odors, thearoma from the tree, which most people like, could irritate their nose andcause symptoms. For these people, avoiding live trees may be best."
Before people start avoiding live Christmas trees because of their moldgrowth, more research needs to be done, said Dr. Dennis Ownby, a professorof pediatrics and medicine at the Medical College of Georgia, in Augusta.Since this study only looked at a single tree in one home, more homes withtrees should be investigated, as well as the types of mold found andwhether those molds trigger allergies. He added that the researchersshould also measure mold counts outside the home and correlate those toindoor mold counts.
Hemmers said that the outdoor mold count was likely low, since thestudy was done during the winter. The research team does plan to dofurther work this Christmas season by looking at more homes and the typesof mold found.
In addition to Christmas trees, there are other potential holidayallergens, said Dr. James Sublett, section chief of Pediatric Allergy atthe University of Louisville School of Medicine in Kentucky. These caninclude foods consumed at holiday parties, such as nuts and shellfish, andChristmas ornaments and lights that have been contaminated with dust ormold.
"Store Christmas decorations in plastic containers that you can wipeoff, since cardboard can potentially have mold," he advised. "Also wear aN95 dust mask when bringing stuff out of storage."
Clinical Trials Update: Nov. 16, 2007
Clinical Trials Update: Nov. 16, 2007
(HealthDay News) -- Here are the latest clinical trials, courtesyof Thomson CenterWatch:
Attention Deficit/Hyperactivity Disorder(ADHD - Adults)
If you are aged 18 to 30 and have ADHD symptoms, youmay be eligible to participate in this study.
The research site isin Lexington, Ky.
More information
Please see http://www.centerwatch.com/patient/studies/cat499.html.
-----
Osteoarthritis
If you are aged 18 to 75 and have been diagnosed withosteoarthritis, you may qualify to participate in this study.
Theresearch site is in Clearwater, Fla.
More information
Please see http://www.centerwatch.com/patient/studies/cat109.html.
-----
Kidney Disease
If you are 18 or older and have chronic kidney diseasebut are not on dialysis, you may be eligible to participate in thisstudy.
The research site is in Great Neck, N.Y.
More information
Please see http://www.centerwatch.com/patient/studies/cat226.html.
-----
Copyright 2007 Thomson CenterWatch. All rights reserved.
(HealthDay News) -- Here are the latest clinical trials, courtesyof Thomson CenterWatch:
Attention Deficit/Hyperactivity Disorder(ADHD - Adults)
If you are aged 18 to 30 and have ADHD symptoms, youmay be eligible to participate in this study.
The research site isin Lexington, Ky.
More information
Please see http://www.centerwatch.com/patient/studies/cat499.html.
-----
Osteoarthritis
If you are aged 18 to 75 and have been diagnosed withosteoarthritis, you may qualify to participate in this study.
Theresearch site is in Clearwater, Fla.
More information
Please see http://www.centerwatch.com/patient/studies/cat109.html.
-----
Kidney Disease
If you are 18 or older and have chronic kidney diseasebut are not on dialysis, you may be eligible to participate in thisstudy.
The research site is in Great Neck, N.Y.
More information
Please see http://www.centerwatch.com/patient/studies/cat226.html.
-----
Copyright 2007 Thomson CenterWatch. All rights reserved.
Diet Drug Rimonabant Tied to Depression, Anxiety
Diet Drug Rimonabant Tied to Depression, Anxiety
THURSDAY, Nov. 15 (HealthDay News) -- People who take the weight-lossdrug rimonabant may face heightened risks for severe depression andanxiety, Danish researchers report.
The finding follows a recommendation by a U.S. Food and DrugAdministration panel in June that the agency not approve the diet drugbecause of continuing concerns about increased risks for suicidal thoughtsamong some users. Previously, the FDA rejected the drug as an aid to helppeople quit smoking.
"Up to this point in time, there has been controversy over the ratesand severity of psychiatric adverse effects with rimonabant," noted Dr.Philip Mitchell, head of the School of Psychiatry at the University of NewSouth Wales in Sydney, Australia, and co-author of an editorial thataccompanies the study.
This is the first review to examine rates of severe psychiatricsymptoms with rimonabant (Acomplia), symptoms severe enough that patientsdiscontinue treatment, Mitchell said.
The report is published in the Nov. 17 edition of TheLancet.
In the meta-analysis, Dr. Arne Astrup, from the department of humannutrition at the University of Copenhagen, collected data on more than4,100 patients enrolled in four clinical trials. Those trials comparedtaking rimonabant (20 milligrams a day) against a placebo.
The researchers found that people taking rimonabant did lose weight --about 15 pounds in a year -- compared to those receiving a placebo.
However, those taking rimonabant were also 40 percent more likely tohave an adverse reaction than people not taking it. In fact, those takingrimonabant were 2.5 times more likely to stop taking the drug because ofdepression and three times more likely to stop the drug because ofanxiety, compared to people on placebo.
"Our findings suggest that 20 milligrams per day of rimonabantincreases the risk of psychiatric events -- i.e., depressed mood disordersand anxiety -- despite depressed mood being an exclusion criterion inthese trials," Astrup's team said. "Taken together with the recent U.S.Food and Drug Administration finding of increased risk of suicide duringtreatment with rimonabant, we recommend increased alertness by physiciansto these potentially severe psychiatric adverse reactions."
Mitchell noted that depression is common in overweight and obesepeople, and is something that doctors need to take into account whenprescribing weight-loss drugs.
"This increased risk of depression and anxiety is a major safety issuein the treatment of obesity, as obese patients already have an increasedrisk of depression even prior to treatment," Mitchell said.
As far as rimonabant is concerned, Mitchell believes doctors shouldconsider alternate weight-loss drugs for people who are depressed. "If oneis using rimonabant, patients should be monitored carefully for theemergence of depressive symptoms and/or suicidal thoughts," he added.
