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The earlier smokers take cessation medication before they give up the better their chances of staying tobacco-free, according to new research.

Research lead by the university at Buffalo Roswell Park Cancer Institute (RPCI) in the US has revealed that smokers who used medication four weeks before quitting were 13 per cent more likely to be smoke-free three months later, versus those who had started only a week prior to giving up.

Among women, the results were particularly encouraging, with a 67 per cent success rate.

Lead author Dr. Larry W Haw Junior said that learning new behaviours can take some time.

'That's why we decided to see if a longer period of treatment with Varenicline before smokers tried to quit would result in better outcomes, and it did in this small study,' he said.

In the UK, around 20 per cent of the population smoke cigarettes, according to Cancer Research UK. ADNFCR-554-ID-801257551-ADNFCR

Parents can widen a child's tastes by providing more aesthetically pleasing meals, a new study reveals.

A study by Cornell University's Dyson School of Applied Economics and Management in the US has shown that children prefer a much larger range of colors and items to be presented on a plate to them than adults.

While adults find three colours and three items most appealing, children are most enticed by six colours and seven items.

Brian Wansink, Cornell's professor of marketing, says that using his team's research, parents can help increase their children's enjoyment of food and provide encouragement to fussy eaters.

'While much of the research concerning food preferences - focuses on 'taste, smell and chemical' aspects… people appear to be significantly influenced by the shape, size and visual appearance of food,' he said.

The team also found that the position of items on a plate plays a big role, with children preferring entrees to be placed in the lower segment of the plate, rather than in the centre like adults. ADNFCR-554-ID-801257544-ADNFCR

January 9, 2012 (Boston, Massachusetts) - Statin use in postmenopausal women is associated with a significantly increased risk of diabetes mellitus, research shows. New data from the Women's Health Initiative (WHI) hints that the risk of diabetes is higher than suggested by previous studies, with investigators reporting a 48% increased risk of diabetes among the women taking the lipid-lowering medications.

"With this study, what we're seeing is that the risk of diabetes is particularly high in elderly women, and this risk is much larger than was observed in another previous meta-analysis," senior investigator Dr. Yunsheng Ma (University of Massachusetts Medical School, Boston) told heartwire. "For doctors treating patients, we would like them to really look at the risk-benefit analysis, especially in different age groups, such as older women."

Annie Culver (Mayo Clinic, Rochester, MN), a pharmacist and lead investigator of the study, published online January 9, 2012 in the Archives of Internal Medicine, said that "close monitoring and an individualized risk-versus-benefit assessment is really a good thing, as well as an emphasis on continued lifestyle changes." Culver added that as the population ages, and because these patients have a higher vulnerability to diabetes anyway, monitoring for diabetes in statin-treated patients becomes more important.

"I think the risk [of diabetes] is definitely there for statins," Culver told heartwire , "and I think physicians are probably aware of this risk. I think we now need more information and more research about precisely how this risk translates to different people and different populations."

Previously Published Data on Statins and Diabetes Risk

Recently published data reported by heartwire highlighted the potential risk of diabetes with statin therapy. In June, Dr Kausik Ray (St George's University of London, UK) and colleagues published a meta-analysis of PROVE-IT, A to Z, TNT, IDEAL, and SEARCH-five trials testing high-dose statin therapy-and found a significant increase in risk of diabetes with higher doses of the lipid-lowering drugs. A meta-analysis published in the Lancet in 2010 by Dr Naveed Sattar (University of Glasgow, UK) also showed that statin therapy was associated with a 9% increased risk of diabetes.

In the present study, Culver, Ma, and colleagues analyzed data from the WHI, an analysis that included 153 840 postmenopausal women aged 50–79 years old. Information about statin use was obtained at enrollment and year three; the current analysis includes data up until 2005. At baseline, 7.0% of women were taking statins, with 30% of women taking simvastatin, 27% taking lovastatin, 22% taking pravastatin, 12.5% taking fluvastatin, and 8% taking atorvastatin. During the study period, 10 242 incident cases of diabetes were reported.

In an unadjusted risk model, statin use at baseline was associated with a 71% (95% CI 1.61–1.83) increased risk of diabetes. After adjusting for potential confounding variables, the risk of diabetes associated with statin therapy declined to 48% (95% CI 1.38–1.59). The association was observed for all types of statins.

"The association between diabetes risk and statin therapy was not observed with any one type of statin, and it seems to be a class effect," said Ma.

Subgroup Risk
A significantly increased risk of diabetes was observed in white, Hispanic, and Asian women (an increased risk of 49%, 57%, and 78%, respectively). Among African Americans, who made up 8.3% of the population studied, there was a nonsignificant 18% increased diabetes risk associated with statin use at baseline. Statin use and diabetes risk was also observed in women across a range of body mass indices (BMIs <25.0, 25.0–29.9, and >30.0 kg/m2). Women with the lowest BMI (<25.0 kg/m2), appeared to be at higher risk of diabetes compared with obese women, a finding the investigators speculate is related to phenotype or hormonal differences between the women.

In an editorial, Dr. Kirsten Johansen (University of California, San Francisco), Editor of the Archives, noted that the increased risk of diabetes in women without CVD has "important implications for the balance of risk and benefit of statins in the setting of primary prevention in which previous meta-analyses show no benefit on all-cause mortality."

Ma agreed, noting to heartwire that statins are used with increasing frequency, including in primary prevention, and-based on the JUPITER trial-in patients with normal LDL cholesterol, but elevated C-reactive protein (>2.0 mg/L). In the present study, baseline statin therapy was associated with a significant 46% and 48% increased risk of diabetes in women with CVD and without CVD, respectively.

Just 7% of women in the WHI study were taking statins in the analysis, but today that number would be significantly higher, making the potential risk of diabetes at the population level much more widespread. Ma said that physicians need to evaluate the risk of diabetes as well as the potential benefits of statin therapy in elderly female patients, and start statins after lifestyle interventions have been attempted.

References
Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Arch Intern Med 2012; DOI: 10.1001/archinternmed.2011.625. Available at:http://archinte.ama-assn.org/

Johansen KL. Increased diabetes mellitus risk with statin use. Arch Intern Med 2012; DOI: 10.1001/archinternmed.2011.625. Available at: http://archinte.ama-assn.org/

January 4, 2012 - Using magnetic resonance imaging (MRI) to measure areas of the brain that are involved in Alzheimer's disease may be a way of detecting the disease at its earliest preclinical stages, a new study suggests.

Cognitively normal adults for whom regions of the brain's cortex were found to be smaller than those of their peers when examined with MRI were significantly more likely to develop symptoms of cognitive decline after 3 years, Bradford C. Dickerson, MD, from Harvard Medical School, Boston, and David A. Wolk, MD, from the University of Pennsylvania, Philadelphia, report.

"MRI cortical thickness, as a biomarker, is capable of detecting preclinical Alzheimer's disease," Dr. Dickerson told Medscape Medical News. "These areas of the brain appear to be atrophic; they are smaller than they should be, and probably have shrunk in these individuals."

Dr. Dickerson and Dr. Wolk are researchers with the Alzheimer's Disease Neuroimaging Initiative (ADNI), which was started in 2003. One of ADNI's aims is to find ways of detecting preclinical Alzheimer's disease at a stage when treatment to slow its progression might be more successful.

"ADNI is a great example of a partnership that involves government agencies from the NIH, private groups, including the Alzheimer's Association, and pharmaceutical companies to improve the knowledge about this disease and make it public," Dr. Dickerson said.

Their findings were published online December 21, 2011, and will appear in the January 10 issue of Neurology.

ADNI Project
In this study, Dr. Dickerson and his group hypothesized that cognitively normal older adults would be more likely to experience cognitive decline if they harbored an MRI biomarker suggestive of early Alzheimer’s disease neurodegeneration than their peers who did not have this biomarker.

To test their hypothesis, they used MRI scans to measure a set of 9 areas of the brain important for memory, language, problem solving, and other cognitive functions that are affected the earliest in Alzheimer's disease.

"I call these areas of the brain the 'Alzheimer's disease signature,' "Dr. Dickerson said.

Their analysis included 159 people free of dementia, the average age of whom was 76 years. Nineteen of these patients were classified as having high risk for preclinical Alzheimer's disease, owing to smaller size of the signature in the cortex; 116 were classified as having average risk, and 24 having as having low risk.

The participants also underwent cognitive testing at study entry and over the next 3 years.

The researchers found that 21% of those at high risk experienced cognitive decline during the 3 years of follow-up after the MRI scan, compared with 7% of those at average risk, and none at low risk (P = 0.03).

The investigators also found that participants whose MRI signature was positive on this measure were twice as likely to have abnormal levels of amyloid in their spinal fluid than those whose MRI signature was not. Of the high-risk preclinical Alzheimer's disease, 60% had amyloid in their spinal fluid, compared with 36% of the average-risk group.

Amyloid levels are thought to be the most specific marker of Alzheimer's disease currently available; however, patients must undergo a spinal tap to have these levels measured.

"It is a testimony to how dedicated these individuals are that so many of them are willing to undergo this procedure. Some of them have family members who are affected, others are just altruistic, but it is really impressive what people will volunteer to do in order to help fight this disease," Dr. Dickerson said.

In this study sample of 159 participants, 84 underwent spinal tap.

Still, Dr. Dickerson pointed out that MRI is not available for use in clinical practice to detect preclinical Alzheimer's disease and may never be.

"It's not necessarily something we are going to recommend that people try to obtain in their clinical practice, unless there's a clinical trial that shows it's actually useful. If it turns out that this is an efficient way to screen people in a clinical trial, and it turns out that a drug in a clinical trial works, then that would be a whole different story," he said.

In that case, MRI could be used to screen people who may be at high risk, such as those with family members who are affected, after an initial screening with a challenging 10-word memory test, he suggested. "I don't see it being a first-line screen because MRI scans, no matter how efficient you try to make them, end up costing about $500."

Preclinical AD
In an accompanying editorial, Susan M. Resnick, PhD, from the National Institute on Aging, and Philip Scheltens, MD, PhD, from the Alzheimer Center at the University Medical Center, Amsterdam, the Netherlands, write that "Dickerson and Wolk provide additional support for the utility of MRI-based biomarkers in identifying cognitively normal individuals at increased risk for cognitive impairment and AD."

They point out that recently published diagnostic criteria for prodromal Alzheimer's disease, mild cognitive impairment associated with Alzheimer's disease, and probable Alzheimer's dementia do incorporate some imaging biomarkers. "However, these measures have limited sensitivity and specificity in predicting who will develop AD in individual patients," they write. "The development and validation of new structural neuroimaging biomarkers sensitive to early changes in the disease process will be critical to implementation of new research criteria for preclinical AD."

Although the sample size in the current study was small, with only 14 individuals with complete cognitive follow-up data meeting the criteria for high risk for preclinical AD, and longer follow-up will be required to validate the AD signature against other imaging biomarkers, the ability to identify cognitively normal individuals at higher risk for subsequent cognitive decline is an important step toward implementing and evaluating the new criteria for preclinical Alzheimer's disease, they conclude.

Dr. Dickerson serves on the editorial board of Hippocampus and has financial relationships with Pfizer, the NIH, and the Alzheimer's Association. Dr. Wolk has financial relationships with GE Healthcare, Pfizer, the NIH, and the PA Department of Health. Dr. Resnick serves as Action Editor for Brain and Cognition; and reports that she has a financial relationship with the NIH/NIA Intramural Research Program, and that her spouse has financial relationships with Amgen, Eli Lilly, Roche, Amgen, Avid Radiopharmaceuticals, Johnson & Johnson, Lundbeck, Synosia Therapeutics, GE Healthcare, and the NIH.Dr. Scheltens reports financial relationships with Danone Research, Wyeth/Elan Corporation, Bristol-Myers Squibb, Genentech, Pfizer, GE Healthcare, Jansen AI, Lundbeck Inc, Nutricia, Avid Radiopharnaceuticals, Eli Lily and Company, Alzheimer Nederland and Stichting VUmc fonds, and that he serves as Book Review Editor for Alzheimer’s Disease and Associated Disorders and on the editorial board of Dementia Geriatric Cognitive Disorders.

Neurology. 2012; 78:84-90, 80-81. Published online December 21, 2011.
Medscape Medical News © 2012 WebMD, LLC
Send comments and news tips to news@medscape.net

A new laser treatment for cataracts has been used in the UK for the first time. The London Eye Hospital on Harley Street introduced the new technology, which can remove cataracts by dissolving them.

Currently, cataract surgery involves an incision with a blade by a surgeon into the lens, so that the cataract can be broken up with high frequency ultrasound, a process known as phacoemulsification.

While it is safe and effective, this treatment remains invasive, so new technologies are being developed including the laser treatment, called FemtoSecond, which is capable of creating a detailed three-dimensional model of the eye, then dissolve the cataract.

Consultant Ophthalmic Surgeon at the hospital Bobby Qureshi said: "The FemtoSecond laser has been specially designed to bring an extraordinary level of accuracy and reproducibility to refractive cataract surgery.

"No matter how accurate manual procedures may have seemed in the past, they simply cannot compete with the accuracy and precision that is now possible with laser cataract removal, which means that this surgery is now safer than ever before."

He added that cataracts affect 60 per cent of those over the age of 60, as well as a number of younger patients as well. ADNFCR-554-ID-801260264-ADNFCR

Healthy people who take an aspirin a day in order to reduce the chance of heart attack or stroke may actually be increasing their risk of internal bleeding, new research suggests.

According to a UK-led study involving 100,000 patients, only people with a history of heart disease and stroke should take the tablets, which thins the blood and can prevent blood clots forming.

The results of the study, published in the journal Archives of Internal Medicine, suggest that these benefits do not outweigh the increased risk of internal bleeding in healthy individuals.

Collectively looking at the results of nine different studies, they found that regularly taking aspirin reduce the prevalence of heart attacks by 20 per cent, but the risk of potentially fatal internal bleeding increased by 30 per cent.

The drug was also shown to have little impact in the likelihood of deaths from heart attack, stroke or cancer.

Lead researcher Professor Kausik Ray, of St George's, University of London, told the BBC: "It suggests that the net benefit for aspirin is not there, it certainly doesn't prolong life. If you think about it the net benefit, actually there is net harm. "ADNFCR-554-ID-801260275-ADNFCR

Patients with rheumatoid arthritis (RA) are more likely to suffer from venous thromboembolism (VT), when blood clots form in the deep veins, new research suggests.

A study by researchers at the Mayo Clinic in Rochester, Minnesota, indicates that people suffering from the arthritic condition are more likely to suffer VT, but not other non-cardiac vascular disease such as cerebrovascular and pulmonary arterial disease.

Dr. Sherine Gabriel and colleagues found that once factors such as age and sex had been discounted, RA patients were more than twice as likely to suffer a VT as people without the condition.

Writing in the journal Arthritis & Rheumatism, the team concluded: "Our findings indicate that the incidence of venous thromboembolism is increased in patients with rheumatoid arthritis compared to non-rheumatoid arthritis subjects."

VT refers specifically to serious conditions including deep vein thrombosis (DVT) and pulmonary embolism, both of which can be fatal if not recognised and treated. ADNFCR-554-ID-801260262-ADNFCR

January 10, 2012 - The nicotine patch, best known as a smoking cessation aid, is now showing benefit as a treatment for mild cognitive impairment. New class I evidence suggests the patch (Nicotrol, Pfizer) improves cognitive test performance in older adults with early memory loss.

"This is a promising treatment," lead investigator Paul Newhouse, MD, from Vanderbilt University in Nashville, Tennessee, told Medscape Medical News. "It is well tolerated with minimal side effects."

Results from the pilot clinical trial appear in the January 10 issue of Neurology.

The study included 74 nonsmokers with mild cognitive impairment. Half of the participants received a nicotine patch of 15 mg/day, and half received a placebo.

The primary outcome variables were attentional improvement, assessed with the Connors Continuous Performance Test, and improvement measured by clinical global impression and safety measures. Secondary measures included computerized cognitive testing and patient and observer ratings.

After 6 months of treatment, the nicotine-treated group regained 46% of normal performance for age on long-term memory. In contrast, patients in the placebo group declined by 26% during the same period.

More Study Needed
The study demonstrated that nicotine improved primary and secondary cognitive measures of attention, memory, and mental processing, but not ratings of clinician-rated global impression.

"We will need larger, longer-term studies to confirm clinical efficacy," Dr. Newhouse pointed out. "This study provides strong justification for further research into the use of nicotine for people with early signs of memory loss."

Nicotine treatment was associated with a modest reduction in systolic blood pressure. Many patients also experienced a reduction in weight with no significant medical consequences. There were no problems in withdrawing treatment, and no participants continued nicotine use.

The transdermal administration probably contributed to improved tolerability, the authors note, particularly reducing the incidence of gastrointestinal adverse effects.

The results are consistent with prior studies. Nicotine has been shown to improve cognitive performance in smokers who have stopped smoking, and previous short-term studies with nicotine have shown attention and memory improvement in patients with Alzheimer's disease. Nicotinic stimulation appears to alter receptors in the brain involved in thinking and memory; patients with Alzheimer's typically lose some of these receptors.

Dr. Newhouse emphasized that people with early memory loss should not start smoking or using nicotine patches by themselves. "Smoking is a terrible delivery system for nicotine, and is filled with carcinogens," he said, "and a medication such as nicotine should only be used with a doctor's supervision."

This study was supported by the National Institute on Aging and the National Institute of General Medical Sciences. Pfizer provided the transdermal nicotine patches. Dr. Newhouse has served as a consultant for AstraZeneca, Gerson Lehrman Group, Guidepoint Global, Summer Street Research Partners, and Biotechnology Value Fund, LP. He also receives research support from Eli Lilly and Targacept.

Neurology. 2012;78:91-101. Medscape Medical News © 2012 WebMD, LLC
Send comments and news tips to news@medscape.net

A new study suggests that eating grapes can help prevent or slow the progression of age-related macular degeneration (AMD), a condition that can ultimately result in blindness.

AMD affects millions of elderly people around the world, but the research suggests that grapes may contain an antioxidant that can protect against against it.

Writing in the journal Free Radical Biology and Medicine, the team from Fordham University in New York, found that a diet rich in antioxidants helped stave off degradation of vision in mice bred to be prone to developing retinal damage in old age.

Mice fed a diet enriched with grapes were less likely to suffer blindness than those given a diet with added lutein, which also offered more protection than a normal diet.

"The protective effect of the grapes in this study was remarkable, offering a benefit for vision at old age even if grapes were consumed only at young age," said principal investigator Silvia Finnemann, PhD, at the university's Department of Biological Sciences.

Uppsala, Sweden - A new analysis of the INTERHEART study, drilling down into exactly how physical activity and its different components contribute to the risk of MI, doesn't turn up any huge surprises but does confirm that inactivity is "a universal cardiovascular risk factor," lead author Dr Claes Held (Uppsala Clinical Research Center, Uppsala, Sweden) tells heartwire. Held and colleagues publish the results online January 11, 2012 in the European Heart Journal.

In fact, the findings reveal a large discrepancy between physical-activity levels in different economies, Held notes, with close to 70% of individuals in low-income nations being sedentary during leisure time compared with around 40% in higher-income countries. The message here is simple, says Held. "Try to incorporate your activity into your daily life. Take the stairs, and walk when you can. Don't complicate it."

Try to incorporate your activity into your daily life. Take the stairs, and walk when you can. Don't complicate it.
The results also show an association between ownership of a TV and car and an increased risk of MI, although Held stresses, "We cannot say this is a causal relationship, it's an association, and we need a prospective trial to confirm this." Nevertheless, he acknowledges, "If you own a TV and a car, your risk of being sedentary is increased. It's an interesting finding that goes with the theme."

In an accompanying editorial, Drs. Emeline M Van Craenenbroeck and Viviane M Conraads (Antwerp University Hospital, Belgium) observe: "Physical activity remains the single most neglected therapeutic intervention worldwide. Staying physically fit throughout life may well be one of the easiest, cheapest, and most effective ways to avoid the coronary care unit."

Mild / moderate occupational - and any leisure-time activity is protective In their new look at INTERHEART-a case-control study of over 29 000 people from 52 countries in Asia, Europe, the Middle East, Africa, Australia, and North and South America - Held and colleagues specifically examine how physical activity during work and leisure time contribute to the risk of MI.

They note that although much prior research has found a link between physical activity during leisure time and CV disease, the association with work-related activity is less clear. And few studies have evaluated the different aspects of physical activity both at work and during leisure time in relation to CV risk.

"What this study adds, among many other things, is a global perspective," says Held. It shows that mild to moderate physical activity at work and any level of physical activity during leisure time "reduce the risk of heart attack, independent of other traditional risk factors, in men and women of all ages, in most regions of the world, and in countries with low-, middle-, or high-income levels."

The researchers found that subjects whose occupation involved either light [multivariable adjusted odds ratio 0.78] or moderate [OR 0.89] physical activity were at lower risk of MI, whereas those who did heavy physical labor were not (OR 1.02) compared with sedentary subjects. Mild exercise (OR 0.87) as well as moderate or strenuous exercise (OR 0.76) was also protective. Those who owned both a car and a TV were at higher risk of MI compared with those who owned neither (OR 1.27).

The fact that heavy physical labor at work did not protect against heart attacks is interesting, says Held, who admits he doesn't have a good explanation for this. The editorialists suggest that shift work or psychosocial stress due to being in an undemanding job and having little or no decision-making authority might be counterbalancing the intrinsic beneficial effect of physical activity.

Turning everyone Danish is a Herculean task
The new results "show that we don't need to have different recommendations for different regions of the world," says Held. "It's easy to reduce the risk of having a heart attack."

In fact, what was somewhat surprising, he says, is that even a small daily duration of exercise seems beneficial. While he does not want to promote the idea that it's good enough to do 15 minutes of exercise a day, he says the findings show that any activity is better than nothing.

The paper of Held et al leaves clinicians with the Herculean task of translating this evidence into effective preventive care.
"Of course, there are cultural differences at play, and climate plays a role," he notes. "If you live in a country with a climate of 35°C, you are less likely to be jogging around." But this just reinforces the overall message, which is to try, as much as possible, to incorporate physical activity into daily life, he says.

The editorialists agree: "Ideally, we should adopt the example set by the Danish and commute by bike," they observe.

"Although timely and relevant, the paper of Held et al leaves clinicians with the Herculean task of translating this evidence into effective preventive care," they continue. "If we want to support healthy longevity, we should put a stop to the pandemic of 'sedentarism.' "

NHS hospitals have been urged to reduce the number of people with dementia who take up hospital beds when a different care environment may be more appropriate.

Toby Siddall, managing director of Care UK, said that busy hospital wards can be 'confusing and frightening' for people with dementia.

'The NHS and local authorities should do everything in their power to ensure that only patients with acute needs are admitted to and retained in our hospitals,' Mr. Siddall argued.

'For frail, elderly people living with dementia, and suffering from less acute conditions, it makes far more sense for them to be cared for in their own homes or in a residential or nursing home where the staff have expertise in dementia care,' he advised.

Mr. Siddall made the comments in the wake of a new report from the Royal College of Psychiatrists, which said that many hospital wards had failed to address simple measures that could help to lessen the distress felt by dementia patients.

The report also suggested that two-thirds of hospital staff are not trained in dementia care - a situation that the Care UK director described as 'not that surprising' given the specialist nature of the condition.

December 16, 2011 (Dubai, United Arab Emirates) - Slightly more than a year of treatment with an investigational obesity drug that the US Food and Drug Administration (FDA) rejected for approval last year reversed type 2 diabetes in 15% of subjects, according to the results of a study presented here at the International Diabetes Federation World Diabetes Congress 2011.

The drug, which has the proposed name Qnexa (developed by Vivus, Mountain View, California), is a controlled-release combination of phentermine, an appetite suppressant, and topiramate, an anticonvulsant.

"We need more options to treat the twin epidemics of diabetes and obesity," said Nancy J.V. Bohannon, MD, director of clinical research in the cardiovascular risk reduction program at St. Luke's Hospital in San Francisco, California, who presented the findings.

"This could potentially be an approach that is nonsurgical for treating obesity and improving glycemic control," said Dr. Bohannon, who is a consultant to, serves on the advisory board of, and holds stock in the company that manufactures the drug.

In a subanalysis of the previously published CONQUER trial (Lancet. 2011;77:1341-1352), researchers examined the effect of 2 different doses of the drug on a subset of 146 adults with type 2 diabetes and a body mass index (BMI) of 35 kg/m^² or higher.

The mean BMI of participants was 39 to 40 kg/m^², the mean duration of their diabetes was 4 years, 65% were female, and diabetes treatment in the group included diet and exercise, with about 50% using metformin.

After a titration period of 4 weeks, subjects were randomized to receive 52 weeks of placebo (n = 58), a half dose daily of the study drug (phentermine 7.5 mg/topiramate 46 mg; n = 24), or a full dose daily (phentermine 15 mg/topiramate 92 mg; n = 64).

At the end of the study period, subjects on the low-dose medication had a weight loss of 6.6% (P < .05) and those on the high dose had a 12.1% loss (P < .0001); in the placebo group, weight loss was 2.8%.

The researchers measured the drug's impact on excess weight, defined as the amount of weight above an ideal BMI of 25 kg/m^².

Compared with subjects on placebo, who lost 7.4% of their excess weight, subjects on the low-dose medication lost 17.8% (P <.05) and those on the full dose lost 32.6% (P <.0001).

"Fasting blood sugar and hemoglobin A1c showed statistically significant changes from baseline at the full dose," said Dr. Bohannon, although she did not elaborate.

Resolution of diabetes, defined as the absence of clinical and laboratory manifestations of diabetes was seen in 1.7% of subjects on placebo, 8.3% of those on the half dose of medication, and 15.4% of those on the full dose.

The most common adverse events included constipation, paresthesia, insomnia, dry mouth, headache, and dysgeusia, she said.

In the FDA's complete response letter rejecting the company's New Drug Application, teratogenicity was mentioned as a major concern, as was elevated heart rate.

Metabolic acidosis, depression, anxiety, and sleep disorders, along with attention, memory, language, and other cognitive disorders have been mentioned.

Compared with recent studies on laparoscopic banding for the treatment of obesity, an excess weight loss of 32.6% seen with the full dose of medication measures up well, said Dr. Bohannon.

A recent study showed a similar 32% loss in diabetic subjects 1 year after gastric banding (Surg Obes Relat Dis. 2010;6:132-137); another study showed a 47% loss 2 years after surgery (Dixon JB et al. Obes Rev. Published online August 31, 2011).

"These are promising results. The question is: Will they be able to show enough safety so the FDA will be comfortable enough to approve it? The hope is that they will," said Francine Ratner Kaufman, MD, professor of pediatrics at the Keck School of Medicine, University of South California, and head of the Center for Diabetes, Endocrinology and Metabolism at the Children's Hospital, both in Los Angeles, who cochaired the session.

"It will be part of the armamentarium of all the potential options for treating obesity and its comorbidities. I am a pediatrician, so it would be one of my last options, but certainly as a diabetologist, I am excited about as many options as possible," she told Medscape Medical News.

"Right now we don't have good pharmacotherapy options," said Arya Sharma, MD, PhD, the other cochair of the session, and also a consultant for the drug's manufacturer.

"No matter how good surgery is, at the current rate, it would take us 100 years to do everyone. So for the many patients who do not have an option for surgery but who have the comorbidities related to obesity, we desperately need pharmacologic options," said Dr. Sharma, who is professor of medicine and chair of obesity research and management at the University of Alberta, Edmonton, Canada.

"If this drug makes it to market and proves to be safe, that's one step. I don't think there will be one drug that is effective and safe for everybody. We have about 100 different compounds for treating hypertension and 20 different compounds for treating diabetes. That's what it will probably take for obesity. We'll need more than 1 drug - we'll need 5, 10, 20 different drugs, and they'll all have to be tested to see which works best in whom and which has the best side-effect profile."

Last month, Vivus resubmitted the New Drug Application for phentermine/topiramate. A decision on the approval is expected in April 2012.

Dr. Bohannon reports being on the advisory board of Vivus (the developer of the study drug), Abbott, Biodel, Boehringer, BMS, Calibra, CeQur, Daiichi-Sankyo, Halozyme, Lilly, Novartis, NovoNordisk, sanofi-aventis, Santarus, Tethys Bioscience, and Valeritas; owning stock (<$25,000) in Vivus, Halozyme, Johnson & Johnson, and Santarus; and being a paid lecturer for Abbott, Biodel, Boehringer, BMS, Calibra, CeQur, Daiichi-Sankyo, Halozyme, Lilly, Novartis, NovoNordisk, Sanofi-Aventis, Santarus, Tethys Bioscience, and Valeritas. Her 2 coauthors are employees of the company. Dr. Kaufman is chief medical officer of Medtronic and has no financial connections to the manufacturer of the study drug. Dr. Sharma is a consultant for Vivus, the developer of the study drug.

International Diabetes Federation (IDF) World Diabetes Congress 2011: Abstract O-0534. Presented December 7, 2011.

Britons who are heading to countries where malaria is prevalent over the festive period have been reminded to take anti-malaria tablets.

Almost one in five cases of malaria in people arriving in the UK are diagnosed in December and January, according to the Health Protection Agency (HPA).

Experts said that most cases are acquired in west African countries, such as Nigeria and Ghana.

Dr. Jane Jones, one of the HPA's travel health experts, advised all travellers to malaria risk areas to be aware of the risk.

'Pre-travel medical advice should be sought from a GP or a travel clinic at least six weeks before travel and travellers must take medication before, during and after their trip, as well as anti-mosquito precautions while they are away, to keep safe,' she said.

Those who have left seeking advice until the last minute should still do so, as it is possible to receive 'appropriate' preventative treatment, the expert added.

A recent study by Thai researchers, published in the Lancet Infectious Diseases, found that women who experience malaria in the first trimester of pregnancy face a three-fold greater risk of miscarriage.

However, they also showed that taking anti-malarial drugs did not increase the risk of miscarriage.

Youngsters are being targeted by junk-food manufacturers when they are playing online, a new report claims.

The British Heart Foundation's (BHF) report suggests that companies are using the internet to market products that are high in fat, salt and sugar to children.

The charity, alongside the Children's Food Campaign, looked solely at products that are banned from advertising during children's television programmes.

Products include Cadbury's Buttons - which contain more fat than a hamburger - and Sugar Puffs, which provides more sugar, per bowl, than a ring doughnut.

Yet manufacturers are still able to promote these products freely on the internet, such as via bespoke websites, free games, gifts and downloads, due to a loophole in the regulations.

The BHF said that advertising regulations should be consistent across all forms of media to prevent this type of advertising and protect children's future health.

Policy manager Mubeen Bhutta said: 'Like wolves in sheep's clothing, junk-food manufacturers are preying on children and targeting them with fun and games they know will hold their attention.

'Regulation protects our children from these cynical marketing tactics while they're watching their favourite children's TV programmes, but there is no protection when they're online.'

Dr. Michael Nelson, director of research at the School Food Trust, told the Independent on Sunday that children receive 'horribly confusing messages' about diet and health.

'Even with good progress to improve food in schools and cooking skills for children, little headway is being made to reduce obesity and this is where legislation really does have a role to play in protecting them,' he added.

December 15, 2011 (San Diego, California) - Heparin-compromised patients can be safely treated with the newer anticoagulants, including dabigatran (Pradaxa, Boehringer Ingelheim), apixaban (Eliquis, Bristol-Myers Squibb/Pfizer), and rivaroxaban (Xarelto, Bayer/Johnson & Johnson), suggest the results from a new laboratory analysis [1]. The new agents did not interact with heparin-induced thrombocytopenia (HIT) antibodies, which suggest they are an anticoagulation option for patients unable to take heparin.

"It's a proof-of-concept study in patients who have existing heparin-induced thrombocytopenia that suggests they can be given these new agents without any of the consequences that we see with heparin," senior investigator Dr Jawed Fareed (Loyola University, Chicago, IL) told heartwire.

The study, presented this week at the American Society of Hematology 2011 Annual Meeting, included blood samples drawn from normal healthy volunteers and HIT sera prepared from clinically symptomatic HIT patients with high concentrations of antiheparin platelet factor 4 antibodies. Rivaroxaban, apixaban, dabigatran, and enoxaparin were dissolved in solution and then each added to separate blood samples drawn from the healthy volunteers. Next, investigators mixed the HIT-positive sera to test for the platelet-aggregation responses of the three new anticoagulants.

Compared with enoxaparin, which resulted in an increase in the antiheparin platelet factor 4 antibodies, apixaban, rivaroxaban, and dabigatran did not increase platelet factor 4 antibodies beyond 15.0 ng/mL. In addition, the researchers noted that none of the new oral agents resulted in platelet aggregation, whereas enoxaparin resulted in a "strong HIT-antibody-mediated response."

"Almost 5% of patients treated with unfractionated heparin have some sort of adverse effects," noted Fareed. "The most serious adverse effect is heparin-induced thrombocytopenia, which has catastrophic outcomes. Of these patients, almost 10% develop thrombosis, HIT syndrome, stroke, and other events. So although it's rare, when [HIT] does occur, the consequences can be very serious."

References

Lewis BE, Aranda C, Lewis M, et al. Unlike heparins, newer oral anticoagulants do not interact with HIT antibodies and maybe useful in the long-term anticoagulant management of heparin-compromised patients. American Society of Hematology 2011 Annual Meeting; December 11, 2011; San Diego, CA. Abstract 2317.

The British Heart Foundation (BHF) has launched a new campaign called 'Hands-only CPR' in a bid to encourage more people to give the life-saving treatment.

The hands-only method of cardiopulmonary resuscitation is designed to help people avoid the discomfort they may feel about giving mouth-to-mouth aid to a stranger.

Tough guy footballer-turned-actor Vinnie Jones is fronting the drive to use 'hard and fast' chest compressions to the beat of 'Stayin' Alive' by disco group the Bee Gees, which has the ideal tempo for CPR.

Head of policy and advocacy at the BHF Maura Gillespie says that she herself was unaware that this method was possible.

'When I found out that you can keep someone alive after a cardiac arrest without having to get 'up close and personal'- I thought, wow, we should tell as many people as possible,' she said.

A study by the Medical University of Vienna, Austria, found that hands-only CPR is 22 per cent effective than normal CPR when performed by a lay member of the public.

Smokers are underestimating the health and financial implications of their habit, according to new research.

The findings published by NHS Smokefree reveal that more than half the smokers surveyed underestimated the number of deaths caused by smoking by at least 70,000 per annum.

Furthermore, despite the health warnings printed on packets, some eight per cent of smokers do not believe that smoking poses a serious health risk and can lead to premature death.

The release of the findings coincides with a new Department of Health campaign designed to help people stop smoking in 2012 and smokers are being urged to consider the benefits of shelving the habit.

Chief executive of Action on Smoking and Health Deborah Arnott said: "Remind yourself that quitting won't just make you much healthier but also wealthier, and there's now good evidence it reduces your stress levels too."

"Quitting smoking is the very best thing you can do to improve your health," public health minister Anne Milton. ADNFCR-554-ID-801253698-ADNFCR

In response to concerns that test-oriented schooling is reducing the amount of time children spend exercising, a new review of scientific evidence suggests that physical activity can actually boost academic performance.

In the work carried out by Doctor Amika Singh and his team from the Vrije Universiteit University Medical Center in the Netherlands and published in this month's issue of the Archives of Pediatrics & Adolescent Medicine journal, ten observational and four interventional studies were reviewed.

Speaking about what the data suggests, the researchers said: "We found strong evidence of a significant positive relationship between physical activity and academic performance."

It is thought that exercise improves performance for a number of reasons, including by increasing blood and oxygen flow to the brain.

However, despite the apparent correlation between physical exercise and academic performance, the scientists are calling for "more high-quality studies" to be carried out before the link can be confirmed.

By Genevra Pittman

NEW YORK (Reuters Health) Dec 29 - In a new study of middle-aged New Jersey men, statin therapy was linked to a lower risk of death from prostate cancer.

"People may be on these medications for their heart, but it may actually be doing them some good for their prostate," study author Dr. Stephen Marcella, from the University of Medicine and Dentistry of New Jersey in New Brunswick, told Reuters Health.

Dr. Marcella and his colleagues collected the medical records of 380 men who had died of prostate cancer and another 380 age- and race-matched controls.

Most of the men were white and in their mid- to late-60s, on average. Close to 25% had ever taken a statin.

The researchers found that men who died of prostate cancer were half as likely to have taken a statin at any time, and for any duration, than men in the control group.

After adjustment for weight, comorbidities, and medications, men with fatal prostate cancer were 63% less likely to have ever taken a statin, according to findings published online December 16 in Cancer.

But, Dr. Marcella added, "I would not tell a person if they don't have a risk of heart disease, (if) they don't have hypertension...to take a statin just to prevent lethal prostate cancer."

And even if statins do turn out to help prevent fatal prostate cancer, he and his colleagues said, previous studies have suggested they don't lower a man's risk of getting less aggressive forms of the disease.

Dr. Marcella's team didn't have the data to determine whether taking a statin for longer, or starting one earlier, was more beneficial than more limited use of the drugs.

They also couldn't tell whether men started using statins before or after they were diagnosed with aggressive cancer.

But they did find that while newer, high-potency statins were linked to a lower risk of fatal prostate cancer, lower-potency drugs were not. That suggests it's something about the drugs themselves that lower men's chances of dying from prostate cancer, Dr. Marcella said.

Statins may protect against fatal prostate cancer through their known cholesterol-lowering effects, said Dr. Stephen Freedland, who studies prostate cancer at the Duke University Medical Center in Durham but wasn't involved in the new study.

He said that cholesterol is a key nutrient for cancer cells, so lower cholesterol levels in the body could prevent more aggressive forms of cancer from developing.

But it's also possible that statins don't prevent certain cancers at all, Dr. Freedland said, and it's something else about men who take statins -- for example, if they also change their diet and start exercising -- that explains their lower risk of fatal cancer.

"It gets very, very tricky to sort out," Dr. Freedland told Reuters Health.

SOURCE: http://bit.ly/v7AokK

Babies that receive poor nutrition inside the womb face an increased risk of developing diabetes, according to a new study published today (December 6th).

The research, conducted by the University of Cambridge and the Medical Research Council (MRC) Toxicology Unit at the University of Leicester, reveals that a poor diet in the womb results in an inability to store fats correctly in the body.

This can result in them accumulating in organs such as the liver, where they can trigger the onset of diabetes.

Professor Anne Willis, director of the MRC Toxicology Unit, says that these findings could help people avoid contracting the disease.

'Some people are at particular risk of these diseases, despite not looking visibly overweight. This research will hopefully allow us to help these people to take precautionary steps,' she said.

According to Diabetes UK, 2.9 million people in the UK have been diagnosed with diabetes and a further 850,000 people have the condition but do not know it. ADNFCR-554-ID-801257537-ADNFCR

Britons are not taking any chances with their health this Christmas and have been stocking up on vitamin and mineral supplements in recent weeks, new figures show.

Sainsbury's said that it witnessed a 200 per cent increase in sales of vitamin products at the start of the winter season.

Vitamin C sales are 200 per cent higher than they were two years ago and sales of multivitamin tablets have also more than doubled.

According to the supermarket giant, 72 per cent of people who purchase vitamins, minerals and supplements are women.

Richard Holland, Sainsbury's healthcare buyer, said: 'It seems our customers aren't prepared to take any chances this year - there's a real focus on prevention over cure.

'We're seeing a significant growth in sales across a whole range of products, such as vitamin C and anti-bacterial hand gel, and our pharmacists have administered over 21,000 more flu vaccinations than this time last year.'

Sainsbury's research also suggests that people are increasingly turning to their pharmacist for health advice.

A poll of more than 2,000 adults, conducted by research firm YouGov, found that 34 per cent of people visit their pharmacist for advice on minor ailments, while 29 per cent look on the internet.

Chickenpox is much less common in countries with high levels of sunlight, suggesting that UV rays may help to prevent the disease's spread, UK scientists have found.

A researcher at St. George's, University of London found that countries in the tropics tend to have far fewer cases of chickenpox than those in temperate regions.

Virologist Dr Phil Rice looked at data from 25 studies on the varicella-zoster virus, which is responsible for chickenpox and shingles.

He found that UV rays were the only factor that matched infection patterns in each country that he studied.

The scientist believes that UV rays may inactivate the varicella-zoster virus.

His discovery could also help to explain why chickenpox tends to be more common in winter and spring in countries such as the UK, as this is when UV rays are weakest.

Commenting on his findings, which are published in Virology journal, Dr. Rice said: 'No one had considered UV as a factor before, but when I looked at the epidemiological studies they showed a good correlation between global latitude and the presence of the virus.'

Dr. Rice believes the discovery could pave the way for new treatments for chickenpox and shingles.

Professor Judy Breuer, from University College London, told the BBC that other factors, such as heat and humidity, could be at play.

'It's quite possible that UV is having an effect, but we don't have any firm evidence showing the extent this is happening,' she added.

Parents could save up to £6.58 per week by purchasing healthier foods, new research suggests.

Scientists at the University of Bristol asked families of obese children to keep food diaries recording everything they ate each week.

They found that by replacing unhealthy items with healthier options, it was usually possible for families to save money.

Healthier eating cost no more than £2.31 extra each week and the researchers showed that it was sometimes possible to save £6.58 by changing shops.

The findings, which are published in the British Journal of General Practice, debunk the myth that healthy eating is more expensive.

Lead researcher Dr Julian Hamilton-Shield, from the Bristol Royal Hospital for Children, said: 'Food cost is frequently cited as a reason for failure to address eating behaviours in clinical practice, and this study demonstrates that for many this is a perceived rather than real barrier.'