In June, rimonabant's maker, French pharmaceutical giantSanofi-Aventis, said in a statement that despite the FDA's decision, thecompany "is confident in the positive benefit-risk ratio of rimonabant 20milligrams when used in the appropriate population."
Another expert said more data on the safety of rimonabant isneeded.
"Rimonabant is potentially beneficial in some patients, but we reallyneed long-term data demonstrating reductions in major obesity-relatedcomorbidities such as heart attack, stroke and sleep apnea and/ormortality, to be completely certain," said Dr. Raj Padwal, an assistantprofessor of general internal medicine at the University of Alberta inEdmonton, Canada.
The drug needs to be avoided in anyone who has a mood disorder, Padwaladded. "Since many patients with weight issues have depression, this meansthat the drug cannot be used in a large number of people. In the remainingindividuals in whom the drug is used, the patient and physician must becognizant of the risk of a mood disorder and monitor accordingly," hesaid.
In a related study in the Nov. 16 issue of the British MedicalJournal, Padwal's team found that long-term users of weight-loss drugssuch as orlistat (Xenical), sibutramine (Meridia) and rimonabantexperienced only modest weight loss -- less than 11 pounds, which was lessthan 5 percent of their total body weight.
Padwal's team also noted that the U.S. National Institute for ClinicalExcellence recommends stopping the use of weight-loss drugs if 5 percentof total body weight is not lost after three months.
Commenting on Padwal's study, Dr. Gareth Williams, dean of the Facultyof Medicine & Dentistry at the University of Bristol in the U.K.,wrote in an accompanying editorial: "Selling anti-obesity drugs over thecounter will perpetuate the myth that obesity can be fixed simply bypopping a pill and could further undermine the efforts to promote healthyliving, which is the only long-term escape from obesity."
THURSDAY, Nov. 15 (HealthDay News) -- People who take the weight-lossdrug rimonabant may face heightened risks for severe depression andanxiety, Danish researchers report.
The finding follows a recommendation by a U.S. Food and DrugAdministration panel in June that the agency not approve the diet drugbecause of continuing concerns about increased risks for suicidal thoughtsamong some users. Previously, the FDA rejected the drug as an aid to helppeople quit smoking.
"Up to this point in time, there has been controversy over the ratesand severity of psychiatric adverse effects with rimonabant," noted Dr.Philip Mitchell, head of the School of Psychiatry at the University of NewSouth Wales in Sydney, Australia, and co-author of an editorial thataccompanies the study.
This is the first review to examine rates of severe psychiatricsymptoms with rimonabant (Acomplia), symptoms severe enough that patientsdiscontinue treatment, Mitchell said.
The report is published in the Nov. 17 edition of TheLancet.
In the meta-analysis, Dr. Arne Astrup, from the department of humannutrition at the University of Copenhagen, collected data on more than4,100 patients enrolled in four clinical trials. Those trials comparedtaking rimonabant (20 milligrams a day) against a placebo.
The researchers found that people taking rimonabant did lose weight --about 15 pounds in a year -- compared to those receiving a placebo.
However, those taking rimonabant were also 40 percent more likely tohave an adverse reaction than people not taking it. In fact, those takingrimonabant were 2.5 times more likely to stop taking the drug because ofdepression and three times more likely to stop the drug because ofanxiety, compared to people on placebo.
"Our findings suggest that 20 milligrams per day of rimonabantincreases the risk of psychiatric events -- i.e., depressed mood disordersand anxiety -- despite depressed mood being an exclusion criterion inthese trials," Astrup's team said. "Taken together with the recent U.S.Food and Drug Administration finding of increased risk of suicide duringtreatment with rimonabant, we recommend increased alertness by physiciansto these potentially severe psychiatric adverse reactions."
Mitchell noted that depression is common in overweight and obesepeople, and is something that doctors need to take into account whenprescribing weight-loss drugs.
"This increased risk of depression and anxiety is a major safety issuein the treatment of obesity, as obese patients already have an increasedrisk of depression even prior to treatment," Mitchell said.
As far as rimonabant is concerned, Mitchell believes doctors shouldconsider alternate weight-loss drugs for people who are depressed. "If oneis using rimonabant, patients should be monitored carefully for theemergence of depressive symptoms and/or suicidal thoughts," he added.
In June, rimonabant's maker, French pharmaceutical giantSanofi-Aventis, said in a statement that despite the FDA's decision, thecompany "is confident in the positive benefit-risk ratio of rimonabant 20milligrams when used in the appropriate population."
Another expert said more data on the safety of rimonabant isneeded.
"Rimonabant is potentially beneficial in some patients, but we reallyneed long-term data demonstrating reductions in major obesity-relatedcomorbidities such as heart attack, stroke and sleep apnea and/ormortality, to be completely certain," said Dr. Raj Padwal, an assistantprofessor of general internal medicine at the University of Alberta inEdmonton, Canada.
The drug needs to be avoided in anyone who has a mood disorder, Padwaladded. "Since many patients with weight issues have depression, this meansthat the drug cannot be used in a large number of people. In the remainingindividuals in whom the drug is used, the patient and physician must becognizant of the risk of a mood disorder and monitor accordingly," hesaid.
In a related study in the Nov. 16 issue of the British MedicalJournal, Padwal's team found that long-term users of weight-loss drugssuch as orlistat (Xenical), sibutramine (Meridia) and rimonabantexperienced only modest weight loss -- less than 11 pounds, which was lessthan 5 percent of their total body weight.
Padwal's team also noted that the U.S. National Institute for ClinicalExcellence recommends stopping the use of weight-loss drugs if 5 percentof total body weight is not lost after three months.