The latest figures from the National Child Measurement Programme reveal that 22.6 per cent of children in reception year (ages four and five) were overweight or obese in 2010-11, along with 33.4 per cent of ten and 11-year-olds.

Penicillin dosing guidelines for children need to be reviewed to reflect the increase in children's average weight over the past few decades, an article in the British Medical Journal suggests.

The guidelines have not been altered for nearly 50 years and are mainly based on a child's weight.

However, scientists and clinicians at King's College London and St George's, University of London, say that the average weight of children has increased over time and that a review of the guidelines is therefore essential to ensure children receive effective doses of penicillin.

The experts conducted a review of evidence and found that prescribing based on age bands was first suggested in the early 1950s, with a general recommendation published in the British Medical Journal in 1963 and still standing today.

The age band guidelines are accompanied by average rates: birth to one year (10kg); two years (13kg); five years (18kg); and ten years (30kg).

However, figures from the Health Survey for England 2009 indicate that the average five-year-old now weighs 21kg, while the average ten-year-old weighs 37kg.

This suggests that some children may not be receiving effective doses of penicillin, contributing to failed treatment and antibiotic resistance.

Dr. Paul Long, senior lecturer in pharmacognosy at King's College London, said: 'Children's average size and weight are slowly but significantly changing, so what may have been adequate doses of penicillin 50 years ago are potentially not enough today.

'If we want to be sure that we are treating childhood bacterial infections effectively, the evidence base behind these prescribing guidelines needs to be improved, and the recommended doses reviewed accordingly.'

Simon Keady, a spokesman for the Royal Pharmaceutical Society, said that penicillin's long history of use 'should not stop us from continuing to identify the most appropriate dose'. ADNFCR-554-ID-801241851-ADNFCR

People who are hospitalised with flu may benefit from taking cholesterol-lowering statin drugs, new research suggests.

A research team at the Oregon Public Health Division in Portland, US, discovered that statins may help to reduce the risk of death among patients with influenza.

The scientists looked at data on hospitalised adults during the 2007-08 flu season in the US.

A total of 3,043 patients were assessed, 33 per cent of whom were given statins either before or during their hospitalisation.

Publishing their findings in the Journal of Infectious Diseases, the study authors revealed that patients who did not receive statins were almost twice as likely to die from flu as those who did take the drugs.

The researchers wrote: 'Our study found that statins were associated with a decrease in odds of dying among cases hospitalised with laboratory-confirmed influenza.'

The findings held true regardless of a patient's age, race, history of cardiovascular, lung or kidney disease and use of anti-viral therapy.

Clinical trials are now needed to determine the benefits of statins for flu sufferers, the researchers added.

Professor John Oxford, a virologist at St Bartholomew's and the Royal London Hospital, told the Daily Express that statins should be stockpiled alongside vaccines and the influenza drug Tamiflu. ADNFCR-554-ID-801240580-ADNFCR

Up to 24,000 people with diabetes die each year from causes that could have been avoided, experts say.

The first ever National Diabetes Audit found that basic health checks and better management of the condition could prevent thousands of deaths.

According to the report, about three-quarters of avoidable diabetes-related deaths occur in over-65s.

However, it also revealed that death rates among 15 to 34-year-old women with diabetes are up to nine times higher than the average for the age group.

About one in every 3,300 women in England die between the ages of 15 and 34, but this rises to one in 360 among women with type-1 diabetes and one in 520 among those with type-2 diabetes.

Audit lead clinician Dr Bob Young, consultant diabetologist and clinical lead for the National Diabetes Information Service, said that many of these early deaths from diabetes could be prevented.

'The rate of new diabetes is increasing every year. So, if there are no changes, the impact of diabetes on national mortality will increase,' he predicted.

'Doctors, nurses and the NHS working in partnership with people who have diabetes should be able to improve these grim statistics.'

Barbara Young, chief executive of Diabetes UK, described the figures as 'incredibly alarming'.

She said: 'Self-management is very important, but it is also vital that people with diabetes receive the care they need to help them manage their condition in the first place.'

Aberdeen, Scotland - A new British study is the latest in a long line of research that has failed to find any impact of vitamin D on cardiovascular-disease mortality [1]. The results also showed no benefit of vitamin D on cancer incidence or mortality, say Dr. Alison Avenell (University of Aberdeen, Scotland) et al.

"We don't have the evidence yet to say that this dose of vitamin D can prevent deaths from heart disease or cancer," Avenell told heartwire. She and her colleagues report the long-term follow-up from the placebo-controlled Randomised Evaluation of Calcium or Vitamin D (RECORD) trial online November 23, 2011 in the Journal of Clinical Endocrinology & Metabolism.

Vitamin D has become somewhat of a panacea lately, following the failure of many other vitamins to have any impact on CVD morbidity or mortality, with many patients taking vitamin-D supplements and/or doctors prescribing it, without any real evidence of benefit. One expert has previously told heartwire the situation resembles "a massive uncontrolled experiment."

Avenell agrees with other physicians in the field that the results of large, ongoing trials are needed before any definitive recommendation can be made regarding vitamin-D supplementation. One is the 20 000-patient US Vitamin D and Omega-3 Trial (VITAL) study, results of which won't be available until 2016 or 2017, and the second is the UK Vitamin D and Longevity (VIDAL) trial, which is currently enrolling 1600 patients but plans, in the long run, to recruit as many patients as VITAL, says Avenell.

RECORD adds to body of evidence on vitamin D: No benefit on CV mortality

The RECORD study was conducted in over 5000 people aged 70 or older with a previous low-risk fracture, 85% of whom were women. Participants were randomly allocated into one of four groups: daily vitamin D3 (800 IU), calcium carbonate (1000 mg), both, or placebo for 24 to 62 months, with a follow-up of three years after intervention. The main outcome measures were all-cause mortality, vascular-disease mortality, cancer mortality, and cancer incidence.

Daily vitamin-D supplementation did not significantly affect all-cause and vascular-disease mortality or cancer incidence and mortality in the intention-to-treat (ITT) analysis.

Supplementation with calcium also had no significant effects, in contrast to a systematic review published in 2010, which included earlier data from RECORD that showed an increased risk of MI with calcium, says Avenell.

In a post hoc analysis adjusting for compliance, thus with fewer participants, trends for reduced mortality with vitamin D and increased mortality with calcium "were accentuated, although the results remain nonsignificant," she and her colleagues say. Hazard ratio for mortality, vascular-disease mortality, and cancer mortality and incidence for vitamin D and calcium, compared with placebo

Outcome
With vitamin D or calcium (% with event)
Without vitamin D or calcium (% with event)
HR, ITT
p
Vitamin D
All deaths
31.6
33.3
0.93
0.132
Vascular deaths
13.2
14.2
0.91
0.175
Cancer deaths
5.7
6.7
0.85
0.157
Cancer incidence
12.8
11.9
1.07
0.376
Calcium


All deaths
32.9
32.0
1.03
0.46
Vascular deaths
14.2
13.3
1.07
0.333
Cancer deaths
6.6
5.8
1.13
0.249
Cancer incidence 12.6
12.1
1.06
0.485

"Our results add to the body of evidence on nonskeletal benefits from supplementation with vitamin D and calcium and are consistent with the view that, at least for vascular disease and cancer, conclusive evidence for such benefits is absent," they state.

Vitamin-D supplements to prevent osteomalacia in the housebound

Avenell says she would recommend vitamin-D supplementation in people who are housebound or have little exposure to sunlight, "but this is primarily to prevent osteomalacia." Advice would vary depending upon where in the world the individual is and whether foodstuffs there are fortified with vitamin D, she says.

Coauthor Dr. RM Francis (University of Newcastle, UK) has received lecture fees from Shire Pharmaceuticals; all other authors have no relevant conflicts of interest.

Source
Avenell A, MacLennan GS, Jenkinson DJ, et al. Long-term follow-up for mortality and cancer in a randomized placebo-controlled trial of vitamin D3 and/or calcium (RECORD trial). J Clin Endocrinol Metab 2011; DOI:10.1210jc.2011-1309. Available at: http://jcem.endojournals.org.

The Trial to Assess Chelation Therapy (TACT), investigating the chelation therapy ethylenediaminetetraacetic acid (EDTA) in coronary heart disease patients, is once again the subject of controversy, this time in an article published yesterday in the Chicago Tribune [1,2].

The $30 million TACT trial, sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institutes of Health, was stopped in 2008 while "allegations of impropriety" were investigated. These centered on concerns over the patient-consent process. The trial was restarted in 2009.

Reviewing much of the previous controversy, the current Chicago Tribune article suggests, among other things, that there was not enough evidence suggesting benefit of chelation therapy in heart disease to justify conducting the trial and that some of the doctors involved in the trial have been in trouble with state medical boards or health departments. The article, by journalist Trine Tsouderos, also reports that two paid consultants to the trial had been convicted of federal crimes. Many of the criticisms of the trial have been reported previously, and TACT was the subject of a whole critical report published in the Medscape Journal of Medicine in 2008 [3]. Tsouderos told heartwire the current Tribune article was the second "of a series on NCCAM and was a look at one of the center's larger studies."

Lead investigator responds

In response to the Tribune article, lead TACT investigator Dr Gervasio Lamas (Mount Sinai Medical Center, Miami Beach, FL) commented to heartwire that EDTA chelation therapy has been postulated to produce a favorable effect on atherosclerotic plaque, and although evidence is limited, approximately 111 000 adults in the US used chelation therapy in 2007. "So patients are being exposed to the risks of this treatment in an uncontrolled fashion and are investing their own money in it. They deserve to know whether there is any evidence of efficacy."

In response to claims in the Tribune article that EDTA is unsafe and that this led to it being delisted by the FDA, Lamas points out that the trial is using the chelation therapy under an FDA investigational new drug (IND) application, which requires regular reports of adverse events. "Indeed, when used as directed within the guidelines of TACT, chelation therapy with EDTA has proved to be remarkably safe." He added that the trial has been the subject of a comprehensive inquiry and has been reviewed by many regulatory bodies, all of which have concluded that it should continue.

On the allegation in the Tribune article that the study misled patients regarding death as a potential side effect of chelation therapy, Lamas says: "Death can be a side effect when the therapy is delivered too quickly or in an incorrect dose. Much like Tylenol, when misused, an overdosage can have serious consequences. In the context of a tightly controlled clinical trial, we did not believe that death was a potential side effect when we developed the original consent form. . . . However, in response to a request from the Office of Human Research Protections the consent form was revised in 2009."

On the reports of misdemeanors of some of the investigators, Lamas notes that over 300 physicians have participated in the trial, "yet Ms Tsouderos focused on a small number of investigators who have had legal problems, unrelated to the trial."

Lamas also says Tsouderos's claim that the trial had difficulty enrolling patients is "misleading."
"Clinical trials—even those addressing 'mainstream' therapies—often have difficulty finding productive sites and enrolling patients. TACT has been no different in this regard."

He concludes: "Anyone who has studied the history of medicine knows that many effective mainstream therapies are derived from empirical folk remedies and that some science-based treatments prove ineffective or even harmful. As a practicing 'mainstream' cardiologist, I have no vested interest in establishing the value of chelation therapy, but I do try to keep an open mind on this issue. Since neither I nor any other TACT clinical investigators are privy to interim outcome data from TACT, we do not know how the study will turn out. Our job is not to prejudge its outcome but to maintain the safety of our participants and the scientific integrity of the study, as judged by those who review our data and practices regularly."

More than half of parents feel anxious or helpless when their child has a fever, new research suggests.

A poll of more than 1,000 parents, conducted on behalf of Pfizer Consumer Healthcare, found that just 32 per cent of parents - including 41 per cent of dads and 25 per cent of mums - said they felt confident about treating a fever.

Dr. Alanna Levine, a paediatrician and spokeswoman for Children's Advil, said: 'As demonstrated in the survey, and as I see in my practice, even some of the most seasoned parents worry about fever.

'During this cold and flu season, all parents should be armed with the proper facts about fevers and how to manage them.'

The poll also revealed that 23 per cent of parents give children an estimated lower dose of adult fever medication, rather than buying a product that is specifically designed for children.

And 54 per cent of parents wake children up in the middle of the night to give them fever medication, despite paediatricians generally believing it is best to let them sleep.

According to NHS experts, a temperature over 37.5 degrees Celsius is generally a fever and should be treated with plenty of cool drinking water.

Parents should keep children cool, maintain their room at about 18 degrees Celsius and give them paracetamol or ibuprofen. ADNFCR-554-ID-801239148-ADNFCR

UK scientists have developed two new algorithms that should help doctors to diagnose bowel and pancreatic cancer more quickly.

The QCancer algorithms cross-reference symptoms and risk factors of patients, drawing attention to those who may need further investigation.

Professor Julia Hippisley-Cox, who led the research at the University of Nottingham's division of primary care, said: 'We hope these new tools will help GPs with the difficult task of identifying patients with suspected cancer earlier and that this in turn could help improve treatment options and outcomes for patients.'

The algorithms were developed using information on patients from 564 GP practices.

Researchers then tested their ability to predict patients' chances of having pancreatic or bowel cancer and found them to be effective in both cases.

The findings are published in the British Journal of General Practice and were welcomed by Dr Clare Gerada, chair of the Royal College of General Practitioners.

She said: 'Early diagnosis, and access to appropriate diagnostic tests and tools, can make an enormous difference to the treatment and outcomes of patients with cancer and this new calculator, which is concerned with two of the most deadly forms of cancer, has the potential to save many lives.'

A new injectable drug that could help to delay the progression of Alzheimer's disease is being tested in the UK.

Researchers are giving monthly injections of gantenerumab to about 50 patients with mild memory problems, according to a report in the Daily Mail.

The drug is designed to accelerate the clearance of a toxic protein called amyloid from the brain and may help to slow the development of dementia, enabling people to remain independent for longer.

Dr. Richard Perry, who is leading one of the trials, told the news provider: 'There is no guarantee, but this is the best chance of a medication that is going to affect the underlying condition at the earliest stage.'

A spokeswoman for Alzheimer's Research UK revealed that research into gantenerumab is still in its early stages, but that the initial results look promising.

Dr. Marie Janson, the charity's director of development, said: 'We still need to know whether gantenerumab can help people's memory and thinking skills, and larger studies such as this one should help answer that question.

San Diego, CA - The use of aspirin reduces the risk of recurrent venous thromboembolism (VTE) by more than half when compared with placebo, according to the results of a new study. Investigators say the reduction in VTE risk, which was achieved without an increased risk of bleeding, makes aspirin an attractive treatment option for the extended prevention of recurrent VTE once oral anticoagulation has been stopped.

"Patients with a first episode of VTE usually receive initial therapy with heparin, which is given for five to seven days, and then they are switched over to oral anticoagulants," lead investigator Dr. Cecilia Becattini (University of Perugia, Italy) told heartwire. "Oral anticoagulant therapy [with vitamin-K antagonists] is not very practical, as it requires laboratory monitoring and medical visits for adjustments. More important, there is the potential for harmful bleeding complications with warfarin, which can occur in about 3% of patients."

The past couple of years have seen the emergence of more anticoagulants for VTE, including the US Food and Drug Administration approval of rivaroxaban (Xarelto, Bayer/Johnson & Johnson) for prevention of deep venous thrombosis (DVT) in the setting of knee- or hip-replacement surgery. Apixaban (Eliquis, Bristol-Myers Squibb/Pfizer) has been approved in Europe for the prevention of VTE events in adult patients who have undergone elective hip - or knee-replacement surgery, while edoxaban (Lixiana, Daiichi Sankyo), another direct factor Xa inhibitor, is approved in Japan. Data from the RECOVER trial also showed that the new anticoagulant dabigatran (Pradaxa, Boehringer Ingelheim) was effective when used in the VTE setting, and it is currently approved for use in Europe.

"There are a lot of new agents out there that don't require laboratory monitoring, and some of these new oral anticoagulants have already been approved for use in patients with venous thromboembolism," said Becattini. "But again, they are anticoagulants, and while they are effective, the risk of bleeding complications is not zero."

In this study, known as WARFASA, which was presented at the American Society of Hematology 2011 Annual Meeting, the researchers tested whether the use of aspirin therapy was more effective than placebo in reducing the risk of recurrent VTE in patients treated with warfarin for six to 18 months following the first idiopathic VTE. After the initial treatment with warfarin, the drug was stopped, and 205 patients were randomized to 100 mg aspirin once daily and 197 patients to placebo.

In this study, known as WARFASA, which was presented at the American Society of Hematology 2011 Annual Meeting, the researchers tested whether the use of aspirin therapy was more effective than placebo in reducing the risk of recurrent VTE in patients treated with warfarin for six to 18 months following the first idiopathic VTE. After the initial treatment with warfarin, the drug was stopped, and 205 patients were randomized to 100 mg aspirin once daily and 197 patients to placebo.

During the two-year study period, recurrent symptomatic VTE occurred in 28 patients in the aspirin arm and 43 patients in the placebo group (6.6% per patient-year vs 11.2% per patient-year, respectively). In multivariate analysis, aspirin reduced the risk of recurrent VTE 42% (hazard ratio 0.58; 95% CI 0.36-0.93) compared with placebo. The risk of major bleeding and clinically relevant nonmajor bleeding was identical in the aspirin- and placebo-treated patients, with one major bleed and three clinically relevant bleeds reported in both groups. There was no significant difference in mortality.

Not as efficacious, but not as risky
To heartwire, Becattini said that the bleeding risk with aspirin is 10-fold lower than that of other oral anticoagulants, and this study shows that putting a patient on aspirin extended therapy lowers the risk of recurrence without any significant increase in bleeding. It is a practical, low-cost option for clinicians and patients, even though it is not as efficacious for the reduction of recurrent VTE as other agents.

"You have to consider that in clinical trials, dabigatran and rivaroxaban showed an 80% to 90% reduction in the risk of venous thromboembolism, which is about double what we found with aspirin," she said. "These are the newer agents, but we don't yet know everything about their potential side effects. As well, there is the issue of cost."

After a three- or six-month treatment course with oral anticoagulants, Becattini said her center typically evaluates the risk for recurrent VTE by assessing conditions that were present at the time of the first event, such as trauma or surgery. Recurrent VTE can occur in as many as one in five patients in the two-year period following the withdrawal of oral anticoagulants.

"In cases that were associated with transient risk factors, we know the risk of a second venous thromboembolism is very low," she said. "So after three or six months, oral anticoagulants are usually discontinued. After the first episode, we'll stop the drugs and advise the patient about symptoms, telling them to come back to the hospital at the first sign something might be wrong."

Source
Becattini C, Agnelli G, Poggio R, et al. Aspirin after oral anticoagulants for prevention of recurrence in patients with unprovoked venous thromboembolism: The WARFASA study. American Society of Hematology 2011 Annual Meeting; December 12, 2011; San Diego, CA.

Related links

• UK NICE gives nod to apixaban for DVT prevention [Thrombosis - Thrombosis risk; Nov 25, 2011]
• Rivaroxaban: CHMP recommends new AF, DVT indications [Arrhythmia/EP > Arrhythmia/EP; Sep 23, 2011]
• RE-MEDY: Dabigatran noninferior to warfarin for extended treatment of VTE [Thrombosis > Thrombosis risk; Jul 27, 2011]
• Apixaban approved in Europe for use after hip/knee surgery [Interventional/Surgery > Interventional/Surgery; May 20, 2011]
• Edoxaban earns VTE indication in Japan [Thrombosis > Thrombosis risk; Apr 22, 2011]
• Experts compare new oral anticoagulants preparing to battle for the warfarin market [heartwire > Features; Dec 14, 2010]
• EINSTEIN data support rivaroxaban for DVT/VTE treatment, but duration debated [Thrombosis > Thrombosis risk; Dec 04, 2010]

A diet containing plenty of omega-3 fatty acids could help to reduce the risk of cardiovascular disease in young women, scientists say.

Researchers at Statens Serum Institut in Copenhagen, Denmark, analysed survey data on approximately 49,000 women, aged 15 to 49 years.

Over an eight-year period, there were 577 cardiovascular events, including hypertensive disease, cerebrovascular disease and ischaemic heart disease.

The researchers found that women who rarely or never ate fish were more likely to be admitted to hospital or treated as an outpatient for cardiovascular disease.

Their findings are published in Hypertension: Journal of the American Heart Association.

Lead researcher Dr. Marin Strom, a postdoctoral fellow at the institute's Centre for Foetal Programming, said: 'To our knowledge this is the first study of this size to focus exclusively on women of childbearing age.

'It is important to emphasise that to obtain the greatest benefit from fish and fish oils, women should follow the dietary recommendations to eat fish as a main meal at least twice a week.'

Oily fish include salmon, trout, mackerel, fresh tuna and sardines.

People who improve their level of fitness can reduce their risk of death, even if they do not actually lose weight, a study has found.

Scientists at the University of South Carolina studied 14,345 men in order to assess the effects of fitness and weight loss on death risk.

They found that maintaining or improving fitness was associated with a lower risk of death, even after changes in body mass index (BMI) had been taken into account.

For each unit of increased fitness over a six-year period, participants benefited from a 19 per cent reduction in their risk of heart disease and stroke-related death, as well as a 15 per cent reduced risk of death from any cause.

BMI change on its own was not found to be associated with a reduced risk of dying.

Lead researcher Dr Duck-chul Lee, who is based at the university's Arnold School of Public Health, commented: 'This is good news for people who are physically active but can't seem to lose weight.

'You can worry less about your weight as long as you continue to maintain or increase your fitness levels.'

Doireann Maddock, senior cardiac nurse at the British Heart Foundation, said that the new study in Circulation: Journal of the American Heart Association should not discourage anyone from trying to achieve a healthy weight.

'If you're overweight or obese you've a higher risk of developing heart disease, while excess weight around your waist has also been shown to be particularly bad for you,' she pointed out.

About 134,000 cases of cancer each year in the UK are caused by lifestyle and environmental risk factors, a new review has found.

Cancer Research UK scientists found smoking to be the most important lifestyle factor, accounting for 23 per cent of cancers in men and 15.6 per cent in women.

Smoking, unhealthy diets, alcohol and excess weight collectively cause more than 100,000 cancers - about one-third of all diagnoses - each year.

And the figure rises to around 134,000 when all 14 lifestyle and environmental factors that were assessed in the review are taken into account.

The research, which is published in the British Journal of Cancer, also suggests that 45 per cent of cancers in men and 40 per cent in women could be prevented.

Study author Professor Max Parkin, a Cancer Research UK epidemiologist at Queen Mary, University of London, said: 'Many people believe cancer is down to fate or 'in the genes' and that it is the luck of the draw whether they get it.

'Looking at all the evidence, it's clear that around 40 per cent of all cancers are caused by things we mostly have the power to change.'

Public health minister Anne Milton noted that small lifestyle changes can cut people's risk of serious health problems.

She advised: 'Give up smoking, watch what you drink, get more exercise and keep an eye on your weight.'ADNFCR-554-ID-801232417-ADNFCR

England's Bowel Cancer Screening Programme is on track to reduce the number of deaths from the disease by 16 per cent, new research shows.

But scientists have found that the programme may be missing tumours on the right side of the body.

Researchers at the University of Nottingham analysed the first 1.08 million tests that were received from patients participating in the scheme.

The programme invites people to complete the DIY 'faecal occult blood' (FOB) test, which they then post to the lab for analysis.

Of those taking part in the first round of screening, 2.5 per cent of men and 1.5 per cent of women had an abnormal test and 17,518 underwent further investigation.

Around one in eight men were found to have bowel cancer, while a further 43 per cent had its immediate precursor.

Among women, almost eight per cent had cancer and 29 per cent were at high risk.

The researchers found that left-sided cancers were much more common than expected - 77 per cent versus 14 per cent for right-sided cancers.

In light of their findings, which are published in Gut journal, the study authors suggested: 'Different screening strategies may be required to effectively screen for right-sided bowel cancer.'

Deborah Alsina, chief executive of Bowel Cancer UK, welcomed the results and revealed that the roll-out of a new form of diagnostic test, called flexible sigmoidoscopy, should help to improve screening and save even more lives.

Britons are being urged to take steps to reduce their risk of carbon monoxide (CO) poisoning.

The gas, which is colourless, odourless and tasteless, is released by faulty gas appliances and can be deadly in left undetected.

Symptoms of carbon monoxide poisoning are initially flu-like and include headache, nausea and dizziness, but without the high temperature that accompanies flu.

These symptoms gradually worsen over time until the person experiences balance, vision and memory loss and may lose consciousness.

The AA is urging people to install a carbon monoxide detector in their home, after research by the AA's Home Emergency Response service revealed that less than 45 per cent of homeowners have an alarm.

Tom Stringer, head of the AA Home Emergency Response service, also urged people to have appliances tested.

He said: 'Carbon monoxide is known as the silent killer as it is so hard to spot.

'One of the main sources of carbon monoxide in the home is faulty gas appliances such as boilers. We would encourage all homeowners to get their appliances serviced, before the hard work of the winter really kicks in. 'ADNFCR-554-ID-801232286-ADNFCR

People who regularly take part in extreme endurance exercise, such as marathons, triathlons and alpine cycling, may suffer damage to their hearts, a study has found.

Researchers at the University of Melbourne in Australia discovered that these athletes often show signs of damage in the right ventricle of the heart.

The scientists assessed 40 athletes, all of whom took part in competitive events.

They found that in the majority of cases, the damage was reversed within a week of competing.

However, five of the athletes (13 per cent) - all of whom had been competing for longer than the other participants - showed signs of more permanent damage, such as scarring or 'fibrosis' of the heart muscle.

The findings, which are published in the European Heart Journal, suggest that some athletes may have a susceptibility to develop damage if they take part in long-term endurance exercise, according to Dr. Andre La Gerche.

He noted: 'It is most important that our findings are not over-extrapolated to infer that endurance exercise is unhealthy. Our data do not support this premise.

'To draw an analogy, some tennis players develop tennis elbow. This does not mean that tennis is bad for you; rather it identifies an area of susceptibility on which to focus treatment and preventative measures.'

Doireann Maddock, senior cardiac nurse at the British Heart Foundation, described the findings as 'interesting, but said it is too soon to draw firm conclusions.

'It is important to remember that the health benefits of physical activity are well established,' she pointed out.

However, Ms Maddock added that any endurance athletes who are concerned about their heart health should talk to their GP.

Stimulating the brain with tiny electric currents may aid the recovery of stroke patients, a study suggests.

Researchers at Oxford University, along with colleagues in Canada, found that the technique helped to improve hand movements for about an hour.

A total of 13 patients took part in the study, with the average participant showing a five to ten per cent improvement in the time they took to make hand movements following the treatment.

Although the improvements only lasted for a short period of time after the single application, previous research has shown that daily use of brain stimulation can have lasting effects.

The findings, which are published in the journal Brain, indicate that the technique could be used alongside standard physiotherapy during the rehabilitation process.

Lead researcher Dr. Charlotte Stagg, from the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), said: 'The improvements in movement and reaction times were significant.

'Patients certainly noticed them, but they were short-lived. However, we are very hopeful that daily brain stimulation would lead to longer-lasting improvements.'

Recent figures published by the Department of Health revealed that the number of people dying from heart attacks and strokes has fallen by two-fifths since 1999.

This means that more people are surviving strokes and relying on support and rehabilitation services to regain their independence.

The gap in life expectancy between the richest and poorest people in Wales is widening, according to a new report from Public Health Wales.

Men in the least deprived areas of the country can expect to enjoy 19 more years of good health than those in the most deprived parts.

There is also more than nine years' difference in overall life expectancy between men in the most and least deprived areas, and seven years for women.

The inequality in life expectancy has widened in recent years, from 8.6 to 9.2 years in men, and from 6.5 to 7.1 years in women.

Dr. Judith Greenacre, director of health intelligence for Public Health Wales, said that a 'powerful response' is needed to address inequalities.

'This report shows that people in poorer areas of Wales not only die sooner, but also spend more of their shorter lives in poorer health. These differences are not inevitable and need urgent attention,' she remarked.

Dr. Tony Jewell, Wales' chief medical officer, said that the government is committed to taking the necessary steps to address the problem.

He commented: 'Reducing health inequalities is a priority for the Welsh government and remains a key theme within the Public Health Framework Our Healthy Future. 'ADNFCR-554-ID-801233714-ADNFCR.

British and American scientists have filed two patents for developing new drugs to tackle low-density lipoprotein (LDL or 'bad cholesterol').

The researchers have improved their understanding of an enzyme called IDOL, which appears to play an important role in regulating the amount of LDL receptors - produced by liver cells - that bind LDL and remove it from the blood.

By developing drugs that target this enzyme, the researchers believe it may be possible to increase the levels of these LDL receptors and lower patients' blood cholesterol.

Professor John Schwabe, head of biochemistry at the University of Leicester, said: 'Development of a drug that interferes with IDOL's activity could help lower levels of LDL.

'Our research has greatly enhanced our understanding of this important process.'

The studies, which are published in the journals Genes & Development and the Proceedings of the National Academy of Science, also involved scientists at the University of California, Los Angeles.

NHS figures suggest that two out of three adults in the UK have a total cholesterol level that exceeds the government's recommended maximum of less than 5mmol/L. ADNFCR-554-ID-801235038-ADNFCR

December 6, 2011 (Dubai, United Arab Emirates) - A couple of handfuls of pistachio nuts eaten with a high-glycemic meal such as pasta can do wonders for postprandial glucose and insulin levels, especially in people with metabolic syndrome, according to new research presented here at the International Diabetes Federation (IDF) World Diabetes Congress 2011.

The study, sponsored by the Western Pistachio Association, Fresno, California, included 20 patients with metabolic syndrome (12 women; average age, 54 years) and an average body mass index of 37.5 kg/m2, reported lead investigator Cyril W.C. Kendall, PhD, from the University of Toronto, Ontario, Canada.

In an expansion of research recently published by his group (Eur J Clin Nutrition. 2011;65:696-702), Dr. Kendall described how pistachios (84 g) were served to fasting patients, either alone or in combination with white bread (50 g) or white bread with butter and cheese.

Venous and finger-prick blood sampling was used to assess glucose and insulin responses over 3 hours, as well as glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) and ghrelin.

The study found that when carbohydrates were consumed with pistachios there was a blunted postprandial glycemic response, suggesting a beneficial effect for patients with the metabolic syndrome.

A previous paper published by the group showed the glycemic response to meals of rice and pasta was similarly blunted by pistachio nuts, and the response approached statistical significance with instant mashed potatoes.

"These data demonstrate that the addition of pistachios to foods with high available carbohydrate content reduces the overall glycemic impact of the foods studied [parboiled rice, pasta, white bread, and mashed potatoes], despite increasing the overall available carbohydrate content," the authors wrote.

But Dana Dabelea, MD, PhD, associate professor at the Colorado School of Public Health, Aurora, and moderator of the session at which the findings were presented, said she is not convinced.

"I'm not convinced by what I've seen because I've seen comparisons to certain food groups that I wouldn't normally associate with pistachios, like pasta and potatoes. It's difficult to select the best reference group," she told Medscape Medical News.

"We're looking at mechanisms," Dr. Kendall responded in an interview. "Nuts have healthy protein and healthy fats and they're low in available carbohydrate, so hopefully they're replacing available carbohydrate, which tends to have a high glycemic index in North America. The effects are quite modest, but these are some of the mechanisms by which nuts — and pistachios in particular - help to improve glycemic control."

The study was sponsored by the Western Pistachio Association, Fresno, California. Dr. Kendall is a co-investigator on an unrestricted grant from the Coca-Cola Company and has served on the scientific advisory board and received research support, travel funding, consultant fees, or honoraria from Pulse Canada, Barilla, Solae, Unilever, Hain Celestial, Loblaws Inc., Oldways Preservation Trust, the Almond Board of California, the International Nut Council, Paramount Farms, the California Strawberry Commission, the Canola and Flax Councils of Canada, and Saskatchewan Pulse Growers. He also receives partial salary funding from research grants provided by Unilever, Loblaws, and the Almond Board of California. Dr. Dabelea has disclosed no relevant financial relationships.

International Diabetes Federation (IDF) World Diabetes Congress 2011. Abstract # O-0479. Presented December 6, 2011.

Medscape Medical News © 2011 WebMD, LLC
Send comments and news tips to news@medscape.net.

December 6, 2011 - Individuals with serious mental illness have a lifespan that is 15 to 20 years shorter than that of the general population in 3 countries with high-quality healthcare, new research shows.

Investigators from the Nordic Research Academy in Mental Health in Gothenburg, Sweden, studied the life expectancy of individuals admitted with a mental disorder to a hospital in Denmark, Finland, and Sweden between 1987 and 2006, and found that these individuals had mortality rates that were 2- to 3-fold higher than those of the general population in all 3 countries.

"Our study shows that major health inequalities persist between people with mental disorders and the rest of the population. Men with mental disorders still live 20 years less, and women 15 years less, than the general population," lead author Professor Kristian Wahlbeck, DMedSc, said in a release.

The study was published online May 18 and in the December print issue of the British Journal of Psychiatry.

Similar to many other developed countries, Sweden, Denmark, and Norway have undergone an era of deinstitutionalization, with a major shift away from inpatient psychiatric care to outpatient care and social participation.

Noting that the "relative life expectancy of people with mental disorders is a proxy measure of effectiveness of social policy and health service provision," the researchers set out to "evaluate the achievements of the Nordic mental healthcare reforms."

To do this, the investigators examined hospital admission and mortality data for all individuals with at least 1 hospital admission resulting from a mental health disorder. The cohort was divided into four 5-year periods. Mortality rates were calculated for age groups 15 to 29 years, 30 to 44 years, 45 to 59 years, 60 to 74 years, and 75 years or older.

Mortality rates for mental health patients were calculated and compared with general population mortality rates.

The investigators found that although there was a 15- to 20-year difference in life expectancy between the mentally ill and the general population, the gap is narrowing, with the exception of male patients in Sweden.

Further, the researchers found that the increase in life expectancy is lower among mentally ill men than among women in all 3 countries.

The investigators list several potential explanations for the high mortality rate among the mentally ill, including unhealthy lifestyle, inadequate access to adequate medical care, and "a culture of not taking physical disease into consideration when treating psychiatric patients."

In addition, they point out that individuals with mental disorders are "more often poor, unemployed, single and marginalised, all known risk factors for poor health and premature mortality."

In an accompanying editorial Graham Thornicroft, FRCPscyh, PhD, professor of community psychiatry at the Institute of Psychiatry, King's College London, United Kingdom, described the study's findings as "a scandal."

"Even in three Scandinavian countries that provide among the best-quality and most equitably distributed healthcare in the world, this mortality gap has narrowed only by a modest extent over the past two decades and remains stubbornly wide," Dr. Thornicroft writes.

The authors and Dr. Thornicroft have disclosed no relevant financial relationships.

Br. J Psychiatry. 2011; 199:453-458, 441-442. Article abstract, Editorial abstract

People who eat fish every week may enjoy some protection against Alzheimer's disease, new research suggests.

US scientists found that people who ate baked or grilled fish at least once a week tended to show less shrinkage in the volume of grey matter in the brain than those who rarely ate fish.

Grey matter volume is an important indicator of brain health, as decreases indicate that the brain cells are shrinking.

The study involved 260 adults, all of whom provided details of their fish consumption and underwent MRI brain scans.

Dr. Cyrus Raji, from the University of Pittsburgh Medical Centre, said: 'This is the first study to establish a direct relationship between fish consumption, brain structure and Alzheimer's risk.

'The results showed that people who consumed baked or broiled fish at least one time per week had better preservation of gray matter volume on MRI in brain areas at risk for Alzheimer's disease.'

Dr. Anne Corbett, research manager at the Alzheimer's Society, noted that the research did not take other lifestyle factors - such as other foods or levels of exercise - into account.

'The best way to lessen your chance of developing dementia is to eat a healthy diet including fruit and vegetables, along with taking regular exercise and giving up smoking,' she advised.

Scientists claim to have shed light on the apparent link between depression and heart disease. Researchers at Concordia University in Canada have discovered that people with mood disorders such as depression take longer to recover after exercise than those who are not depressed.

The findings indicate that, in people with depression, there is a problem with the biological stress system that may contribute to heart problems.

The research team studied a group of 886 people, typically around 60 years of age, who were asked to undergo a stress test.

When the researchers compared the recovery heart rates and blood pressure levels of depressed and non-depressed people, they found that it took longer for the heart rate of depressed individuals to return to normal.

Senior author Professor Simon Bacon, whose findings are published in Psychophysiology journal, said: 'The delayed ability to establish a normal heart rate in the depressed individuals indicates a dysfunctional stress response.

'We believe that this dysfunction can contribute to their increased risk for heart disease.'ADNFCR-554-ID-801225848-ADNFCR

Scientists have identified a substance in the blood of people with Parkinson's disease that could form the basis of a new diagnostic test.

Phosphorylated alpha-synuclein is commonly elevated in the blood of people with Parkinson's, even if they are in the earliest, symptom-free stages of the disease, according to research published in the Faseb journal.

The study, which was carried out by scientists at the University of Lancaster, revealed that people with Parkinson's disease tended to have higher levels of the substance, compared with healthy volunteers.

The researchers say that a blood test that detects phosphorylated alpha-synuclein could therefore be used to diagnose Parkinson's before the onset of symptoms.

Dr. David Allsop, from the university's Division of Biomedical and Life Sciences, said: 'This would help the development of medicines that could protect the brain, which would be better for the quality of life and future health of older people.'

Dr. Gerald Weissman, editor-in-chief of the Faseb journal, added that early detection of Parkinson's disease could enable caregivers to prepare patients for the possibility of mental, emotional and behavioural problems.

One in every 500 people in the UK is affected by Parkinson's disease, according to the charity Parkinson's UK.

The National Institute for Health and Clinical Excellence (NICE) has published new draft guidance which does not recommend a new therapy for multiple sclerosis, called fingolimod (brand name Gilenya), for use on the NHS.

Fingolimod is designed to treat relapsing-remitting multiple sclerosis (RRMS), in which patients experience periods when their condition worsens and then improves.

Research suggests that the drug, which is taken once-a-day in tablet form, may help to prevent relapses.

But NICE's independent appraisal committee said it would be less cost-effective than other drugs that are already available on the NHS.

Chief executive Sir Andrew Dillon said that new treatments 'must represent value for money so that everyone can get the most out of the NHS'.

'While [manufacturer] Novartis submitted evidence that shows fingolimod can reduce relapses, our independent committee has not been convinced that it is a cost-effective treatment option for the NHS, even with the proposed patient access scheme,' he revealed.

NICE will not issue final guidance until April 2012 and Dr Jayne Spink, director of policy and research at the MS Society, urged people with MS to contact NICE with their views during the consultation period.

She said: 'This is incredibly disheartening news for people with MS and it will leave some people with no effective treatment option. We would like to see Gilenya freely available to all those that could benefit and remain hopeful that this will happen.' ADNFCR-554-ID-801227191-ADNFCR

The amount of caffeine in drinks served by high-street coffee shops varies widely depending on the outlet, new research has found.

A team of scientists at the University of Glasgow analysed single-shot espressos from 20 different outlets in the city.

They discovered that some beverages contained just 51mg of caffeine, while others contained as much as 322mg.

The findings, which are published in the journal Food and Function, are cause for concern, as high levels of caffeine could be harmful to pregnant women, those taking oral contraceptives and people with liver disease.

Because of these harms, the UK's Food Standards Agency advises pregnant women to limit themselves to 200mg of caffeine per day - a threshold that was exceeded in four of the 20 coffees that were tested.

Professor Alan Crozier, from the University of Glasgow's School of Medicine, said: 'The variations in the amount of caffeine reflect differences in the batch-to-batch bean composition, roasting procedures, grinding conditions and the many variables in the coffee-making process such as water temperature and the ratio of water to coffee.'

He added that there is currently no way for consumers to know how much caffeine they are consuming and called for a larger study, as well as information so that customers can make an informed choice.

People who monitor their own treatment with blood-thinning drugs such as warfarin tend to have a reduced risk of blood clots, new research suggests.

Scientists at Oxford University pooled data on more than 6,400 patients involved in 11 previous trials in order to see whether self-monitoring provided any benefits.

They found that patients who self-monitored had a 49 per cent reduction in their risk of blood clots, compared with usual care.

Lead researcher Dr. Carl Heneghan, whose findings are published in the Lancet medical journal, commented: 'Management of oral anticoagulation treatment is often done badly.

'But it is possible to empower patients not only to self-measure but also to self-adjust their therapy.'

The expert confirmed that self-monitoring proved to be a 'safe' intervention across a wide range of ages, from 17 to 94 years.

He also claimed that self-monitoring should now become widespread among younger patients and those with artificial heart valves, as these were found to benefit the most.

Maureen Talbot, senior cardiac nurse at the British Heart Foundation, said that patients may be able to self-monitor their medicine effectively, as long as they have appropriate support.

'It's reassuring to know that self-monitoring doesn't appear to cause more harm than conventional monitoring in a healthcare setting, and can even lead to a decreased risk of having a heart attack or stroke,' she commented.

'However, this research shouldn't act as a green light for people to start playing doctor with their meds. Always follow the advice of your GP and take your medication as it's prescribed. 'ADNFCR-554-ID-801227198-ADNFCR

There have been improvements in the care provided to people with bowel cancer in England and Wales, according to the latest audit published by the NHS Information Centre.

In the 12 months to July 2010, 30 per cent of cases underwent keyhole procedures, compared with 25 per cent in the previous 12 months.

Overall, the percentage of deaths within 30 days of surgery fell from four per cent to 3.7 per cent, while deaths among elective patients dropped from 2.6 per cent to 2.4 per cent.

However, there are concerns about the lack of improvement in mortality rates among patients undergoing urgent and emergency surgery (six per cent and 11.2 per cent respectively).

Professor Paul Finan, clinical lead for the audit, said: 'Late presentation as an acute case remains an issue and contributes significantly to the overall mortality figure.

'There needs to be an increased awareness of the symptoms of bowel cancer in the general population, along with implementation of modern management protocols for those patients presenting acutely.'

Nigel Scott, president of the Association of Coloproctology of Great Britain & Ireland, said that healthcare professionals were achieving 'increasing success' in combating the disease.

But he agreed that advanced emergency presentation of the disease remains a concern.

'All too often worries are locked behind the bathroom door because of embarrassment until the problem is too advanced to be retrievable,' he said. ADNFCR-554-ID-801228255-ADNFCR

Countries in Europe are being urged to take immediate action to prevent continued outbreaks of measles.

A new report by the World Health Organisation European Region warns that the high season for measles transmission is approaching, and that countries should increase their efforts to control the disease.

Latest figures show there were more than 26,000 cases of measles in 36 European countries between January and October 2011.

The vast majority of these cases (83 per cent) occurred in western European countries, with more than 14,000 cases recorded in France alone.

There have also been nine deaths from measles, including six in France.

Zsuzsanna Jakab, WHO regional director for Europe, said: 'The increase in measles in European countries reveals a serious challenge to achieving the regional measles elimination goal by 2015.

'Every country in the European region must take the opportunity now to raise coverage amongst susceptible populations, improve surveillance and severely reduce measles virus circulation before the approaching measles high season.'

Earlier this year, the UK's Health Protection Agency warned that measles cases were increasing in London.

There were 104 confirmed cases of the disease between January and April 2011 in London, compared with just 79 cases for the whole of 2010. ADNFCR-554-ID-801228436-ADNFCR

Women who are receiving fertility treatment may benefit from taking vitamins, new research suggests.

Dr. Rina Agrawal led a small pilot study which looked at the effects of supplementation on 58 sub-fertile women, all of whom were treated with drugs such as Clomid to induce ovulation.

Half of the women took a daily vitamin supplement called Pregnacare Conception for four weeks, while the others took standard doses of folic acid.

The researchers, who conducted the trial at University College London and the Royal Free Hospital, found that 60 per cent of women in the vitamin group subsequently got pregnant, compared with just 25 per cent of women in the folic acid group.

The findings are published in the journal Reproductive BioMedicine and a larger study is now underway.

Dr. Agrawal, who is a consultant and associate professor in reproductive medicine and obstetrics and gynaecology, told the Press Association she would 'absolutely' encourage women to take a pregnancy supplement.

Recent figures from the Human Fertilisation and Embryology Authority revealed that 45,264 women underwent IVF in 2010. ADNFCR-554-ID-801228446-ADNFCR

Obese children with low levels of vitamin D tend to have higher degrees of insulin resistance - a major risk factor for type-2 diabetes.

That is according to a new study by scientists at the University of Texas Southwestern Medical Centre, which is published in the Journal of Clinical Endocrinology and Metabolism.

Researchers analysed blood samples from 411 obese children and 87 youngsters who were not overweight and recorded their vitamin D levels, blood sugar levels, serum insulin, body mass index (BMI) and blood pressure.

They found that obese children were more likely to have low vitamin D levels than non-obese children.

Low vitamin D was also associated with risk factors for type-2 diabetes in these youngsters, such as insulin resistance.

Dr. Micah Olson, who led the study, said that the findings 'suggest that low vitamin D levels may play a role in the development of type-2 diabetes'.

He added: 'Future studies are needed to determine the clinical significance of lower vitamin D levels in obese children, the amount and duration of treatment necessary to replenish vitamin D levels in these children and whether treatment with vitamin D can improve primary clinical endpoints such as insulin resistance.'

Between 85 and 95 per cent of people with diabetes have type-2 diabetes, which occurs when the body does not make enough insulin or produces insulin that does not work properly. ADNFCR-554-ID-801229788-ADNFCR

Parents of children with cancer typically struggle to cope with the financial consequences of their diagnosis, a report has found.

Research by children's charity Clic Sargent discovered that 66 per cent of parents have to borrow to cover the costs of travel, childcare, food and accommodation while their child is receiving treatment.

More than three-quarters (76 per cent) said their child's diagnosis had majorly affected their family finances, with the average parent spending £367 on cancer-related expenses each month.

Three in five respondents had been forced to reduce the number of hours they worked and a worrying six per cent had even resorted to taking out a high-interest payday loan to cover additional costs.

Lorraine Clifton, chief executive of Clic Sargent, said: 'Everyone is suffering in this economic climate but parents of children with cancer are amongst the hardest hit.

'The extra costs can be significant. It's shocking to hear that some families felt driven to debt in order to get through financially.'

Separate research published by Macmillan Cancer Support in October 2011 revealed that one in six cancer patients had been forced to cut back on everyday essentials, such as food, in order to save money. ADNFCR-554-ID-801229781-ADNFCR

Researchers hope to raise awareness of two little-known signs that may be symptoms of a possible stroke.

A recent NHS campaign highlighted three important signs of stroke - facial weakness, arm weakness and speech problems.

But scientists at the University Hospital of Leicester NHS Trust say there are two more that are not so well known - leg weakness and loss of vision.

Research among 1,300 people in Leicestershire revealed that awareness of the three signs publicised by the FAST campaign was high.

However, only 57 per cent of respondents knew leg weakness was a possible symptom and just 44 per cent recognised the significance of vision loss.

Professor Ross Naylor, who is based at Leicester Royal Infirmary, said: 'The NHS FAST campaign was very successful, but it's important that people know leg weakness and loss of vision are also signs to look out for.

'It's my fear that many people may not be aware that anyone experiencing one or both of these additional signs, on their own or with one of the already recognised symptoms, may be an indicator that they or a loved one is having a stroke and should also seek urgent medical advice.'

About 150,000 people in the UK are affected by stroke each year, according to figures from the Stroke Association. ADNFCR-554-ID-801228432-ADNFCR

A different vaccine is to be used to protect girls against cancer-causing strains of the HPV virus, the government has announced.

At present, a vaccine called Cervarix is used that protects against HPV strains 16 and 18, which account for more than 70% of cases of cervical cancer.

The Department of Health has confirmed that, from September 2012, a different vaccine called Gardasil will be used instead. Gardasil also protects against HPV strains 16 and 18, but provides protection against HPV types six and 11, which cause genital warts, as well.

The decision was taken following a competitive tendering exercise, the department said.

Professor David Salisbury, the government's director of immunisation, noted: 'Young women and girls who have already been vaccinated or who are due to be vaccinated before September do not need to be vaccinated again.

'They have done exactly the right thing and they can be assured that they are protected against types of HPV virus that cause over 70 per cent of cervical cancer.'

Robert Music, director of Jo's Cervical Cancer Trust, said that just over 80 per cent of 12 to 13-year-old girls in England and Wales and around 90 per cent in Scotland and Northern Ireland have had the three doses of HPV vaccine.

He added: 'Uptake is hugely encouraging and something the UK should be proud of, but we would like to see every effort made to see this increase further.'ADNFCR-554-ID-801221877-ADNFCR

The risk of harm is greater for first-time mums who have a home birth than it is for women who have already experienced childbirth, new research suggests.

Scientists at the University of Oxford analysed data on 64,538 infants, all of whom were born at full term to women with low-risk pregnancies.

The researchers found that just 4.3 per 1,000 births were affected by adverse outcomes, and that there was no significant difference between the rate of problems for hospital births and that for home births.

However, analysis revealed that women who were giving birth for the first time were more likely to have an adverse outcome (9.3 per 1,000 births) if they gave birth at home, compared with an obstetric unit setting.

The study authors, whose findings are published in the British Medical Journal, said that the overall risk remains low for all birth settings and that women with low-risk pregnancies should be able to choose where they give birth.

They concluded: 'These results will enable women and their partners to have informed discussions with health professionals in relation to clinical outcomes and planned place of birth.

'For policy makers, the results are important to inform decisions about service provision and commissioning.'

Recent figures revealed that the number of women choosing to have a home birth has fallen since 2009.

The proportion of obese people varied between 8% and 25% across Europe in 2008-09, a new report has revealed.

EU statistics officer Eurostat has published the results of the latest European Health Interview Survey, which collected data on 19 member states.

Researchers found that the lowest levels of obesity in 2008-09 occurred in Romania, where just eight per cent of women and 7.6 % of men were obese.

Italy, Bulgaria and France also observed comparatively low levels of adult obesity.

In contrast, the UK recorded the highest levels of obesity among women (23.9%) and had the second highest proportion of obese men (22.1%).

Eurostat noted: 'There is no systematic difference in obesity between women and men; the proportion of obesity was higher for women in eight member states, higher for men in ten and equal in one.'

The report also revealed that obesity tends to become more common with age and is associated with lower educational achievement.

Tam Fry, a spokesman for the National Obesity Forum, insisted that education was key to tackling the problem.

He claimed: 'For a significant number of UK women, knowing what food to buy and how to cook it is foreign territory. Mainland Europe doesn't have this problem.'

A low-calorie diet may be beneficial for obese people with type-2 diabetes, a new study has found.

Researchers at Leiden University Medical Centre in The Netherlands studied seven men and eight women, all of whom had type-2 diabetes and were clinically obese.

Participants consumed just 500 calories per day for four months, during which time their body mass index (BMI) fell from 35.3, on average, to 27.5.

In addition, insulin dependence was eliminated and the amount of visceral fat around the heart - which can be detrimental to heart function - typically dropped from 39ml to 31ml.

Lead author Dr. Sebastiaan Hammer, from the medical centre's Department of Radiology, said: 'It is striking to see how a relatively simple intervention of a very low-calorie diet effectively cures type-2 diabetes mellitus.

'Moreover, these effects are long-term, illustrating the potential of this method.'

The researcher, who presented the findings at the annual meeting of the Radiological Society of North America, concluded that 16 weeks on a low-calorie diet improved patients' heart function, and that these beneficial effects 'were persistent over the long term'.

NHS figures suggest that about 2.8 million people in the UK are affected by diabetes, while a further one million may have the disease without realizing.

People who get at least 150 minutes of exercise per week are more likely to sleep well and feel alert during the day, a study has found.

Scientists at Oregon State University in the US studied a group of more than 2,600 men and women, aged 18 to 85.

They found that 150 minutes of moderate to vigorous activity per week was associated with a 65 per cent improvement in sleep quality.

In addition, people who exercised on a regular basis typically said they felt less sleepy during the day.

The findings, which are published in the journal Mental Health and Physical Activity, highlight yet another benefit of regular exercise.

Brad Cardinal, professor of exercise science at Oregon State University, said: 'We were using the physical activity guidelines set forth for cardiovascular health, but it appears that those guidelines might have a spill-over effect to other areas of health.

'Increasingly, the scientific evidence is encouraging as regular physical activity may serve as a non-pharmaceutical alternative to improve sleep.'

According to the latest guidelines from the Department of Health, Britons should aim to take at least 150 minutes of moderate intensity activity in bouts of ten minutes or more.

One way to achieve this is to exercise for 30 minutes on at least five days per week

High levels of TV viewing appear to have a worse effect on children's future risk of heart disease and stroke than regular computer use, a study has found.

Scientists at Queen's University in Canada failed to find a link between the extent of sedentary behaviour and a person's risk of developing coronary heart disease or type-2 diabetes.

However, among the children involved in the study, certain types of sedentary activity - in particular high levels of TV viewing - were found to be a risk factor for cardiovascular diseases during adulthood.

The findings re published in the journal BMC Public Health and underline the importance of restricting children's time spent in front of the TV.

Valerie Carson, a researcher at Queen's University, said: 'Even if a child is physically active, this activity is really only making up a short period of their whole day, so it's important to look at other aspects of their day to see what's going on.

'The take home message is that we want children to be more physically active, but then, at the same time, we need to think about what they're doing the rest of the time.'

NHS figures suggest that just 32 per cent of boys and 24 per cent of girls in England, aged two to 15, met the recommended levels of physical activity in 2008.

November 23, 2011 - Adverse drug events (ADEs) cause an estimated 100,000 emergency hospitalizations for seniors each year, yet two thirds involve just a handful of anticoagulants and diabetes medications, according to a study published in the November 24 issue of the New England Journal of Medicine.

The study, by researchers from the US Centers for Disease Control and Prevention (CDC), singles out 4 drugs and drug classes - warfarin, oral antiplatelet medications, insulins, and oral hypoglycemic agents. Alone or together, they account for 67% of emergency ADE hospitalizations of adults 65 years and older. Warfarin was implicated in 33%, lead author Daniel Budnitz, MD, MPH, director of the CDC's Medication Safety Program, and coauthors write.

In contrast, medications red-flagged as high risk or inappropriate by health authorities explained only 1.2% and 6.6%, respectively, of such hospital admissions.

For clinicians, the take-home message of the study is clear: Improved management of antithrombotic and antidiabetes drugs can keep thousands of seniors out of the hospital.

"These data suggest that focusing safety initiatives on a few medicines that commonly cause serious, measurable harms can improve care for many older Americans," Dr. Budnitz said in a press release. "Blood thinners and diabetes medicines often require blood testing and dosing changes, but these are critical medicines for older adults with certain medical conditions."

"Doctors and patients should continue to use these medications but remember to work together to safely manage them."

Dr. Budnitz and coauthors analyzed data collected from 2007 to 2009 from 58 hospitals participating in an ADE surveillance project to come up with national estimates for that time frame. Nearly two thirds of the estimated 100,000 emergency ADE hospitalizations of seniors each year stemmed from unintentional overdoses, they write. In 48% of the cases, the patient was 80 years or older.

Hospitalizations arising from ADEs promise to increase "as Americans live longer, have greater numbers of chronic conditions, and take more medications," the authors note. Lowering the number of such hospitalizations, they write, is a major priority of a federal initiative called Partnership for Patients, which was launched in April.

The program aims, among other things, to reduce the number of preventable hospital readmissions by 20% by the end of 2013.

The authors have disclosed no relevant financial relationships.

N Engl J Med. 2011;365:2002-2012.
Medscape Medical News © 2011 WebMD, LLC
Send comments and news tips to news@medscape.net.

CMAJ. 2011;183:1991-2001, 1957-1958.

November 28, 2011 - Canadian women will now have to wait as long as 3 years between breast-screening mammograms, according to a new set of breast cancer guidelines released by the Canadian Task Force on Preventive Health Care (CTFOPHC).

They have also been told not to do breast self-exams, and their doctors have been told not to perform breast examinations in the office.

The CTFOPHC reasons that regular screening for breast cancer with mammography, breast self-exam, and clinical examinations - all practices that have been widely recommended to reduce breast cancer mortality - causes women too much anxiety, results in too many false positives, and is too costly.

Currently, women in Canada have yearly mammograms, and primary care physicians do manual breast exams, usually during a woman's annual physical examination.

The restrictive new recommendations were published in the November 22 issue of CMAJ.

Thousands of Women Will Die, Says ACR

These breast cancer screening guidelines will cost the lives of Canadian women, according to the American College of Radiology (ACR).

They "ignore the results of landmark randomized controlled trials, which show that regular screening significantly reduces breast cancer deaths in these women. While implementation of the CTFOPH guidelines may save money each year on screening costs, the result will be thousands of unnecessary breast cancer deaths," the ACR says.

Barbara Monsees, MD, a diagnostic radiologist from St. Louis, Missouri, who chairs the ACR's Breast Imaging Commission, said in a statement that "panels without profound expertise in breast cancer screening should not be issuing guidelines. These recommendations are derived from flawed analyses and they defy common sense. Women and providers who are looking for guidance are getting bad advice from both task forces."

In 2009, the United States Preventative Services Task Force (USPSTF) issued similar guidelines, which created a furor among breast cancer prevention advocates.

Canadian Task Force Should Be Congratulated

In an editorial accompanying the release of the new guidelines, Peter C. Gøtzsche, MD, from the Nordic Cochrane Centre, Copenhagen, Denmark, lauds the CTFOPHC for its recommendations.

He writes that the Canadian recommendations on mammography screening "are even more conservative" than those introduced 2 years ago in the United States, "which created an uproar...from people interested in maintaining the status quo."

Dr. Gøtzsche maintains that screening with mammography does not reduce the occurrence of advanced cancers. He also states that "rigorous observational studies" in Europe have failed to find an effect of mammography screening, and that mammography screening produces patients with breast cancer from among healthy women and increases the number of mastectomies.

"The best method we have to reduce the risk of breast cancer is to stop the screening program. This could reduce the risk by one third in the screened age group, as the level of overdiagnosis in countries with organized screening programs is about 50%," he writes.

"If screening had been a drug, it would have been withdrawn from the market. Which country will be first to stop mammography screening?" he asks.

Dr. Gøtzsche is well known for his outspoken views against mammography, and the Nordic Cochrane Group, of which is a member, was recently accused of orchestrating "an active antiscreening campaign" by an international group of breast screening experts in a letter to the Lancet.

Women in Their 40s Get Breast Cancer

The Canadian guidelines are even more negative than the American guidelines, noted radiologist Stamatia Destounis, MD, from Elizabeth Wende Breast Care, LLC, in Rochester, New York.

"The USPSTF said that for women 40 to 49, it should be a decision made with your doctor; they didn't come out and say don't do it. The Canadians even say no to breast self-exam and clinical breast exam. I don't know. We have patients coming in who have found lumps in their breasts that are significant lumps. We have doctors finding lumps in their patients that are significant lumps. It's very hard to know what to do when you have these kind of recommendations," Dr. Destounis told Medscape Medical News.

She recently did a retrospective review of patients who came to her center over a 10-year period and found that almost 20% of the breast cancers that were diagnosed were in women 40 to 49 years of age. About half of these were diagnosed in women with no known risk factors for breast cancer.

"These task forces say going through screening is stressful for women. But what woman is going to say: 'No, this is too stressful. I am not happy having extra views. I'm not going to have an ultrasound?' Most of us would say: 'I have family, I have kids, I have responsibilities. I want to make sure I'm ok and I'm a productive member of society at any age.' We women tend to be the care providers whatever our age, and we have a lot of things to do. So what woman is going to say: 'No, I'm too stressed to have this needle biopsy; it is just too much for me to handle'?" Dr. Destounis asked.

"Instead, I am going to say: 'Do whatever you need to do to make sure I'm ok.' Yes, it is stressful to go through these tests, but it's our lot as women. Saying don't do screening because it is stressful just doesn't make any sense."

Dr. Monsees is the chair of the American College of Radiology Breast Imaging Commission. Dr. Gøtzsche and Dr. Destounis have disclosed no relevant financial relationships.

Jennifer E. Yates, MD; Syed Hadi Shah, MD
New Hanover Regional Medical Center, Wilmington, NC
Jean C. Blackwell, MLS, AHIP
Health Sciences Library, University of North Carolina at Chapel Hill, NC

NO, ALTHOUGH THE EVIDENCE VARIES. Non-steroidal anti-inflammatory drugs (NSAIDs) don't appear to impair clinical fracture healing (strength of recommendation [SOR]: B, inconsistent evidence from a randomized controlled trial [RCT] and retrospective studies). Even though animal studies show delayed healing and nonunion with NSAID use, evidence in humans doesn’t merit avoiding NSAIDs in patients with fractures who need the drugs’ analgesic and anti-inflammatory benefits.

NSAIDs are commonly prescribed to control pain in patients with fractures. Laboratory studies have found that their anti-prostaglandin properties delay callus formation and subsequent healing.1 However, human studies evaluating the effects of NSAIDs on fracture healing have found variable results

TABLE
Fracture healing with NSAIDs: What the studies show

CI, confidence interval; OR, odds ratio; RR, relative risk

An RCT finds no delay in healing

An RCT of 42 postmenopausal women with displaced Colles' fractures who were given piroxicam or placebo found no difference in the rate of healing between the intervention and control groups.

After 8 weeks, the bone mineral content of the radius and ulna, measured by bone density, was similar in both groups. Patients in the piroxicam group had significantly less pain at 10 days and 4 weeks, and used significantly less rescue medication.

Other studies beg to differ

Three observational studies of patients with different types of fractures found an increase in nonunion associated with NSAIDs.3-5 Two retrospective studies of patients with long-bone fractures reported a higher rate of nonunion among patients taking indomethacin, diclofenac, or ibuprofen.

The third study, a retrospective analysis of postoperative spinal fusion patients who took ketorolac, also found an association between increased risk of nonunion and NSAIDs.

A retrospective study of 94 patients with tibial fractures reported delayed healing in patients who had taken any NSAID. This association persisted after elimination for age, sex, fracture severity, and high-energy injuries.

A relationship, but is it causal?

A larger retrospective cohort study of 9995 patients with humeral shaft fractures found an increased risk of nonunion in patients exposed to NSAIDs during the 90 days after the fracture.

On further analysis, however, only NSAID exposure 60 to 90 days after the fracture was significantly associated with nonunion.

Because patients with painful nonunion fractures are likely to use more NSAIDs, the relationship may not be causal.7

Benefits of NSAIDs outweigh concerns

Three reviews of the effect of NSAIDs on fracture healing all come to the same conclusion: Although animal studies raise theoretical concerns that NSAIDs affect fracture healing, no conclusive evidence supports denying patients the analgesic benefits of these drugs for managing fractures.

Recommendations

The American Academy of Family Physicians recommends using NSAIDs temporarily along with other measures—such as stretching, ice, and a steady return to the aggravating exercise—to relieve the pain of stress fractures until the patient is pain-free

The American College of Sports Medicine, The American Academy of Orthopedic Surgeons, and the American Academy of Physical Medicine and Rehabilitation haven't issued definitive guidelines concerning whether to use NSAIDs in managing fractures.

References

• Gerstenfeld LC, Al-Ghawas M, Alkhiary YM, et al. Selective and nonselective cyclooxygenase-2 inhibitors and experimental fracture-healing. Reversibility of effects after short-term treatment. J Bone Joint Surg Am. 2007;89:114–125.
• Adolphson P, Abbaszadegan H, Jonnson U, et al. No effects of piroxicam on osteopenia and recovery after Colles’ fracture. A randomized, double-blind, placebo-controlled prospective trial. Arch Orthop Trauma Surg. 1993;112:127–130.
• Burd TA, Hughes MS, Anglen JO. Heterotopic ossification prophylaxis with indomethacin increases the risk of long-bone nonunion. J Bone Joint Surg Br. 2003;85:700–705.
• Giannoudis PV, MacDonald DA, Matthews SJ. Nonunion of the femoral diaphysis: the influence of reaming and nonsteroidal anti-inflammatory drugs. J Bone Joint Surg Br. 2000;82:655–658.
• Glassman SD, Rose SM, Dimar JR, et al. The effect of postoperative nonsteroidal anti-inflammatory drug administration on spinal fusion. Spine. 1998;23:834–838.
• Butcher CK, Marsh DR. Nonsteroidal anti-inflammatory drugs delay tibial fracture union. Injury. 1996;27:375.
• Bhattacharyya T, Levin R, Vrahas MS, et al. Nonsteroidal anti-inflammatory drugs and nonunion of humeral shaft fractures. Arthritis Rheum. 2005;53:364–367.
• Wheeler P, Batt ME. Do nonsteroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med. 2005;39:65–69.
• Clarke S, Lecky F. Best evidence topic report. Do nonsteroidal anti-inflammatory drugs cause a delay in fracture healing? Emerg Med J. 2005;22:652–653.
• Koester MC, Spindler KP. NSAIDs and fracture healing: what's the evidence? Curr Sports Med Rep. 2005;4:289–290.
• Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician. 2003;68:1527–1532.

Joint pain: it throbs, aches, and hurts. Quite likely, it makes you think twice about everyday tasks and pleasures like going for a brisk walk, lifting your grandchild or some grocery bags, chasing a tennis ball across the court, or driving a golf ball down the fairway. Sharp reminders of your limitations arrive thick and fast, practically every time you move.

What causes joint pain?
Very often, the culprits behind joint pain are

• osteoarthritis
• old injuries
• repetitive or overly forceful movements during sports or work
• posture problems
• aging
• inactivity.

How exercise can help

Ignoring the pain won't make it go away. Nor will avoiding all motions that spark discomfort. In fact, limiting your movements can weaken muscles, compounding joint trouble, and affect your posture, setting off a cascade of further problems. And while pain relievers and cold or hot packs may offer quick relief, fixes like these are merely temporary.

By contrast, the right set of exercises can be a long-lasting way to tame ankle, knee, hip, or shoulder pain…… Practiced regularly, joint pain relief workouts might permit you to postpone - or even avoid - surgery on a problem joint that has been worsening for years by strengthening key supportive muscles and restoring flexibility.

Over time, you may find limitations you've learned to work around will begin to ease. Tasks and opportunities for fun that have been weeded out of your repertoire by necessity may come back into reach, too.

Beyond the benefits to your joints, becoming more active can help you stay independent long into your later years.

Regular activity is good for your heart and sharpens the mind. It nudges blood pressure down and morale up, eases stress, and shaves off unwanted pounds.

Perhaps most importantly, it lessens your risk of dying prematurely. All of this can be achieved at a comfortable pace and very low cost in money or time.

Why weight matters?

Being overweight raises your risk for developing osteoarthritis in a weight-bearing joint like the knee - and even in the hand, according to some research, since inflammatory factors related to weight might exacerbate this condition.

Simply walking across level ground puts up to one-and-a-half times your body weight on your knees. That means a 200-pound man will deliver 300 pounds of pressure to his knee with each step. Off level ground, the news is worse: each knee bears two to three times your body weight when you go up and down stairs, and four to five times your body weight when you squat to tie a shoelace or pick up an item you dropped.

Fortunately, strengthening your quadriceps (the muscles on the fronts of the thighs) changes the equation, and so does losing weight.

Each pound you lose, reduces knee pressure in every step you take. One study found that the risk of developing osteoarthritis dropped 50% with each 11-pound weight loss among younger obese women. If older men lost enough weight to shift from an obese classification to just overweight - that is, from a body mass index (BMI) of 30 or higher down to one that fell between 25 and 29.9 - the researchers estimated knee osteoarthritis would decrease by a fifth. For older women, that shift would cut knee osteoarthritis by a third.

Updated November 16, 2011 (Orlando, Florida) - Tripling the maintenance dose of clopidogrel to 225 mg daily in stable heart disease patients carrying one clopidogrel loss-of-function allele (CYP2C19*2) achieved levels of platelet reactivity similar to that seen with the standard 75-mg dose in noncarriers, according to the results of the ELEVATE-TIMI 56 trial [1].

In contrast, in patients with two loss-of-function alleles, doses as high as 300 mg daily did not result in comparable degrees of platelet inhibition.The study was presented today at the American Heart Association 2011 Scientific Sessions by Dr Jessica Mega (Brigham and Women's Hospital, Boston, MA) and published simultaneously in the Journal of the American Medical Association.

Speaking in a morning press conference, Mega said the findings will have an influence on her practice. "If I knew someone's genotype [indicated loss of function], I would feel uncomfortable treating them with standard doses of clopidogrel," she said, adding that there are also other agents available, prasugrel and ticagrelor, that have been shown to reduce events in "all-comers."

That's despite the fact that ELEVATE did not look at effects on patient outcomes. As Mega commented to heartwire : "It is important to understand that this is a pharmacodynamic study . . . but I think it gives us a great deal of insight into the optimal ways of treating different patients with clopidogrel."

The ELEVATE Study

In the study, 333 patients were genotyped and then received various maintenance doses of clopidogrel dependent on genotype for four 14-day treatment periods. The 247 noncarriers of a loss-of-function CYP2C19*2 allele received clopidogrel doses of 75 mg and 150 mg daily (two periods each), whereas 86 carriers (80 heterozygotes, six homozygotes) received doses of 75 mg, 150 mg, 225 mg, and 300 mg daily. At the end of each study period, platelet-function testing was performed with both VASP and VerifyNow assays.

When treated with a standard clopidogrel maintenance dose of 75 mg daily, both CYP2C19*2 heterozygotes and homozygotes had significantly higher on-treatment platelet reactivity than did noncarriers.

Among CYP2C19*2 heterozygotes, each 75-mg increase in clopidogrel dose led to an approximate 8% to 9% absolute reduction in platelet-reactivity index as measured by the VASP test. Similar results were seen with the VerifyNow test.

Effect of Clopidogrel Dose and Loss-of-Function Genotype on Platelet-Reactivity Index (PRI) as Measured by the VASP Test Group 75 mg 150 mg 225 mg 300 mg p
Noncarriers 57.5 46.9 -- -- <0.001
CYP2C19*2 heterozygotes 70.0 61.4 52.7 48.9 <0.001
CYP2C19*2 homozygotes 86.6 77.8 73.0 68.3 0.003

Effect of Clopidogrel Dose and Loss of Function Genotype on Platelet Reactivity Units as Measured by the VerifyNow Test Group 75 mg 150 mg 225 mg 300 mg p
Noncarriers 163.6 126.7 -- -- <0.001
CYP2C19*2 heterozygotes 225.6 188.1 152.9 127.5 <0.001
CYP2C19*2 homozygotes 328.8 310.2 286 287.0 0.32

She said it was encouraging that a dose of 225 mg of clopidogrel gave the same degree of platelet inhibition in heterozygous CYP2C19*2 carriers as a 75-mg dose gives in normal patients. "This means we can work with clopidogrel in the vast majority of patients."

This means we can work with clopidogrel in the vast majority of patients.

She continued, "It appears that it is only the patients who are homozygous CYP2C19*2 carriers--and these make up only 2% of the population--who are really difficult to treat with clopidogrel, and they probably do need to be treated with one of the other agents--prasugrel or ticagrelor," Mega added.

Asked if this study might prompt more doctors to test for clopidogrel loss-of-function genotypes, Mega said she thought this would happen as new, easier-to-use devices for genotyping become available. "At the moment, you still have to send a sample off for the results, which puts many doctors off, but this will change in the not-too-distant future, and I think people are becoming more comfortable with the idea. If you are homozygous for CYP2C19*2, I think you do really need to know about it."

In the morning press conference, Mega pointed out that even if without genotype information, clinical factors such diabetes or previous MI can also sway decisions on dose or medication.

"We need to pay attention to genotype, as well as their clinical characteristics, to give the right drug to the right patient to reduce thrombotic events."

Dr. Lawrence J Lesko

Dr. Lawrence J Lesko (University of Florida, Gainesville), who discussed the trial following Mega's presentation, praised its "actionable information," namely that physicians have "clear dose information," at least for patients with one clopidogrel loss-of-function allele.

But there are other nuances to take into account, he noted. For example, the sensitivity and specificity of both genotyping and platelet-function tests are "less than 100%," Lesko told the press.

"I could be tested as a *2 carrier and still respond adequately to a 75-mg dose. . . . Likewise, some *1--about 20% of them--won't respond to 75 mg at all, even if they are extensive metabolizers."

Lesko also made a distinction between test utility at a population level and the patient level.

"I've been both a patient and a scientist. There is clinical utility that is generally speaking to the population benefit of doing the test--does it change treatment decisions? And then there is personal utility: what this test means for me. If I were a patient, I'd very much want this genetic test if I were going on Plavix today. And I would work with my physician to make a personal decision--that's what genetics brings."

Reinforces the Need to Know Genotype

Commenting on the study for heartwire , Dr. Eric Topol (Scripps Translational Science Institute, La Jolla, CA) said: "This is quite a novel and impressive study---by [increasing the usual] dose of clopidogrel to three times in heterozygote loss-of-function carriers, Mega and colleagues nicely show suppression of platelet function. These findings are indeed important, confirming the vital pharmacogenomic clopidogrel story in CYP2C19 loss-of-function carriers and, further, the inability to address this even with tripling of dose in homozygotes." He added: "All of this reinforces the need to know genotype in patients at risk, such as those with stent implantation."

References

1. Mega JL, Hochholzer W, Frelinger AL, et al. Dosing clopidogrel based on CYP2C19 genotype and the effect on platelet reactivity in patients with stable cardiovascular disease. JAMA 2011; DOI:10.1001/jama.2011.1703. Available at:

People who consume a moderate amount of beer may benefit from a reduced risk of heart disease and stroke, research suggests.

A large body of previous research indicates that drinking wine in moderation is good for cardiovascular health and the latest study at Fondazione 'Giovanni Paolo II' in Italy has found that beer may have a similar effect.

Scientists pooled the results of several studies, involving more than 200,000 people, to examine the links between alcohol consumption and heart disease.

Their analysis confirmed that moderate wine consumption - about two glasses per day for men and one for women - may reduce the risk of cardiovascular disease by up to 31 per cent, compared with non-drinkers.

The researchers also found that drinking slightly more than one pint of beer (five per cent ABV) provides protection.

Augusto Di Castelnuovo, head of the Statistic Unit of Research Laboratories, commented: 'What we are talking about is moderate and regular drinking.

'Wine or beer are part of a lifestyle. One glass can pair with healthy foods, eaten at a proper time, maybe together with family or friends. There is no place for binge drinking or any other form of heavy consumption.'

The findings are published in the European Journal of Epidemiology.

The government has issued new guidance on the use of antibiotics in hospitals, amid concerns that bacteria are becoming resistant to these commonly used drugs.

Doctors and nurses have been asked to think twice before prescribing antibiotics, ensuring that patients receive the right drug, at the correct dose, and for the appropriate length of time.

Professor Dame Sally Davies, England's chief medical officer, explained: 'Many antibiotics are currently prescribed and used when they don't need to be - meaning antibiotics lose their effectiveness at a rapidly increasing rate.'

The professor said the guidance should help to ensure the best outcomes for patients and slow down the rate of bacterial resistance.

The new Department of Health guidance came as Professor Martin Cormican, a leading Irish professor at NUI Galway's School of Medicine, expressed concern about the lack of new antibiotics being discovered.

Professor Cormican told the Irish Health website that certain types of surgery and cancer treatments will become 'almost impossible to do safely' if doctors do not have antibiotics that work.

A new drug called evacetrapib may help to increase levels of high-density lipoprotein (HDL or 'good cholesterol') and lower levels of low-density lipoprotein (LDL or 'bad cholesterol'), research suggests.

Scientists at the Cleveland Clinic in the US presented clinical trial data at the American Heart Association Scientific Sessions and have published their findings in the Journal of the American Medical Association.

Their research suggests that evacetrapib may be beneficial for people with too much harmful cholesterol in their blood.

The study authors revealed: 'These preliminary findings suggest that evacetrapib could be administered with statins and may yield potentially clinically important incremental effects on lipoproteins.'

Researchers now plan to conduct a large phase-III clinical trial to assess the drug's efficacy and safety.

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, noted that the latest study was very small and was conducted over a short period of time.

'We need to see studies on a larger scale to determine how beneficial this drug will be in the long run,' she added. ADNFCR-554-ID-801214127-ADNFCR

The second annual Winterwatch service has been launched by the government to provide the public with the information they need to stay safe and well over the colder months.

The service, which was launched yesterday (November 17th) by chief medical officer Professor Dame Sally Davies, will provide regular updates on flu levels and pressure on A&E and hospital departments, as well as practical advice on staying well.

'The cold winter months bring additional risks to our health and wellbeing,' said Dame Sally.

'It's important we all look after ourselves and those around us to make sure we stay safe and well.'

The service's unveiling came as new figures revealed that 29 per cent of healthcare workers have received the seasonal flu vaccine this winter, compared with just 11 per cent at the same time last year

Government health experts hope to increase uptake of the vaccine this year, as 602 people died with flu last winter.

Approximately 70 per cent of these deaths involved patients who were young or middle-aged. ADNFCR-554-ID-801215298-ADNFCR

The size and subsequent damage caused by a heart attack appears to vary depending on the time of day or night, new research has found.

Scientists at the Minneapolis Heart Institute Foundation in the US analysed data on 1,031 patients, all of whom had previously suffered a heart attack.

Among these, they identified 165 patients who had experienced their first heart attack and had narrowed arteries.

The researchers discovered that the size of an individual's heart attack was linked to the time of day that they experienced the attack.

Patients who had their heart attack between 01:00 and 05:00 tended to suffer the greatest level of injury - around 82 per cent worse than levels seen at the time of least injury.

The findings, which are published in the journal Circulation Research, echo those seen in earlier studies on animals.

Senior author Dr Jay Traverse, a cardiologist at the Minneapolis Heart Institute, said: 'It is important to understand that the heart's ability to protect itself against more severe damage varies over a 24-hour cycle.

'Identifying those protective changes may be particularly relevant for pharmaceutical manufacturers that are seeking to develop cardio-protective drugs.'

There are around 124,000 heart attacks in the UK each year, according to the British Heart Foundation, with one in three patients dying before they reach hospital.

Cancer Research UK has started enrolling patients in a new project aimed at helping scientists design better targeted treatments in the future.

Up to 9,000 patients with breast, bowel, lung, prostate, ovarian or melanoma skin cancer will provide consent for a small sample of their tumour to be sent for genetic testing.

Information on patients' DNA will be stored to enable researchers to analyse the success of different treatments in relation to specific genetic faults within cancer cells.

Participants' own treatment will not be affected, but the £5.5 million Stratified Medicine Programme will help to show how genetic tests could be used within the NHS to determine the best course of treatment for individual patients.

Programme director James Peach said: 'We know that prescribing certain drugs according to the genetic basis of the tumour can improve the chances of successful treatment.

'I'm confident that within the next few years we'll see personalised medicine changing the face of cancer treatment and saving many more lives from cancer.'

Cancer Research UK has also launched nine new projects which will use high-tech gene sequencing technology to scan the genes in a range of different types of cancer cell, including rare forms of skin cancer. ADNFCR-554-ID-801216501-ADNFCR

High positive affect measured over a single day predicts long-term survival in women, older men

Positive affect (PA) is associated with survival, with high PA linked to considerably improved survival in older men and women, according to a study published online Oct. 31 in the Proceedings of the National Academy of Sciences.

Andrew Steptoe, Ph.D., and Jane Wardle, Ph.D., from University College London, investigated the association between PA and survival in a cohort of 3,853 men and women aged 52 to 79 years. Participants who completed ecological momentary assessment over a 24-hour period were included and followed up for an average of five years. Affect measures were obtained at four time points in a day. At each time, participants self-rated the extent to which they felt happy, excited, content (positive affect), or worried, anxious, and fearful (negative affect) on a four-point scale from one (not at all) to four (extremely).

The investigators found that participants in the lowest, medium, and highest third of PA had death rates of 7.3, 4.6, and 3.6 percent, respectively. Compared with the low-PA group, the age- and sex-adjusted hazard ratio for high-PA participants was 0.498, which was attenuated to 0.646 on adjusting for demographic factors, negative affect, depressed mood, health indicators, and health behaviors. Negative affect and depressed mood showed no association with survival following adjustment for covariates. "These findings indicate that experienced PA, even over a single day, has a graded relationship with survival that is not caused by baseline health status or other covariates," the authors write.

People with cancer are now living nearly six times longer after their diagnosis than they would have done 40 years ago, new research shows.

Macmillan Cancer Support's latest report reveals that median survival time has increased from one year to six years. However, median survival times for nine of the 20 cancers studies are still three years or less, indicating that progress in recent years has been uneven.

While 'dramatic' improvements have been seen for cancers such as breast, bowel and non-Hodgkin's lymphoma, Macmillan said that cancers such as lung, brain and pancreatic cancer have seen little improvement.

Ciaran Devane, chief executive of Macmillan Cancer Support, said: 'This research is a huge breakthrough in seeing the real picture of how long people are living after a cancer diagnosis.

'But the good news is tempered by the shocking variation between cancer types.'

Mr. Devane added that 'much more money' is needed for research into new treatments and surgical procedures for those cancers with the poorest prognosis.

Sara Lyness, executive director of policy and information at Cancer Research UK, welcomed the improvement in average survival but agreed that more research is needed on cancers such as lung, stomach, oesophageal, pancreas and brain cancer.

November 2011 · Vol. 23, No. 11

The first noninvasive maternal blood test for Down syndrome is available to physicians on request in 20 major metropolitan regions in the United States, with more widespread availability planned in the coming months.

According to manufacturer Sequenom, Inc., the MaterniT21 assay is indicated for use in pregnant women at "high risk" of carrying a fetus with Down syndrome and can accurately test maternal blood as early as 10 weeks of gestation.

The test is based on the presence of cell-free fetal nucleic acids in maternal plasma. The health provider draws a small sample of whole blood from a pregnant woman and ships the sample to the Sequenom Center for Molecular Medicine in San Diego, California, where massively parallel sequencing (MPS) is used to measure a possible overabundance of chromosome 21, or Trisomy 21 (Down syndrome).

Down syndrome affects approximately 6,000 infants or 1 in every 691 pregnancies each year in the United States.

Currently, identification of Trisomy 21 requires assessment of several maternal serum screening markers and sonographic measurement of nuchal translucency. If these tests identify a high risk of Trisomy 21, chorionic villus sampling (CVS) or amniocentesis follows. First-trimester screening identifies as many as 90% of all cases of Down syndrome, with a false-positive rate of 2%.1 Because CVS and amniocentesis are invasive, however, they carry a small risk of pregnancy loss.

All MaterniT21 tests must be interpreted at one of the manufacturer’s laboratories. Approximate cost: $1,900—roughly equivalent to the cost of amniocentesis. Sequenom expects the out-of-pocket cost for patients with insurance to be no more than $235. The test is not approved by the US Food and Drug Administration, which does not regulate tests when only one laboratory is involved. Similar tests for Down syndrome are reportedly being developed by other laboratories.