Commenting on Padwal's study, Dr. Gareth Williams, dean of the Facultyof Medicine & Dentistry at the University of Bristol in the U.K.,wrote in an accompanying editorial: "Selling anti-obesity drugs over thecounter will perpetuate the myth that obesity can be fixed simply bypopping a pill and could further undermine the efforts to promote healthyliving, which is the only long-term escape from obesity."
Sunday, December 30, 2007
Forgetting long-time bonds, Alzheimer's patients fall in love
Forgetting long-time bonds, Alzheimer's patients fall in love
Retired Supreme Court justice Sandra Day Oa??Connor, pictured in May, recently revealed that her husband, John, an Alzheimer's patient, has begun a romance with a fellow patient after moving into an assisted living center, one of the possible effects of the progressive degenerative disease which deprives a suffer of the memories of their past live and ties.(AFP/File/Mandel Ngan)WASHINGTON (AFP) - When her husband of 55 years began seeing another woman, former US Supreme Court justice Sandra Day O'Connor did not begin high-profile divorce proceedings or condemn his infidelity.
Indeed, it was O'Connor herself who recently went public with the news that her husband John, 77, who suffers from Alzheimer's disease, had struck up a relationship with a woman patient at a care facility in Arizona.
"Mom was thrilled that dad was relaxed and happy and comfortable living here, and wasn't complaining," one of the O'Connors' three sons, Scott, said on television.
Before meeting his new romantic interest, who also suffers from Alzheimer's disease, John O'Connor was depressed and had talked of suicide, his son said.
Sandra Day O'Connor left her seat on the Supreme Court last year to look after her husband, who has suffered from Alzheimer's disease for 17 years.
The former judge chose to reveal her husband's "infidelity" to raise awareness of a lesser-known side of the degenerative brain disease, but did not comment publicly about the new woman in the life of her long-time partner.
Experts say it is not uncommon for Alzheimer's patients, who suffer memory loss and tend to live for the moment, to embark on new romantic relationships.
"I can't quantify how often this type of situation occurs, but it will continue to occur in greater number as the years go by, and particularly with baby boomers coming into long-term care settings," Rubin Dessel, head of memory care services at the Hebrew Home care facility in New York, told AFP.
Peter Reed, director of programs at the Alzheimer's Association, agreed that it was difficult to estimate how common the phenomenon was, but explained how it might come about.
"Alzheimer's is a progressive disease that affects the memory. Sufferers can forget familiar people, and live in the moment," he said.
"But people with dementia still need social connections, still need to interact and have meaningful relationships," he added.
Relationships between Alzheimer sufferers can take the form of an almost child-like romance where the couple simply holds hands.
But sexual relations are not unheard of.
"Sex? People certainly develop new relationships and they can take a variety of different forms," said Reed.
"They are not children despite having a memory problem," he said.
"While hand-holding is one demonstration of caring and camaraderie and intimacy, it may well extend to something more physical," said Dessel.
To families, watching a father or mother, husband or wife begin a new life with a new person, even as they have difficulty remembering their children and spouse, can be hurtful.
"If the marital relationship was a happy one, this can be extraordinarily hurtful and the family can react with sadness and pain," said Dessel.But, she said, an Alzheimer patient who embarks on a new relationship is not truly cheating on their marriage."These relationships are not based on adultery or betrayal. Alzheimer's patients lose so much of their past and very often have no memory or recall of anything of their lives, apart from their day-to-day experience."They live in the moment without the luxury of their past lives," Dessel said.She praised O'Connor's reaction to her husband's new object of affection."I applaud her. I believe that her support is noble and selfless. She is really looking to support the health of her husband and is concerned only at this point with his happiness and well-being," said Dessel."You have to be like Justice O'Connor. You have to be selfless."
Retired Supreme Court justice Sandra Day Oa??Connor, pictured in May, recently revealed that her husband, John, an Alzheimer's patient, has begun a romance with a fellow patient after moving into an assisted living center, one of the possible effects of the progressive degenerative disease which deprives a suffer of the memories of their past live and ties.(AFP/File/Mandel Ngan)WASHINGTON (AFP) - When her husband of 55 years began seeing another woman, former US Supreme Court justice Sandra Day O'Connor did not begin high-profile divorce proceedings or condemn his infidelity.
Indeed, it was O'Connor herself who recently went public with the news that her husband John, 77, who suffers from Alzheimer's disease, had struck up a relationship with a woman patient at a care facility in Arizona.
"Mom was thrilled that dad was relaxed and happy and comfortable living here, and wasn't complaining," one of the O'Connors' three sons, Scott, said on television.
Before meeting his new romantic interest, who also suffers from Alzheimer's disease, John O'Connor was depressed and had talked of suicide, his son said.
Sandra Day O'Connor left her seat on the Supreme Court last year to look after her husband, who has suffered from Alzheimer's disease for 17 years.
The former judge chose to reveal her husband's "infidelity" to raise awareness of a lesser-known side of the degenerative brain disease, but did not comment publicly about the new woman in the life of her long-time partner.
Experts say it is not uncommon for Alzheimer's patients, who suffer memory loss and tend to live for the moment, to embark on new romantic relationships.
"I can't quantify how often this type of situation occurs, but it will continue to occur in greater number as the years go by, and particularly with baby boomers coming into long-term care settings," Rubin Dessel, head of memory care services at the Hebrew Home care facility in New York, told AFP.
Peter Reed, director of programs at the Alzheimer's Association, agreed that it was difficult to estimate how common the phenomenon was, but explained how it might come about.
"Alzheimer's is a progressive disease that affects the memory. Sufferers can forget familiar people, and live in the moment," he said.
"But people with dementia still need social connections, still need to interact and have meaningful relationships," he added.
Relationships between Alzheimer sufferers can take the form of an almost child-like romance where the couple simply holds hands.