Data on the new test

MaterniT21 was evaluated in a validation study of 4,664 women who had a high risk of Down syndrome. Fetal karyotyping was compared with the MaterniT21 test in 212 cases of Down syndrome and 1,484 matched euploid cases. The Down syndrome detection rate for the MaterniT21 test was 98.6% (209 of 212 cases); the false-positive rate was 0.20% (three of 1,471 cases); and testing failed in 13 pregnancies (0.8%), all of which were euploid. Researchers concluded that the new test "can substantially reduce the need for invasive diagnostic procedures and attendant procedure-related fetal losses."

"The results of this large clinical validation study are extremely promising," said Allan T. Bombard, MD, laboratory director of Sequenom Center for Molecular Medicine and one of the authors of the study. "We believe perinatal specialists and obstetricians will appreciate the introduction of a test that is noninvasive and highly specific."

The manufacturer is planning outreach to clinicians through its sales force, medical science liaisons, managed care team, and genetic counselors.

Is the test ready for widespread use ?

"I certainly think this test needs to be confirmed by other studies before it becomes ready for prime time," says Jeffrey A. Kuller, MD, a maternal-fetal medicine specialist and clinical geneticist at Duke University Medical Center in Durham, NC. Dr. Kuller notes that the MaterniT21 test detects only Trisomy 21, whereas conventional first-trimester screening assesses Trisomy 18 and, usually, Trisomy 13 as well. Dr. Kuller is professor of obstetrics and gynecology in the division of maternal-fetal medicine at Duke.

"Another big question mark is what does one do with an abnormal result? We have a pretty standardized algorithm for what we do if a patient has an abnormal first-trimester screen," he points out - "they're offered invasive testing." But it's unclear whether this test is intended to be diagnostic if it detects Trisomy 21.

"Can we essentially tell a patient, 'You're carrying a fetus with Down syndrome?’ Or do we need to do invasive testing like we do right now ?"

Another unresolved issue is whether the test can be used reliably in a "low-risk" population. The creators of the MaterniT21 assay tested the product only in a "high-risk" population, Dr. Kuller notes. "I don't think we know whether this would be a reasonable test for all patients."

These three issues remain unresolved, says Dr. Kuller:

• confirmation of the test’s efficacy in additional studies
• clarification of whether it is diagnostic of Down syndrome
• evaluation of the test in a population at low risk of Trisomy 21.

Panel offers recommendations for genetic counseling

The International Society for Prenatal Diagnosis (ISPD) issued a "rapid response statement" on the new test on October 24: "At this time, individual women who might be considering the MPS test need to receive detailed genetic counseling that explains the benefits and limitations of the test. Testing should only be provided after an informed consent."

The ISPD recommends that the following information be conveyed to the patient:

• The test identifies only Down syndrome, or only "about half of the fetal aneuploidy that would be identified through amniocentesis or CVS".
• The test is not perfect; that is, it does not identify all cases of fetal Down syndrome.
• Because false-positive results are possible, women who test positive still need the result confirmed by amniocentesis or CVS. If a woman tests positive for Down syndrome on the MPS test, the waiting period for the results of confirmatory testing may be "highly stressful".
• The MPS test may not be informative in all cases.
• Women who have an elevated risk of having a child with a "prenatally diagnosable disorder with Mendelian pattern of inheritance, microdeletion syndrome, or some other conditions” still need to undergo amniocentesis or CVS.

People who regularly take exercise tend to enjoy better sleep and be more alert during the daytime than those who rarely indulge in physical activity, a study has found.

Scientists at Oregon State University analysed data on more than 2,600 people, aged 18 to 85, in order to investigate the links between exercise and sleep quality.

They found that people who took 150 minutes of moderate to vigorous exercise per week typically benefited from a 65 per cent improvement in the quality of their sleep.

In addition, active people tended to report less daytime sleepiness than those who did little exercise.

The findings - which are published in the journal Mental Health and Physical Activity - were consistent even after age, body mass index (BMI), smoking status and other factors had been taken into account.

Assistant professor Paul Loprinzi, who is now based at Bellarmine University, said: 'Our findings demonstrate a link between regular physical activity and perceptions of sleepiness during the day, which suggests that participation in physical activity on a regular basis may positively influence an individual's productivity at work.'

NHS figures suggest that just 39 per cent of men and 29 per cent of women met the recommended levels of exercise - at least 30 minutes of moderate intensity activity on at least five days per week - in 2008. ADNFCR-554-ID-801219277 - ADNFCR

All pregnant women who are anxious about giving birth naturally should be able to have an elective caesarean as long as they fully understand the risks, new NHS guidelines state.

The National Institute for Health and Clinical Excellence (NICE) has updated its guidance on caesarean section, which was originally published in April 2004.

It now says that all women should be able to have a caesarean section on the NHS if they feel it is most appropriate for them and their baby.

However, they should first be given counselling in an attempt to allay their fears about a natural delivery and informed about the risks associated with caesarean sections.

Dr. Gillian Leng, NICE deputy chief executive, explained: 'For a very small number of women, their anxiety about childbirth will lead them to ask for a caesarean section.

'The new recommendations in this guideline mean that these fears will be taken seriously and women will be offered mental health support if they need it. If the woman's anxiety is not allayed by this support, then she should be offered a planned caesarean section.'

Cathy Warwick, chief executive of the Royal College of Midwives, welcomed the new guidelines.

She noted that in many cases, individualised support can ease women's anxieties about childbirth and many go on to have a natural birth.

Older people should ensure they have a healthy and balanced diet to prevent a range of health problems, it has been claimed.

Laura Williams, a diet and fitness expert, said that milk, yoghurt and cheese provide a good source of calcium, which is important to maintain bone health.

Red meat is also a valuable part of the diet, as it can help to prevent anaemia - a common problem in older people.

Fibre is another dietary component that should not be neglected in later life, as this reduces the risk of constipation and digestive complaints. Fibre-rich foods include fruit, vegetables, whole grains and beans.

Ms. Williams noted: 'High-fat or sweet and salty foods can be tempting, especially if you're suffering with a poor appetite, but there can be risks involved if too much poor-quality food is eaten.

'Excess salt can raise blood pressure and cause water retention, while an excess of saturated fat can have a detrimental effect on heart health.'

The expert made her comments after a study in Neurology journal found that people in the earliest stages of Alzheimer's disease are more likely to have a low body mass index (BMI) than those who are free from dementia.

People who regularly eat beef mince or processed meat appear to be more likely to develop aggressive prostate cancer, scientists say.

Researchers at the University of California, San Francisco, studied the meat-eating habits of approximately 1,000 men. They discovered that those with a high intake of ground beef or processed meat were more likely to develop prostate cancer and had a heightened risk of an aggressive form of the disease.

Grilling and barbequing were also found to be associated with an increased risk.

The findings, which are published in the journal PLoS One, may be due to the higher levels of cancer-causing chemicals that occur when meat is prepared in this way.

'Higher intake of well-done grilled or barbequed red meat and ensuing carcinogens could increase the risk of aggressive prostate cancer,' the study authors concluded.

Known risk factors for prostate cancer include age, a family history of the disease and racial background, with black and mixed-race men having a greater risk than white and Asian men.

Women who wish to regain their shape after giving birth should avoid taking the usual diet approach, an expert has claimed.

Dr. Joanna Helcke, a wellness consultant and founder of Zest4LifeUK.com, said that dieting is a short-term measure that tends to be unsustainable in the longer term.

'It is also inappropriate, given the demands of breastfeeding and looking after a little baby,' she pointed out.

Instead, Dr. Helcke advises women to take a three-pronged approach, consisting of abdominal work to strengthen and flatten the tummy muscles, a weekly exercise regime to kick-start the metabolism, and a balanced and healthy diet.

'With regard to the latter, I would suggest that for most post-natal women, simply making sure that they get the correct balance and type of protein, carbohydrates, fat, dairy, fruit and vegetables - combined with the right sort of exercise - is enough to see the baby weight come off at a steady and healthy rate,' she said.

The expert added that women who follow this approach should lose weight without feeling hungry or tired, and without needing to count calories or resort to food replacement shakes.

Risk factors for stroke appear to also be associated with an increased risk of cognitive problems, US scientists say.

Researchers funded by the National Institutes of Health analysed data on nearly 24,000 over-45s who had been followed since 2003.

None of the participants had any history of stroke or cognitive impairment, and none experienced a stroke during the study period.

However, the researchers found that even without suffering a stroke, people with risk factors for stroke - such as high blood pressure - were more likely to experience cognitive problems.

Study author Dr Frederick Unverzagt, professor of psychiatry at Indiana University School of Medicine in Indianapolis, said: 'Our results emphasise the importance of early intervention to treat high blood pressure and preserve cognitive health prior to a stroke or other cerebral event.'

The researchers - whose findings are published in Neurology journal - believe there is an overlap between the pathology of stroke and that of Alzheimer's disease.

Dr. Anne Corbett, research manager at the Alzheimer's Society, said that high blood pressure has been known to increase a person's chances of developing dementia for some time.

'This study adds weight to the fact that high blood pressure must be treated early, even if the condition is not so severe as to lead to a stroke,' the expert added. ADNFCR-554-ID-800789379-ADNFCR

Patients are putting themselves at risk of serious harm by believing it is beneficial to occasionally stop taking long-term medicines in order to given their body a 'detox', experts have warned.

Research by the National Pharmacy Association (NPA) suggests that one in five people believe a so-called 'medicines detox' is beneficial.

However, the NPA warned that this could be seriously harmful for patients with conditions such as diabetes, asthma or depression, as they could lose control of their illness.

The survey, which was published during Ask Your Pharmacist Week (November 7th to 13th), also revealed that nearly one in three people believe it is safe to take non-prescription medicines that have been recommended for other people.

And some wrongly assume it is okay for a child to take an adult's medication, as long as the dosage is reduced.

NPA head of information Leyla Hannbeck said: 'There is a lot of misunderstanding about how medicines work in your body.

'It's important to get the right treatment and the right advice - which you can get from your local pharmacy, often without an appointment.'

Pharmacies provide a wealth of services in addition to dispensing medicines.

These include the disposal of unwanted medicines, promotion of healthy lifestyles and support for self-care.

Pharmacists can also provide personalised advice on medicines, smoking cessation support and guidance on sexual health. ADNFCR-554-ID-800789373-ADNFCR

Putting the clocks forward all year round could help to improve children's physical activity levels and tackle the nation's worrying levels of obesity, scientists say.

A study led by the London School of Hygiene & Tropical Medicine found that children between the ages of eight and 11 tend to be most active on long summer days, particularly between the hours of 17:00 and 20:00.

The main influencing factor appears to be the number of daylight hours, rather than the weather.

This indicates that extending the number of daylight hours in winter - by maintaining British Summer Time (BST) throughout the winter months - may help to increase children's activity levels.

Dr. Anna Goodman, who led the research, said: 'The fact that kids spend more time playing outdoors and are more physically active overall on these longer days could be important at a population-level for promoting their fitness and in preventing child obesity.'

The findings are published in the Journal of Physical Activity and Health and provide support for the daylight saving bill, which is currently being considered by MPs and proposes putting the clocks forward by an extra hour all year round.

At present, the clocks move forward by one hour (BST) between the last Sunday in March and the last Sunday in October, before reverting to Greenwich Mean Time for the remainder of the year. ADNFCR-554-ID-800927153-ADNFCR

There are 350,000 people living with type-1 diabetes in the UK, a spokeswoman for the Juvenile Diabetes Research Foundation (JDRF) has revealed.

Louisa Sampson revealed that the charity hopes to use World Diabetes Day (November 14th) to raise awareness of the disease, which is much less common than type-2 diabetes.

Ms Sampson explained that people with type-1 diabetes face 'serious complications' if they do not manage their blood glucose levels effectively.

She revealed that type-1 diabetes is a very different condition to type-2 and that there is currently no cure and no way to prevent it.

'Type-1 is not linked to lifestyle choices, such as diet and exercise. The media do tend to focus on the obesity agenda, looking at how lifestyle factors can sometimes cause onset of type-2 diabetes, rather than exploring the realities of living with type-1 diabetes,' Ms Sampson claimed.

The JDRF spokeswoman added that people with type-1 diabetes have to constantly balance everything they eat and any exercise they take against how much insulin they inject.

'It can cause devastating long-term complications including blindness, heart disease, amputation, stroke and kidney failure and reduces life expectancy by up to 20 years,' she added.

The World Health Organisation predicts that the number of deaths from diabetes will double between 2005 and 2030. ADNFCR-554-ID-800789382-ADNFCR

Reducing the amount of salt in your diet may cause an increase in cholesterol levels, new research suggests.

But scientists at the British Heart Foundation (BHF) insist that consumers should follow existing guidelines on salt consumption until further research has been carried out.

At present, adults are advised to consume no more than 6g of salt per day, as higher levels may increase the risk of high blood pressure.

However, a review by scientists in Denmark, published in the American Journal of Hypertension, found that a low intake of salt may also cause significant increases in cholesterol and other compounds that have an adverse effect on heart health.

BHF heart health dietician Tracy Parker said: 'These findings aren't conclusive but they do highlight the complexities of how diet impacts on our risk of cardiovascular disease.

'As the scientists themselves say we'll need more research to confirm these findings, and understand better how they might need to be interpreted into practical guidelines.'

In the meantime, Ms Parker said people should continue to limit their salt intake to 6g (about one teaspoon) per day. ADNFCR-554-ID-800927154-ADNFCR

Bowel screening has had a noticeable effect on the number of cancer deaths in Scotland, a study shows.

Researchers at the Bowel Screening Research Centre in Dundee found that the number of bowel cancer deaths was 27 per cent lower among men who had taken part in screening than in men who had not.

The study, which was presented at the National Cancer Research Institute (NCRI) Cancer Conference in Liverpool, is the first to reveal the impact of population-based screening with the faecal occult blood test (FOBt).

The test kit is mailed to eligible people, who are then able to complete it at home and post it back to the lab for analysis.

Dr. Jane Cope, director of the NCRI, said: 'These figures are evidence that the bowel cancer screening programme is helping to lower the number of deaths from the disease.

'It's expected that when all of the national screening programmes across the UK have been up and running for a couple of years, that similar results will be seen for the whole of the UK.'

Hazel Nunn, head of health information at Cancer Research UK, explained that the test can detect growths in the bowel before they develop into cancer or cause symptoms.

She advised: 'It's really important to take up the opportunity to use the free bowel screening kit when it comes through your door.'ADNFCR-554-ID-800790806-ADNFCR

People with Parkinson's disease may benefit from a new technique that teaches them how to alter activity in specific parts of their brain, scientists say.

Researchers at Cardiff University have found that the technique, called neurofeedback, could help to improve the symptoms of people with early-stage Parkinson's.

The technique uses an MRI scanner to produce real-time images of the patient's brain.

Activity levels are displayed on a screen and the patient can use this information to learn to alter their brain activity to improve their motor function.

Professor David Linden, lead researcher at Cardiff University's School of Psychology, revealed: 'This is the first time that the neurofeedback technique has been used with patients with Parkinson's disease.

'We found that the five patients who received neurofeedback were able to increase activity in brain networks important for movements and that this intervention resulted in an overall improvement in motor speed - in this case, finger tapping.'

The research is published in the Journal of Neuroscience and was welcomed by experts at Parkinson's UK.

Claire Bale, the charity's senior research communications officer, told the BBC that the results were 'exciting', but that much larger, in-depth studies are needed to determine the technique's potential. ADNFCR-554-ID-800790698-ADNFCR

People who eat plenty of dietary fibre tend to have a reduced risk of bowel cancer, according to the results of a comprehensive review.

Scientists at Imperial College London analysed the results of 25 studies involving almost two million people in order to investigate the association between intake of dietary fibre and whole grains and the risk of bowel cancer.

They found that, overall, the reduction in risk of bowel cancer was small but noticeable.

For every 10g per day increase in dietary fibre consumption, there was a ten per cent reduction in a person's risk of developing bowel cancer, compared with the lowest levels of fibre intake.

However, fruit and vegetable fibre did not appear to be associated with a reduced risk of disease.

The findings, which are published in the British Medical Journal, indicate that people may be able to reduce their risk of bowel cancer by consuming more fibre from whole grain foods, such as breads, cereals, oatmeal, brown rice and porridge.

A recent study in the Lancet found that people with an inherited susceptibility to bowel cancer may also be able to reduce their risk of developing the disease by taking aspirin each day. ADNFCR-554-ID-801082700-ADNFCR

People who have a transient ischaemic attack (TIA or 'mini stroke') have an elevated risk of premature death, new research has found.

Scientists at the University of New South Wales and Ingham Institute in Australia looked at the medical records of 22,157 people, all of whom had been hospitalised with a TIA between July 2000 and June 2007.

Participants were followed for at least two years to see if they survived.

The researchers found that at one year after their TIA, 91.5 per cent of patients were still alive, compared with an expected survival rate of 95 per cent for the general population.

At five years, survival among TIA patients was 13.2 per cent lower than expected, and by the time nine years had passed, TIA patients' survival was 20 per cent lower than expected.

People who were older at the time of their TIA were found to be more likely to die than their younger counterparts.

Dr. Melina Gattellari, whose findings are published in Stroke: Journal of the American Heart Association, said: .People experiencing a TIA won.t die from it, but they will have a high risk of early stroke and also an increased risk of future problems that may reduce life expectancy.'

She added that patients and doctors should 'intensely manage' lifestyle and medical risk factors following a TIA.

Approximately 65,000 people have a first TIA each year in the UK, according to the Stroke Association.

Patients who believe they may be experiencing a TIA - symptoms include temporary facial weakness, arm weakness and speech problems - are urged to seek immediate medical attention.

A significant proportion of people with diabetes do not feel comfortable discussing their illness, new research suggests.

A poll of 2,000 people, conducted by Onepoll on behalf of price comparison service Confused.com, revealed that more than a fifth (22 per cent) of people with diabetes are reluctant to tell people about their condition.

Twenty-six per cent of respondents admitted they did not really understand what diabetes was, yet 31 per cent of people knew someone with the disease.

Matt Lloyd, head of life insurance at Confused.com, warned that people who fail to tell their insurer about their diabetes could invalidate their policy.

He revealed: 'Having a condition such as diabetes does not always mean you cannot get life insurance.

'Particularly if a person with diabetes is controlling their condition as directed by their doctor it is possible that they may be able to get a policy put in place.'

The survey follows recent research by Diabetes UK, which revealed that one in three people with diabetes keep their condition a secret from others.

The charity warned that nearly one million people in the UK could therefore be risking their health by failing to share the physical and psychological impact of the disease. ADNFCR-554-ID-801208458-ADNFCR

Women who take omega-3 supplements during pregnancy are less likely to give birth prematurely and their children are less likely to have problems with cognitive and language development, a large clinical study has found.

Research funded by the Australian government looked at almost 2,400 pregnant women between 2005 and 2010.

Some of the women were given omega-3 supplements from the 19th week of pregnancy until birth, while others received a placebo (dummy pill).

The researchers found that omega-3 supplementation was associated with a 50 per cent reduction in very early pre-term deliveries and a 35 per cent drop in the incidence of low birth-weight babies.

In addition, they observed that infants whose mothers took omega-3 were less likely to be slow to develop cognitive and language skills, while supplemented women were less likely to experience postnatal depression.

Commenting on the research, Oxford University's Dr. Alex Richardson said: 'In this trial - the largest of its kind - highly significant reductions were found in many factors that can adversely affect children's development and wellbeing over their lifetimes.'

Omega-3 fatty acids are also found in oily fish, such as salmon, fresh tuna and mackerel.ADNFCR-554-ID-801211576-ADNFCR

Exposure to a chemical solvent called trichloroethylene (TCE) may greatly increase a person's risk of developing Parkinson's disease, US scientists have found.

Researchers at the Parkinson's Institute in California studied the effects of exposure to TCE and several other solvents in 99 pairs of twins.

One of each set of twins had Parkinson's disease while the other did not.

The researchers found that TCE exposure was associated with a more than six-fold increased risk of Parkinson's, while slight links were also observed between two other chemicals - perchloroethylene (PERC) and carbon tetrachloride (CCI4) - and the neurodegenerative disease.

The findings are published in the Annals of Neurology and are the first to indicate a significant link between TCE exposure and Parkinson's.

Dr. Samuel Goldman, an associate professor at the Parkinson's Institute, said: 'Our study confirms that common environmental contaminants may increase the risk of developing Parkinson's disease, which has considerable public health implications.'

Dr. Michelle Gardner, research development manager at Parkinson's UK, noted that the study had only examined heavy exposure to TCE solvent in the workplace.

'Further larger-scale studies on populations with more defined exposures are needed to confirm the link,' she added.

November 12, 2011 (Philadelphia, Pennsylvania) - Patients on hemodialysis consuming a moderate amount of pomegranate juice for a year saw a continuous, cumulative, beneficial effect on their lipid profile, their blood pressure, and the number of antihypertensive medications they required, Batya Kristal, MD, MHA, from the Nephrology Department at the Western Galilee Hospital in Nahariya, Israel, reported here at Kidney Week 2011: American Society of Nephrology 44th Annual Meeting.

In addition to water, sugars, and pectin, pomegranates contain the antioxidants ascorbic acid and polyphenolic flavonoids.

Hemodialysis patients were randomized to receive 100 mL of pomegranate juice (n = 66) or an equivalent-tasting placebo (n = 35) 3 times a week for 12 months. End points of the trial were lipid profile, including triglycerides (TGs), low-density-lipoprotein cholesterol, high-density-lipoprotein cholesterol (HDL), systolic and diastolic blood pressure, and the number of antihypertensive drugs required.

At 12 months, all components of the lipid profile improved in the pomegranate juice group but not in the placebo group. In the juice group, there were statistically significant decreases in TGs from baseline to 12 months (P = .01), especially in patients with a baseline TG level of at least 200 mg/dL (P < .001). Over the same time period, HDL rose significantly (P = .005) in the juice group. There was no significant change in any of these parameters in the placebo group.

During the study period, there was a significant decrease in systolic blood pressure in the juice group overall (P < .006), especially in patients who had a baseline systolic pressure of at least 140 mm Hg (P < .005); this was not the case in the placebo group.

At 12 months, those in the juice group were taking significantly fewer antihypertensive drugs than those in the placebo group (P < .05). In the juice group, 22% of the subjects were taking fewer and 12.2% were taking more antihypertensive drugs; in the placebo group, 7.7% were taking fewer and 34.6% were taking more antihypertensive drugs.

Dr. Batya Kristal

Dr. Kristal speculated that the consumption of pomegranate juice might lower the risk for cardiovascular disease in patients on hemodialysis, and recommended that it be added to diets that improve cardiometabolic risks, including low-salt diets, Dietary Approaches to Stop Hypertension (DASH), and the Mediterranean diet.

One safety concern is that pomegranate juice contains a high level of potassium, so potassium overload is a risk, especially in patients with chronic kidney disease and dietary potassium restrictions. Dr. Kristal recommended that such patients be monitored by a dietician and a nephrologist. In addition, pomegranate juice intake can interfere with the metabolism of certain drugs, raising their levels in the blood. However, no adverse effects were detected in the group taking pomegranate juice.

Katherine Tuttle, MD, executive director for research at Providence Sacred Heart Medical Center and professor of medicine at the University of Washington School of Medicine in Spokane, who was not involved in the study, told Medscape Medical News that "it's an interesting preliminary study.... I think before we conclude that we should be giving our patients pomegranate juice, we need to do bigger studies in other settings [with] more diverse populations and, of course, look beyond just the risk factors that they measured."

In light of the high levels of potassium in pomegranate juice, Dr. Tuttle advised that "if [patients] decide to use it, [they should] be sure to let their healthcare professionals know."

The study had no commercial funding. Dr. Kristal and Dr. Tuttle have disclosed no relevant financial relationships.

Kidney Week 2011: American Society of Nephrology 44th Annual Meeting. Abstract FR-PO1660. Presented November 11, 2011.
Medscape Medical News © 2011 WebMD, LLC
Send comments and news tips to news@medscape.net.

November 11, 2011 (Chicago, Illinois) - Spine-related disability is higher in patients with low levels of vitamin D. A new study found that 65% of patients undergoing spinal fusion had vitamin D inadequacy (<32 ng/mL), which can delay recovery. Low levels of vitamin D predispose to fracture pseudarthrosis and suboptimal surgical outcome.

The results of the study were presented here at the North American Spine Society 26th Annual Meeting. The work was performed by Jacob M. Buchowski, MD, and orthopedic surgeons at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri. The study was chosen as one of the meeting's best papers.

Dr. Buchowski noted that "it was alarming to see that so many patients have inadequate or deficient vitamin D levels, especially when vitamin D is so readily available and inexpensive." He suggested that it is reasonable to screen patients scheduled for surgery for vitamin D levels, and those with a documented deficiency should be given vitamin D supplements.

Dr. Buchowski was initially prompted to perform the study because he had a patient in her 40s who experienced a slow recovery after spinal fusion therapy. During examination, the patient mentioned that she had recently been diagnosed with vitamin D deficiency. Dr. Buchowski and colleagues at Barnes-Jewish Hospital now routinely screen all patients undergoing spinal fusion surgery for vitamin D deficiency.

The study consisted of 313 patients undergoing spinal fusion surgery, which involved the removal of the discs between 2 or more vertebrae. The average age of the study population was 55.2 ±12.9 years (55% female, 41% obese, 94% white, and 4.6% black). Overall, 44% of the fusions were cervical, 38% were thoracic, and 53% were lumbar.

The mean vitamin D level in the study population was 28.6 ± 13.0 ng/mL, and 27% of the patients were vitamin D deficient (<20 ng/mL).

The subset of patients with inadequate vitamin D had a higher rate of obesity (body mass index, ≥30 kg/mm²; P = .025), black race (P = .005), and smoking (P = .023). They also had a higher mean visual analog scale pain score (P = .024), lower bone mineral density (P = .032), and more prevalent neurologic deficits (P = .094).

The authors generated a composite disability measurement by pooling the Neck Disability Index and Oswestry Disability Index scores of cervical and thoracolumbar patients. When the 57 patients who had had previous multivitamin or vitamin D supplementation were excluded, the mean pooled disability score was significantly higher in the inadequate cohort (P = .003).

Although a previous study showed inadequate vitamin D levels in 43% of patients undergoing orthopedic procedures, this is the first study to look solely at patients undergoing spine surgery.

In discussing the limitations of the study, Maxwell Boakye, MD, FACS, from the Stanford School of Medicine, in California, told Medscape Medical News that "rigorous multivariate analysis was not performed to control for potential confounders, and selection bias could explain the differences in outcomes. The results may not necessarily generalize to other populations, and need to be confirmed in other geographic populations and settings."

Vitamin D helps with calcium absorption, and patients with a deficiency can have difficulty producing new bone. Low vitamin D levels are known to be common in elderly patients. Dr. Buchowski and colleagues found, however, that many younger patients also have vitamin D deficiency. The researchers found that the main risk factors for inadequate vitamin D are smoking, obesity, disability prior to surgery, and never having taken vitamin D or multivitamin supplements.

Sun exposure is one of the best ways to get the body to produce vitamin D. Vitamin D is also easily stored in the body. To maintain bone health and normal calcium metabolism, the Institute of Medicine established a recommended daily allowance for vitamin D of 600 IU.

Dr. Buchowski reports consulting for Stryker and CoreLink, and has a speaking and/or teaching arrangement with Stryker. Dr. Boakye has disclosed no relevant financial relationships.

North American Spine Society (NASS) 26th Annual Meeting: Abstract 45. Presented November 3, 2011.
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November 13, 2011 (Philadelphia, Pennsylvania) - Poor glycemic control - whether too high or too low - is associated with decreased survival in diabetic patients on hemodialysis, Kamyar Kalantar-Zadeh, MD, MPH, PhD, professor of medicine, pediatrics, and epidemiology at the University of California at Los Angeles David Geffen School of Medicine, reported here at Kidney Week 2011: American Society of Nephrology 44th Annual Meeting.

Dr. Kalantar-Zadeh reported that in a 6-year study, moderate hyperglycemia raised the risk for all-cause or cardiovascular mortality of hemodialysis patients with diabetes, and levels of glycated hemoglobin (HbA1c) below 6% or blood glucose below 100 mg/dL were associated with an elevated risk for death.

According to most studies, he said, if glucose is well controlled, there are improvements in mortality, microvascular complications, and cardiovascular disease. One study showed that for every 1% decrease in HbA1c, deaths related to diabetes decreased 21%, microvascular complications decreased 37%, and myocardial infarctions decreased 14%. "Diabetes mellitus is a potent cardiovascular risk factor in both the general population and dialysis patients, almost half of whom suffer from diabetes in the United States, Dr. Kalantar-Zadeh said during a news conference.

"Some guidelines recommend that diabetic dialysis patients follow the same HbA1c target area as the American Diabetic Association [recommends]." However, he said, although there are some data from studies with varying methodologies, there is no clear guidance on glucose targets for the dialysis patient population.

He and his colleagues examined the predictive value of glycemic control on all-cause and cardiovascular mortality, using a large database (n = 54,757) of hemodialysis patients with HbA1c data from 2001 to 2006, and follow-up to 2007. Random (not necessarily fasting) serum glucose measurements correlated moderately well with HbA1c (correlation coefficient, r = 0.56).

Examining a range of HbA1c values (from less than 5% to more than 10%), they found the lowest all-cause mortality between 6% and 8%. Above 8%, the higher the HbA1c, the greater the mortality; it is "up to 50% higher for HbA1c above 10%, "Dr. Kalantar-Zadeh said. "At the same time,...a very low HbA1c level, below 5%...increased mortality." A similar relation was seen for cardiovascular mortality.

A subgroup analysis showed that HbA1c above 7% had a detrimental effect on mortality for all parameters and groups of maintenance hemodialysis diabetic patients examined, including race, sex, age, and serum albumin, hemoglobin, and ferritin levels.

The same sort of relation held when random glucose measurements were considered. All-cause mortality rose at glucose levels below 100 mg/dL, and rose dramatically above 200 mg/dL. The lowest death rates were seen at glucose levels between 100 mg/dL and 200 mg/dL. Cardiovascular mortality was lowest in this same range. Subgroup analyses in terms of glucose levels yielded results very similar to those of HbA1c.

Potential limitations of the study are that it was observational, Dr. Kalantar-Zadeh noted. Patients were not randomized to receive treatments, treatments for diabetes were not considered, and medication data were lacking. In addition, HbA1c and glucose measurements were taken at random times.

Dr. Kalantar-Zadeh concluded that poor glycemic control, with HbA1c above 8% or glucose above 200 mg/dL, "appears to be associated with decreased survival in prevalent diabetic dialysis patients, and moderate hyperglycemia increases the risk for all-cause or cardiovascular mortality of diabetic hemodialysis patients, especially in...Caucasians, men, and individuals with serum albumin less than 3.8 g/dL." Levels of HbA1c below 6% or glucose below 100 mg/dL "are bad, too," he said.

He suggested performing controlled trials to target a certain range of HbA1c in diabetic dialysis patients to verify these observational findings.

News conference moderator Katherine Tuttle, MD, executive director for research at Providence Sacred Heart Medical Center and professor of medicine at the University of Washington School of Medicine in Spokane, who was not involved in the study, told Medscape Medical News that clinical guidelines have been updated and will be issued soon. Although she could not elaborate before they are published, she said: "You will see a change in several things, including targets for glycemic control based on published data. I think the data [Dr. Kalantar-Zadeh was] presenting will only add to that."

She said previous Kidney Disease Outcomes Quality Initiative guidelines were based on the primary prevention of kidney disease, and an HbA1c below 7% was shown to prevent new-onset kidney disease. But there were no data on the treatment of patients with kidney disease; those data are expected to figure in the new guidelines, with higher HbA1c targets for people with multiple comorbidities and limited life expectancies, which would include the dialysis population.

This study received no commercial funding. Dr. Kalantar-Zadeh reports receiving research funding from Abbott, DaVita, and Shire; and being a consultant and scientific advisor for Abbott, Amgen, DaVita, Fresenius, Otsuka, Shire, and Vifor. Dr. Tuttle has disclosed no relevant financial relationships.

Kidney Week 2011: American Society of Nephrology 44th Annual Meeting: Abstract TH-OR085. Presented November 10, 2011.
Medscape Medical News © 2011 WebMD, LLC.
Send comments and news tips to news@medscape.net

The Lancet, Volume 378, Issue 9802, Page 1528, 29 October 2011

Release of interim results from a phase 3 trial of GlaxoSmithKline's experimental vaccine against malaria generated much excitement (and even more questions) last week. 'Malaria vaccine could save millions of children's lives', declared the UK's Guardian. “Malaria-vaccine trials raise hope of eradicating deadly disease", proclaimed Canada's Globe and Mail.

The study, published in the New England Journal of Medicine, showed that the RTS,S/AS01 vaccine roughly halved the risk of clinical and severe malaria in African infants aged 5—17 months a year after vaccination. These results are promising and consistent with findings from phase 2 trials. However, the release of this interim analysis is not without controversy. As Nick White wrote in an accompanying editorial, "there does not seem to be a clear scientific reason why this trial has been reported with less than half the efficacy results available". Some observers have suggested that the timing of the publication was political. The results were released at the Bill & Melinda Gates Foundation's forum on malaria in Seattle, following the same event in 2007 at which they famously called for the eradication of malaria.

But well intentioned political agendas must not obscure the evidence. In terms of side-effects, meningitis and generalised convulsive seizures occurred more frequently in those receiving the RTS,S/AS01 vaccine than in the control group, and the vaccine did not reduce deaths from malaria. Additionally, this vaccine is not a single magic bullet against malaria. It only offers partial protection. Still, modelling studies have suggested that the vaccine could save hundreds of thousands of lives, together with existing control methods.

The key RTS,S/AS01 data are still to come. The ideal population for this vaccine is 6—12-week-old infants who could receive the vaccine at the same time as immunisation against other major childhood illnesses. Data for efficacy in this age group will be released in 2012, and the final combined trial results will be out in 2014. This will provide crucial information about the effect of a booster dose and long-term protection. Although the latest findings are encouraging, we look forward to the full results of the RTS,S/AS01 trial in 3 years time.

Women who undergo IVF treatment may face an increased risk of developing ovarian tumours in later life, new research suggests.

Scientists at the Netherlands Cancer Institute in Amsterdam analysed data from the Omega study, which examined the effects of hormone stimulation in sub-fertile women in The Netherlands between 1980 and 1995.

The study involved 19,146 women who received at least one ovarian stimulation treatment and a further 6,006 who were not treated with IVF.

There were 77 ovarian malignancies among the women, including 61 women in the IVF treatment group.

Of these, 31 had borderline ovarian cancer - tumours which are not usually fatal - and 30 had invasive cancer.

Overall, the long-term risk for ovarian cancer and borderline ovarian tumours was twice as high among women who underwent ovarian stimulation, compared with women who did not undergo IVF.

The findings are published in the journal Human Reproduction.

Lead researcher Professor Flora van Leeuwen, head of the institute's department of epidemiology, said: 'This study, with 15 years of follow-up, is the first to include a comparison group of sub-fertile women not treated with IVF.

'Our data clearly show that ovarian stimulation for IVF is associated with an increased risk of borderline ovarian tumours and this risk remains elevated up to more than 15 years after the first cycle of treatment.'

Dr Claire Knight, senior health information officer at Cancer Research UK, said that the study suggested a possible link between ovarian stimulation and borderline ovarian tumours, 'but it certainly doesn't show that IVF causes invasive ovarian cancer'.ADNFCR-554-ID-800778071-ADNFCR

Children who eat a low-fat, high-fibre diet may be less likely to develop chronic diseases in later life, new research suggests.

Scientists at the Fox Chase Cancer Centre in Philadelphia, US, studied 230 women, aged 25 to 29 years, who had taken part in a dietary study nine years earlier that required them to eat a reduced-fat, increased-fibre diet.

They found that women who had followed the diet in childhood tended to have much lower fasting blood glucose levels and lower systolic blood pressure in early adulthood.

The findings are published in the Journal of Clinical Endocrinology and Metabolism and indicate that a low-fat, high-fibre diet in adolescence may reduce the risk of disease in later life.

Lead author Dr. Joanne Dorgan described the research as 'important'.

She said: 'It suggests that modest reductions in total fat and saturated fat intake and increased consumption of dietary fibre during childhood and adolescence may have beneficial effects later in life by decreasing risk of chronic diseases such as diabetes and heart disease.'

Fibre-rich foods include fruit and vegetables and whole grains. ADNFCR-554-ID-800779591-ADNFCR

Long-term aspirin use may help to reduce the risk of bowel cancer in people with an increased genetic risk of the disease, scientists have found.

Researchers at Newcastle University led a randomised controlled trial involving 861 people with Lynch syndrome - a genetic anomaly that increases the risk of bowel cancer and other solid organ tumours.

Between 1999 and 2005, participants took 600mg of aspirin a day or a placebo (dummy pill) for varying lengths of time.

By 2010, people who took aspirin had a 44 per cent reduced incidence of bowel cancer compared with those who took the placebo.

The risk among patients who took aspirin for at least two years fell by 63 per cent, with the effect becoming apparent five years after patients started taking aspirin.

Publishing their findings in the Lancet medical journal, the study authors concluded: 'Further studies are needed to establish the optimum dose and duration of aspirin treatment ... The case for prescription of aspirin to this high-risk group is clear.'

Mark Flannagan, chief executive of Beating Bowel Cancer, welcomed the 'very promising' results, saying: 'We have known about the link between daily aspirin and a reduced risk of bowel cancer for many years, but this study makes a convincing case for the use of daily aspirin in people with an increased genetic risk.'

However, Mr. Flannagan emphasised that anyone considering a course of aspirin should first talk to their GP.ADNFCR-554-ID-800779582-ADNFCR

The number of people dying from circulatory disease - including heart attacks and strokes - has fallen by 41% in England over the last ten years.

Figures published by the Department of Health show that 67 deaths among every 100,000 under-75s were caused by heart and circulatory disease in 2008-10, compared with 115 per 100,000 in 1999-2001.

Meanwhile, life expectancy for those born between 2008 and 2010 has increased to 78.4 years for men and 82.4 years for women - an increase by more than two years for both sexes since 1999-2001.

Professor Jeremy Pearson, associate medical director at the British Heart Foundation, welcomed the 'fantastic' figures.

He observed that 'breakthroughs in the prevention and treatment of heart and circulatory disease have made a real difference over the decades'.

However, the figures also revealed that the gap between life expectancy in deprived areas and the rest of the UK is growing.

Professor Pearson said: 'It's completely unacceptable that your postcode should have a bearing on your health.

'Any new health policies or services should take inequalities into account to make sure they are reaching everyone who needs them.'

The number of new cancer cases in the UK is likely to rise by 45 per cent over the next two decades, scientists have warned.

According to a study in the British Journal of Cancer, there will be around 432,000 new cases of cancer a year by 2030, up from around 298,000 in 2007.

Cases in men will rise by 55 per cent, while women will see a 35 per cent increase in new cancer cases.

Some of the largest increases are expected to be from oral, liver, malignant melanoma and kidney cancers.

However, the Cancer Research UK study also revealed that survival rates are likely to continue improving over the next 20 years.

Study author Professor Peter Sasieni, an epidemiologist at Queen Mary, University of London, said: 'Projections of cancer cases are important for planning health services so we can understand where the future burden is on the NHS and also where health awareness messages need to be raised.'

Jenny Ritchie-Campbell, director of cancer services innovation at Macmillan Cancer Support, said the figures were 'disturbing'.

She added that the NHS now faces a challenge to support cancer survivors to live with the disease as a long-term condition, including planning better services and developing more personalised care.

'Without this, the NHS will completely buckle under the additional strain within 20 years,' she warned. ADNFCR-554-ID-800779588-ADNFCR

Back pain sufferers who do yoga tend to experience greater improvements than those who receive standard care alone, new research suggests.

Scientists at the University of York, funded by Arthritis Research UK, studied a group of 313 patients with chronic low back pain, all of whom were receiving standard GP care.

In addition, half of the patients were offered group yoga classes for 12 weeks.

After three months, people who had done yoga reported greater improvements in back function than those who had received standard care alone.

In addition, yoga was associated with an improved ability to complete everyday tasks, such as getting dressed without help.

'While previous studies have focused on the short-term benefits of yoga, we also wanted to see the long-term effects and measured improvements three, six and 12 months after entry into the study,' revealed chief investigator Professor David Torgerson, whose findings are published in the Annals of Internal Medicine.

'Our results showed that yoga can provide both short and long-term benefits to those suffering from chronic or recurrent back pain, without any serious side-effects.'

Last month (October), a separate study by scientists at the Group Health Research Institute in Seattle, US, also found yoga to be associated with improved function in the lower back and a reduction in chronic pain.

November 1, 2011 - The number of overdose deaths from opioid prescription pain relievers (OPRs) in the United States has reached epidemic proportions and is now greater than fatalities from heroin and cocaine combined, according to a new report released by the Centers for Disease Control and Prevention (CDC).

According to CDC director Thomas Frieden, MD, MPH, 1 out of every 20 adults in the United States - 12 million individuals - has a history of inappropriate narcotic use, a problem that largely stems from inappropriate prescribing. Dr. Thomas Frieden

Data from the Drug Enforcement Administration shows sales of OPRs to pharmacies and healthcare providers have increased by more than 300% since 1999.

According to the report, enough prescription painkillers were prescribed in 2010 to medicate every American adult around the clock for a month. Although most of these pills were prescribed, many were diverted and ended up being abused.

"The burden of dangerous drugs is being created more by a few irresponsible doctors than drug pushers on street corners," Dr. Frieden told reporters attending a press briefing.

Fastest-Growing Drug Problem

The issue of prescription opioid abuse has been front and center for some time and garnered particular attention in April 2011 when the Drug Enforcement Administration (DEA) announced a comprehensive action plan to stem the United States' national drug epidemic.

Among other initiatives, the federal plan called for pharmaceutical companies to pay for targeted educational initiatives for prescribers and included support for the expansion of state-based prescription drug monitoring programs and support for law enforcement efforts that reduce the prevalence of "pill mills" and doctor shopping.

"Prescription drug abuse is our nation's fastest-growing drug problem... and the facts as outlined are truly devastating," said Gil Kerlikowske, director of National Drug Control Policy.

Kerlikowske added that state laws and policies can make a major difference to curbing the prescription drug problem in the United States. So far, 48 of 50 states have implemented state-based monitoring programs designed to reduce medication diversion and doctor shopping.

In addition, the Department of Justice has conducted a series of takedowns of rogue pain clinics operating as "pill mills."

The Obama Administration has also signed into law the Secure and Responsible Drug Disposal Act, which will allow states and local communities to collect and safely dispose of unwanted prescription drugs and support the DEA's efforts to collect unneeded or expired prescription drugs.

Wide Variation in Mortality Rates

To better understand the scope of the problem, the CDC analyzed rates of fatal OPR overdoses, nonmedical use, sales, and treatment admissions.

The investigators found that in 2008 drug overdoses in the United States caused 36,450 deaths. Of the 20,044 prescription drug overdose deaths, OPRs were involved in 14,800 (73.8%) - more than 3 times the rate in 1999.

Sales of OPRs quadrupled between 1999 and 2010, and the researchers found that nearly half a million emergency department visits in 2009 were due to misuse or abuse of prescription painkillers.

Further, death rates varied 5-fold by state. For instance, they ranged from a high of 27 deaths per 100,000 population in New Mexico to a low of 5.5 deaths per 100,000 in Nebraska.

Perhaps not surprisingly, the study also showed that states with lower death rates had lower rates of nonmedical use of OPRs and OPR sales.

With a rate of prescription opioid sales of 12.6 kg per 10,000 population, Florida had the highest rate of OPR sales. Illinois had the lowest rate of OPR sales, at 3.7 kg per 10,000 population.

The CDC estimates that nonmedical used of prescription painkillers costs health insurers up to $72.5 billion annually in direct healthcare costs.

Treatment of Last Resort

According to Dr. Frieden, opioids should be used only when all other treatments fail. It is possible, he said, to provide patients with adequate pain relief without necessarily resorting to narcotics. Such strategies range from addressing mood disorders to prescribing physical therapy for pain relief.

"There are many things that can be done to increase patients' comfort and functionality without risking a lifetime of addiction,' he said.

In cases where narcotics are necessary, he added, physicians should prescribe only the quantity of pain medications needed based on the expected length of pain.

"For example," said Dr. Frieden, "if someone comes in with acute pain, 3 days rather than 30 days [of OPR] should be the standard."

He noted that many hospital emergency departments around the country are rethinking their use of long-acting narcotics, recognizing that perhaps the clinician who provides the patient's ongoing care is the best source for these types of highly addictive medications.

Patient education is also critical, said Dr. Frieden, and it is important for them to understand the risks of opioids and how to use, store, and dispose of them safely.

"Nonmedical use of prescription pain killers costs the healthcare system an estimated $70 billion a year, but there are measures that can be taken, particularly by states, where we have a huge variation in the rate of prescriptions and the rate of prescription overdose and overdose deaths.

"Through better monitoring and by taking appropriate action for patients and providers that are using these medications inappropriately; by cracking down on pill mills and doctor shopping and doctors who are prescribing inappropriately and by promoting good medical practice...it is possible to make a big difference and reduce this epidemic to controllable levels," said Dr. Frieden.

The report authors have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published online November 1, 2011. Full text
Medscape Medical News © 2011 WebMD, LLC

October 25, 2011 (Orlando, Florida) — High doses of flaxseed oil supplements may help to improve symptoms of dry eyes.

In a preliminary study, 12 people who worked themselves up to taking 9,000 milligrams per day of flaxseed oil reported substantially less itching, dryness, burning, and eye fatigue after three months.

Also, oily secretions from meibomian glands in their eyelids increased. Failure of these glands to produce or secrete oil produces dry eye symptoms.

The findings were presented here at the annual meeting of the American Academy of Ophthalmology.

Omega-3 Fatty Acid Softens Secretions

Dry eye syndrome affects about 12 million Americans.

Tears are a combination of water, for moisture; oils, for lubrication; mucus, for even spreading; and antibodies and special proteins, for resistance to infection.

People in the study all had a problem with oil secretions from their meibomian glands.

Study researcher Jack Greiner, DO, PhD, of Schepens Eye Research Institute in Boston, believes the average American's high-fat diet is the blame, at least in part. "Fats get thick and can't move out of the oil glands. We believe that due to their high omega-3 fat content, flaxseed oils soften the secretions, so they can flow."

Previous research has linked a diet rich in omega-3 containing fish to a lower risk of dry eyes in women.

Flaxseed Oil Dose Gradually Increased

Not everyone can tolerate 9,000 milligrams a day of flaxseed oil. Some people develop diarrhea and intestinal distress when taking just 1,000 milligrams a day. It would be virtually impossible to get that much flaxseed oil from the diet without supplementation.

In the study, people started out taking three 1,000-milligram capsules per day for two weeks. The dose was gradually increased.

"I think they're on to something here, but not everyone will respond the same way," says Samuel Amstutz, MD, an ophthalmologist at Grene Vision in Wichita, Kan.

Amstutz asks why the researchers didn't test omega-3 fish oil supplements -- which might be easier to tolerate -- against dry eye syndrome.

Greiner says it was simply because he wanted to better control the experiment. It's difficult to know how much fish oil each person is eating in their diet, he explains.

"Omega-3 supplements should work," Greiner says. In fact, his team is testing them right now.

If you're considering taking omega-3 supplements -- or any other supplement -- talk to your health care providers about it, so that they can check on the chance of any side effects.

Other options for people whose dry eyes are caused by poor oil secretion are warm compresses and blinking therapy, though they don't work for everyone, he says.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

SOURCES:

115th Annual Meeting of the American Academy of Ophthalmology, Orlando, Fla., Oct. 23-25, 2011.

Jack Greiner, DO, PhD, department of ophthalmology, Schepens Eye Research Institute, Boston.

Samuel Amstutz, MD, ophthalmologist, Grene Vision, Wichita, Kan.

October 27, 2011 — "Hepatocellular carcinoma, one of the most lethal human cancers, is largely amenable to primary prevention with existing knowledge and technology," according to American researchers. They report a study showing strong links between liver cancer and the modifiable risk factors of smoking, heavy alcohol consumption, and obesity, and between liver cancer and chronic infection with hepatitis B and C.

The findings, from a team led by Dimitrios Trichopoulos, MD, PhD, from the Department of Epidemiology at the Harvard School of Public Health, Boston, Massachusetts, were published online October 21 in the Journal of the National Cancer Institute.

The data come from the European Prospective Investigation Into Cancer and Nutrition (EPIC), a study that followed about 500,000 individuals from 1992 to 2000 in 10 countries in Europe. From this database, Dr. Trichopoulos and colleagues identified 115 patients with hepatocellular carcinoma, and matched them with 229 control subjects.

Investigators found that the highest risk factors for liver cancer were chronic hepatitis B infection (odds ratio [OR], 9.10) and chronic hepatitis C infection (OR 13.36), followed by obesity (OR, 2.13), former or current smoking (OR, 1.98 and 4.55, respectively), and heavy alcohol intake (OR, 1.77).

Smoking a Major Contributor

The researchers highlight smoking in particular. In this European cohort, smoking was associated with more hepatocellular carcinoma than chronic hepatitis infections.

Smoking contributed to almost half of all liver cancer cases (47.6%), whereas chronic hepatitis B and C infections contributed 13.2% and 20.9% respectively, they report. Obesity contributed to 16.1% of cancer cases, and heavy alcohol intake contributed to 10.2%.

When taken together, these documented risk factors accounted for 65.7% of all liver cancer in the European cohort.

An accompanying editorial also highlights the "remarkable and controversial" finding that smoking increases the risk for liver cancer.

"Somewhat surprisingly, smoking carried an attributable risk of almost 50%, a figure that challenges our current knowledge," write editorialists Morris Sherman, MD, and Joseph Llovet, MD, both from the Mount Sinai School of Medicine in New York City.

These data are compelling and we should take note.

Although they outline some limitations to the study - including the fact that smoking was reported in more than twice as many patients with liver cancer as in control subjects - they say: "These data are compelling and we should take note."

"We should be counseling our patients who have other risk factors for hepatocellular carcinoma to quit smoking," they write.

"There are many other health reasons to stop smoking," they acknowledge, adding: "Here is one more."

The authors have disclosed no relevant financial relationships.

J Natl Cancer Inst. Published online October 21, 2011. Abstract, Editorial

Healthcare professionals are missing vital opportunities to help prevent obesity-related cancers, Scottish scientists say.

Obesity is known to be associated with an increased risk of cancer, but researchers at Dundee University found that doctors often fail to pass this information on to patients.

Their research revealed that healthcare professionals who work with bowel cancer patients often feel uncomfortable discussing diet and lifestyle.

The study, which was presented at the National Cancer Research Institute cancer conference in Liverpool, also found that patients often receive little guidance on diet, exercise or weight management after completing treatment for bowel cancer.

Study author Professor Annie Anderson said: 'If we are to tackle the rising cancer incidence, we must do all we can to combat obesity.

'Cancer doctors and nurses need better training in how to approach this sensitive subject.'

Hazel Nunn, head of health information at Cancer Research UK, said that obesity is known to increase the risk of at least seven types of cancer.

'Many people won't be thinking about cancer risk when they notice those few extra pounds creeping on. But extra weight means more fat cells, which pump out hormones and cancer-causing chemicals around the body,' she explained.

There has been a significant decrease in the time taken to diagnose some forms of cancer, new research shows.

According to experts at Bangor University, who conducted the research, the greatest improvements in the time taken to diagnose disease have been seen in bowel, oesophageal and pancreatic cancer cases.

The researchers analysed data from the General Practice Research Database on more than 14,400 patients who were diagnosed with breast, bowel, lung, pancreatic, oesophageal or stomach cancer between 2001-02 and 2007-08.

They found that the average time taken to diagnose oesophageal cancer after a patient's first GP visit fell from 59 days to 48 days during that time.

Pancreatic cancer diagnosis times fell from 63 days to 52 days, while bowel cancer times dropped from 96 days to 75 days.

There were also small decreases in average diagnosis times for breast, stomach and lung cancers.

Dr. Richard Neal, lead researcher at the North Wales Centre for Primary Care Research, suggested: 'The reduction between 2001-02 and 2007-08 may in part be due to the roll-out of the 2005 NICE (National Institute for Health and Clinical Excellence) referral guidance for suspected cancer.

'This gives clear guidance on which symptoms should prompt a doctor to refer a patient for further investigation.'

Sara Hiom, director of information at Cancer Research UK, welcomed the figures.

But she noted: 'There is still room for considerable improvement though, and reducing the time to diagnose and treat is a critical part of improving outcomes for people with cancer. 'ADNFCR-554-ID-800789378-ADNFCR

Many women with breast cancer do not receive adequate advice on preserving their fertility before commencing treatment for the disease, experts say.

A research team at the Royal Free Hampstead NHS Trust surveyed more than 300 breast cancer surgeons, nurses and cancer doctors to see whether they discussed fertility preservation with patients.

They found that fewer than two-fifths of healthcare workers took into account whether or not a patient had children or a partner when deciding whether to discuss fertility preservation.

Report author Dr Judy King, a cancer specialist at the Royal Free Hospital, said there appears to be 'wide variation' in the knowledge, attitudes and practices of healthcare professionals who work with young women with breast cancer.

'This may mean there is a lack of standard information being given to patients, and that referral to a fertility specialist is not always being offered,' she claimed.

The findings were presented at a conference of the National Cancer Research Institute and raise concerns about the advice given to women, according to Dr Jane Cope, the institute's director.

She said: 'This first survey of the referral practices of healthcare professionals in the UK highlights that there is a lack of clear and consistent advice being given to patients and this needs to be addressed urgently.'

Breast cancer is the most commonly diagnosed form of the disease in women under the age of 35, according to the charity Breast Cancer Care. ADNFCR-554-ID-800788021-ADNFCR

Men from deprived areas of the country are more likely to die from bowel cancer than their more affluent counterparts, a study has found.

Researchers at the University of Dundee analysed data contained in the Scottish Cancer registry, relating to bowel and rectal cancer cases between 2004 and 2009.

During that time, there were around 12,000 cases of bowel cancer and more than 6,000 cases of rectal disease.

The study authors found that deprivation was associated with a heightened risk of bowel cancer death, particularly among men.

In addition, men from deprived areas were more likely to develop rectal cancer.

The findings were presented at the NCRI Cancer Conference in Liverpool by study author Professor Robert Steele.

He said: 'People's knowledge of bowel cancer risks, screening uptake and lifestyles tend to differ depending on their socio-economic background - these factors may play an important role in why deprivation has more of an effect on men and is more apparent for rectal cancer.'

A recent study in the Lancet medical journal found that a daily dose of aspirin may reduce the risk of bowel cancer in people with an inherited susceptibility to the disease. ADNFCR-554-ID-800788013-ADNFCR

There has been an increase in the incidence of cervical cancer among women in their 20s, according to new research presented at the annual conference of the National Cancer Research Institute.

Scientists at the University of Manchester, funded by Cancer Research UK, studied cervical cancer trends in 20 to 79-year-olds between 1982 and 2006.

They found that the number of diagnoses dropped following the introduction of cervical screening in England.

However, the number of 20 to 29-year-olds being diagnosed with the disease rose by more than 40 per cent between 1992 and 2006.

This is despite the fact that rates are dropping in all other age groups, with the overall incidence of the disease falling by 30 per cent.

Study author Robert Alston said: 'Our results show that although numbers getting cervical cancer are dropping in the immediate years after cervical screening began, the numbers of women in their 20s now developing the disease have been rising since the early 90s.'

The expert emphasised that women should taken part in the NHS HPV vaccination programme and attend cervical screening when invited.

Robert Music, director of Jo's Cervical Cancer Trust, expressed concern at the figures.

He said: 'It is essential we make every effort to find targeted ways to educate and persuade younger women to attend screening when invited and remind them that quite simply it could save their life. 'ADNFCR-554-ID-800788015-ADNFCR

November 4, 2011 - The Internet puts solid health information at a patient's fingertips, but 2 new studies suggest that too many of those fingertips stray into questionable territory.

In a survey from Wolters Kluwer Health, 78% of physicians said that lack of time is one of the most common challenges for physician-patient communication. The next biggest problem in this regard - cited by 53% of physicians - is misinformed patients.

The phone survey, conducted in August, included more than 300 US physicians, roughly split between primary care physicians and specialists.

The survey sheds more light on the increasingly larger role - for good and ill - that the Internet plays in healthcare. The Pew Research Center reports that 78% of adults use the Internet, and of these, 83% look up health information online.

However, the value of that information is debatable. While just over half (53%) of physicians in the Wolters Kluwer Health survey said that easier access by patients to medical knowledge has improved the exam-room experience, 1 in 5 said that this easier access "has been detrimental, leading to misinformation and incorrect self-diagnosis."

YouTube Videos on IBD Found Wanting

Similar misgivings emerged in a study presented by Cleveland Clinic Foundation researchers at the annual scientific meeting of the American College of Gastroenterology (ACG) that ended this week. The researchers analyzed the 100 most-viewed YouTube videos on inflammatory bowel disease (IBD) and rated their overall educational quality as poor.

"Clinicians and their patients need to be aware of misleading information posted by patients or particularly by pharmaceutical companies who often post videos to make it seem like they are coming from a patient when in actuality it is a company advertisement," said researcher Saurabh Mukewar, MD, in an ACG press release. "These sources are not transparent."

"The Internet and social media are not going away - YouTube is a powerful platform to deliver and receive healthcare information," said Dr. Mukewar, an internal medicine resident at the Cleveland Clinic. "But healthcare providers and professional societies need to provide more educational and efficient materials using this powerful tool to counteract misleading information."

A new government campaign has been launched in a bid to increase the number of people with dementia who receive a diagnosis.

Research suggests that six out of ten people with dementia in England do not receive a diagnosis and therefore do not get the support and treatment they need.

This is partly because people simply do not recognise the signs and symptoms of dementia.

A survey commissioned by the government found that only one in three adults over the age of 40 were confident they could tell the difference between normal signs of ageing and signs of possible dementia.

Care services minister Paul Burstow said: 'If we are worried, the sooner we discuss it and help the person seek support the better.

'Don't wait until a crisis. Being diagnosed with dementia won't make the condition worse but leaving it untreated will.'

Dr. Simon Ridley, head of research at Alzheimer's Research UK, agreed that the ability to diagnose dementia is 'crucial' to providing effective treatment.

He revealed: 'Although people may be fearful of the worst, a diagnosis can empower them to access the right treatments and support to preserve independence. 'ADNFCR-554-ID-800787835-ADNFCR

Many women with breast cancer do not receive adequate advice on preserving their fertility before commencing treatment for the disease, experts say.

A research team at the Royal Free Hampstead NHS Trust surveyed more than 300 breast cancer surgeons, nurses and cancer doctors to see whether they discussed fertility preservation with patients.

They found that fewer than two-fifths of healthcare workers took into account whether or not a patient had children or a partner when deciding whether to discuss fertility preservation.

Report author Dr Judy King, a cancer specialist at the Royal Free Hospital, said there appears to be 'wide variation' in the knowledge, attitudes and practices of healthcare professionals who work with young women with breast cancer.

'This may mean there is a lack of standard information being given to patients, and that referral to a fertility specialist is not always being offered,' she claimed.

The findings were presented at a conference of the National Cancer Research Institute and raise concerns about the advice given to women, according to Dr Jane Cope, the institute's director.

She said: 'This first survey of the referral practices of healthcare professionals in the UK highlights that there is a lack of clear and consistent advice being given to patients and this needs to be addressed urgently.'

Breast cancer is the most commonly diagnosed form of the disease in women under the age of 35, according to the charity Breast Cancer Care. ADNFCR-554-ID-800788021-ADNFCR

There has been a significant decrease in the time taken to diagnose some forms of cancer, new research shows.

According to experts at Bangor University, who conducted the research, the greatest improvements in the time taken to diagnose disease have been seen in bowel, oesophageal and pancreatic cancer cases.

The researchers analysed data from the General Practice Research Database on more than 14,400 patients who were diagnosed with breast, bowel, lung, pancreatic, oesophageal or stomach cancer between 2001-02 and 2007-08.

They found that the average time taken to diagnose oesophageal cancer after a patient's first GP visit fell from 59 days to 48 days during that time.

Pancreatic cancer diagnosis times fell from 63 days to 52 days, while bowel cancer times dropped from 96 days to 75 days.

There were also small decreases in average diagnosis times for breast, stomach and lung cancers.

Dr. Richard Neal, lead researcher at the North Wales Centre for Primary Care Research, suggested: 'The reduction between 2001-02 and 2007-08 may in part be due to the roll-out of the 2005 NICE (National Institute for Health and Clinical Excellence) referral guidance for suspected cancer.

'This gives clear guidance on which symptoms should prompt a doctor to refer a patient for further investigation.'

Sara Hiom, director of information at Cancer Research UK, welcomed the figures.

But she noted: 'There is still room for considerable improvement though, and reducing the time to diagnose and treat is a critical part of improving outcomes for people with cancer.' ADNFCR-554-ID-800789378-ADNFCR

November 1, 2011 — Resveratrol, an ingredient found in red wine, may improve the health of obese men, according to the results of a small trial published in the November issue of Cell Metabolism.

"Although most of the effects that we observed were modest, they were very consistently pointing toward beneficial metabolic adaptations," write Silvie Timmers, MSc from Top Institute Food and Nutrition, Wageningen, and the Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, the Netherlands, and colleagues.

In previous studies, resveratrol appeared to prolong the life of mice and to reverse some of the damage caused by obesity. This study, the first clinical trial of resveratrol published in a peer-reviewed journal, was too short to show an effect on human lifespan, but it duplicated many of the same metabolic effects seen in mice.

The effects were similar to those seen in severe calorie restriction, which has also been shown to improve metabolism and prolong life in mammals.

To see whether the animal effects could be duplicated in people, the researchers recruited 11 obese but otherwise healthy men to a randomized, double-blind, cross-over trial. The men took placebo or 150 mg of resveratrol in the form of resVida (DSM Nutritional Products) once per day for 30 days. After a 4-week washout period, they then took the other treatment option (ie, resveratrol 150 mg for those who had taken placebo, or placebo for those who had taken resveratrol) for the next 30 days.

Researchers measured a series of metabolic biomarkers each week during each of these trials. They found the following differences in the men after 30 days of resveratrol supplementation compared with after placebo supplementation:

• Both reseveratrol and dihydroresveratrol total (the sum of conjugated and unconjugated resveratrol) were in the participants' plasma. This confirmed that the men were metabolizing resveratrol.
• Mean systolic blood pressure was 124.7 (±3.1) with resveratrol vs 130.5 (±2.7) with the placebo, which is a statistically significant difference (P = .006). Diastolic blood pressure remained statistically the same. Mean arterial pressure was significantly lower (94.9 vs 97.9; P = .02).
• There were no effects on body mass (99.9 ± 3.9 kg vs 99.6 ± 2.5 kg; P = .43).
• After consuming a liquid test meal, the subjects reached peak glucose and insulin responses in 30 minutes when they were taking the placebo, and 60 minutes when they were taking resveratrol.
• Leptin level and leukoytes were significantly lower in participants taking resveratrol compared with those taking placebo (P = .04 and P = .03, respectively).
• Markers of systemic inflammation, including interleukin 6 and tumor necrosis factor alpha, were lower for the resveratrol group, but only tumor necrosis factor alpha was statistically significant (P = .09 and P = .04, respectively).
• Plasma glucose and insulin concentrations were lower in the resveratrol group (P = .05 and P = .04, respectively), suggesting an improved insulin sensitivity.
• Plasma triglyceride concentrations were significantly lower in the resveratrol group compared with placebo (P = .03). There were no significant differences in plasma nonsterified fatty acids (P = .59).
• Respiratory quotient values over the course of 24 hours tended to be higher after resveratrol, (P = .09) mostly because of higher values during the day (P = .001, as opposed to the nighttime difference between resveratrol and placebo, which was P = .18).
• There were no effects on thermogenesis or the physical activity index.
• Hepatic lipid accumulation was lower.
• Sleeping metabolic rate was slower in the resveratrol group (P = .007), even though the participants' 24-hour energy expenditure was similar in both groups (P = .64).
• A microarray analysis on vastus lateralis muscle biopsies showed 469 genes to be differentially expressed, of which 219 were increased and 250 were decreased. Several gene sets related to mitochondrial oxidative phosphorylation were upregulated, whereas pathways linked to inflammation were downregulated.
• Basal and postprandial energy expenditure were reduced in the resveratrol group, which is a finding opposite to what studies have found in mice, but is consistent with endurance training and calorie restriction in people.

The researchers noted that the dosage they used was about 200-fold lower than the dosage used in mouse studies. The duration of the trial was also much shorter than the 4 to 6 months seen in the animal studies. However, they said the plasma concentration in this trial was about the same as in the mouse trials.

The supplement did not appear to cause any adverse reactions. The researchers looked at clinical chemistry, hematology and coagulation, and electrocardiograms, but found nothing out of the ordinary.

"The study is surprising because of the relatively low dose and time window that were required to produce benefits," said David Sinclair, PhD, a professor of pathology at Harvard University in Cambridge, Massachusetts, in an email to Medscape Medical News.

Dr. Sinclair conducted some of the earlier mouse studies but was not involved in this trial. He added that other compounds, known as sirtuins, with a similar mechanism of action are being tested. "It's a good first step to confirming some of the mouse results in humans, but more studies are needed to know the effects of consuming resveratrol for longer periods and at higher doses," he said.

The study was funded by the Top Institute Food and Nutrition, as well as grants from the Netherlands Organization for Scientific Research to 2 of the authors and laboratory support from the European Research Council, the Swiss National Science Foundation, the Velux Foundation and École Polytechnique Fédérale de Lausanne. One of the researchers in this study is employed by DSM Nutritional Products, which makes resveratrol supplements and supplied the supplements, along with placebo capsules, for the study. Dr. Sinclair disclosed that he is a consultant to GlaxoSmithKline and OvaScience.

Mobile phone users are not at a greater risk of developing brain cancer, according to a new study.

The Institute of Cancer Epidemiology in Denmark analysed more than 350,000 consumers with mobile phones over an 18-year period and found that they were at no greater risk of brain cancer than non-mobile phone users.

The research found that 356 gliomas - a form of brain cancer - and 846 cancers of the central nervous system were diagnosed in the 358,403 study participants. These figures are almost identical to the incidence rate of cancers in those who did not own a mobile.

Furthermore, even long-term use of phones was not shown to be damaging as those who owned a mobile for 13 years or more were at no greater risk of brain cancer.

Professor Malcolm Sperrin, director of medical physics at Royal Berkshire Hospital, said: 'The findings clearly reveal that there is no additional overall risk of developing a cancer in the brain although there does seem to be some minor, and not statistically significant, variations in the type of cancer.'

The study was published on the British Medical Journal website.

The Selenium and Vitamin E Cancer Prevention Trial (SELECT), a study of over 35,000 men age 50 and older that was sponsored by the National Institutes of Health (NIH), showed that men who took 400 international units (IU) of vitamin E daily for several years had more prostate cancers compared with men who took a placebo. The findings showed that per 1,000 men, there were 76 cases of prostate cancer in men who took only vitamin E supplements versus 65 in men taking a placebo over a 7-year period. This represents a 17 percent increase in prostate cancers in men who took vitamin E compared with those who took a placebo, a difference that was statistically significant and therefore not likely due to chance. Some men in the study took both vitamin E (400 IU/day) and selenium (200 micrograms [mcg]/day). These men were also more likely to develop prostate cancer than men who took a placebo, but those increases were small and possibly due to chance. "SELECT has definitively shown a lack of benefit from vitamin E and selenium supplements in the prevention of prostate cancer and has shown there is the potential for harm," said Lori Minasian, M.D., study co-author and acting director of the NIH National Cancer Institute's Division of Cancer Prevention. "Nevertheless, this type of research has been critically important to understanding the potential benefits and risks from supplements." The results of this study appeared October 12, 2011, in the Journal of the American Medical Association. The National Cancer Institute has more information on the results of the SELECT trial.

Saw palmetto, a popular herbal dietary supplement used by some men, does not reduce urinary problems associated with prostate enlargement any better than a placebo, according to research recently published in the Journal of the American Medical Association.

Prostate enlargement, also called benign prostatic hyperplasia (BPH), can cause frequent urination (especially at night); a hesitant, interrupted, or weak urine stream; urgency and leaking or dribbling; and an inability to empty the bladder completely.

More than half of men in their 60s, and up to 90 percent in their 70s and 80s, have symptoms of BPH.

The study was a randomized, double-blind, placebo-controlled clinical trial involving 369 men age 45 years or older with symptoms of BPH.

The men took either saw palmetto (at daily doses that increased during the study from 320 milligrams (mg) to 640 mg and finally 960 mg) or a placebo for 72 weeks.

At the end of the study, the men who had taken saw palmetto had no greater improvement in urinary symptoms associated with BPH than those taking the placebo.

The study was funded by NIDDK, NCCAM, and ODS, all part of NIH. For more information, see the NCCAM Research Spotlight article about this study.

Americans suffering from the eye disease keratoconus could feel the benefits of a new treatment that is already proving a success in Europe and other parts of the world.

A new treatment, which involves vitamin B being applied to the cornea, is called collagen crosslinking and is undergoing clinical trials in the US.

The treatment improved the vision in almost 70 per cent of patients who took part in a three-year trial in Milan, Italy.

Results from this trial will be presented to the 115th Annual Meeting of the American Academy of Ophthalmology in Orlando, Florida, today (October 24th).

Dr. Paolo Vinciguerra will be presenting the findings, which found that patients over the age of 18 were most likely to find their eyesight improve after the treatment, which sees the vitamin being exposed to ultraviolet light.

This encourages collagen fibres to regenerate, increasing the strength and stiffness of the cornea, treating keratoconus and preventing it from returning at a later date.

Dr. Vinciguerra said: 'For many people with keratoconus, collagen crosslinking can provide a better and more permanent solution to their vision problems.'

Keratoconus is a degenerative disorder of the eye in which structural changes causes the cornea to thin and become more conical in shape.

Ann Rheum Dis. 2011 Sep;70(9):1534-41.

Doherty M, Hawkey C, Goulder M, et al.

OBJECTIVES: To compare the efficacy and safety of single versus combination non-prescription oral analgesics in community-derived people aged 40 years and older with chronic knee pain.

METHODS: A randomized, double-blind, four-arm, parallel-group, active controlled trial investigating short-term (day 10) and long-term (week 13) benefits and side-effects of four regimens, each taken three times a day: ibuprofen (400 mg); paracetamol (1000 mg); one fixed-dose combination tablet (ibuprofen 200 mg/paracetamol 500 mg); two fixed-dose combination tablets (ibuprofen 400 mg/paracetamol 1000 mg).

RESULTS: There were 892 participants (mean age 60.6, range 40-84 years); 63% had radiographic knee osteoarthritis and 85% fulfilled American College of Rheumatology criteria for osteoarthritis.

At day 10, two combination tablets were superior to paracetamol (p<0.01) for pain relief (determined by mean change from baseline in WOMAC pain; n=786).

At 13 weeks, significantly more participants taking one or two combination tablets rated their treatment as excellent/good compared with paracetamol (p=0.015, p=0.0002, respectively; n=615).

The frequency of adverse events was comparable between groups. However, by 13 weeks, decreases in haemoglobin (>/=1 g/dl) were observed in some participants in all groups. Twice as many participants taking two combination tablets had this decrease compared with those on monotherapy (p<0.001; paracetamol, 20.3%; ibuprofen, 19.6%; one or two combination tablets, 24.1%, 38.4%, respectively).

CONCLUSIONS: Ibuprofen/paracetamol combination analgesia, at non-prescription doses, confers modest short-term benefits for knee pain/osteoarthritis.

However, in this population, paracetamol 3 g/day may cause similar degrees of blood loss as ibuprofen 1200 mg/day, and the combination of the two appears to be additive.

Cambridge, MA - A study of Harvard alumni shows that obesity early in life does not portend a coronary disease death in people who reach a healthier weight by their mid-40s.

The National Institutes of Health-sponsored Harvard Alumni Health Study has followed nearly 19000 men who began regular medical examinations during their undergraduate years at Harvard University between 1916 and 1950. The median follow-up period was 56.4 years and the maximum was 82.5 years. The authors report their findings in the October 24, 2011 issue of the Archives of Internal Medicine.

Investigators Dr. Linsay Gray (Medical Research Council, Glasgow, Scotland) and colleagues found that Harvard men who were obese in early adulthood had twice the risk of dying from coronary disease as men with a normal body-mass index as young men (18.5 to 28 years). The association between obesity as young men and cardiovascular mortality later on held even after adjustment for confounding variables in early adulthood such as smoking and physical activity and after adjustment for midlife risk factors including type 2 diabetes and hypertension.

However, the link seen between early obesity (18.4 years) and later coronary disease death disappeared after taking into account midlife body-mass index (46.1 years), suggesting that men who were obese when they were young can reduce their risk by reaching a normal weight by middle age. The authors caution that their results should be replicated in more studies with a broader population.

Commenting on the study, Archives editor Dr. Rita Redberg (University of California, San Francisco) writes that this study "brings us some reason for hope that efforts to address childhood obesity are well worth it, [and] it is never too late to adopt healthy lifestyle changes."

Sources

• Gray L, Lee IM, Sess H, and Batty GD. Body weight in early and mid-adulthood in relation to subsequent coronary heart disease mortality: 80-year follow-up in the Harvard alumni study. Arch Intern Med 2011; 171:1768-1770.
• Redberg RF. Editor's note—Never too late to reduce obesity: Comment on "Body weight in early and mid-adulthood in relation to subsequent coronary heart disease mortality." Arch Intern Med 2011; 171:1770

Am J Gastroenterol. 2011 Sep;106(9):1697-704.

Lai SW, Muo CH, Liao KF, et al.

OBJECTIVES: The objective of this study was to assess the risk of acute pancreatitis among patients with type 2 diabetes mellitus (DM) and identify the roles of co-morbidities and anti-diabetic drugs.

METHODS: From claims data of one million enrollees randomly sampled from a population covered by the Taiwan National Health Insurance, 19,518 adults with type 2 DM diagnosed between 2000 and 2005 were identified.

In addition, 78,072 DM-free persons, frequency matched with sex, age, and index year for comparison were identified.

Subjects were followed up until the end of 2008 or censored to ascertain incident acute pancreatitis cases and associations with co-morbidities and anti-diabetic drugs.

RESULTS: Patients with type 2 DM had 1.95-fold greater incidence of acute pancreatitis compared with non-diabetics (27.7 vs. 14.2 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.89 (95% confidence interval (CI)=1.65-2.18) based on multivariable Cox regression analysis. Additive Poisson regression analysis revealed an absolute risk increase of 14.4 per 10,000 person-years (95% CI=13.4-15.5) among type 2 DM patients. Co-morbid alcoholism, hepatitis C infection, and gallstones yielded additional risk of acute pancreatitis among type 2 DM patients (absolute risk increase ranges 86.3, 41.1, and 23.5 per 10,000 person-years, respectively). Patients taking anti-diabetic drugs had a reduced risk of acute pancreatitis, however. The adjusted HR decreased to 0.31 (95% CI=0.18-0.56) among patients who took five different anti-diabetic drugs.

CONCLUSIONS: Patients with type 2 DM are at an elevated risk of acute pancreatitis. Alcoholism, hepatitis C infection, and gallstones increase the risk further. However, anti-diabetic drugs reduce the risk as the number of drugs used increases and as the duration of treatment increases

Vigo, Spain - Among patients with chronic kidney disease (CKD) and hypertension, taking at least one antihypertensive medication at bedtime significantly improves blood-pressure (BP) control, with an associated decrease in risk for cardiovascular events, according to new research.

Dr. Ramón C Hermida (University of Vigo, Spain) and colleagues published their study online October 24, 2011 in the Journal of the American Society of Nephrology.

According to the researchers, the beneficial effect of taking BP medication at night has been previously documented, but "the potential reduction in [cardiovascular-disease] risk associated with specifically reducing sleep-time BP is still a matter of debate."

The current prospective study sought to investigate in hypertensive patients with CKD whether bedtime treatment with hypertension medications better controls BP and reduces CVD risk compared with treatment on waking.

The study included 661 patients with CKD who were randomly assigned either to take all prescribed hypertension medications on awakening or to take at least one of them at bedtime. Ambulatory BP at 48 hours was measured at least once a year and/or at three months after any adjustment in treatment.

CV risk significantly reduced with bedtime dosing

The composite measure of cardiovascular events used included death, MI, angina pectoris, revascularization, heart failure, arterial occlusion of lower extremities, occlusion of the retinal artery, and stroke. The investigators controlled their results for sex, age, and diabetes

Patients were followed for a median of 5.4 years; during that time, patients who took at least one BP-lowering medication at bedtime had approximately one-third the CVD risk as those who took all medications on awakening (adjusted hazard ratio 0.31; p<0.001).

A similar significant reduction in risk with bedtime dosing was noted when the composite CVD outcome included only cardiovascular death, MI, and stroke (adjusted HR 0.28; p<0.001).

Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping, and a greater proportion of these patients had ambulatory BP control (56% vs 45%; p=0.003).

The researchers estimate that for each 5-mm-Hg decrease in mean sleep-time systolic BP, there was a 14% reduction in the risk for cardiovascular events during follow-up (p<0.001).

According to Hermida and colleagues, "Treatment at bedtime is the most cost-effective and simplest strategy of successfully achieving the therapeutic goals of adequate asleep BP reduction and preserving or reestablishing the normal 24-hour BP-dipping pattern."

The authors suggest that a potential explanation for the benefit of nighttime treatment may be associated with the effect of nighttime treatment on urinary albumin excretion levels. "We previously demonstrated that urinary albumin excretion was significantly reduced after bedtime, but not morning, treatment with valsartan," they note. In addition, this reduction was independent of 24-hour changes of BP but correlated with a decline in BP during sleep.

The authors and editorialists have disclosed no relevant financial relationships.

A blood test could soon be used to determine if a smoker is at risk of developing heart disease or not.

That is according to researchers at UT Southwestern Medical Centre, whose study is available in Arteriosclerosis, Thrombosis, and Vascular Biology.

Dr. Anand Rohatgi, assistant professor of internal medicine at UT Southwestern and co-lead author of the study, said: 'We now are close to having a blood test to help measure the smoking-related effects that contribute to atherosclerotic heart disease.

'Smoking is one of the biggest contributors to the development of heart disease.'

The blood test works by measuring the levels of a lung protein (circulating pulmonary surfactant B) in the blood of smokers, which can indicate a build-up of dangerous plaque in the blood vessels.

It is based on a Dallas survey of 3,200 smokers aged between 30 and 65, which found that those with high levels of the protein in their blood had a more dangerous build-up of plaque in the aorta - the largest artery in the body.

Blockages in the aorta could lead to heart disease, heart attacks and strokes, of which smokers are at an increased risk.

In the UK, around ten million adults smoke cigarettes, although this could be an underestimate of around 2.8 per cent according to Cancer Research UK.

Men with high or moderate levels of stress over a number of years have a 50 per cent higher mortality rate than those who do not.

A study from Oregon University published in the Journal of Aging Research on October 20th came to this conclusion and found that people who reported good health tended to live longer than those who did not.

Married men and moderate drinkers also lived longer than single men and non-drinkers.

There are other ways in which men can reduce their stress levels and lead a healthier live, such as through regular exercise.

Anne McCracken, chair of the International Stress Management Association UK, said: 'Keeping active and regularly exercising helps to keep the body’s emotional chemicals in balance.

'This means we think, behave and react more appropriately to the situation we find ourselves in; this in turn increases the resources we have to deal with situations we perceive as difficult or challenging.'

She also advised those who want to reduce their stress levels to follow a healthy diet comprising rice and pasta as well as fruit and vegetables.

Men who enjoy a healthy diet high in fruit and vegetables are less likely to be infertile, according to new research.

New studies from Harvard University and the University of Murcia have revealed that poor nutrition can have a negative effect on sperm movement.

Male volunteers who stuck to a healthy diet were found to have higher sperm movement while the sperm of men on poor diets was found to be less mobile.

Audrey Gaskins of Harvard School of Public Health's department of nutrition and lead author of the study, said: 'The main overall finding of our work is that a healthy diet seems to be beneficial for semen quality.'

'Specifically, a healthy diet composed of a higher intake of fish, fresh fruit, whole grains, legumes and vegetables seems to improve sperm motility... which means a higher number of sperm actually move around, rather than sit still.'

A second study led by Dr. Jorge Chavarro of the Harvard School of Public Health showed those who enjoyed a diet rich in trans fat[s] had lower sperm concentration levels.

The findings of the reports were presented at the Annual Meeting of the American Society for Reproductive Medicine. ADNFCR-554-ID-800763439-ADNFCR

October 19, 2011 — A vaccine candidate being studied in phase 3 clinical trials in 7 African countries has prevented half of the potential malaria cases among 1 group of the study population, researchers from the RTS,S Clinical Trials Partnership report in an article published online October 18 in the New England Journal of Medicine.

In an accompanying editorial, Nicholas J. White, FRS, professor of tropical medicine at Mahidol University, Bangkok, Thailand, writes: "[I]ndeed we are still not there yet, but it is becoming increasingly clear that we really do have the first effective vaccine against a parasitic disease in humans." He also writes that this particular vaccine candidate is closer than other candidates to registration, and approvable by the World Health Organization in 2015 is possible.

The report by the RTS,S Clinical Trials Partnership covers the results of a study involving 15,460 children in 2 age groups (6 - 12 weeks and 5 - 17 months). The goal of the study was to analyze vaccine efficacy against clinical malaria in the first 6000 (of 8923) children in the older category 1 year after vaccination, and among the children in that group who received all 3 doses of vaccine. The efficacy of the vaccine iin the first 250 children from both age groups who contract severe malaria was also evaluated. Further data from the ongoing trial are expected to be published in 2014.

Fourteen months after vaccine administration to the 6000 older children, the incidence of first-time malaria was 0.32 episode per person-year in the RTS,S/AS01 group and 0.55 episode per person-year in the control group; this translates to an efficacy of 50.4% (95% confidence interval [CI], 45.8% - 54.6%) in the intention-to-treat group.

The vaccine candidate, RTS,S/AS01, is a hybrid combining the hepatitis B antigen with part of the protein called sporozoite, the infective form of the malaria parasite. In earlier studies, RTS,S/AS01 showed consistent protection against Plasmodium falciparum, the most serious form of malaria, and showed a 45.1% (CI, 23.8% - 60.5%) improvement in the intention-to-treat population in the current results.