But sexual relations are not unheard of.
"Sex? People certainly develop new relationships and they can take a variety of different forms," said Reed.
"They are not children despite having a memory problem," he said.
"While hand-holding is one demonstration of caring and camaraderie and intimacy, it may well extend to something more physical," said Dessel.
To families, watching a father or mother, husband or wife begin a new life with a new person, even as they have difficulty remembering their children and spouse, can be hurtful.
"If the marital relationship was a happy one, this can be extraordinarily hurtful and the family can react with sadness and pain," said Dessel.But, she said, an Alzheimer patient who embarks on a new relationship is not truly cheating on their marriage."These relationships are not based on adultery or betrayal. Alzheimer's patients lose so much of their past and very often have no memory or recall of anything of their lives, apart from their day-to-day experience."They live in the moment without the luxury of their past lives," Dessel said.She praised O'Connor's reaction to her husband's new object of affection."I applaud her. I believe that her support is noble and selfless. She is really looking to support the health of her husband and is concerned only at this point with his happiness and well-being," said Dessel."You have to be like Justice O'Connor. You have to be selfless."
New Drug Option for Late-Stage Breast Cancer Patients (American Cancer Society)
New Drug Option for Late-Stage Breast Cancer Patients (American Cancer Society)
There's good news for advanced breast cancer patients whohaven'tresponded to current chemotherapy drugs.
RESOURCES:
Detailed Guide: BreastCancer
UnderstandingChemotherapy: A Guide For Patients And Families
BreastCancer Treatment Decision Tools
After a swift 6-month priority review, the Food and DrugAdministration put its stamp of approval on ixabepilone(IxempraTM), a new chemotherapy drug shown to reduce tumor sizeand slow tumorgrowth in some patients with metastatic or locally advanced breastcancer.
The new drug, developed by Bristol-Myers Squibb, is approved for use incombination with another chemotherapy drug capecitabine, in patientswho haven't had success with an anthracycline (like doxorubicin orepirubicin) and a taxane (like paclitaxel or docetaxel), and as astandalone option for patients who have exhausted all 3 options (ananthracycline, a taxane, and capecitabine).
The FDA review was based on studies of ixabepilone alone andin combination with capecitabine. In a study of 126 breast cancerpatients who received ixabepilone alone, 12% saw a significant decreasein the size of their tumors. In a randomized trial of 752 patients whotook both ixabepilone and capecitabine, tumor growth slowedsignificantly compared to patients who were taking capecitabine alone.
Ixabepilone belongs to a class of drugs known as epothiloneanalogs, which work by binding to and interfering with microtubules,structures that play a key role in cell division. The net effect is aslowing of the growth of cancer cells in the body.
Ixabepilone is given by intravenous infusion over 3 hoursevery 3 weeks. One of the possible side effects of taking ixabepiloneis bone marrow suppression, so it is not recommended for patients whohave low white blood cell or platelet counts. Other possible sideeffects include numbness or tingling in the hands or feet,constipation, nausea, vomiting, and muscle and joint pain.
There's good news for advanced breast cancer patients whohaven'tresponded to current chemotherapy drugs.
RESOURCES:
Detailed Guide: BreastCancer
UnderstandingChemotherapy: A Guide For Patients And Families
BreastCancer Treatment Decision Tools
After a swift 6-month priority review, the Food and DrugAdministration put its stamp of approval on ixabepilone(IxempraTM), a new chemotherapy drug shown to reduce tumor sizeand slow tumorgrowth in some patients with metastatic or locally advanced breastcancer.
The new drug, developed by Bristol-Myers Squibb, is approved for use incombination with another chemotherapy drug capecitabine, in patientswho haven't had success with an anthracycline (like doxorubicin orepirubicin) and a taxane (like paclitaxel or docetaxel), and as astandalone option for patients who have exhausted all 3 options (ananthracycline, a taxane, and capecitabine).
The FDA review was based on studies of ixabepilone alone andin combination with capecitabine. In a study of 126 breast cancerpatients who received ixabepilone alone, 12% saw a significant decreasein the size of their tumors. In a randomized trial of 752 patients whotook both ixabepilone and capecitabine, tumor growth slowedsignificantly compared to patients who were taking capecitabine alone.
Ixabepilone belongs to a class of drugs known as epothiloneanalogs, which work by binding to and interfering with microtubules,structures that play a key role in cell division. The net effect is aslowing of the growth of cancer cells in the body.
Ixabepilone is given by intravenous infusion over 3 hoursevery 3 weeks. One of the possible side effects of taking ixabepiloneis bone marrow suppression, so it is not recommended for patients whohave low white blood cell or platelet counts. Other possible sideeffects include numbness or tingling in the hands or feet,constipation, nausea, vomiting, and muscle and joint pain.
CDC Report: Smoking Rate Steady for Two-Years Running (American Cancer Society)
CDC Report: Smoking Rate Steady for Two-Years Running (American Cancer Society)
The number of adult smokers in the United States hasremainedconstantsince 2004, according to a report published this week by the US Centersfor Disease Control and Prevention (CDC).
RESOURCES:
GreatAmerican Smokeout Challenge
Guideto Quitting Smoking
Quiz:What's the Best Way For You to Quit?
Based on the CDC's numbers, 20.8% of US adults smoked in 2006,compared to the 20.9% who were smoking in 2004 and 2005, data thatsuggests a marked slowdown from the steady declines seen in previousyears.
Who's Smoking?
The CDC analyzed data from the 2006 National Health InterviewSurvey (NHIS), a questionnaire that evaluated the smoking habits of24,275 adults 18 and older. Of the group, 20.8% currently smoked, andamong those individuals, 44.2% had made an effort to stop smoking inthe last 12 months.