However, the results also showed that the level of protection from the vaccine was lower after the first year than immediately after vaccination. The authors write that studies have shown different results for protection levels, with some positive and some negative, and that this calls for further investigation.

According to the US Centers for Disease Control and Prevention (CDC), which also issued a positive statement yesterday about the study results, malaria killed almost 800,000 people in 2009, 90% of whom were African children. As a result of wide-ranging efforts going on now in many countries, deaths of children younger than age 5 years have decreased up to 50%, according to a CDC report published in April of this year.

In its statement, the CDC said it is part of a group working toward zero preventable deaths from malaria. "These promising vaccine trial results add to the hope that adding an effective vaccine to current malaria interventions will move us closer to that goal."

The trial is supported by GlaxoSmithKline Biologicals and the Program for Appropriate Technology for Health Malaria Vaccine Inititiative, which received support from the Bill & Melinda Gates Foundation. Disclosure forms provided by the authors are available with the full texts of this article and editorial at www.NEJM.org.

N Engl J Med. Published online October 18, 2011. Full text, Editorial
Medscape Medical News © 2011 WebMD,
LLC Send comments and news tips to news@medscape.net.

October 21, 2011 (London, United Kingdom) - The European Medicines Agency (EMA) has launched a new review of the cardiovascular safety of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), while also clarifying a previous opinion on the use of the antidiabetic agent pioglitazone (Actos, Takeda) and the risk of bladder of cancer.

In 2011, the EMA recommended that new contraindications and warnings be added to the label of pioglitazone, noting there was a small increased risk of bladder cancer with the diabetes drug. Today, the agency confirmed their previous opinion, with the earlier warnings and contraindications remaining in place, but provided some clarification on its use. The EMA stated that pioglitazone should be used as a second- or third-line treatment, noting it "remains a valid treatment option for certain patients with type 2 diabetes, when certain other treatments (metformin) have not been suitable or have failed to work adequately."

Based on the earlier recommendations, the EMA continues to recommend against the use of pioglitazone in patients with current or a history of bladder cancer, or those with uninvestigated macroscopic hematuria. Before use in any patient, physicians should take into account risk factors for bladder cancer, especially in older patients, according to the EMA.

In June 2011, the US Food and Drug Administration informed physicians that using pioglitazone for more than 12 months was associated with an increased risk of bladder cancer, and revised the drug's label to highlight the risks. French regulators suspended sales of pioglitazone, also in June 2011, while German health authorities said it should not be started in new patients.

NSAIDs Also Under Review

In a separate statement, the EMA also said that it has begun a new review of the latest data on the cardiovascular safety of nonselective NSAIDs. In 2006, the EMA's Committee for Medicinal Products for Human Use (CHMP) concluded the drugs were safe for use, with a positive overall risk–benefit profile, but was unable to rule out a small risk of thrombotic events, especially when used at high doses or for long durations.

Since 2006, new studies on the cardiovascular safety of NSAIDs have been published, including data from the Safety of Nonsteroidal Anti-inflammatory Drugs (SOS) project, led by investigators from Erasmus University in Rotterdam, Germany, the EMA notes. CHMP is currently reviewing data from SOS, as well from other clinical trials, epidemiological studies, and postmarketing reports, to determine if there is a need to update their 2006 opinion on the safety of NSAIDs.

References

• EMA. European Medicines Agency starts new review of cardiovascular risk of nonselective NSAIDs [press release]. October 21, 2011.
• EMA. European Medicines Agency clarifies opinion on pioglitazone and the risk of bladder cancer [press release]. October 21, 2011.

October 20, 2011 (London, United Kingdom) - In a decision mirroring that of the US FDA in June, the European Medicines Agency (EMA) released the results of a review by its Committee for Medicinal Products for Human Use (CHMP) today, concluding that there is likely no increased risk of cancer associated with use of angiotensin-receptor blockers (ARBs).

"The European Medicines Agency concludes that benefit/risk balance of angiotensin-II–receptor antagonists remains positive," a press release from the EMA states today.

The EMA's review was prompted by a controversial 2010 meta-analysis, reported by heartwire , pointing to a 7.2% increased risk of new cancers--lung cancer in particular--as compared with a 6% increased risk in patients taking placebo or other heart drugs.

"The CHMP reviewed all available data on the risk of cancer in patients taking ARBs, including the meta-analysis," the statement reads. "It found that the evidence from the meta-analysis was weak, noting several problems with the quality of the data, specifically that patients in the trials were not followed up for long enough to clearly establish a link between ARBs and cancer, information on the risk of cancer before start of treatment was lacking, and there was a possibility of publication bias, whereby studies that showed a link with cancer were more likely to have been included in the analysis."

As chronicled by heartwire over the past year, researchers have published a raft of studies and analyses either supporting or rejecting a link between ARBs and cancer, the most recent in the October 4, 2011 issue of CMAJ, by Dr Chan Yoon (Seoul National University of Medicine, South Korea) and colleagues, actually pointing to a beneficial effect of ARBs and ACE inhibitors on the risk of cancer [2]. Another recent study, however, in diabetic patients treated with ARBs, suggested that candesartan (Atacand, AstraZeneca) was associated with a significant risk of cancer, while there was a trend toward an increased risk with telmisartan (Micardis, Boehringer Ingelheim).

Commenting on the announcement, Dr. Ilke Sipahi (University Hospitals Case Medical Center, Cleveland, OH), whose 2010 meta-analysis first brought this issue into the spotlight, told heartwire that he believes both the EMA and FDA "fumbled the ball."

Both agencies, he notes, had the opportunity to request patient-level data from the companies and to conduct analyses that took into account drug dose, patient compliance, and duration of exposure--but neither did.

"So I am very disappointed. The EMA had a total of 16 months to do this review. . . . Unfortunately, all they could do in 16 months was review the publications that came after my own. And even that review is incomplete, since there have been several studies that have come out since then supporting our findings."

Repeating the criticism he had of the FDA's decision back in June, Sipahi observed that cancer biologists and epidemiologists trying to determine the cancer risk of something like smoking or an environmental toxin will pay "extreme attention" to intensity and duration of exposure. "So it's really surprising that neither of the agencies did that," he said.

References

• European Medicines Agency. European Medicines Agency concludes that benefit-risk balance of angiotensin II receptor antagonists remains positive [press release]. October 20, 2011.
• Yoon C, Yang HS, Jeon I, et al. Use of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers and cancer risk: a meta-analysis of observational studies. CMAJ 2011; 183:E1073-84.

October 21, 2011 (Vancouver, British Columbia) - Exercise is an effective, but potentially underused, treatment option for mental illness, experts say.

In a symposium presented here at the Canadian Psychiatric Association (CPA) 61st Annual Conference, Christopher Willer, MD, a senior psychiatry resident at the University of Toronto, Ontario, Canada, made the case for exercise as an adjunctive therapy.

Emerging research, he said, strongly suggests that exercise can improve patients' physical and mental health and may help offset some of the metabolic effects associated with older antidepressants and newer atypical antipsychotics.

Dr. Christopher Willer

"It's not too soon to talk to patients about exercise as another treatment option, especially if they are asking about it or if they have a history of sport being important in their lives.

"There's often a time lag between the time research comes out and when treatment guidelines are published. Based on the quality of the research that has been published [on exercise and mental illness] in the last 5 years, I think it would be irresponsible to wait," Dr. Willer told Medscape Medical News.

In his presentation, Dr. Willer reviewed the existing literature for aerobic exercise as a treatment for mental illness, some of which suggests it can be as effective as pharmacotherapy and/or talk therapies.

However, potential mental health benefits aside, Dr. Willer noted that the physical benefits of exercise are clear and include reducing cardiovascular risk factors that are often associated with mental illness and the medications used to treat psychiatric disorders.

"Exercise mitigates certain illnesses; it protects against obesity, which certainly is a big problem with much of our patient population; and it has been shown to help with cognition and affective problems in well people.

"As psychiatrists, we have to remember that we're not just concerned with our patients' psychiatric symptoms but also their physical health. It is important that we promote an active lifestyle to our clients as part and parcel of good psychiatric treatment," he said.

Antianxiety Properties

Early research examining exercise and depressive symptoms has been relatively simple, relying on case reports or short-term intervention studies. However, said Dr. Willer, in the past 5 years it has become more sophisticated.

"We've come a long way, and now there are randomized trials that are attempting to compare exercise to a sham version of exercise that include larger numbers of patients, so the studies are higher quality," he said.

Most of the evidence to date supports the use of aerobic exercise in unipolar depression, he added.

However, a Cochrane review published in 2010 and reported by Medscape Medical News at that time showed that regular physical exercise in individuals with schizophrenia and schizophrenia-like illnesses is feasible and may help improve the mental and physical well-being of these patients.

Nevertheless, although the overall results were positive, the review included only 3 small studies, prompting the authors to point out that larger randomized trials are needed "before any definitive conclusions can be drawn."

Dr. Willer also noted that physical activity has been shown to have antianxiolytic properties.

In patients with anxiety, sometimes there is a concern that the somatic expression of exercise — elevated heart rate, sweating, and heavy breathing — may invoke a panic response, but the literature does not bear this out, said Dr. Willer.

"There are studies that suggest that in the moment, anxiety can be moderated by physical activity, and there are also studies showing 20 minutes of exercise a day for 10 weeks can modify on trait anxiety," he added.

Worthwhile Endeavor

Dr. Willer pointed out that only about 30% of North Americans get the recommended amount of 150 minutes of exercise per week, and that the therapeutic dose for the treatment of mental illness is unclear. However, he noted, as the research becomes more refined, this will be elucidated.

In the meantime, he said, encouraging psychiatric patients to become more physically active is a worthwhile endeavor.

"It is not expensive, and it can be independent of the healthcare system. It doesn't require [the psychiatrist] to be involved, other than to mentor patients and to check in with them," he said.

Dr. Saul Marks

Asked by Medscape Medical News to comment on Dr. Willer's presentation and assertion that psychiatrists should consider exercise as a viable treatment option, Saul Marks, MD, a practicing sports psychiatrist at North York General Hospital in Toronto, said it is a routine part of his practice.

"Exercise confers a definite benefit. I have a patient myself who was able to come off antidepressant medication by taking up running, and she is doing extremely well now. There is a growing body of literature that psychiatric patients are at particular risk of metabolic syndrome, especially if they are taking atypical antipsychotics, suggesting psychiatrists need to promote exercise as a treatment," said Dr. Marks.

Dr. Marks added that he routinely talks to his patients about the importance of being physically active every day.

"Even if they do something as simple as walking for 45 minutes a day, that will keep them physically fit and also help their mental health," he said.

Dr. Willer and Dr. Marks have disclosed no relevant financial relationships.

Canadian Psychiatric Association (CPA) 61st Annual Conference: Abstract S11b Presented October 13, 2011.

Medscape Medical News © 2011 WebMD, LLC Send comments and news tips to news@medscape.net.

By making a number of simple lifestyle changes, people can add more than ten years onto the average lifespan, a new study has suggested.

Cardiologist Dr. Clyde Yancy has claimed that seven lifestyle factors produce a 90 per cent chance that somebody will live to the age of 90 or above.

He highlighted the importance of being physically active, following a healthy diet and maintaining a healthy weight to prolonged life.

In addition, subjects who know and control their cholesterol levels and their blood pressure can also substantially reduce the risk that they will suffer heart attacks or heart disease.

Finally, by managing diabetes and giving up smoking people can substantially reduce the risk of stroke and increase their life expectancy.

Dr. Yancy said: "It demonstrates the striking potential that prevention has if it is broadly embraced. We know how to prevent heart disease and stroke – we now need to build the tools to empower our citizens to manage their risk."

Recent research by Harvard University also found that following a healthy diet rich in fruit and vegetables can benefit men looking to boost their fertility, as this is connected with improved sperm movement rates. ADNFCR-554-ID-800771831-ADNFCR

A new study has found that many women are not getting enough vitamin D during the menopause, with potential health repercussions.

Research published in Gynecological Endocrinology has warned that the importance of a healthy diet is often overlooked during this period of a woman's life.

Marina Pollan, co-author and researcher at the Carlos III Institute of Health, has highlighted the fact that extra care must be taken to obtain enough of this vitamin.

She said: "Biological and physiological changes in women caused by the menopause come with a greater risk of developing health problems in which diet plays an important role. These include diabetes, osteoporosis, cardiovascular disease and certain types of cancer."

Among the test group of 3,574 women, researchers found that – on average – none of the subject groups received 50 per cent.

Recent research published in BJOG: An International Journal of Obstetrics and Gynaecology has found that many women continue to suffer from hot flushes and night sweats for years after the menopause. ADNFCR-554-ID-800771830-ADNFCR

Women who have radiotherapy after surgery for breast cancer are half as likely to develop the disease again, according to new research.

Researchers from Oxford University assessed data from more than 10,000 women who have had breast-conserving surgery (lumpectomy) for breast cancer over a ten-year period.

Published in The Lancet, the study finds that 35 per cent of women who had not received radiotherapy had suffered a recurrence of the disease within ten years of the initial diagnosis.

However, just 19 per cent of women who had undergone radiotherapy had their breast cancer come back at some point over the trial period.

Lead researcher Professor Sarah Darby said: 'Some people have been wondering whether radiotherapy is really necessary for all women after breast conserving surgery.

'Our results identify several groups of women for whom radiotherapy is a major life saver.'

The study was funded by the Early Breast Cancer Trialists' Collaborative Group, the British Heart Foundation and the Medical Research Council

A new study has linked the quantity of alcohol that is consumed with the likelihood that a patient will die from cancer.

Research published by the National Institutes of Health took into account deaths from lung, colorectal, prostate and breast cancers.

It found that light to moderate alcohol intake did not increase the risk of all-site cancers or site-specific cancers in the above areas.

Those who consumed three or more drinks per drinking day experienced an increase in all-site cancer mortality of 22 per cent, with lung cancer risk rising for the heaviest drinkers.

Women are also more likely to experience a heightened risk of cancer than men who drink similar quantities, although both genders experience increased mortality risk with more frequent drinking.

Underweight women are less likely to conceive than those who are obese, a new study has found.

Dr. Richard Sherbahn, of the Advanced Fertility Centre of Chicago, analysed around 2,500 cases over an eight-year period where women of varying weights underwent IVF treatment.

The women were separated into three groups - very thin, normal and obese - with the results showing that 50 per cent of those in the normal weight group gave birth to a healthy baby.

However, the findings for the other two groups are most surprising with 45 per cent of those in the obese group going on to have children, while just 34 per cent of those classed as very thin did so.

Dr. Sherbahn said: 'It could be in evolutionary terms that if people were too thin that maybe food wasn't readily available and maybe it wasn't the best time to reproduce and maybe the uterus wasn't at its best.'

The findings were presented at the American Society for Reproductive Medicine's annual conference.

People from lower socioeconomic backgrounds tend to be more pessimistic about the benefits of diagnosing cancer at an early stage than more affluent members of society, a study has found.

Researchers at University College London (UCL) interviewed more than 2,000 British adults to shed light on their attitudes towards early detection and the benefits of seeing a doctor about worrying symptoms.

They found that most people were correct in thinking that half of those diagnosed with cancer are still alive five years later.

However, people from the poorest sections of society were less likely to believe that cancer could be cured.

Study author Dr. Rebecca Beeken, whose findings are published in the journal Cancer Epidemiology, Biomarkers & Prevention, said: 'This study shows that people with lower socioeconomic status may think it is less worthwhile to detect cancer early because they are more fatalistic about the outcome.'

She added that these differences in perception could lead to inequalities in survival.

Sara Hiom, director of health information at Cancer Research UK, which funded the study, said that cancer survival in the UK has doubled over the last 40 years.

But she emphasised that inequalities need to be reduced if the UK's survival rates are to compare favourably with the best-performing countries in the world.

More than one in three people in the UK will develop cancer during their lifetime, according to Cancer Research UK.

October 10, 2011 - In women aged 55 to 69 years, several widely used dietary vitamin and mineral supplements, especially supplemental iron, may be associated with increased risk for death, according to new findings from the Iowa Women's Health Study.

Although many vitamin supplements did not appear to be associated with a higher risk for total mortality, several were, including multivitamins, vitamins B6, and folic acid, as well as minerals iron, magnesium, zinc, and copper.

Jaakko Mursu, PhD, from the Department of Health Sciences, Institute of Public Health and Clinical Nutrition at the University of Eastern Finland in Kuopio, Finland, and colleagues reported their findings in the October 10 issue of the Archives of Internal Medicine.

"Supplements are widely used, and further studies regarding their health effects are needed," Dr. Mursu and colleagues write. "Also, little is known about the long-term effects of multivitamin use and less commonly used supplements, such as iron and other minerals."

The current study sought to evaluate the link between supplement use and total mortality rate, using data from the Iowa Women's Health Study. A total of 38,772 older women were included in the analysis. Women were aged between 55 to 69 years, with an average of 61.6 years at the beginning of the study in 1986. Self-reported data on vitamin supplement use were collected in 1986, 1997, and 2004.

A total of 15,594 deaths were reported through December 31, 2008, representing about 40% of the initial participants. The use of multivitamins overall was associated with 2.4% increased absolute risk for death (hazard ratio, 1.06; 95% confidence interval, 1.02 - 1.10). Self-reported use of dietary supplements increased substantially between 1986 and 2004. In addition, supplement users had a higher educational level, were more physically active, and were more likely to use estrogen replacement therapy.

Vitamin B₆, folic acid, iron, magnesium, and zinc were associated with about a 3% to 6% increased risk for death, whereas copper was associated with an 18.0% increased risk for total mortality when compared with corresponding nonuse.

In contrast, use of calcium was inversely related to risk for death (hazard ratio, 0.91; 95% confidence interval, 0.88 - 0.94; absolute risk reduction, 3.8%).

The researchers assessed the findings for iron and calcium in more detailed analyses conducted during shorter periods (10-year, 6-year, and 4-year follow-up) and found results similar to those for the analyses conducted during the entire time.

"In agreement with our hypothesis, most of the supplements studied were not associated with a reduced total mortality rate in older women," Dr. Mursu and colleagues conclude. "In contrast, we found that several commonly used dietary vitamin and mineral supplements, including multivitamins, vitamins B6, and folic acid, as well as minerals iron, magnesium, zinc, and copper, were associated with a higher risk of total mortality."

"Although we cannot rule out benefits of supplements, such as improved quality of life, our study raises a concern regarding their long-term safety," the authors add.

In a related editorial, Goran Bjelakovic, MD, DMSc, and Christian Gluud, MD, DMSc, from the Centre for Clinical Intervention Research, Cochrane Hepato-Biliary Group, Rigshospitalet, Copenhagen University Hospital, Denmark, note that the current study adds "to the growing evidence demonstrating that certain antioxidant supplements, such as vitamin E, vitamin A, and beta-carotene, can be harmful."

"We cannot recommend the use of vitamin and mineral supplements as a preventive measure, at least not in a well-nourished population," they add. "Those supplements do not replace or add to the benefits of eating fruits and vegetables and may cause unwanted health consequences."

This study was partially supported by the National Cancer Institute and the Academy of Finland, the Finnish Cultural Foundation, and the Fulbright program's Research Grant for a Junior Scholar. One study author is an unpaid member of the Scientific Advisory Board of the California Walnut Commission. The other authors and editorialists have disclosed no relevant financial relationships.

New York, NY - About half the experts serving on the committees that wrote national clinical guidelines for diabetes and hyperlipidemia over the past decade had potential financial conflicts of interest (COI), and about 4% had conflicts that were not disclosed.

Dr. Jennifer Neuman (Mount Sinai School of Medicine, New York, NY) and colleagues reviewed the financial ties to industry of 288 panel members who served on 14 guidelines committees in the US and Canada between 2000 and 2010. Results of their study were published online October 11, 2011 in BMJ.

Five of the guidelines did not include a declaration of the panel members' conflicts of interest, but 138 of the 288 panel members (48%) reported conflicts of interest at the time of the publication of the guideline. Eight reported more than one conflict. Of those who declared conflicts, 93% reported receiving honoraria, speaker's fees, and/or other kinds of payments or stock ownership from drug manufacturers with an interest in diabetes or hyperlipidemia, and 7% reported receiving only research funding. Six panelists who declared conflicts were chairs of their committee.

Of the 73 panelists who had a chance to declare a conflict of interest but declared none, eight had undeclared COI that the researchers identified by searching other sources. Among the 77 panel members who did not have an opportunity to publicly declare COI in the guidelines documents, four were found to have COI.

The study also found that panelists on government-sponsored guidelines committees—such as those organized by the Veterans Administration or the US Preventive Services Task Force—were less likely to have conflicts of interest than panelists on nongovernment guidelines panels (15/92 [16%] vs 135/196 [69%]; p <0.001). However, the researchers point out that the government-sponsored guidelines committees were less likely to have rigorous COI transparency policies.

A recent study of COI among members of American College of Cardiology/American Heart Association-sponsored guidelines found that about half of guidelines committee members reported potential conflicts of interest. Neuman et al point out that their study includes a wider range of guideline-producing organizations and that it "exposes the problem of incomplete disclosure and highlights the important relation between sponsorship of guidelines and presence of COI."

"In contrast to government-sponsored panels, we found that COI were very common among panel members for guidelines produced by specialty societies," Neumann et al write. Neumann cites a 2000 study by Dr Roberto Grilli (Istituto di Ricerche Farmacologiche, Milan, Italy) as evidence that "guidelines produced by nongovernment-sponsored organizations have been shown to be of poor methodological quality; however, they contribute substantially to the guideline pool in the United States and Canada . . . [and] may have broad international influence. The high prevalence of COI among panel members of guidelines sponsored by specialty societies combined with the less rigorous development process may adversely affect the independence and the evidence base of the recommendations issued."

In an accompanying editorial, Dr. Edwin Gale (Southmead Hospital, Bristol, UK) observes that the proportion of guideline committee members declaring a conflict of interest has increased recently, but the proportion of members with a potential conflict has not decreased.

The common suggestion that that guideline committees should include only experts with no conflicts of interest has "a charming sense of unreality," Gale argues. "Money from drug companies is the oxygen on which the academic medical world depends. The income of the professional societies that publish guidelines largely derives from their annual conferences, which depend on the rents charged to exhibitors and the registration of company-sponsored delegates," he observes. "Let us therefore forget the hand-wringing and confront the reality of the world in which we live.

Gale believes the conflicts on committees cannot be eliminated unless fewer experts take money from industry. "Legislation will not change the situation, for the smart money is always one step ahead. What is needed is a change of culture in which serving two masters becomes as socially unacceptable as smoking a cigarette. Until then, the drug industry will continue to model its behavior on that of its consumers, and we will continue to get the drug industry we deserve."

A worrying number of contact lens wearers fail to take care of their lenses properly, new research suggests.

A poll of 2,000 adult contact lens wearers, conducted on behalf of Biotrue multi-purpose contact lens solution, found that 20 per cent have used something other than lens solution to clean their lenses.

Many admitted using spit or saliva - which could be highly dangerous, considering there are between 500 and 1,000 different types of bacteria in the average person;s mouth.

Sixteen per cent of respondents said they had used water to clean their contact lenses, which could put them at risk of developing a corneal infection called Acanthamoeba keratitis.

Other ill-advised alternatives to contact lens solution included baby oil, lemonade and beer.

Nick Dash, an optometrist at Visual Edge Optometrists, said: 'Although the numbers for the more extreme examples such as beer and baby oil were low, it is most concerning to see the risks people are willing to take when it comes to their eye health.'

The expert noted that alcohol can cause serious, lasting damage to the cornea, while baby oil can irritate the eye and cause blurred vision.

Around three million people in Britain wear contact lenses, according to the Association of Contact Lens Manufacturers. ADNFCR-554-ID-800758987-ADNFCR

October 11, 2011 (Orlando, Florida) — An analysis of cost data from several major national databases confirms that the cost of managing the cardiovascular risks associated with obesity increase with the severity of the obesity.

Dr. Diana Brixner (University of Utah, Salt Lake City) and colleagues presented the results of their analysis of GE's electronic medical records database, the National Health and Nutrition Examination Survey, and the Thomson Reuters Marketscan database at Obesity 2011.

The analysis found that the cardiovascular risk factors of patients with a BMI over 35 cost healthcare payers an average of about $3600. Patients with a BMI between 30 and 35 cost about $2700, patients with a BMI between 27 and 30 cost about $2000, and patients with a BMI between 25 and 27 cost about $1700.

"We wanted to look at the impact that obesity itself has on the cost and risk of both cardiovascular risk factors and events," coauthor Dr. Brandon Bellows (University of Utah) told heartwire. "We generally assume that obesity is associated with higher risk factors and more events and costs more, but we didn't really have the data or the numbers to support that."

The researchers stratified all the patients in the databases by four BMI groups, gender, and number of cardiovascular risk factors-including hypertension, diabetes, and hyperlipidemia-and by the specific risk-factor combinations. They analyzed how the prevalence of different cardiovascular adverse events correlated to different combinations of risk factors and then tracked the costs associated with those events and risk factors. If the patient had no adverse events, the analysis assumed the cost was whatever was associated with managing their particular risk factors.

Not surprisingly, the prevalence of cardiovascular events increased with the number of risk factors, ranging from 0.1% in obese patients with no other risk factors to 10.2% in those with multiple risk factors. The analysis showed a similar trend of increased cost, but lower costs overall, when the cost of patients with risk factors but no events was assumed to be $0, suggesting that both the cost of managing the risk factors and the cost of treating the adverse events contribute to the increased costs of managing obesity.

"This is from the perspective of healthcare payers . . . patients with higher BMI cost them more, but what we didn't show yet was that if patients decrease their BMI, then that decreases cost," Bellows said. The next step in this research will be to determine whether annual costs decrease in patients who lose weight from one year to the next. "That would incentivize insurance companies to promote weight-loss programs or use drug treatments to treat patients who are overweight."

Bellows' group also plans to study the link between costs and obesity severity in specific patient populations and to also study the costs associated with noncardiovascular problems associated with obesity, such as back pain.

This study was sponsored by Takeda Pharmaceuticals.

Brixner D, Bron M, Bellows B, et al. Evaluation of cardiovascular risk factors, events, and costs across four BMI categories. Obesity 2011; October 1-5; Orlando FL. Abstract 830-P.

The Department of Health has outlined new plans aimed at tackling the nation's high levels of obesity.

Figures show that over three-fifths of adults and a third of ten and 11-year-olds in England are overweight or obese, giving the nation one of the highest rates of obesity in Europe.

Ministers and health experts want the number of overweight and obese people to begin to fall by 2020 and hope to slash five billion calories off the nation's daily diet to achieve this.

Health secretary Andrew Lansley said that businesses, government and non-governmental organisations should work together to support people to make healthier choices.

England's chief medical officer, Professor Dame Sally Davies, said: 'Obesity is a leading cause of serious diseases such as type-2 diabetes, heart disease and cancer.

'We must get to grips with the problem now to save lives and money in the future.'

Professor Davies claimed that most people eat or drink too much and do too little exercise.

She claimed that reducing the amount of calories people consume will be 'key' to tackling obesity.

The British Heart Foundation welcomed the call for businesses to play a greater role, but emphasised that cutting calories is not the only solution.

Dr. Mike Knapton, the charity's associate medical director, said: 'There are other things to consider too, like reducing saturated fat.

industry wants to be part of the solution then they should make sure we all have the information we need to make healthy choices, so colour-coded front-of-pack labelling must show calories but also saturated fat, salt and sugar

People with fatty deposits around their eyes should visit their GP to have their cholesterol checked, a national charity has advised.

Heart UK said that the deposits may be a sign of raised cholesterol, which increases a person's chances of having a heart attack.

The charity is concerned by recent reports of people resorting to cosmetic surgery to deal with the deposits, instead of having their cardiovascular health checked.

Dr. Nigel Capps, chairman of the charity's Medical and Scientific Research Committee, said: 'Patients with fatty deposits around their eyes may be at higher risk of heart attacks and should have their cholesterol checked and risk of vascular disease assessed.

'Raised cholesterol, a risk factor for coronary heart disease, is the problem and can be dangerous if not diagnosed and treated.'

Dr. Capps also pointed out that unless the underlying cholesterol problem is addressed, any deposits that are removed by cosmetic surgery are likely to recur.

Last month (September), Danish scientists published an article in the British Medical Journal reporting that fatty deposits around the lower or upper eyelids could indicate an increased risk of developing heart disease or having a heart attack.

A new study has shed light on the heavy burden of ill health experienced by many people who survive cancer.

Researchers at Queen's University Belfast and Macmillan Cancer Support found that 45 per cent of cancer survivors in Northern Ireland had physical and mental health problems years after finishing their treatment.

These included nerve damage, extreme tiredness, memory problems and depression.

Two-fifths of survivors also said they had unmet health and social care needs.

Dr. Olinda Santin, from Queen's University Belfast, said: 'While the majority of cancer survivors make a good recovery from their cancer, there are a number of patients and their carers who may require additional support.'

The expert claimed that further research is needed to identify cancer survivors who are affected by poor health and who experience late effects of their treatment so that they can receive the necessary support.

Heather Monteverde, general manager of Macmillan Cancer Support in Northern Ireland, noted that the number of people living with cancer is increasing every year.

'So it is essential changes are made now to avoid serious problems in the future,' she added.

Survival rates for nearly all of the most common cancers have improved in recent years, according to Cancer Research UK.

Stem cells obtained from human umbilical cord blood could be used to repair heart muscle that has been damaged during a heart attack, new research suggests.

Many heart attack survivors require ongoing care if large areas of their heart muscle have been damaged.

Scientists are therefore keen to find new ways to repair the damage and improve patients' life expectancy.

Researchers at the University of Bristol's School of Clinical Sciences have now found that it is possible to grow cardiac muscle cells from cord blood-derived stem cells, expanding their number up to seven-fold.

These cells could then be re-introduced into the patient to repair their damaged heart muscle.

Lead researcher Professor Raimondo Ascione, chair of cardiac surgery & translational research, said: 'We believe our study represents a significant advancement and overcomes the technical hurdle of deriving cardiac muscle-type cells from human cord blood.

'Our research suggests that in the future, stem cells derived from cord blood bank facilities might be used for repair after a heart attack.'

The study is published in the journal Stem Cell Reviews & Reports and was part-funded by the British Heart Foundation, whose associate medical director Professor Jeremy Pearson described research into regenerative medicine as 'absolutely crucial'.

He said the latest results were encouraging, but that much more research is needed to determine whether the cells can be used to repair patients' heart muscle. ADNFCR-554-ID-800758974-ADNFCR

Many people do not know whether cancer is a preventable disease, according to a new survey by the British Dental Health Foundation.

Researchers questioned people about ten cancers and found that only 41 per cent thought lung cancer was largely preventable, despite its clear association with smoking.

Another form of cancer that is closely linked to smoking is mouth cancer, yet just 32 per cent of respondents thought the disease was avoidable.

Experts are concerned that Britons' poor awareness of the links between lifestyle factors and certain forms of cancer could discourage many people from leading healthier lifestyles and reducing their risk.

In fact, the World Health Organisation says that more than 30 per cent of cancers could be prevented by modifying or avoiding risk factors such as smoking, dietary components including red meat, alcohol and sun exposure.

Dr. Nigel Carter, chief executive of the British Dental Health Foundation, which conducted the survey ahead of Mouth Cancer Action Month in November, said: 'There is enough evidence to suggest that many cancers are largely preventable, although it is clear that public perception indicates a confused picture and understanding.'

The expert claimed that all cancer charities and health organisations should strengthen their campaigns on risk factors and prevention.

Smoking causes nine out of ten cases of lung cancer, while about three-quarters of cases of mouth cancer are thought to be caused by smoking or excess alcohol consumption, according to Cancer Research UK.

People with inflammatory forms of arthritis, such as rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis, often feel the disease interferes with their quality of life, a new survey has found.

Researchers at healthcare company Abbott surveyed 3,000 Canadians, all of whom were living with inflammatory arthritis. One in three participants had been living with their disease for at least two decades and 48 per cent said they were unable to work full-time.

Three-quarters (73 per cent) felt their illness affected their day-to-day activities and 42 per cent said it interfered with their recreational time.

Sixty-seven per cent of respondents also said they were no longer able to enjoy all the activities that they used to. Dr. Carter Thorne, a rheumatologist in Newmarket, Canada, said that inflammatory arthritis has a 'dramatic' effect on people's lives.

He revealed: 'People with these conditions often wait a significant period of time before they are diagnosed, and many come to just accept that pain and restricted activity are a part of their lives.

'But with the advances we have made in treatment in the past decade, that doesn't need to be the case.'

Yesterday (October 12th), people around the world celebrated World Arthritis Day, the focus of which was the importance of physical activity.

Premature babies are five times more likely to develop autism, according to new research.

Although it has long been thought that babies born before their due date were at risk of developing health problems and cognitive issues, US researchers have found a link between low birth weight and the condition.

Scientists from the University of Pennsylvania School of Nursing found that babies born before the 37th week of pregnancy were five times more likely to have autism than those born within a normal weight range and on time. The study was published in the journal Pediatrics.

Lead author Jennifer Pinto-Martin said: 'As survival of the smallest and most immature babies improves, impaired survivors represent an increasing public health challenge.

'Emerging studies suggest that low birth weight may be a risk factor for autism spectrum disorders (ASDs).'

In 2008, researchers from the McGill University in Montreal found that around 25 per cent of babies born seven to 14 weeks prematurely could be at an increased risk of developing autism.

Women who smoke may experience the menopause around a year earlier than non-smokers, according to new research.

Researchers from the University of Hong Kong assessed data from several past studies and found that on average non-smokers hit the menopause between the ages of 46 and 51 while smokers were shown to reach their menopause between 43 and 50 on all but two of the studies.

Volodymyr Dvornyk, author of the study, which was published in the journal Menopause, said: 'Our results give further evidence that smoking is significantly associated with earlier (age at menopause) and provide yet another justification for women to avoid this habit.'

Mr. Dvornyk added that the earlier onset of menopause is associated with a number of postmenopausal health problems such as osteoporosis, cardiovascular diseases, diabetes mellitus, obesity and Alzheimer's disease. Early menopause has also been linked with a shorter life expectancy.

It is estimated that ten million Britons - or one in six - now smoke.

A leading charity has highlighted the important role that diet plays in maintaining healthy organs and avoiding the risk of heart disease.

Linda Main, dietetic advisor at HEART UK – The Cholesterol Charity, has highlighted the strong positive impact that a small number of changes can play in cutting the number of premature deaths caused by cardiovascular disease.

She advised those worried about their health to eat a diet rich in fruit and vegetables, which provide people with vitamins, minerals, plant fibre and polyphenols.

These are a range of compounds that she suggested are behind a plant-based diet's strong positive effect on heart health. Ms Main said: "These structurally diverse compounds show a range of activities that may help to explain the cardiovascular protective properties of consuming diets high in fruits and vegetables."

She highlighted research suggesting significant evidence that flavonoids and foods rich in these carry cardiovascular benefits. Her comments follow research published in Plos Medicine earlier this month that suggested that a diet containing raw vegetables and fruit cut the risks of myocardial infection and cardiovascular diseases.

Oakland, CA - Pregnant women with treated or untreated hypertension are at higher risk of carrying fetuses with congenital anomalies than are normotensive women. The finding points to elevated blood pressure as the teratogen, rather than the drugs used to treat it, according to a report published online October 18, 2011 in BMJ.

ACE inhibitors are known to be teratogenic during the second and third trimesters. A 2006 study using data from the Tennessee Medicaid population associated first-trimester ACE-inhibitor exposure with neural tube defects and cardiac malformations but did not find a similar association with other antihypertensives. Two subsequent studies implicated other drugs. The new investigation disentangles the effects of antihypertensive drugs from those of the condition they treat.

Dr. De-Kun Li (Kaiser Foundation Research Institute, Oakland, CA) and colleagues conducted a population-based retrospective cohort study that evaluated 465754 mother-infant pairs from northern California in the Kaiser Permanente database from 1995 to 2008. This included electronic medical records of fetal malformations, maternal drug exposures, and potential confounding factors such as preexisting diabetes and overweight during pregnancy. The researchers compared four groups of pregnant women:

• Those with hypertension who took ACE inhibitors during the first trimester.
• Those with hypertension who took other antihypertensives during the first trimester.
• Those with hypertension who took no antihypertensives during the first trimester.
• Pregnant women who did not have hypertension and did not receive antihypertensives for other indications.

Use of ACE inhibitors in women with hypertension was associated with increased risk for congenital heart defects compared with normal control participants (those with neither hypertension nor use of antihypertensives), at 3.9% vs 1.6% of patients (odds ratio 1.54; 95% CI, 0.90-2.62).

Similar associations were found for other antihypertensives. However, compared with the 2.4% of pairs with untreated hypertension that had congenital heart defects, the use of ACE inhibitors or other antihypertensives in the first trimester was not associated with increased risk (odds ratio 1.14; 95% CI 0.65-1.98; and odds ratio 1.12; 95% CI 0.76-1.64, respectively).

"Compared with the hypertension controls, there was no increased risk of malformation associated with use of either ACE inhibitors or other antihypertensive drugs," the investigators conclude.

Limitations of the study include not controlling for influences of diet and exposures to other medications and not delineating more specific types of birth defects.

In an editorial Dr. Allen Mitchell (Boston University, MA) writes that the new findings, on top of previous studies, make it "reasonable to conclude that exposure to ACE inhibitors during the first trimester poses no greater risk of birth defects than exposure to other antihypertensives." But he adds, "The greater concern is that the underlying hypertension itself places the fetus at risk," a possibility that deserves further study.

Montreal, QC - A nationwide program in the US that makes it easy for patients on clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) to be tested for CYP2C19 polymorphisms found a fairly high proportion of patients were on concomitant drugs that inhibit enzyme activity and who thus could be at increased risk of cardiovascular (CV) events.

Dr. Lon Castle (Medco Health Solutions, Franklin Lakes, NJ) and colleagues assessed the uptake and impact of a personalized medicine program that informs physicians and patients about the value of CYP2C19 genotyping and facilitates access to that testing. They reported their findings here at the 2011 International Congress of Human Genetics (ICHG)/2011 Annual Meeting of the American Society of Human Genetics (ASHG).

Of the first 100 patients tested between December 1, 2010 and April 30, 2011, approximately 30% of patients on clopidogrel were either poor or intermediate metabolizers, 37% were extensive metabolizers, and 33% were ultrarapid metabolizers. "Some 38% of patients had the *17 allele and thus could be at greater bleeding risk," Castle told delegates here.

The same percentage of patients were also on a CYP2C19-inhibiting drug—25% on a proton-pump inhibitor (PPI), 6% on an antidepressant, and 7% on both a PPI and an antidepressant, he added. Three months after physicians had been informed about the concomitant drugs' ability to inhibit clopidogrel metabolism, close to 40% of patients on concomitant PPI therapy had a change in their treatment regimen, physicians either discontinuing the PPI or switching to the weaker CYP2C19 inhibitor pantoprazole. Five percent actually discontinued clopidogrel.

In contrast, no change in treatment regimen was made in patients on concomitant antidepressant therapy.

As Castle explained in an interview, patients covered by Medco's pharmacy benefits plan were eligible for CYP2C19 genotyping and, if interested, were provided with information on the test and a DNA collection kit. DNA is then genotyped for alleles *1 to *8 as well as the *17 allele. This information together with metabolism phenotype and a list of medications that inhibit CYP2C19 are reported to physicians. Specially trained CV pharmacists then discuss treatment options for patients with poor metabolism phenotypes. In all, 675 physicians were offered the testing program for their patients.

Testing was most frequently offered to cardiologists (45% of all physicians), followed by primary-care physicians (approximately 35%), but surprisingly, of those offered the information, neurologists were the most likely to want to learn what the test results showed (53% of those offered), while cardiologists had the lowest acceptance rate, at approximately 30%, and primary-care physicians falling in between at approximately 42%.

Asked about the cost of the program, Castle felt that it was probably cost-neutral. "By the time you figure in the cost of the test and the cost of administering the program to physicians and to patients, it's probably cost-neutral," he said. "But at the end of the day, if something is cost-neutral and clinically the right thing to do, I still don't think there is any reason why you shouldn't do it."

Dr. Howard Levy (Johns Hopkins University, Baltimore, MD) agreed, saying that offering patients the CYP2C19 genotype test is "absolutely" the right thing to do.

"If you are going to go to the trouble of putting patients on medications that we hope will make them better, it would be nice to know that we are indeed making them better or at least not making them worse," he said in an interview.

The test also importantly identifies patients with the *17 allele who were particularly sensitive to clopidogrel and who theoretically may be at increased risk for bleeding, he added. Several novel antiplatelet agents have been approved that could be used instead of clopidogrel; however, as Levy noted, some of these drugs carry a higher risk of bleeding, at least in certain patient groups.

With clopidogrel poised to lose patent protection, the new drugs will cost considerably more. "I love the clopidogrel story, because here we have a medication that is [soon to be] available generically, so it's [going to be] inexpensive, it's got a great track record, and the majority of the population can benefit from it," Levy said. "But for patients who are on an inhibiting drug or for those who are genetically not able to activate clopidogrel and who won't benefit from it as much, we now have a tool to identify those patients for whom it is worth the extra expense to use one of the newer drugs."

Infants are prescribed acid-suppressing drugs too frequently as often these are no more effective in treating the symptoms they suffer from than a placebo.

Research published in the Journal of Pediatrics has highlighted the fact that spitting up, irritability and unexplained crying are often interpreted by doctors as symptoms of gastro-oesophageal reflux disease despite the fact these are rarely connected with the condition.