Slightly more men (23.9%) than women (18.0%) still light up.Only 10.4% of Asians surveyed still smoked, followed by Hispanics(15.2%), non-Hispanic whites (21.9%), non-Hispanic blacks (23%), andAmerican Indians/Alaskan Natives (32.4%). And overall, the likelihoodthat a person might smoke decreased as education level increased.
Numbers were especially high among those who had already beendiagnosed with smoking-related chronic diseases (36.9%), includingcertain cancers. That indicates a need for more aggressive cessationmessages directed at this population, the researchers say, especiallygiven data that shows that continued smoking has harmful effects ontreatment and survival.
Behind the Numbers
There are likely several reasons for the standstill in smokingrates. The authors of the study point to the 20.3% decrease in fundingfor comprehensive state-sponsored smoking cessation and preventionprograms from 2002 to 2006. On top of that, many states havere-allocated funds previously devoted to tobacco control, says ThomasJ. Glynn, Ph.D., director of the American Cancer Society's CancerScience and Trends and International Tobacco programs.
Also to blame: tobacco companies have offset the burden ofcigarette price increases by offering coupons, two-for-one deals, andother incentives to smokers, retailers, and wholesalers. Approximately81% of tobacco-industry marketing efforts were related to discountingstrategies, according to the report.
Call to Action
In order to get the numbers down, tobacco control advocatesneed to turn the heat up, Glynn says. The American Cancer Society iscalling for tighter regulations on cigarettes, from increasingworkplace laws and cigarette tax increases to granting the Food andDrug Administration the authority to regulate tobacco products.
"Tobacco use rates could even begin to rise rather thanstagnate if strong, effective action is not taken now," says Glynn.
Citation: "Tobacco Use Among Adults --United States, 2006." Published in the Nov. 9, 2007 Morbidityand Mortality Weekly Report (Vol. 56, No. 44:1157-1161). First author: VJ Rock, MPH, US Centers for Disease Controland Prevention.
The number of adult smokers in the United States hasremainedconstantsince 2004, according to a report published this week by the US Centersfor Disease Control and Prevention (CDC).
RESOURCES:
GreatAmerican Smokeout Challenge
Guideto Quitting Smoking
Quiz:What's the Best Way For You to Quit?
Based on the CDC's numbers, 20.8% of US adults smoked in 2006,compared to the 20.9% who were smoking in 2004 and 2005, data thatsuggests a marked slowdown from the steady declines seen in previousyears.
Who's Smoking?
The CDC analyzed data from the 2006 National Health InterviewSurvey (NHIS), a questionnaire that evaluated the smoking habits of24,275 adults 18 and older. Of the group, 20.8% currently smoked, andamong those individuals, 44.2% had made an effort to stop smoking inthe last 12 months.
Slightly more men (23.9%) than women (18.0%) still light up.Only 10.4% of Asians surveyed still smoked, followed by Hispanics(15.2%), non-Hispanic whites (21.9%), non-Hispanic blacks (23%), andAmerican Indians/Alaskan Natives (32.4%). And overall, the likelihoodthat a person might smoke decreased as education level increased.
Numbers were especially high among those who had already beendiagnosed with smoking-related chronic diseases (36.9%), includingcertain cancers. That indicates a need for more aggressive cessationmessages directed at this population, the researchers say, especiallygiven data that shows that continued smoking has harmful effects ontreatment and survival.
Behind the Numbers
There are likely several reasons for the standstill in smokingrates. The authors of the study point to the 20.3% decrease in fundingfor comprehensive state-sponsored smoking cessation and preventionprograms from 2002 to 2006. On top of that, many states havere-allocated funds previously devoted to tobacco control, says ThomasJ. Glynn, Ph.D., director of the American Cancer Society's CancerScience and Trends and International Tobacco programs.
Also to blame: tobacco companies have offset the burden ofcigarette price increases by offering coupons, two-for-one deals, andother incentives to smokers, retailers, and wholesalers. Approximately81% of tobacco-industry marketing efforts were related to discountingstrategies, according to the report.
Call to Action
In order to get the numbers down, tobacco control advocatesneed to turn the heat up, Glynn says. The American Cancer Society iscalling for tighter regulations on cigarettes, from increasingworkplace laws and cigarette tax increases to granting the Food andDrug Administration the authority to regulate tobacco products.
"Tobacco use rates could even begin to rise rather thanstagnate if strong, effective action is not taken now," says Glynn.
Citation: "Tobacco Use Among Adults --United States, 2006." Published in the Nov. 9, 2007 Morbidityand Mortality Weekly Report (Vol. 56, No. 44:1157-1161). First author: VJ Rock, MPH, US Centers for Disease Controland Prevention.
Naples bans smoking near pregnant women, children: city official
Naples bans smoking near pregnant women, children: city official
Cigarettes burn in an ashtray. A new law has taken effect in Naples prohibiting smoking near pregnant women and children in the southern Italian city's public parks.(AFP/File/Joel Saget)ROME (AFP) - A new law took effect in Naples on Monday prohibiting smoking near pregnant women and children in the southern Italian city's public parks.
"We're not going to use a ruler to measure the distance between smokers and women or children," Deputy Mayor Gennaro Nasti told AFP.
"But it will be forbidden to smoke during open-air shows or under covered structures."
Violators will have to pay fines of between 27.50 and 500 euros (40 and 730 dollars), Nasti said, adding that police would enforce the law.
Smoking in public buildings has been illegal throughout Italy since January 2005.
Cigarettes burn in an ashtray. A new law has taken effect in Naples prohibiting smoking near pregnant women and children in the southern Italian city's public parks.(AFP/File/Joel Saget)ROME (AFP) - A new law took effect in Naples on Monday prohibiting smoking near pregnant women and children in the southern Italian city's public parks.
"We're not going to use a ruler to measure the distance between smokers and women or children," Deputy Mayor Gennaro Nasti told AFP.
"But it will be forbidden to smoke during open-air shows or under covered structures."
Violators will have to pay fines of between 27.50 and 500 euros (40 and 730 dollars), Nasti said, adding that police would enforce the law.
Smoking in public buildings has been illegal throughout Italy since January 2005.
Want to lose that baby weight? Get some sleep
Want to lose that baby weight? Get some sleep
A mother and her toddler are shown in this undated file photo. Researchers presented a conundrum to new mothers on Monday, saying that women who want to lose the extra weight gained in pregnancy should try to get more sleep. (Kieran Doherty/Reuters)WASHINGTON (Reuters) - Researchers presented a conundrum tonew mothers on Monday, saying that women who want to lose theextra weight gained in pregnancy should try to get more sleep.
They found that mothers who slept five hours or less a daywhen their babies were six months old were three times morelikely than more rested mothers to have kept on the extraweight at one year.
"We've known for some time that sleep deprivation isassociated with weight gain and obesity in the generalpopulation, but this study shows that getting enough sleep --even just two hours more -- may be as important as a healthydiet and exercise for new mothers to return to theirpre-pregnancy weight," said Erica Gunderson of KaiserPermanente, which runs hospitals and clinics in California.
Gunderson and colleagues studied 940 women taking part in astudy of prenatal and postnatal health at Harvard MedicalSchool in Boston.
The women who slept five hours or less a night when theirbabies were six months old were more likely to have kept on 11pounds (5 kg) of weight one year after giving birth, theyfound.
Women who slept seven hours a night or more lost moreweight, they reported in the American Journal of Epidemiology.
The researchers acknowledged this may pose a dilemma to newmothers, given that infants sleep so fitfully.
"With the results of this study, new mothers must bewondering, 'How can I get more sleep for both me and my baby?'Our team is working on new studies to answer this importantquestion," said Dr. Matthew Gillman of Harvard Medical Schooland Harvard Pilgrim Health Care.
A mother and her toddler are shown in this undated file photo. Researchers presented a conundrum to new mothers on Monday, saying that women who want to lose the extra weight gained in pregnancy should try to get more sleep. (Kieran Doherty/Reuters)WASHINGTON (Reuters) - Researchers presented a conundrum tonew mothers on Monday, saying that women who want to lose theextra weight gained in pregnancy should try to get more sleep.
They found that mothers who slept five hours or less a daywhen their babies were six months old were three times morelikely than more rested mothers to have kept on the extraweight at one year.
"We've known for some time that sleep deprivation isassociated with weight gain and obesity in the generalpopulation, but this study shows that getting enough sleep --even just two hours more -- may be as important as a healthydiet and exercise for new mothers to return to theirpre-pregnancy weight," said Erica Gunderson of KaiserPermanente, which runs hospitals and clinics in California.
Gunderson and colleagues studied 940 women taking part in astudy of prenatal and postnatal health at Harvard MedicalSchool in Boston.
The women who slept five hours or less a night when theirbabies were six months old were more likely to have kept on 11pounds (5 kg) of weight one year after giving birth, theyfound.
Women who slept seven hours a night or more lost moreweight, they reported in the American Journal of Epidemiology.
The researchers acknowledged this may pose a dilemma to newmothers, given that infants sleep so fitfully.
"With the results of this study, new mothers must bewondering, 'How can I get more sleep for both me and my baby?'Our team is working on new studies to answer this importantquestion," said Dr. Matthew Gillman of Harvard Medical Schooland Harvard Pilgrim Health Care.
New research explains why some tumors undetected
New research explains why some tumors undetected
LONDON (Reuters) - Researchers looking at immune systems inhealthy people have discovered an interaction between two typesof cells that may help explain why the body's natural defensesfail to detect and fight tumors.
The findings could lead to better cancer treatments and newtargets for drugs, said Leonie Taams, an immunologist at King'sCollege London, who led the study published on Tuesday.
The study looked at regulatory T-cells, which keep theimmune system stable and are key in controlling immune cellscalled macrophages that cause inflammation. Inflammation is oneof the body's first responses when fighting infection.
Taams said the study showed that just as regulatory "policeofficer" T-cells can stop killer T-cells from attacking atumor, they can also shut off macrophages, suppressinginflammation and keeping the body from detecting tumors.
"Before these police officers were never believed to speakto these macrophages. We have shown they can do it," Taams saidin a telephone interview.
"The regulatory T-cells trick the immune system intothinking there is no problem."
Scientists had known things like the presence of bacteriatypically activated macrophages but understood less about whatcaused the cells to switch off.
Taams said the study -- in which researchers tookmacrophages from healthy people and cultured them in disheseither on their own, with normal T-cells or with regulatoryT-cells -- answered that question for the first time.
Their findings, published in the Proceedings of theNational Academy of Sciences, could lead to better ways todetect whether someone's immune system is fighting a tumorafter treatment, she said.
It could also lead to more specific drugs aimed at removingor altering these non-inflammatory macrophages that suppressthe immune system's response, Taams added.
"The work was done in healthy people but we believe it hasimplications for cancer," she said. "We believe that theregulatory T-cells are doing the job they are supposed to dobut they are doing it at the wrong place and the wrong time."
"The findings provide more ammunition for the idea thatregulatory T-cells should be removed from tumors."
(Editing by Maggie Fox and Michael Winfrey)
LONDON (Reuters) - Researchers looking at immune systems inhealthy people have discovered an interaction between two typesof cells that may help explain why the body's natural defensesfail to detect and fight tumors.
The findings could lead to better cancer treatments and newtargets for drugs, said Leonie Taams, an immunologist at King'sCollege London, who led the study published on Tuesday.