Dr. Eric Hassall, staff gastroenterologist at the Sutter Pacific Medical Foundation, said that these symptoms are often just 'life' rather than a disease and do not warrant treatment.

He said: "In the absence of better information and physician guidance and fed by advertising and misinformation on the internet, distressed parents take their concerns to doctors who very frequently comply and prescribe acid-suppressing medications."

New research published by the University of Pennsylvania School of Nursing has warned that premature babies are five times more likely to develop autism.

Many older women continue to suffer from hot flushes and night sweats for years after the menopause, a new study has found.

Research published in BJOG: An International Journal of Obstetrics and Gynaecology has found that these symptoms will often last for longer than had previously been believed.

Factors that increased the probability of these symptoms lasting for a long period included having undergone a previous hysterectomy, having been a smoker and consuming a higher alcohol intake.

Myra Hunter, co-author and professor at the King's College London's Institute of Psychiatry, said that the study examined a larger number of post-menopausal women and that the outcome was surprising.

She said: "Age didn't seem to affect the prevalence or frequency of the symptoms. Health professionals need to be aware that women can still have hot flushes and night sweats in their late 50s and 60s."

Recent research published in the American Journal of Clinical Nutrition recently advised women that a glass of wine a day can reduce the risk of osteoporosis, which can increase following the menopause. ADNFCR-554-ID-800770234-ADNFCR

Women who suffer depression are more likely to develop dementia in later life, according to a leading psychologist.

Speaking at an ageing and memory conference in Toronto, clinical psychologist Nasreen Khatri claimed that bouts of depression can double a person's risk of developing Alzheimer's disease and potentially other forms of dementia.

Dr. Khatri from Baycrest Aging Centre in Toronto said that more and more women could develop dementia in the future as more of us live in to old age.

She said: 'The fastest-growing segment of the population right now is older women,' quotes the Daily Mail.

'So the older a population is, the more depressed people it has in it because it's the kind of disorder that starts young and keeps going.'

Women, especially middle-aged females, may be more prone to depression than men as they struggle to juggle multiple roles by caring for their children and elderly parents simultaneously, Dr. Khatri added.

Hormonal cycles and women's methods of coping with stress have also been linked with depression.

September 29, 2011 (Little Rock, Arkansas) - The number of patients admitted to the hospital suffering from hypertensive emergencies has risen since 2000, but deaths resulting from these hospitalizations have dropped, new figures show.

The study is one of the few looks at the subject of hypertensive crises, which tend to be ignored in guidelines, says lead author Dr Abhishek Deshmukh (University of Arkansas for Medical Sciences, Little Rock). He and his colleagues report their findings online September 3, 2011 in the American Journal of Cardiology.

And although Deshmukh believes the US Seventh Report of the Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommendations on blood-pressure management, which were issued in 2003, may have contributed to the reduction in mortality seen in his study, he told heartwire he would love to see more attention being paid to hypertensive emergencies, which were not specifically mentioned in JNC 7.

He explains that a hypertensive emergency--also known as acute hypertension--exists when blood pressure reaches levels that are damaging organs, generally at values exceeding 180 mm Hg systolic or 120 mm Hg diastolic, but they can occur at even lower levels in patients whose BP had not been previously high.

In their study, he and his colleagues show that the frequency of hospitalizations with a diagnosis of hypertensive emergency inched up from 101/100 000 in 2000 to 111/100 000 in 2007, an average increase of about 1.1%. But despite this rise in admissions, in-hospital deaths fell from 2.8% in the pre-JNC 7 era (2000–2003) to 2.6% in the post-JNC 7 era (2004–2007; odds ratio 0.91).

The authors speculate that the improvement in mortality is likely due to increased awareness of how to treat hypertension among doctors following publication of the JNC 7 guidance.

I hope that in JNC 8 they mention something about how to handle patients admitted with hypertensive emergencies.

But there is much room for further improvement, which would help in the management of hypertensive emergencies, says Deshmukh. The JNC 8 guidelines, which will be the next US advice on blood-pressure management, have been eagerly awaited for some time and it is hoped they will be issued by the end of this year or sometime in 2012.

"I hope that in JNC 8 they mention something about how to handle patients admitted with hypertensive emergencies and perhaps list appropriateness criteria as to who should get hospitalized with very high blood pressure," he notes. And Deshmukh says he would also like to see JNC 8 "focus on what blood pressure it is safe to send a patient home with."

References

Deshmukh A, Kumar G, Kumar N, et al. Effect of Joint National Committee VII report on hospitalizations for hypertensive emergencies in the United States. Am J Cardiol DOI:10.1016/j.amjcard.2011.06.046.

October 3, 2011 — The Nobel prize for medicine was awarded today to 3 scientists whose discoveries about the immune system are expanding how clinicians prevent and treat infection, inflammatory diseases, and cancer, including a form that claimed the life of one of the new Nobel laureates 3 days ago.

Bruce Beutler, MD, and Jules Hoffmann, PhD, received a half-share in this year's prize for discovering receptor proteins that can spot bacteria and other microorganisms and then activate the body's innate immunity to defend itself. The other half of the $1.5 million prize went to the late Ralph Steinman, MD, who discovered the dendritic cells that turn on the T cells at the heart of active immunity, which creates an immunologic memory against invaders.

Dr. Steinman, age 68, a cell biologist at Rockefeller University in New York City, died on September 30 after a 4-year bout with pancreatic cancer. He extended his life with a form of immunotherapy that incorporated his research on dendritic cells, according to a Rockefeller University press release.

The Nobel committee at Sweden's Karolinksa Institute, responsible for awarding the prize in physiology or medicine, selected Dr. Steinman before learning of his death, according to the Nobel Foundation. Nobel prizes are not deliberately awarded on a posthumous basis, but the Nobel Foundation announced today that Dr. Steinman would remain a Nobel laureate because the decision to select him "was made in good faith, based on the assumption that [he] was still alive." The organization noted that Dr. Steinman's situation resembles an exception in the Nobel rules that allows a prize to be presented to someone who is named a laureate while alive, but dies before the prize ceremony.

"The Future Translation Is Obvious"

The work of Dr. Beutler and Dr. Hoffmann has "triggered an explosion of research in innate immunity" and the identification of dozen or so different receptor proteins called Toll-like receptors in humans and mice, according to the Nobel Foundation. Each Toll-like receptor recognizes certain types of molecules found in trespassing microorganisms. Genetic variations in these Toll-like receptors come with an increased risk for infection or chronic inflammatory disease.

Dr. Beutler is a professor of genetics and immunology at the Scripps Research Institute in La Jolla, California. Dr. Hoffmann is a senior researcher emeritus and professor at the National Center for Scientific Research in Strasbourg, France.

Dr. Steinman's research into dendritic cells figured into the development of sipuleucel-T (Provenge, Dendreon) for advanced prostate cancer, the first therapeutic vaccine for cancer.

All 3 scientists made "substantial contributions" to the field of immunology, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, said in an interview with Medscape Medical News.

For the most part, researchers are still in the early stages of turning the discoveries of the latest Nobel laureates into new vaccines and treatments for infectious disease, but "the future translation is obvious," said Dr. Fauci. "It's absolutely going to happen."

Medscape Medical News©2011 WebMD.

September 28, 2011 (San Diego, California) - A topical formulation of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac sodium 1% gel (Voltaren Gel, Endo Pharmaceuticals) shows safety and efficacy in relieving knee osteoarthritis pain in both younger and elderly patients, according to research presented here at the American Academy of Pain Management (AAPM) 22nd Annual Clinical Meeting.

Topical NSAIDs represent an attractive alternative to oral forms of the drug, providing pain relief while avoiding the various risks and adverse effects of oral NSAIDS that can be a particular concern in elderly patients, including gastrointestinal, cardiovascular, and renal adverse events.

For the study, researchers pooled data from three 12-week randomized, double-blind trials involving patients with knee osteoarthritis pain. The patients were treated with 4 g topical diclofenac (Voltaren Gel) or a vehicle 4 times daily.

The results showed that among 602 younger patients, aged 25 to 64 years, improvement after 12 weeks was greater with topical diclofenac compared with the vehicle in pain scores on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; least squares mean [LSM], −5.8 vs −4.7; P = .007).

Scores were also improved on WOMAC physical function (LSM, −17.9 vs −14.2; P = .002), global rating of disease (LSM, −29.5 vs −23.8; P = .01), and pain on movement (LSM, −37.3 vs −29.0; P < .001).

The improvement in older patients treated with topical diclofenac was similarly improved compared with the vehicle group in terms of WOMAC pain score (P = .85), physical function (P = .70), global rating of disease (P = .86), and pain on movement (P = .81).

The only treatment-related adverse event that was more common in the treatment group compared with the vehicle group was application site dermatitis, which was seen in younger (4.0% vs 0.7%), as well as older (5.8% vs 0.4%), patients.

Voltaren was approved by the US Food and Drug Administration for osteoarthritic pain in 2007. The gel is applied to the painful joint 4 times daily, and the effects are primarily analgesic and presumably anti-inflammatory, said lead author Herbert S.B. Baraf, MD, FACP, FACR, clinical professor of medicine at George Washington University in Washington, DC.

"I would expect the therapeutic effect to be related to its half-life, and benefits rely on continued applications of the gel," he said.

Although there are no head-to-head studies comparing oral with topical NSAIDs, the treatment effects are comparable, he added. The study's objective was to determine whether the treatment or safety or efficacy were any different among the 2 age groups.

"I was personally more concerned with the adverse event profile between the 2 groups, [but] safety and efficacy were similar in the compared groups," Dr. Baraf said.

Body of Evidence

Asked by Medscape Medical News to comment on these findings, Gary M. Reisfield, MD, said the findings add to evidence supporting the benefits of topical diclofenac sodium.

"This industry-sponsored study adds to a growing evidence base in support of the safety and efficacy of topical diclofenac for osteoarthritis of the knee," said Dr. Reisfield, an assistant professor and director of the Division of Pain and Palliative Medicine at the University of Florida College of Medicine's Department of Community Health & Family Medicine in Jacksonville.

"Specifically, it demonstrates small but significant decrements in pain and pain on movement and improvements in physical function both in younger an older adults.... The major limitation of topic agents is their unsuitability for widespread or multifocal pain."

The study was supported by Endo Pharmaceuticals Inc. Dr. Baraf and Dr. Reisfield have disclosed no relevant financial relationships.

American Academy of Pain Management (AAPM) 22nd Annual Clinical Meeting: Abstract 26. Presented September 22, 2011.

September 27, 2011 (Chicago, Illinois) - A multidisciplinary antimicrobial stewardship program (ASP) at a tertiary-care hospital has reduced antibiotic use in that institution by one quarter. In addition, the use of simple innovative changes to prescribing practices reduced the development and transmission of multidrug resistant (MDR) organisms over a 3-year period.

The ASP was accompanied by a reduction in hospital costs and improvement in patient care.

A vital aspect of the ASP was not to restrict antibiotics, Kimberly Leuthner, PharmD, infectious disease clinical specialist at the University Medical Center of Southern Nevada in Las Vegas, reported here at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Leuthner said that the overuse of antibiotics imposes selective pressure on bacteria, leading to MDR organisms. Elevated rates of MDR pathogens, high rates and long duration of therapy, and excessive expense within the medical center led staff in 2006 to implement a multidisciplinary ASP involving the infection control, microbiology, and pharmacy departments and functions.

The ASP included the evaluation of medication use for targeted drugs, a 10-day "stop protocol" for antimicrobial agents, expansion of a hospital-wide antibiogram, prevention strategies, and a continuing education program for nurses and physicians.

The ASP team decided not to restrict antibiotic prescribing, but to allow their use with education and de-escalation guidance. Drug use was monitored and was adjusted for patient census by expressing use as doses per 1000 patient-days.

Dr. Leuthner reported that antibiotic use decreased by 26.6%, and attributed the decrease to better compliance with medication use criteria and to the influence of the 10-day stop protocol. Stopping antimicrobial drugs sooner was associated with a significant decrease in the isolation of MDR pathogens (P = .02).

She said that through the efforts of the infection control department, isolates of Acinetobacter species, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA) have decreased sharply (by 30.7%, 24.6%, and 25.5%, respectively). The budget for antimicrobial drugs dropped by approximately 40% over a 3-year period.

Session moderator Stephan Harbarth, MD, MS, associate professor, attending physician in infectious diseases, and associate hospital epidemiologist at Geneva University Hospitals in Switzerland, called the presentation "terrific" and "very courageous."

Dr. Harbarth said: "What they showed is that they overtreated common infections for extended durations of 16 to 21 days. What was the reason? They just had the wrong physician order entry system, which renewed automatically the antibiotic orders.... Of course, it's gross misconduct by the hospital to have this kind of automatic renewal of antibiotic orders."

Rather than automatic renewal of orders, the standard with the ASP is to have automatic stop orders to reduce the duration of antibiotic therapy.

Dr. Harbarth said that the hospital's resistance situation was a "nightmare," and that its antibiotic usage was "apocalyptic," with overuse of carbapenems, quinolones, and other classes.

Despite the progress that this particular medical center has made, Dr. Harbarth said that, based on what he heard in Dr. Leuthner's presentation, and compared with hospitals in Western Europe, it still has "huge overuse of antibiotics" and problems with Acinetobacter and MRSA. But he congratulated her for the progress made so far and for being "honest enough to report" the situation.

Dr. Harbarth emphasized to Medscape Medical News that an important part of an ASP is not to restrict the use of available antibiotics, because staff often shift to using other antibiotics, but often no more appropriately. "It's clear that in this setting, it wouldn't make sense to target specific agents if they are still allowed to use 16 to 21 days of antibiotics," he said.

In general, any ASP needs to be tailored for the specific setting, including intensive care, acute care, or long-term care, and to each facility. "It depends also on the country, on the epidemiology of resistance, on specific usage patterns; there is no 'one size fits all' antibiotic stewardship approach," Dr. Harbarth noted.

He pointed out some generally applicable principles that target the "low-hanging fruits" in many settings. "For instance, improved antibiotic prophylaxis, perioperative prophylaxis before patients go into surgery...[may lead to a] reduction of duration. [It] may be just providing some educational material that is not generic, but that is adapted to a specific institution, like providing them the antibiotic-resistance situation, providing them some pocket books with local guidelines," he advised.

Another essential aspect of an ASP is good diagnostic support, which he sees as a major problem in the United States. "Many microbiology labs have been outsourced. That means that even in large hospitals, you send it all across the United States.... If you don't get the results back quickly and you don't have direct contact with the microbiologists, sometimes you will have trouble narrowing the antibiotic treatment, and you may continue a broad-spectrum antibiotic," he warned.

He explained that Europe is ahead of the United States in the approval and availability of tools for the rapid identification of infections and causative pathogens. One such tool is matrix-assisted laser desorption/ionization – time-of-flight (MALDI-TOF) mass spectrometry.

"That really gives you a time gain - sometimes up to 2 days" — in identifying the bacterium and adapting antibiotic treatment appropriately, he said. "It's really revolutionizing clinical microbiology, at least in Europe."

Although MALDI-TOF mass spectrometry is an expensive technology to purchase, Dr. Harbarth emphasized that "the consumables are very cheap. It costs almost nothing to run."

Another advance is the measurement of serum procalcitonin as a biomarker of systemic infection. He said it is approved in the United States only for use in the intensive-care setting; in Western Europe, clinicians are using it to diagnose respiratory tract infections, "which may be also very useful for antibiotic stewardship."

The good negative predictive value of the test "has an anxiolytic effect on the prescriber," Dr. Harbarth said. "That means that it encourages him to withhold antibiotics. The second, even more important, advantage of this biomarker is that you can individualize treatment duration." About a dozen clinical trials support this point, showing that, in some cases, therapy could be reduced from an average of 10 days down to 6.

Finally, Dr. Harbarth advised colleagues to learn from each other, encouraging clinicians from the United States to visit hospitals outside of North America. He also foresees better practice with the use of computerized decision support tools and decreased diagnostic uncertainty with improved diagnostics.

He acknowledges the pressure on physicians in the United States to practice defensive medicine because of the threat of malpractice suits.

"Sometimes there's overuse of antibiotics because colleagues want to be on the safe side. If you go to some places in Denmark, in the Netherlands, in Germany, in Switzerland, people get amoxicillin for pneumonia, even when they come to the hospital," he said. "You wouldn't suggest this at a meeting here to colleagues in the United States.'

Dr. Leuthner reports receiving speakers' fees from Cubist Pharmaceuticals and consulting fees as a scientific advisor to Forrest Pharmaceuticals. Dr. Harbarth has disclosed no relevant financial relationships.

51st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC): Abstract K-384. Presented September 17, 2011.

Men tend to develop type-2 diabetes at a lower body mass index (BMI) than women, Scottish scientists have found.

Researchers at the University of Glasgow analysed data on 51,920 men and 43,137 women, all of whom had been diagnosed with diabetes.

The scientists compared participants' BMI scores within one year of diagnosis, as well as taking into account people's age and smoking rates.

They found that men had an average BMI of 31.83 at diagnosis, compared with 33.69 for women.

Lead researcher Professor Naveed Sattar, from the Institute of Cardiovascular & Medical Sciences, said that being overweight is a 'major risk factor' for type-2 diabetes.

He said: 'Previous research has indicated that middle-aged men are at a higher risk of developing diabetes than women and one possible explanation is that men have to gain less weight than women to develop the condition.

'The results from this research confirm an inverse relationship between BMI and age at diagnosis of type-2 diabetes. But they also confirm our hypothesis that men have to gain less weight to develop diabetes.'

Dr. Victoria King, head of research at Diabetes UK, welcomed the study in Diabetologia journal.

She pointed out that this type of research will help scientists to understand why men develop type-2 diabetes at a higher rate than women, as well as what men can do to reduce their risk.

Type-2 diabetes accounts for between 85 and 95 per cent of all people with diabetes, according to the charity.

People with very pale skin may not get the amount of sunlight needed to provide sufficient levels of vitamin D, a study has found.

Most of our vitamin D is manufactured by the body in response to sunlight, while small amounts can be obtained from certain foods.

However, Cancer Research UK-funded scientists at the University of Leeds have found that people with very pale skin may not be able to safely spend enough time in the sun to make enough of the important vitamin.

Their study, which is published in the journal Cancer Causes and Control, looked at around 1,200 people and found that those with fair skin tended to have significantly lower levels of vitamin D than those with a darker complexion.

Lead author Professor Julia Newton-Bishop, from the Cancer Research UK Centre at the University of Leeds, said: 'Fair-skinned individuals who burn easily are not able to make enough vitamin D from sunlight and so may need to take vitamin D supplements.

'This should be considered for fair-skinned people living in a mild climate like the UK and melanoma patients in particular.'

Meanwhile, a separate study presented at the annual meeting of the American Society for Radiation Oncology found that more than three-quarters of cancer patients involved in the study had insufficient levels of vitamin D.

Smoking could be to blame for 40 million excess deaths from tuberculosis (TB) between 2010 and 2050, experts say.

The habit is known to increase the risk of contracting TB and smokers who develop the disease are also more likely to die from it.

Researchers at the University of California used a mathematical model to determine the effect of smoking on future TB rates.

They found that smoking could lead to 40 million excess TB deaths between 2010 and 2050.

Furthermore, if current smoking trends continue, the scientists believe the number of excess TB cases could rise from 256 million to 274 million.

Writing in the British Medical Journal, Dr. Sanjay Basu and his colleagues claimed that aggressively lowering the prevalence of tobacco smoking around the world 'could reduce smoking-attributable deaths from tuberculosis by 27 million by 2050'.

Other major risk factors for TB include living in an environment where the level of existing infection is higher than normal and having a compromised immune system (such as with HIV infection).

The number of cancer survivors over 65 years of age will rise significantly over the next ten years, a US study suggests.

Researchers at the US National Cancer Institute (NCI) found there were approximately three million cancer survivors in the US in 1971, compared with nearly 12 million in 2008.

Three-fifths of survivors in 2008 were at least 65 years of age and this is expected to rise to 63 per cent by 2020.

Dr. Julia Rowland, director of the NCI's Office of Cancer Survivorship, said: 'We can expect a dramatic increase in the number of older adults who are diagnosed with or carry a history of cancer.

'Cancer is largely a disease of ageing, so we're seeing yet another effect of the baby boom generation and we need to prepare for this increase."

The findings are published in the journal Cancer Epidemiology, Biomarkers & Prevention and highlight the need for more cancer specialists.

Cancer survival rates have doubled over the last 40 years in the UK, according to Cancer Research UK, indicating that Britain will also witness an increase in older survivors in the coming years.

Schoolchildren in Wales should be given free sunscreen to reduce their risk of developing skin cancer in later life, a charity says.

Tenovus is presenting the Welsh government with a petition containing more than 9,000 signatures in support of making sunscreen available to under-11s on prescription.

Dr. Ian Lewis, the charity's associate director of research, said that just one case of blistering sunburn in childhood can double a person's risk of getting skin cancer later in life.

'With over 100 people in Wales dying from malignant melanoma each year, and cases in both men and women more than doubling in the last 15 years, we need to prevent the incidence of malignant melanoma increasing in the next generation,' he insisted.

Experts say that people should wear at least factor 15 sunscreen when going out in the sun.

It is also important to spend time in the shade, particularly between 11am and 3pm when the sun's UV rays are strongest.

Other sensible measures include covering up with long-sleeved clothing, a hat and sunglasses.

More investment is needed to ensure students with mental health problems get the support they need, psychiatrists say.

A new report from the Royal College of Psychiatrists points out that student numbers have grown in recent years and that many face high levels of debt and fewer employment opportunities.

As a result, many students are under emotional strain and at risk of mental health problems.

Dr. John Callender, consultant psychiatrist and chair of the report's working group, said that demand for counselling and mental health advisor services is rising, with a recent survey showing that four per cent of university students see a counsellor each year.

'Although there are some excellent support services for students across the country, in many universities the provision of services has not kept pace with expanding student numbers, leaving existing services overstretched,' he revealed.

Figures from the Young Minds charity indicate that nearly 80,000 children and young people are affected by severe depression, while more than half of adults with mental health problems were diagnosed in childhood. ADNFCR-554-ID-800745379-ADNFCR

People with large amounts of abdominal (belly) fat may be more likely to develop asthma, a study has found.

Scientists at the Norwegian University of Science and Technology followed 23,245 adults, aged 19 to 55 years, for an 11-year period.

None of the participants had asthma at the start of the study, allowing the researchers to investigate possible contributing factors when new cases developed.

Presenting their findings at the European Respiratory Society's annual congress, the researchers revealed that people with central obesity were 1.44 times more likely to develop asthma than normal-weight people.

Ben Brumpton, who conducted the research, said: 'Asthma can affect people of all sizes, but our study has highlighted both the individual and combined effect of central obesity and overall obesity on asthma development.'

The scientists noted that the reasons for the link are not clear, but may be uncovered in further studies.

Some 5.4 million people in the UK are affected by asthma, according to national charity Asthma UK. ADNFCR-554-ID-800739492-ADNFCR

People who regularly drink a small amount of alcohol may be less likely to develop asthma, research suggests.

Dutch scientists assess nearly 20,000 twins, aged 12 to 41 years, to investigate the links between alcohol consumption and asthma.

Participants completed questionnaires at the start of the study and again after eight years, providing information on their weekly alcohol intake.

The researchers found that people with a moderate intake of alcohol - one to six units per week - tended to have the lowest risk of asthma.

People who rarely or never consumed alcohol were 1.4 times more likely to develop the condition, while heavy drinkers were 1.2 times more likely to develop symptoms.

The findings were presented at the annual congress of the European Respiratory Society by Sofie Lieberoth, a researcher at the Bispebjerg Hospital in Denmark.

She said: 'Whilst excessive alcohol intake can cause health problems, the findings of our study suggest that a moderate intake of one to six units can reduce the risk of developing asthma.'

The study coincides with research from the Norwegian University of Science and Technology, which found a link between abdominal fat and asthma risk.

Patients' relatives should be encouraged to help care for their loved ones in hospital, the head of the Royal College of Nursing (RCN) has claimed.

Dr. Peter Carter told the Sunday Times that restricted hospital visiting times should be relaxed so that relatives could help to feed patients and take them to the bathroom.

'If you have a 24-bed ward and have got five nurses and everybody is having lunch at the same time and half the patients need feeding, it becomes difficult to get it all done,' he explained.

'If someone is coming in and sitting with their loved one, they are going to have the focused, dedicated time.'

Dr. Carter later clarified his comments, insisting that relatives should not be forced to carry out nursing duties, but arguing that allowing relatives to help make patients comfortable 'can make hospital stays in particular less stressful for all concerned'.

In response, England's chief nursing officer, Christine Beasley, said that relatives' help was 'welcome' but must be 'in addition to NHS care, not instead of it'.

She added that safe, high-quality nursing care 'must be at the heart of the NHS'. ADNFCR-554-ID-800739500-ADNFCR

People who cycle through large cities may be at risk from inhaled soot, experts claim.

Scientists at Barts and the London School of Medicine recruited five people who commuted by bicycle in London and five pedestrians.

Samples were taken from participants' low airway to assess the amount of black carbon in their lungs.

The researchers found that cyclists typically had between 2.3 and three times more black carbon in their lungs than pedestrians.

The findings, which were presented at the annual congress of the European Respiratory Society, indicate that cyclists could be at greater risk of lung damage.

Dr. Chinedu Nwokoro, who was involved in the research, said: 'The results of this study have shown that cycling in a large European city increases exposure to black carbon.

'This could be due to a number of factors, including the fact that cyclists breathe more deeply and at a quicker rate than pedestrians while in closer proximity to exhaust fumes.'

Transport planners should take this risk into account when planning new cycling routes, Dr. Nwokoro suggested.

The study follows recent research carried out at the London School of Hygiene and Tropical Medicine, which found that high levels of air pollution could trigger heart attacks. ADNFCR-554-ID-800739497-ADNFCR

A large systematic review of available evidence on nonsteroidal anti-inflammatory drugs (NSAIDs) confirms that rofecoxib (Vioxx, Merck) is associated with a significantly increased risk of cardiovascular events, while also suggesting that diclofenac, a widely used, over-the-counter NSAID, also poses an equivalent risk to patients [1]. Of the medications studied, ibuprofen and naproxen are the least likely to increase the risk of MI and coronary heart disease death.

"What this allows us to do is start to discriminate a little better between the individual drugs than was possible in the past,"Dr. David Henry (University of Toronto, ON), the senior investigator of the review, told heartwire. "The paper is not to guide drug regulation but really to guide clinical practice in what drugs doctors might choose in people at high risk for having a heart attack or stroke. There are no huge surprises, but it does give us more confidence in the data."

The study, with first author Dr Patricia McGettigan (Hull York Medical School, UK), provides estimates of the risks of individual NSAIDs at standard doses in community settings and is published September 27, 2011 in the open-access journal PLoS Medicine. The updated review includes data from 31 case-control studies with 184 946 cardiovascular events and 21 cohort studies that include outcomes in more than 2.7 million individuals exposed to the drugs.

To heartwire, Henry noted that when the selective COX-2 inhibitor rofecoxib was taken off the market in 2004, there were questions about the risk of other NSAIDs, and this led to an outpouring of published data. In 2006, McGettigan and Henry published a systematic review of observational studies that focused on the cardiovascular risk of selective COX-2 inhibitors and nonselective NSAIDs. That study, reported by heartwire, showed that cardiovascular risk was increased with diclofenac, indomethacin, and meloxicam as well as with rofecoxib. Naproxen was not cardioprotective, as had been previously suggested, but appeared to have a neutral risk, and results with ibuprofen were inconclusive.

The new review confirms the increased risk of cardiovascular events with rofecoxib, as well as an increased risk with diclofenac. Although rofecoxib is no longer on the market, Henry said that diclofenac is still available, even though the risk between the two drugs is nearly identical. Regulatory agents seem reluctant to remove the drug from the market, he said, adding that clinicians should take regulatory action on their own and not use diclofenac in certain patients.

"We think this is a significant issue and that people should know about this," said Henry. "It probably doesn't matter in people at very low risk of a heart attack. But if you have had a heart attack or have a lot of cardiovascular risk factors, you probably want to avoid diclofenac because it increases the risk by about 40%. For somebody that has a 5% to 10% risk of having a heart attack, that's a significant increase in absolute risk, particularly if there are other drugs that don't seem to have that risk. For people at very low risk, it probably doesn't matter what drugs you use."

Drugs and pooled relative risks of cardiovascular events

Naproxen was consistently shown to be safe, even at high doses, suggesting it should be the NSAID of choice in patients with increased cardiovascular risk. Naproxen was shown to be safer than ibuprofen, with the risk of cardiovascular events increasing with ibuprofen at daily doses ranging from 1200 mg to 1600 mg. If ibuprofen is used in high-risk patients, Henry said the dose should be kept low, but if a higher dose is needed, clinicians should switch to naproxen. Of the three NSAIDs available over the counter, ibuprofen and naproxen were safe at low doses, while diclofenac was associated with a 22% increase in risk at low doses.

The researchers also observed a significantly increased risk of cardiovascular events in patients treated with indomethacin, an older NSAID historically used to treat gout. While the drug is known to cause gastrointestinal problems as well as confusion in the elderly, the increased risk of cardiovascular events suggests it shouldn't be used at all, said Henry. Celecoxib (Celebrex, Pfizer), on the whole, had an increased risk of cardiovascular events at low and high doses, although there were few studies testing doses >200 mg/day. Henry said celecoxib, especially at doses >400 mg/day, should not be used in patients at high risk of cardiovascular disease.

To heartwire, Henry commented that 10 years ago there were many NSAIDs in widespread use, but the number of drugs considered safe to use has declined substantially, down to just two. "The number we're settling on, the number of preferred drugs, is actually quite small now," he said

Consumers should beware of special offers involving cosmetic surgery and non-surgical cosmetic procedures, experts have warned.

Research presented at the annual scientific meeting of the British Association of Aesthetic Plastic Surgeons (Baaps) suggests that ill-advised marketing tactics are not uncommon in the UK.

In fact, researchers found that 26 per cent of British clinics offer financial incentives for cosmetic surgery, such as prize draws, 'buy-one-get-one-free' deals, discounts for multiple procedures and rewards.

This compares with just 12 per cent of cosmetic surgery clinics in the US.

Baaps president Fazel Fatah claimed: 'It has become common to bundle together the practice of aesthetic plastic surgery such as facelifts and breast augmentation alongside beauty treatments such as facials, lasers and injectable fillers under the term 'cosmetic industry'.

'This blurring of lines has encouraged blatantly unethical marketing tactics which trivialise serious surgery.'

Baaps also expressed concern over a recent segment on ITV's This Morning programme, which featured an unproven stem cell breast augmentation procedure.

Mr. Fatah said the programme's 'unchallenged' portrayal of the procedure 'could put the millions of women who watched it in danger'.

Small blood vessels that act as a 'back-up system' for the main arteries in the heart appear to play an important role in reducing people's chances of dying from coronary artery disease, scientists have found.

The vessels, known as 'coronary collaterals', are tiny, specialised blood vessels that connect the larger vessels in the heart and can expand in order to carry more blood in the event that an important vessel becomes blocked.

According to a new study in the European Heart Journal, people with large numbers of these tiny blood vessels are 36 per cent less likely to die from coronary artery disease than those with few.

The discovery suggests that the vessels could provide an important target for the development of new heart disease treatments.

Lead author Dr. Pascal Meier, a consultant for University College Hospitals NHS Foundation Trust, explained that this 'back-up system' of coronary collaterals is 'better developed in some patients'.

'We should find means to promote these natural bypass vessels in order to improve outcomes for patients with heart disease,' he observed.

Maureen Talbot, senior cardiac nurse at the British Heart Foundation, described the findings as 'encouraging'.

She said that more research is now needed to explain why the vessels are more effective in some people than others. ADNFCR-554-ID-800745043-ADNFCR

Drugs called beta-blockers, which are commonly used to treat high blood pressure, could help to prevent breast cancer spread, new research suggests.

Scientists at Nottingham University Hospitals NHS Trust are studying the drugs to see whether they could have a role to play in improving survival from the disease.

Early results are due to be presented at the Royal Society of Medicine today (September 30th) and indicate that women with breast cancer who take beta-blockers may be less likely to see their cancer spread.

Dr. Des Powe, a Cancer Research UK-funded scientist based in Nottingham, said: 'It is absolutely crucial to conquer cancer spread if we are to really improve breast cancer survival, as this problem causes nearly all deaths from the disease.

'This study will be sufficiently large to determine whether we should progress to clinical trials and identify which type of beta-blockers have the strongest effect.'

Earlier this month, a German study, published in the Journal of Clinical Oncology, found that a diet rich in phyto-oestrogens - which occur in seeds, fruits, vegetables and whole-grains - may help to reduce a woman's risk of dying from breast cancer.

Scientists have identified five new genes that appear to be associated with an increased risk of coronary artery disease.

The international consortium of researchers examined more than 49,000 genetic variants in 15,596 people with coronary artery disease and 34,992 healthy volunteers

They then confirmed their findings in an additional 17,121 coronary artery disease cases and a further 40,473 healthy controls.

According to the researchers, many of the genes that affect an individual's risk of developing coronary artery disease are the same for Europeans and south Asians.

Thanks to the study, scientists are now aware of more than 30 genes that appear to influence coronary artery disease risk.

Co-principal investigator Professor Hugh Watkins, from the University of Oxford, said: 'Although the effects of the new genetic variants that we have identified are individually small, in the order of five to ten per cent per copy, new treatments that are developed on the basis of the findings could have a much broader effect.'

The study, which is published in the journal PLoS Genetics, was part-funded by the British Heart Foundation.

Ellen Mason, the charity's senior cardiac nurse, said that understanding the genes that increase heart disease risk is 'vital'.

She added: 'We hope to use these new discoveries to gain insight into how the disease develops, and find new ways of preventing people getting coronary heart disease in the future.'

Woman who are diagnosed with breast cancer late in life are more likely to die from the disease than younger patients, a study has found.

The research, which was presented at the European Multidisciplinary Cancer Congress, suggests that doctors may not be treating older women as aggressively as their younger counterparts.

Scientists at Athens University Medical School analysed data on 9,766 postmenopausal breast cancer patients who took part in the Tamoxifen Exemestane Adjuvant Multinational (Team) trial in order to examine causes of death.

They found that older patients had a much higher risk of dying from causes other than breast cancer.

The risk of dying from breast cancer itself also increased with age.

Lead researcher Professor Christos Markopoulos said: 'For those not suffering from other conditions or those who have survived other conditions, deaths from breast cancer are higher compared to younger patients with the same tumour characteristics.

'This probably means that old women with breast cancer are being under-treated as doctors think they will die from something else.'

For instance, the researchers observed that older women were less likely to be given radiotherapy and chemotherapy.

Earlier this year, a study by scientists at the University of Manchester found that older women in the UK are less likely to have surgery for breast cancer than younger patients.

This is despite the fact that surgery is one of the most effective ways to treat the disease. ADNFCR-554-ID-800738220-ADNFCR

New research suggests that low levels of vitamin D may cause changes in the airways of children with severe therapy-resistant asthma (STRA).

Scientists at Imperial College and King's College London assessed 86 children, including 36 with STRA, 26 with moderate asthma and 24 without asthma.

They found that children with STRA had significantly lower levels of vitamin D, were more reliant on asthma medications and had poorer lung function than children with moderate asthma or no symptoms.

Analysis also revealed that children with STRA had greater airway muscle tissue mass.

Researcher Dr. Atul Gupta said: 'This study clearly demonstrates that low levels of vitamin D are associated with poorer lung function, increased use of medication, worse symptoms and an increase in the mass of airway smooth muscle in children with STRA.'

He added that the link between airway smooth muscle mass and lung function in severe asthma may therefore be 'partly explained' by low levels of vitamin D.

The findings are published in the American Journal of Respiratory and Critical Care Medicine and follow a recent study by scientists at the Harvard School of Public Health in Boston, who found that women who eat low-fat yoghurt during pregnancy may be more likely to have children with asthma.

Women at risk of the bone-thinning disease osteoporosis may benefit from a simple 15-minute screening program, new research shows.

Scientists at the University of Bristol, funded by Arthritis Research UK, looked at 3,000 postmenopausal women.

They found that women who were screened in doctors' surgeries were 124 per cent more likely to be given bone-strengthening drugs than those who were not screened.

Furthermore, women who were screened had fewer fractures, particularly of the forearm.

Dr. Emma Clark, who conducted the research, said: 'These findings provide powerful evidence that this screening programme should be rolled out nationally to identify who should have a spinal x-ray to diagnose a vertebral fracture.'

Dr. Clark noted that fewer than one in three women with vertebral fractures are diagnosed and treated properly at present.

The findings were presented at the annual meeting of the American Society for Bone and Mineral Research.

Half of women and one in five men over the age of 50 sustain a bone fracture, according to the National Osteoporosis Society.

In the majority of cases, these fractures are the result of osteoporosis, which tends to develop in older people. ADNFCR-554-ID-800738188-ADNFCR

The Lancet, Volume 378, Issue 9797, Pages 1124 - 1125, 24 September 2011

Christopher JL Murray a

For the past three decades, Japan has had the highest life expectancy in the world. This has been achieved while keeping health expenditures as a fraction of gross domestic product (GDP) under 8·5% in 2008, by contrast with 16·4% in the USA or 10·7% in Germany.

• Excellent health outcomes in Japan have been attributed to favourable risk factor profiles, health system performance,
• and universal coverage. Elucidating the underlying reasons for Japan's health success has important ramifications for other nations looking to achieve good outcomes at affordable cost. Nayu Ikeda and colleagues
• provide a careful analysis of the cause of death and risk factor data to investigate potential causes for Japan's decline in mortality since World War 2. The data in Ikeda and colleagues' paper3 for the under-5 mortality rate and young and middle-aged adult mortality, compared to eight other high-income countries, indicate that there have been three phases of mortality change since World War 2. From 1950 to 1975, there was an extraordinary pace of mortality decline both for children and adults. By 1975, Japan had the lowest adult mortality among the eight high-income countries for men and women, and the lowest child mortality second only to Sweden. Ikeda and colleagues argue that this was perhaps attributable to a culture of hygiene, high levels of educational attainment, an egalitarian society, and strong government that led public health programmes, particularly for tuberculosis control. Although proving which factors are responsible for mortality decline from time-series cross-sectional data is notoriously difficult, Ikeda and colleagues' argument is a plausible account of the age, sex, and cause-specific trends in mortality during this remarkable period of progress. Although Ikeda and colleagues use a slightly different set of time periods for their analysis, there seems to be a clear second phase from 1975 to 1995 where Japan kept pace with mortality progress in other high-income countries but did not outperform them in terms of the annual rate of decline for children or adults. By 1975, many non-communicable diseases were already at extremely low levels compared with other high-income nations, due in large part to a favourable cultural heritage of dietary risk factors and physical activity. The health system and universal coverage cannot claim credit for this historical circumstance. The key exception is stroke mortality where high salt intake and high blood pressure meant increased rates of stroke mortality. Ikeda and colleagues argue, supported by other studies,
• that public health programmes to promote salt reduction and primary care management of high blood pressure with anti-hypertensives were instrumental in bringing down stroke mortality. This is a key argument that lends support to the notion that some of the 1975 to 1995 continued decline was related to the actions of the health system. The progress on blood pressure in Japan is in sharp contrast to the USA where female blood pressure has been very slow to decline. The third and more troubling phase for Japan begins in the mid to late 1990s. Since that time, the pace of decline in mortality for adult men and, to a lesser extent, adult women (aged 15—59 years) has been slower than other nations. Japan has fallen behind Sweden, Italy, and Australia for men and behind Sweden for women. If recent trends continue, other nations are likely to achieve lower rates of adult mortality than Japan. Given the previous two decades during which Japan remained in the top rank, this recent change is dramatic. Many explanations for this worsening relative performance are offered by Ikeda and colleagues, including high tobacco consumption compared with other high-income countries, a modest rise in body-mass index, and high and rising rates of suicide. Unstated is the hypothesis that although Japan has a universal health-care system, the quality of the care delivered might be low. Treatment coverage for high cholesterol, for example, is much lower than in other high-income countries.
• Given poor measures on quality of care, further reduction in mortality may require that Japan revamp its health-care system. Economic stagnation and rising income inequality could also be part of the explanation of recent trends.
  
  What lessons can be drawn from the experience of Japan?
  
  Drawing from Ikeda and colleagues' analysis, I make four observations. First, strong government action at relatively low national income per capita (Japan in the 1950s) in a comparatively educated population can result in implementation of effective infectious disease control programmes. The critical necessity for high levels of educational attainment
• should not be underestimated. Second, the main effects of the health-care system in explaining accelerated mortality decline were probably through public health action and primary care management of key risks such as blood pressure. These make up a small fraction of health expenditure in any nation. Low health expenditure as a fraction of GDP in Japan associated with excellent health outcomes could be because most health expenditure in other nations contributes little to improved population health outcomes. Third, Japan has benefited enormously from favourable risk factors for ischaemic heart disease and some cancers. Japan already had lower death rates from ischaemic heart disease than the other eight nations in the 1950s. Favourable risk factor endowment must be taken into consideration when undertaking any type of assessment of health system performance. Fourth, in an era of economic stagnation, political turmoil, ageing populations, and inadequate tobacco control, Japan does not seem to be effective in addressing its new set of health challenges. It will take more than universal access to a low-spending, high-volume health system to tackle these challenges. Without concerted action, Japan, like the USA
• is likely to continue dropping in the global mortality league tables. Although the relative decline will not be as severe as we are witnessing in the USA, it is a cautionary tale that success in the past does not guarantee top performance in the future.