The study looked at regulatory T-cells, which keep theimmune system stable and are key in controlling immune cellscalled macrophages that cause inflammation. Inflammation is oneof the body's first responses when fighting infection.
Taams said the study showed that just as regulatory "policeofficer" T-cells can stop killer T-cells from attacking atumor, they can also shut off macrophages, suppressinginflammation and keeping the body from detecting tumors.
"Before these police officers were never believed to speakto these macrophages. We have shown they can do it," Taams saidin a telephone interview.
"The regulatory T-cells trick the immune system intothinking there is no problem."
Scientists had known things like the presence of bacteriatypically activated macrophages but understood less about whatcaused the cells to switch off.
Taams said the study -- in which researchers tookmacrophages from healthy people and cultured them in disheseither on their own, with normal T-cells or with regulatoryT-cells -- answered that question for the first time.
Their findings, published in the Proceedings of theNational Academy of Sciences, could lead to better ways todetect whether someone's immune system is fighting a tumorafter treatment, she said.
It could also lead to more specific drugs aimed at removingor altering these non-inflammatory macrophages that suppressthe immune system's response, Taams added.
"The work was done in healthy people but we believe it hasimplications for cancer," she said. "We believe that theregulatory T-cells are doing the job they are supposed to dobut they are doing it at the wrong place and the wrong time."
"The findings provide more ammunition for the idea thatregulatory T-cells should be removed from tumors."
(Editing by Maggie Fox and Michael Winfrey)
Condoms for inmates: a tough sell
Condoms for inmates: a tough sell
NEW YORK - To activists concerned about AIDS and prisoners' rights, it's an urgent, commonsense step that should already be nationwide policy — letting inmates have condoms to reduce the spread of sexually transmitted diseases behind bars.
Yet their efforts have run headlong into a stronger political force: Authorities' desire not to encourage inmates who flout prison rules against sex. Only one state, Vermont, and five cities regularly hand out condoms to inmates. Mississippi does so only for inmates receiving conjugal visits from their spouses.
Left out are the vast majority of America's 2.2 million prisoners — many held in facilities where sex between men is common and the risk of STDs is far higher than in the general population.
"I realize this is not a comfortable topic for many people, but it's one we simply cannot afford to ignore," said Rep. Barbara Lee, D-Calif. "When more than 90 percent of incarcerated people return to our communities, taking a head-in-the-sand approach to the fact that our prisons have become a breeding ground for HIV/AIDS poses a serious public health risk."
Despite such warnings, recent efforts to expand behind-bars condom access have gone almost nowhere. Prison officials contend that condoms can be used to conceal drugs, and law-and-order politicians scoff at what they depict as a step that would encourage both consensual and coercive sex.
"Removing the freedoms of criminals is in itself a deterrent," said California Assemblyman Paul Cook. "Allowing condoms into prisons simply sends the wrong message and confirms what we all suspect: Our prison system has serious and severe behavioral and inmate-control issues."
A measure introduced by Lee in Congress this year to allow condom access in federal prisons has made little headway. A bill in Illinois failed to clear a legislative committee in March. And a bill in California was vetoed last month by Gov. Arnold Schwarzenegger, who said the proposal conflicted with prison regulations banning sexual activity.
Yet Ron Snyder, an HIV-positive Californian who served 19 months in the state's prison systems for embezzlement, said sex was widespread despite the rules. Some inmates used rubber gloves as makeshift condoms, and some supervisors allowed romantically involved men to share cells, he said.
Schwarzenegger, in his veto message, offered a ray of hope to advocates of condom access. He described it as "not an unreasonable public policy" and instructed corrections officials to assess the feasibility of a pilot program at a yet-to-be-selected state prison.
Snyder predicted a "tough struggle" to extend any such program systemwide because of staff attitudes. Many of the correctional officers are from rural areas, "and they assume men don't have sex with men," he said. "They just don't understand the picture."
California already is home to two of the local condom programs, at jails in Los Angeles and San Francisco. New York, Philadelphia and Washington, D.C., also have programs — New York's dates back to 1987.
In Los Angeles, the condoms are distributed by an activist group, the Center for Health Justice, only in a special unit reserved for gay men who ask to be assigned there. San Francisco, for nearly 20 years, has allowed prisoners to be issued condoms by the health staff; distribution was expanded in April in the form of a condom-dispensing machine placed in a jail recreation hall.
Mary Sylla, the Center for Health Justice's policy director, said there have been no security problems in either city.
"If there was a case of somebody doing something horrible with a condom, we would have heard about it — it would be all over the corrections community," she said. "But it doesn't happen."
Though disappointed by Schwarzenegger's veto, Sylla is hopeful that a pilot program will indeed get started in the state prison system. She said corrections officials already had visited the Los Angeles unit to see that local program in action.
But Sylla acknowledged that the cause is tough to promote.
"It's easy to make fun of," she said. "People don't like to think about prisoners having sex, even though everybody knows it goes on."
Vermont's Corrections Department, although it holds relatively few HIV-positive inmates, has been making condoms available in prisons since 1992 — even though sexual activity remains officially prohibited."It's a courageous position that Vermont took then and continues to have now," said the department's health services director, Dr. Dolores Burroughs-Biron.Under the program, inmates are granted a single condom at a time if they request one from a nurse. Burroughs-Biron said there had been no reports of any security problems.But corrections officials insist there are dangers. Glenn Goord, New York State's former corrections commissioner, told the Legislature that inmates use condoms to transport drugs within prison grounds. He also said condoms might embolden prison rapists, who could use them to avoid leaving DNA evidence after their assaults.There is no authoritative U.S. data on the extent of HIV behind bars, but the federal Centers for Disease Control did conduct a detailed study in Georgia which found that 856 male inmates — about 2 percent of the state's total — were HIV-positive, and that 76 of them apparently got the virus while in prison.The CDC report, published last year, suggested that lawmakers consider the condom policy.Patrick Sullivan, the CDC epidemiologist who led the study, said sex among inmates was common in Georgia despite being prohibited. He said many of the sexually active inmates used condoms — or some improvised substitute — even though they were considered contraband.In several foreign countries — including Canada, Australia and much of Western Europe — condoms have been freely distributed to prisoners for years without security problems.Though activists are convinced condom access would reduce STD transmission, they are cautious in making specific health claims."I don't know how we'd ever be able to prove how much they reduce HIV," said Ron Snyder, who now works for the Center for Health Justice. "But if we could affect one or two people who wouldn't bring it back to their women when they get home, that's dramatic impact right there."
NEW YORK - To activists concerned about AIDS and prisoners' rights, it's an urgent, commonsense step that should already be nationwide policy — letting inmates have condoms to reduce the spread of sexually transmitted diseases behind bars.
Yet their efforts have run headlong into a stronger political force: Authorities' desire not to encourage inmates who flout prison rules against sex. Only one state, Vermont, and five cities regularly hand out condoms to inmates. Mississippi does so only for inmates receiving conjugal visits from their spouses.
Left out are the vast majority of America's 2.2 million prisoners — many held in facilities where sex between men is common and the risk of STDs is far higher than in the general population.
"I realize this is not a comfortable topic for many people, but it's one we simply cannot afford to ignore," said Rep. Barbara Lee, D-Calif. "When more than 90 percent of incarcerated people return to our communities, taking a head-in-the-sand approach to the fact that our prisons have become a breeding ground for HIV/AIDS poses a serious public health risk."
Despite such warnings, recent efforts to expand behind-bars condom access have gone almost nowhere. Prison officials contend that condoms can be used to conceal drugs, and law-and-order politicians scoff at what they depict as a step that would encourage both consensual and coercive sex.
"Removing the freedoms of criminals is in itself a deterrent," said California Assemblyman Paul Cook. "Allowing condoms into prisons simply sends the wrong message and confirms what we all suspect: Our prison system has serious and severe behavioral and inmate-control issues."
A measure introduced by Lee in Congress this year to allow condom access in federal prisons has made little headway. A bill in Illinois failed to clear a legislative committee in March. And a bill in California was vetoed last month by Gov. Arnold Schwarzenegger, who said the proposal conflicted with prison regulations banning sexual activity.
Yet Ron Snyder, an HIV-positive Californian who served 19 months in the state's prison systems for embezzlement, said sex was widespread despite the rules. Some inmates used rubber gloves as makeshift condoms, and some supervisors allowed romantically involved men to share cells, he said.
Schwarzenegger, in his veto message, offered a ray of hope to advocates of condom access. He described it as "not an unreasonable public policy" and instructed corrections officials to assess the feasibility of a pilot program at a yet-to-be-selected state prison.
Snyder predicted a "tough struggle" to extend any such program systemwide because of staff attitudes. Many of the correctional officers are from rural areas, "and they assume men don't have sex with men," he said. "They just don't understand the picture."
California already is home to two of the local condom programs, at jails in Los Angeles and San Francisco. New York, Philadelphia and Washington, D.C., also have programs — New York's dates back to 1987.
In Los Angeles, the condoms are distributed by an activist group, the Center for Health Justice, only in a special unit reserved for gay men who ask to be assigned there. San Francisco, for nearly 20 years, has allowed prisoners to be issued condoms by the health staff; distribution was expanded in April in the form of a condom-dispensing machine placed in a jail recreation hall.
Mary Sylla, the Center for Health Justice's policy director, said there have been no security problems in either city.
"If there was a case of somebody doing something horrible with a condom, we would have heard about it — it would be all over the corrections community," she said. "But it doesn't happen."
Though disappointed by Schwarzenegger's veto, Sylla is hopeful that a pilot program will indeed get started in the state prison system. She said corrections officials already had visited the Los Angeles unit to see that local program in action.
But Sylla acknowledged that the cause is tough to promote.
"It's easy to make fun of," she said. "People don't like to think about prisoners having sex, even though everybody knows it goes on."
Vermont's Corrections Department, although it holds relatively few HIV-positive inmates, has been making condoms available in prisons since 1992 — even though sexual activity remains officially prohibited."It's a courageous position that Vermont took then and continues to have now," said the department's health services director, Dr. Dolores Burroughs-Biron.Under the program, inmates are granted a single condom at a time if they request one from a nurse. Burroughs-Biron said there had been no reports of any security problems.But corrections officials insist there are dangers. Glenn Goord, New York State's former corrections commissioner, told the Legislature that inmates use condoms to transport drugs within prison grounds. He also said condoms might embolden prison rapists, who could use them to avoid leaving DNA evidence after their assaults.There is no authoritative U.S. data on the extent of HIV behind bars, but the federal Centers for Disease Control did conduct a detailed study in Georgia which found that 856 male inmates — about 2 percent of the state's total — were HIV-positive, and that 76 of them apparently got the virus while in prison.The CDC report, published last year, suggested that lawmakers consider the condom policy.Patrick Sullivan, the CDC epidemiologist who led the study, said sex among inmates was common in Georgia despite being prohibited. He said many of the sexually active inmates used condoms — or some improvised substitute — even though they were considered contraband.In several foreign countries — including Canada, Australia and much of Western Europe — condoms have been freely distributed to prisoners for years without security problems.Though activists are convinced condom access would reduce STD transmission, they are cautious in making specific health claims."I don't know how we'd ever be able to prove how much they reduce HIV," said Ron Snyder, who now works for the Center for Health Justice. "But if we could affect one or two people who wouldn't bring it back to their women when they get home, that's dramatic impact right there."
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