I declare that I have no conflicts of interest.

References

• Organisation for Economic Co-operation and Development. StatExtracts: health expenditures and financing. http://stats.oecd.org/Index.aspx. (accessed on July 23, 2011).
• WHO. The World Health Report 2000—Health systems: improving performance. Geneva: World Health Organization, 2000.
• Ikeda N, Saito E, Kondo N, et al. What has made the population of Japan healthy?. Lancet 201110.1016/S0140-6736(11)61055-6. published online Sept 1.
• Ikeda N, Gakidou E, Hasegawa T, Murray CJL. Understanding the decline of mean systolic blood pressure in Japan: an analysis of pooled data from the National Nutrition Survey, 1986—2002. Bull World Health Organ 2008; 86: 978-988.
• Roth GA, Fihn SD, Mokdad AH, Aekplakon W, Hasegawa T, Lim SS. High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries. Bull World Health Organ 2011; 89: 89-92.
• Gakidou E, Cowling K, Lozano R, Murray CJL. Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet 2010; 376: 959-974.
• Kulkarni S, Levin-Rector A, Ezzati M, Murray CJL. Falling behind: life expectancy in US counties from 2000 to 2007 in an international context. Popul Health Metr 2011; 9: 16.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA

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People who are exposed to high levels of air pollution may face an increased risk of heart attack for up to six hours afterwards, new research suggests.

Previous studies have shown a link between high pollution levels and premature death from heart disease, but this is the first to clarify the association with heart attack risk.

Researchers at the London School of Hygiene and Tropical Medicine reviewed 79,288 cases of heart attack from 2003 to 2006, including patients' exposure to levels of various pollutants, including carbon monoxide, sulphur dioxide and ozone.

They found that high levels of pollution were associated with an increased risk of heart attack for up to six hours, but that the level of risk then dropped back to expected levels.

Professor Jeremy Pearson, associate medical director at the British Heart Foundation, which co-funded the research, commented on the British Medical Journal report.

He said: 'This large-scale study shows conclusively that your risk of having a heart attack goes up temporarily, for around six hours, after breathing in higher levels of vehicle exhaust.'

The expert added that patients who have been diagnosed with heart disease should try to avoid areas with high levels of traffic pollution, such as busy roads.

Patients admitted to hospitals in London at weekends are more likely to die than those admitted on a weekday, according to NHS London.

The strategic health authority's latest review suggests that more than 500 lives could be saved each year in London by increasing the number of hospital consultants available at weekends and improving access to diagnostic scans.

New commissioning standards state that all emergency patients should be seen and assessed by a consultant within 12 hours of being admitted to hospital.

In addition, patients in a critical condition should have access to diagnostic scans within one hour, 24 hours a day.

Dr. Andy Mitchell, medical director at NHS London, said: 'We want patients in London to have access to the same, high-quality and reliable services 24 hours a day, seven days a week - after all, patients cannot always choose when they will need NHS care in an emergency.'

The expert added that the problem is not specific to London, but that the authority is 'leading the way to find a solution'.

Earlier this month, a report from think-tank Reform claimed that up to 40 hospitals in Britain could fail by 2013 unless their working practices are radically reformed.ADNFCR-554-ID-800735517-ADNFCR

Hao Q, Lu Z, Dong BR, et al.

Cochrane Database Syst Rev. 2011 Sep 7;9: CD006895. (Review)

BACKGROUND:Probiotics may improve a person's health by regulating their immune function. Some studies show that probiotic strains can prevent respiratory infections. However, no evidence of the benefits of probiotics for acute upper respiratory tract infections (URTIs) and related potential adverse effects has been published.

OBJECTIVES: To assess the effectiveness and safety of probiotics for preventing acute URTIs.

SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (Ovid) (1950 to May week 1, 2011), EMBASE (1974 to May 2011), Web of Science which includes Science Citation Index (from 1900 to May 2011) and Conference Proceedings Citation Index (from 1991 to May 2011), the Chinese Biomedical Literature Database, which includes the China Biological Medicine Database (from 1978 to May 2011), the Chinese Medicine Popular Science Literature Database (from 2000 to May 2011) and the Masters Degree Dissertation of Beijing Union Medical College Database (from 1981 to May 2011).

SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing probiotics with placebo to prevent acute URTIs.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility, quality of trials and extracted data.

MAIN RESULTS: We included 14 RCTs, although we could only extract available data to meta-analyse in 10 trials which involved 3451 participants.

We found that probiotics were better than placebo when measuring the number of participants experiencing episodes of acute URTI: at least one episode: odds ratio (OR) 0.58; 95% confidence interval (CI) 0.36 to 0.92; at least three episodes: OR 0.53; 95% CI 0.36 to 0.80; rate ratio of episodes of acute URTI: rate ratio 0.88; 95% CI 0.81 to 0.96; and reduced antibiotic prescription rates for acute URTIs: OR 0.67; 95% CI 0.45 to 0.98.

Probiotics and placebo were similar when measuring the mean duration (MD) of an episode of acute URTI: MD -0.29; 95% CI -3.71 to 3.13 and adverse events: OR 0.92; 95% CI 0.37 to 2.28.

Side effects of probiotics were minor and gastrointestinal symptoms were the most common. We found that some subgroups had a high level of heterogeneity when conducting pooled analyses.

AUTHORS' CONCLUSIONS:

Probiotics were better than placebo in reducing the number of participants experiencing episodes of acute URTIs, the rate ratio of episodes of acute URTI and reducing antibiotic use. This indicates that probiotics may be more beneficial than placebo for preventing acute URTIs. However, the results have some limitations and there were no data for older people.

Dumville JC, Deshpande S, O`Meara S, et al..

Cochrane Database Syst Rev. 2011 Sep 7;9:CD009111. (Review)

BACKGROUND: Foot ulcers in people with diabetes are a prevalent and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from.

A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use.

OBJECTIVES: The review aimed to evaluate the effects of foam wound dressings on the healing of foot ulcers in people with diabetes.

SEARCH STRATEGY:We searched the Cochrane Wounds Group Specialised Register (searched 10 June 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2); Ovid MEDLINE (1950 to June Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 8 June, 2011); Ovid EMBASE (1980 to 2011 Week 22); EBSCO CINAHL (1982 to 3 June 2011). There were no restrictions based on language or date of publication.

SELECTION CRITERIA: Published or unpublished randomised controlled trials (RCTs) that evaluated the effects on ulcer healing of one or more foam wound dressings in the treatment of foot ulcers in people with diabetes.

DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment and data extraction.

MAIN RESULTS: We included six studies (157 participants) in this review. Meta analysis of two studies indicated that foam dressings do not promote the healing of diabetic foot ulcers compared with basic wound contact dressings (RR 2.03, 95%CI 0.91 to 4.55).Pooled data from two studies comparing foam and alginate dressing found no statistically significant difference in ulcer healing (RR 1.50, 95% CI 0.92 to 2.44).

There was no statistically significant difference in the number of diabetic foot ulcers healed when foam dressings were compared with hydrocolloid (matrix) dressings.

All included studies were small and/or had limited follow-up times.

AUTHORS' CONCLUSIONS: Currently there is no research evidence to suggest that foam wound dressings are more effective in healing foot ulcers in people with diabetes than other types of dressing, however all trials in this field are very small. Decision makers may wish to consider aspects such as dressing cost and the wound management properties offered by each dressing type e.g. exudate management.

September 16, 2011 (Rochester, New York) — A new review describes alternatives to pharmaceutical therapies for patients with hypertension, concluding that while there are a number of options, many of them require more studies with regard to safety and efficacy [1].

Writing in the Journal of Clinical Hypertension, Drs. Kevin J Woolf and John D Bisognano (University of Rochester Medical Center, NY) outline 12 dietary supplements and four herbal remedies believed to be beneficial in terms of lowering BP. They also list other approaches to treat hypertension, including acupuncture and meditation. Importantly, they also caution that some herbal remedies could exacerbate hypertension including, for example, St John's Wort and licorice.

The doctors emphasize that the first-line approach to hypertension should always be lifestyle modification and, when this fails, pharmacologic therapy in combination with the low-salt Dietary Approaches to Stop Hypertension (DASH) diet. But the wide variety of alternative therapies on offer means they are often used to complement medications, or as a first-line approach in combination with lifestyle modification for mild hypertension, they note. Such therapies may also be of particular use in patients who are reluctant to take conventional medications, they point out.

Nevertheless, "randomized, placebo-controlled trials are needed to confirm the efficacy of many of the herbal or dietary supplements on the treatment of hypertension," they observe.

They go on to discuss devices, including one based on the concept of paced breathing (RESPeRATE device, InterCure Inc, New York, NY) and a dynamometer (Zona Plus, Zona Health, Boise, ID) that enables the user to perform isometric hand-grip exercises, said to reduce BP. They also describe two invasive device-based therapies in development for resistant and/or refractory hypertension: the Rheos device (CVRx Inc, Minneapolis, MN) and Symplicity catheter (Ardien Inc, Mountain View, CA).

Such devices, if shown to be safe and effective, "may offer the advantage of a one-time treatment that has lasting benefit," they conclude.

Bisognano has been involved in trials of the Rheos device.

References

Woolf KJ, Bisognano JD. Nondrug interventions for treatment of hypertension. J Clin Hypertens 2011;
DOI: 10.1111/j.1751-7176.2011.00524.x.

People who regularly eat white fruit, such as apples and pears, may benefit from a reduced risk of stroke, scientists say.

A research team at Wageningen University in The Netherlands studied information on 20,069 men and women, aged 20 to 65 years, who were free from cardiovascular disease at the start of the study.

Participants provided details on their dietary habits and were followed to see whether they had a stroke during the next ten years.

There were 233 cases of stroke during the study period and the researchers found no link between consumption of green, orange, yellow, red or purple fruits or vegetables and stroke risk.

However, a high intake of white fruits and vegetables - in particular apples and pears - was associated with a reduced risk of stroke.

For every 25g/day increase in white fruit and vegetable consumption, a person's risk of having a stroke dropped by nine per cent.

The findings are published in Stroke: Journal of the American Heart Association and were welcomed by Dr.Sharlin Ahmed, research liaison officer at the Stroke Association.

She said: 'It's interesting to see that fruit and vegetables with white flesh, such as apples and pears, could reduce a person's stroke risk more so than others.

'However, this should not deter people from eating other colours of fruit and veg as they all have health benefits and remain an important part of a staple diet.'

Smokers should be encouraged to use smokeless cigarettes to prevent tobacco-related illness and death, a government-backed report says.

Smokeless cigarettes do not contain the harmful toxins and cancer-causing chemicals that are found in regular cigarettes, but still deliver nicotine to the lungs.

According to the Cabinet Office's behavioural insight team, the technology could save tens of thousands of lives.

A report in the Guardian newspaper reveals that the team believes encouraging smokers to manage their nicotine addiction - as opposed to telling them they will die if they do not quit - is more likely to be effective.

'It will be important to get the regulatory framework for these products right, to encourage new products,' the Guardian quotes the report as saying.

'If alternative and safe nicotine products can be developed which are attractive enough to substitute people away from traditional cigarettes, they could have the potential to save tens of thousands of lives a year.'

The behavioural insight team was previously responsible for the introduction of a system of 'prompted choice' on organ donor registration for people renewing or applying for driving licenses.

It is hoped that the system will lead to a significant increase in the number of organ donors.

Nearly two-thirds of people in the UK are affected by back pain, according to a new survey from Pfizer.

The company commissioned Vision Critical Sydney to question 2,391 Britons about their experience of back pain and its impact on their daily lives.

Sixty-two per cent of respondents said they had back pain, with 50 per cent revealing they had suffered for more than five years.

The research also found that back pain affected people's physical ability to perform daily activities in 21 per cent of cases, and their sexual relationships in 19 per cent of cases.

Dr. Ollie Hart, a GP with a special interest in chronic pain, said that GPs often treat back pain as a routine condition.

He revealed: 'Neuropathic (nerve-related) back pain is typically under-diagnosed but healthcare professionals can use simple checks, including asking their patients some key questions about the specific types of pain they are experiencing.'

According to Dr. Hart, descriptions of freezing, shocking, crawling or burning pain may be indicators of neuropathic back pain.

A number of factors may contribute to back pain, according to the charity BackCare, such as heavy lifting, mental stress and depression.

People who have raised yellow patches of skin on their upper or lower eyelids may face a heightened risk of heart disease, scientists say. The patches, known as xanthelasmata, were already known to be deposits of cholesterol, but half of people with these deposits do not test positive for high blood cholesterol.

Scientists at the University of Copenhagen surveyed 12,745 people, aged 20 to 93, who were free from heart disease at the start of the study in 1976-78.

Participants were then followed until May 2009 to see whether those with yellow patches around their eyelids were more likely to develop heart disease.

They found that 4.4 per cent of people had xanthelasmata at the start of the study and that these individuals were more likely to have a heart attack, develop heart disease or die within ten years than those without the deposits.

Men between the ages of 70 and 79 were most at risk, according to a study report in the British Medical Journal.

However, the researchers noted that white or grey rings around the cornea of the eye were not associated with an increased risk of cardiovascular disease or death.

Judy O'Sullivan, senior cardiac nurse at the British Heart Foundation, said that the yellow patches can be particularly useful for flagging up the need for further investigation in young people with a family history of heart disease.

But she noted: 'This study showed xanthelasmata most accurately predicts heart disease risk in people aged over 70 - an age group known to be at a higher risk anyway and often already being treated.

Britons are increasingly relying on the internet to provide health information, rather than treating their doctor as the first port of call, a survey suggests.

Research by Simplyhealth found that nearly 50 per cent of people believe the way they seek health-related information and advice has changed over the past decade.

Thirty-one per cent of people now use the internet to see if their symptoms warrant a trip to their GP; and 79 per cent of 18 to 24-year-olds say they would share information about their health over the internet.

The survey, which was carried out by YouGov among 5,097 adults, also revealed that 58 per cent of people would rather rely on the internet than visit a health professional for advice.

Raman Sankaran, a spokesman for healthcare provider Simplyhealth, said that online healthcare resources 'fit in to our modern, busy lifestyles'.

'In a world where time is a precious commodity, our survey demonstrates a growing trend to use the internet to not only seek health information and advice but to engage in online conversations about health,' the expert observed.

Simplyhealth's research also found that 56 per cent of people who would be willing to share information about their symptoms online would consider taking part in an instant web chat with a doctor.

Britons' apparent desire to avoid making trips to the GP surgery could be a reflection of concerns about increasing NHS waiting times.

New figures for England show that the number of patients waiting more than 18 weeks for NHS treatment has risen slightly over the last 12 months.

September 14, 2011 — The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is just as common among patients with chronic kidney disease (CKD) as it is among the general public, despite concerns about the nephrotoxicity of these drugs, according to a study published in the September/October issue of the Annals of Family Medicine.

"Our findings suggest there may be large numbers of individuals with CKD, many of whom unaware of their disease, who may be at risk for further kidney injury through use of NSAIDs," write Laura Plantinga, ScM, from the University of California, San Francisco, and other members of the Centers for Disease Control and Prevention CKD Surveillance Team.

"CKD screening in those who use NSAIDs daily, and effective communication of the risks of NSAID use among those with CKD may be warranted to prevent further kidney damage and progression of disease," the investigators add.

The study used data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004 to examine the use of over-the-counter and prescription NSAIDs in relation to CKD.

Better Risk Communication Needed

The authors suggested that the nephrotoxicity of and potential interactions with NSAIDs may need to be more clearly communicated to primary care physicians and other prescribers.

"Primary care physicians, who are likely to manage both early-stage CKD and indications for NSAID use, should be aware of NSAID (both prescribed and over-the-counter) use, assess the risk of NSAID use in each patient, and, most importantly, engage each patient in informed decision making about the risks and benefits of NSAID use," they recommend.

The study included a total of 12,065 adult survey participants (mean age, 51 years) who answered questions about both demographics and medication use and provided samples for the measurement of serum creatinine and urine albumin and creatinine.

CKD status was defined by using estimated glomerular rate (eGFR) and albumin-to-creatinine ratio (ACR) as follows:

• No CKD: eGFR ≤ 60 mL/ min per 1.73 m2, and ACR ≤ 30 mg/g
• Mild CKD (stages 1 and 2): eGFR ≥ 60 mL/min per 1.73 m2, and ACR ≥ 30 mg/g
• Moderate to severe CKD (stages 3 and 4): eGFR 15 to 59 mL/min per 1.73 m2

In total, 80% of the study participants were classified as having no CKD (mean age, 47 years), 9% as having mild CKD (mean age, 57.5 years), and 11% as having moderate to severe CKD (mean age, 73 years).

Awareness of CKD Very Low

Awareness of having CKD, defined as a yes or no answer to "Have you ever been told by a doctor or other health professional that you have weak or failing kidneys?" was very low among study participants, with 95.6% of those with mild disease and 90% of those with moderate to severe disease being unaware of their illness.

NSAID use was defined by self-reported use of ibuprofen, naproxen, sulindac, piroxicam, indomethacin, tolmetin, or diclofenac (with brand names and combination formulas identi?ed) daily or nearly every day for the past 30 days.

Long-term use was de?ned as use for 1 year or longer.

Self-reported cardiovascular disease, hypertension, obesity, cancer, arthritis, and use of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers were also recorded.

Overall, current use of NSAIDs was "not uncommon" (3.5%) in the general US population and "low but not rare" among those with both mild and moderate to severe CKD (4.3% and 5.7%, respectively), report the authors. "At a population level, this percentage reflects up to 870,000 persons in the United States with advanced CKD who are using NSAIDs," they write."Among those with CKD, current NSAID use was similar among those [who] were aware and those who were unaware of their CKD status (5.7% vs 5.0%, P = .80)," they note.

In addition, long-term use of NSAIDs was reported by two thirds of users (66%) and did not differ between those with and those without CKD.

Among patients with CKD who reported NSAID use, 10% of those with moderate to severe disease and 11% of those with mild disease reported having an NSAID prescription, "possibly reflecting the lack of both clinician awareness of CKD status and possible adverse effects of NSAIDs in patients with CKD who have additional competing indications for NSAID use," the authors suggest.

Although arthritis was reported by 28% of the overall cohort, it was more common in patients with CKD (35% of those with mild CKD and 44% of those with moderate to severe CKD) than in those without CKD (23%).

Patients with CKD who used NSAIDs also reported other prescription drug use. Specifically, 16% of NSAID users with stage 3 CKD and 20% with stage 4 CKD also had prescriptions for angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and loop diuretics.

Contradictory Evidence

While describing the "general consensus" that NSAIDs should be avoided in CKD, the authors also acknowledge that there is contradictory evidence for this risk, a factor that might contribute to the continuing use of NSAIDs in this population. Additionally, they suggest that in considering patients’ overall quality of life, the benefits of NSAID use may be considered to outweigh the risks.

Asked to comment on the findings, Jeffrey Berns, MD, professor of medicine and pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, said they did not ring any alarm bells.

"The number of people taking significant amounts of NSAIDs was actually not that high," he told Medscape Medical News. "Among those who had some impairment of kidney function…a small percentage of them were taking NSAIDs on a long-term basis, and of that relatively small number of patients some may have had an impact on their kidney function because of the NSAID use."

But it's still an open question as to how much NSAID use contributes to kidney problems, he added.

"We don’t have great evidence to indicate the regular, low-dose NSAID use is deleterious in terms of kidney disease progression or even short-term GFR in the vast majority of patients."

A more contemporary cohort of patients might look quite different, he added, given that current awareness of CKD is much higher than it was at the time of the survey.

"There were a lot of patients who were unaware that they had CKD. I'm not sure that is the case any longer. I think [today] their doctors would be more likely to be aware of CKD, and more attentive to their patient's NSAID use."

"Patients don't always report over-the-counter medication use, so one of the messages out of this paper is to emphasize to physicians that they ought to be asking about this."

The study was supported under a cooperative agreement from the Centers for Disease Control and Prevention through the Association of American Medical Colleges. One of the study authors (Dr. Robinson) received grants in the last 3 years from Abbott Laboratories, Amgen, Genzyme Corporation, and Kyowa Hakko Kirin. Another study author (Dr. Powe) is partially supported by the National Institute of Diabetes and Digestive and Kidney Diseases. No other study authors have disclosed relevant financial relationships. Dr. Berns is editor-in-chief of Medscape Nephrology and has served as an advisor or consultant for Amgen Inc. Ann Fam Med. 2011;9:423-430.Abstract

Women who drink plenty of milk during their teenage years appear to enjoy lasting health benefits, US scientists say. A research team at Harvard University looked at more than 37,000 women to assess the links between food intake and health risks.

They found that those who had about four servings of milk products a day during their teenage years tended to have a lower risk of type-2 diabetes than those who had a low intake.

In addition, women who had consumed plenty of milk as teenagers were more likely to continue drinking milk throughout adulthood and less likely to have gained weight over time.

The findings, which are published in the American Journal of Clinical Nutrition, could have important implications in the UK, where rates of diabetes are rising.

A recent report from the NHS Information Centre revealed that diabetes now accounts for nearly a tenth of the health service's annual drugs bill, with approximately £725 million spent on drugs for the disease in 2010-11.

People who lead a healthy lifestyle and eat plenty of vegetables can reduce their risk of heart failure, scientists have found.

Researchers at the Pennington Biomedical Research Centre in the US followed 18,346 men and 19,729 women from Finland, aged 25 to 74 years.

Participants were followed for around 14 years, during which time 638 of the men and 445 women developed heart failure.

The researchers found that male and female smokers had an 86 per cent and 109 per cent higher risk of heart failure, respectively, than non-smokers.

Overweight men were 15 per cent more likely to develop heart failure than normal-weight people, and overweight women were 21 per cent more likely.

The increase in risk was even more apparent for obese men and women, who were 75 per cent and 106 per cent more likely to develop heart failure, respectively.

Regular exercise and a diet rich in vegetables were also found to significantly reduce people's risk of heart failure, according to the study report, which is published in the journal Circulation: Heart Failure.

Lead author Dr Gang Hu suggested that about half of all new heart failure cases in the study population could have been prevented if everyone had adopted at least three healthy lifestyle behaviours.

He added: 'Any steps you take to stay healthy can reduce your risk of heart failure.'

Heart failure occurs when the organ is no longer able to pump blood around the body effectively. It often occurs after a heart attack, but may also develop slowly as a result of high blood pressure or excessive alcohol consumption. ADNFCR-554-ID-800728678-ADNFCR

Cases of tuberculosis (TB) that are resistant to some of the most powerful drugs are on the rise across Europe, the World Health Organisation (WHO) has warned.

Doctors have been urged to keep an eye out for multidrug-resistant TB, which causes around 81,000 new cases each year in Europe.

This form of the disease now accounts for almost 12 per cent of newly diagnosed cases of TB, and almost half of people with the disease will die because of the lack of effective treatments.

According to WHO experts, the disease is spreading at an 'alarming rate', including a particularly deadly form known as extensively drug-resistant TB.

And newer, more effective drugs are unlikely to be commercially available until 2013 at the earliest.

Dr. Ibrahim Abubakar, a TB expert at the Health Protection Agency's centre for infections, said: 'I think without a doubt there's a need to make all healthcare workers, but GPs and A&E staff in particular, aware of the signs and symptoms of TB so they can recognise this earlier.'

Symptoms of pulmonary TB - which affects the lungs - include a persistent cough with thick (sometimes bloody) phlegm; increasing breathlessness; weight loss; lack of appetite; high temperature; and extreme tiredness.

The disease can also spread to other parts of the body, causing a range of symptoms depending on the affected area.

Parents in the UK could be prevented from learning the sex of their unborn baby if a European proposal gets the go-ahead.

The Council of Europe's equal opportunities committee has passed a draft resolution stating that doctors should be told to 'withhold information about the sex of the foetus'.

The proposed change is a reaction to the practice of selectively aborting babies on the basis of their gender - a trend that is becoming increasingly common in some former Soviet states.

If approved at the council's parliamentary assembly in October, the rule would apply to all European member states.

Cathy Warwick, general secretary of the Royal College of Midwives, commented: 'This is a complex issue, but the predominant issue in the UK is that we expect women to be given information about their pregnancy.'

Ms Warwick said there are no ethical reasons to withhold this information, unless there is evidence it would be used for foetal selection.

She pointed out that this practice, other than for sex-linked diseases, 'would be illegal under the framework for termination'.

The majority of mums are not shown how to care for their baby's umbilical cord wound, a survey has found.

Parenting website Mumsnet polled more than 1,000 parents on behalf of nappy brand Huggies.

Its survey revealed that 72 per cent of mums were confused about how to deal with their new baby's cord wound, as they had not been shown how to care for it before giving birth.

Almost seven in ten respondents said they felt nervous when touching or cleaning their baby's wound and some said they had cleaned it by filling it with salt or honey or rubbing earth on the cord.

Speaking on behalf of Huggies, midwifery expert Nikki Khan said: 'It's very interesting that so many parents are obviously confused about how to care for their baby's cord in those very early days.

'The advice has changed over the years and many mums will hear various different bits of advice from friends and family, so it's no wonder that parents are unsure.'

According to Ms Khan, midwives now advise parents not to routinely clean the cord and to allow the wound to heal and dry naturally.

If cleaning becomes necessary due to the wound becoming contaminated, this should be done using cool boiled water and cotton balls.

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Scientists have identified a number of genes that appear to influence a person's risk of developing high blood pressure.

An international study published in Nature journal found that common genetic factors in 28 regions of DNA are associated with blood pressure in humans.

The research looked at the genes of more than 275,000 people from around the world and uncovered an important new physiological pathway involved in the control of blood pressure - a discovery that could pave the way for the development of new treatments.

Dr. Christopher Newton-Cheh, senior author from Massachusetts General Hospital in the US, said: 'Identifying these novel pathways expands our current understanding of the determinants of blood pressure and highlights potential targets for new drugs to treat and prevent cardiovascular complications.'

A second paper published in the journal Nature Genetics also uncovered six novel genetic variants that play an important role in high blood pressure.

Professor Peter Weissberg, medical director at the British Heart Foundation, which co-funded both studies, said that millions of people in the UK have high blood pressure.

'But your genes are only one piece of the puzzle,' he noted. 'You are less likely to have high blood pressure if you stick to a healthy diet, do plenty of exercise and maintain a healthy weight.'

A new medical device launched by a British company may help doctors to diagnose Alzheimer's disease at an earlier stage.

Cambridge Cognition says that its new Cantab Mobile test will be available in GP surgeries following successful NHS trials.

The test allows doctors to carry out a simple yet accurate cognitive assessment in around ten minutes.

It works by comparing the patient's test results with those of thousands of other patients.

'This test can detect the earliest signs of dementia before the damage is done, so that more effective interventions can be made to prolong the patient's independence,' the company said in a statement.

Dr. Anne Corbett, research manager at the Alzheimer's Society, said that finding ways to improve the early identification of dementia is 'essential', as around 60 per cent of patients never receive a diagnosis.

'This tool could help change this appalling picture,' Dr. Corbett claimed. 'However, it is too early to tell if it will prove to be a usable, effective and accurate tool for GPs.

'We must now wait for the results of the trials to see if it could fit into the wider diagnostic process.'

People with diabetes are at risk of preventable complications as a result of not having regular health checks, a leading national charity has said.

Diabetes UK revealed that more than half a million people in England could be at risk of blindness because they do not attend annual retinal screening to test for eye disease.

Meanwhile, 32 per cent of people with type-1 diabetes and 15 per cent of people with type-2 diabetes have not had a foot check.

This is vital as it can help to prevent the need for amputation - 100 instances of which occur each week in people with diabetes.

The figures are reflected throughout Britain, with estimates suggesting that 56,000 Scots with diabetes may be at increased risk of amputation, while 27,000 people in Wales could lose their sight.

Barbara Young, chief executive at Diabetes UK, said: 'Diabetes is a serious condition which can lead to devastating long-term complications including blindness, kidney failure and amputations.

'The tragedy is that, for example, 90 per cent of cases of sight loss could have been avoided if they had been identified early enough and treated appropriately.'

Diabetes UK is promoting a checklist of 15 measures to ensure people with diabetes get the care they need.

Patients are advised to use the checklist and demand they receive the recommended standards of care and specialist services.

UK cardiologists have found that some patients with heart failure may benefit from a heart scan using a technique called cardiovascular magnetic resonance (CMR).

At present, an invasive technique called an angiogram is used to diagnose heart failure resulting from dilated cardiomyopathy.

However, experts at Royal Brompton Hospital say that CMR could provide a simpler and more cost-effective approach.

The technique captures images of the heart muscles and enables doctors to spot scarring of the heart wall that would not be visible with an angiogram.

Dr. Sanjay Prasad, consultant cardiologist at Royal Brompton, explained that an angiogram cannot help to diagnose and treat patients with DCM who have unobstructed arteries.

'Using CMR, we were able to identify a pattern of scarring to the heart tissue caused by DCM in patients who have early onset heart failure,' he revealed.

The researchers have tested the technique in 120 patients. Their results, which are published in Circulation journal, show that it enabled them to correctly diagnose 95 per cent of cases of DCM.

Professor Peter Weissberg, medical director of the British Heart Foundation, which helped to fund the research, said: 'This research could have a big impact on the way thousands of patients are tested in the future.'

Parents who lose a child during its first year of life are significantly more likely to die early, a study has found.

Researchers looked at a random five per cent sample of registered deaths in the UK, among parents whose child had survived beyond the first year of life or died within 12 months of birth between 1971 and 2006.

They discovered that bereaved mothers in England and Wales were more than four times as likely to die in the first 15 years after losing a child as those who did not lose a child in this way.

Parents in Scotland were more than twice as likely to die or lose their partner in the first 15 years after the loss of a child.

The researchers also observed that this increased risk of mortality was still apparent up to 25 years after the child's death.

Writing in the journal BMJ Supportive & Palliative Care, the study authors claimed: 'It is imperative that cause of death be further investigated in order to establish the factors leading to increased mortality in bereaved parents.'

According to stillbirth and neonatal death charity Sands, 17 babies are stillborn or die shortly after birth every day in the UK.

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Women who have one alcoholic drink a day may be healthier in later life than those who drink more heavily or abstain, a study has found.

Researchers at the Harvard School of Public Health analysed information provided by women who had enrolled in the US Nurses' Health Study.

They found that middle-aged women who drank between one-third of a drink and one whole drink per day were around 20 per cent more likely to have good overall health when older than non-drinkers.

Women who drank on most days of the week were almost 50 per cent more likely to have good overall health than those who did not drink.

Publishing their findings in the journal PLoS Medicine, the study authors concluded: 'These data suggest that regular, moderate consumption of alcohol at midlife may be related to a modest increase in overall health status among women who survive to older ages.'

Figures published by the NHS Information Centre indicate that 55 per cent of adult women in England drank an alcoholic beverage on at least one day per week in 2009.

Women who use medicines such as ibuprofen and naproxen during early pregnancy may face a heightened risk of miscarriage, experts have warned.

The drugs are examples of non-steroidal anti-inflammatory drugs (NSAIDs) and are commonly taken to relieve pain and inflammation.

However, scientists at the University of Montreal have found that women who take any type and dosage of these drugs in early pregnancy face a 2.4-fold increase in their risk of miscarriage.

The scientists looked at 4,705 cases of miscarriage up to 20 weeks' gestation and found that 7.5 per cent occurred in women who had taken non-aspirin NSAIDs.

They also analysed 47,050 women who did not miscarry and found that just 2.6 per cent of them had been exposed to non-aspirin NSAIDs.

Researcher Dr Anick Berard, whose findings are published in the Canadian Medical Association Journal, concluded: 'The use of non-aspirin NSAIDs during early pregnancy is associated with statistically significant risk (2.4-fold increase) of having a spontaneous abortion.'

The study authors advised that non-aspirin NSAIDs 'should be used with caution during pregnancy'.

Janet Fyle, from the Royal College of Midwives, said that midwives often advise women to avoid buying over-the-counter medication for pain relief.

'If a pregnant woman does need to take any analgesia, then paracetamol would be appropriate,' she added.

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Ovarian screening is not a reliable way of diagnosing early-stage cancers, according to early results from a UK study.

Researchers at the University of Manchester and Central Manchester University Hospitals NHS Foundation Trust looked at 1,004 women, all of whom were concerned about their risk of ovarian cancer.

Out of more than 900 women who underwent ovarian screening, 23 developed the disease and just nine were detected when their cancer was at an early stage.

This means that 61 per cent of the women who developed ovarian cancer after being screened for the disease were only diagnosed when their cancer was advanced or had spread through their body.

Study leader Professor Gareth Evans said that women with a family history of ovarian cancer 'can't rely on screening'.

He said: 'Once they've completed their family and if they're over 40, they should consider having their ovaries removed.'

However, just one in five women over 60 choose to have their ovaries removed within eight years of testing positive for a genetic fault that increases their risk of ovarian cancer.

The professor is due to discuss his work at the British Society for Human Genetics annual conference tomorrow (September 7th).

More than 6,500 women in the UK were diagnosed with ovarian cancer in 2008, according to figures from Cancer Research UK.

Women do not suddenly become more likely to die of a heart attack after the menopause, US scientists have found.

Older women are known to have an increased risk of cardiovascular death than younger ones, and scientists have previously assumed that the arrival of menopause and its hormonal impact was to blame.

Now, however, a research team at Johns Hopkins University School of Medicine has shown that heart disease mortality rates progress at a constant rate as women age and do not spike sharply after menopause.

Lead researcher Dr. Dhananjay Vaidya, whose findings are published in the British Medical Journal, said: 'What we believe is going on is that the cells of the heart and arteries are ageing like every other tissue in the body, and that is why we see more and more heart attacks every year as women age.'

The scientist added that ageing itself is 'an adequate explanation' for the increase in heart attacks and that menopause 'does not seem to play a role'.

Amy Thompson, senior cardiac nurse at the British Heart Foundation, said that experts are still a long way from fully understanding the gender differences in heart disease.

She added that much more research is needed 'to find out what is going on and why'.

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August 25, 2011 - Arterial calcification in major vessel beds outside the brain, as shown with magnetic resonance imaging (MRI), is associated with vascular brain disease and may be linked to future risk for dementia and stroke, a new study shows.

"Most notably, larger intracranial carotid calcification load relates to larger WML [white matter lesion] volumes, and larger extracranial carotid calcification load relates to the presence of cerebral infarcts, independently of ultrasound carotid plaque score," the authors, led by Daniel Bos, MD, from Erasmus Medical Center, Rotterdam, the Netherlands, write. Such calcification "provides novel insights into the etiology of vascular brain disease," the authors note.

"The relationship between calcium in atherosclerotic plaque and brain changes exists on top of the effect of classic cardiovascular risk factors such as high blood pressure, smoking and diabetes," senior author Meike W. Vernooij, MD, PhD, also from Erasmus Medical Center, said in a statement.

The amount of calcified plaque outside the brain provided more information about the extent of brain changes than traditional ultrasound measures of plaque in the carotid artery, the authors add.

The findings were published online August 25 in Arteriosclerosis, Thrombosis and Vascular Biology.

The researchers studied 885 community-dwelling people (50.8% women), mean age 66.7 years, who were participants in the Rotterdam Study, a prospective, population-based cohort study on causes of disease in the elderly.

The authors used computed X-ray tomography (CT) scans to measure calcification in the coronary arteries, aortic arch, and extracranial and intracranial carotid arteries. They also used brain MRI scans to assess cerebral infarcts, microbleeds, and WMLs, which are considered important markers of vascular brain disease.

The study found that higher CT calcification was associated with larger WML volume and the presence of cerebral infarcts, but not with presence of cerebral microbleeds.

The strongest associations were between intracranial carotid calcification and WML volume, and between extracranial carotid calcification and infarcts. Adjusting for cardiovascular risk factors or ultrasound carotid plaque scores did not change these results.

"The distinction between the impact of calcification in the extracranial and intracranial carotids adds to the current belief that [WMLs] mainly result from disease in smaller intracranial vessels, while brain infarctions are thought to be mainly caused by larger vessel disease," Dr. Vernooij said in a statement.

The authors note that using CT-calcification measurement on a large scale means exposing people to radiation and requires further research.

They add that they can speculate about the possibilities for using CT for such a purpose in the future and point out that at this time, CT is being used more frequently for both diagnostic and screening purposes.

"It is a long way from these results towards making meaningful inferences on what this means for screening individual subjects with CT. Primarily, this study provides novel insight into the link between atherosclerosis and vascular brain disease, which we will use for further studies on how atherosclerosis may affect brain function, and ultimately the risk to develop dementia," Dr. Vernooij told Medscape Medical News.

Dr. Vernooij added that this does not imply that screening for vessel calcification will be cost-effective.

"In the short term, a practical use of our findings in clinical practice could be found in the fact that cardiac CT scans are increasingly performed to assess the risk for coronary heart disease. For a clinician, it may be useful to understand that calcification in coronary arteries, though far away from the brain, may indicate presence of subclinical brain disease as well. However, at present this does not have, yet, implications for therapeutic management," Dr. Vernooij said.

In general, calcification is a marker for chronic and more extensive vascular disease, Joseph Broderick, MD, Albert Barnes Voorheis Chair of Neurology at University of Cincinnati, Ohio, told Medscape Medical News.

"This study of arterial calcification in 4 vascular beds by CT, and correlating this with brain parenchymal changes on MRI, has not been done before," Dr. Broderick, a spokesperson for the American Academy of Neurology, said. "However, it is not surprising that [intracranial carotid artery] calcification correlates better with MRI tissue changes than coronary or aortic arch calcification."

He added that he found it "interesting" that large-vessel calcification load was not associated with microbleeds. "However, these microbleeds have generally been associated with small-vessel, rather than large-vessel, disease. For instance, amyloid vascular disease in brain is small-vessel disease of the cortical vessels."

The findings from this study are consistent with a growing body of knowledge, Patrick Lyden, MD, chairman of the Department of Neurology at Cedars-Sinai Medical Center, Los Angeles, California, told Medscape Medical News.

"These patients all had atherosclerosis; they had hardening of the arteries. That's all that calcium is telling you, that there's hardening of the arteries, so you see hardening of the arteries outside the brain, and that tells you there is something wrong in the brain."

Dr. Lyden noted that originally, Alzheimer's disease was thought to be caused by atherosclerosis in the brain.

"When Alzheimer published his very first paper in Germany, he said that Alzheimer's disease was really due to hardening of the arteries in the brain. Then, about 30 years ago, a very clever biochemist showed that no, it has nothing to do with hardening of the arteries. It's all about amyloid, it's all about plaques and tangles in the brain, and so the vascular part of the story was forgotten. But in the last 5 years, the vascular part of the story has been rediscovered, and doctors are paying attention to it again," he said.

Dr. Bos and Dr. Lyden have disclosed no relevant financial relationships. Dr. Vernooij was supported by an Alzheimer's Association Grant.

Arteriscler Thromb Vasc Biol. Published online August 25, 2011. Abstract.

Opticians could help to identify people with undiagnosed type-2 diabetes by performing simple finger prick tests during routine eye exams, experts have claimed.

Scientists at Durham University believe that screening in opticians, chiropodists and dentists could help to identify many of the people who do not realise they have diabetes.

To test their idea, they launched a pilot study in collaboration with the James Cook University Hospital in Middlesbrough.

Among the 1,000 patients who had one or more risk factors for diabetes and had their blood glucose levels checked during an eye test, almost 32 per cent were referred to their GP for further investigation.

The findings, which are published in the British Journal of General Practice, suggest that opticians could play a role in diagnosing people at an early stage of the disease so that they receive timely treatment.

Lead author and former optician Dr Jenny Howse, from Durham University's School of Medicine and Health, said: 'In the UK, our initial results show screening for diabetes in opticians is a feasible option but we now need to look at the practicalities of delivering it, including liaison between opticians and GPs and the time costs for opticians.'

Simon O'Neill, director of care and advocacy at the charity Diabetes UK, warned that finger prick tests can be 'misleading'.

However, he conceded: 'A commitment to find new ways to ensure early diagnosis of type-2 diabetes is always positive.'

UK scientists have found that a decrease in smoking rapidly leads to a reduction in mortality rates, both in individuals and across populations, within six months.

Meanwhile, the positive effects of dietary improvements become apparent within one to three years.

Writing in the Lancet medical journal, Professor Simon Capewell and Dr. Martin O'Flaherty, from the University of Liverpool, revealed that the introduction of smoke-free legislation in Scotland in 2006 was followed by a 17 per cent drop in hospital admissions for acute coronary syndrome.

Meanwhile, similar legislation in Helena in the US led to a 40 per cent drop in admission rates for acute coronary syndrome within six months in one hospital.

Professor Capewell said that smoking bans and dietary improvements 'powerfully and rapidly' reduce chronic disease.

He revealed: 'This actually happens quickly, within a far shorter timescale than had previously been assumed; within months and years rather than decades.'

The professor added that policies such as smoking bans and reducing the amount of saturated fat in the nation's diet could save the NHS millions of pounds in a short space of time.

According to the NHS Information Centre, 21 per cent of adults in England smoked in 2009.

McDonald's will add calorie information to all of its menus from Wednesday September 7th, the government has revealed.

Customers at all 1,200 outlets in the UK will easily be able to see how many calories are in their chosen meal.

The move is part of the fast food chain's commitment to the Responsibility Deal, which aims to tackle public health concerns without imposing regulations on companies.

By the end of 2011, more than 5,000 high street food outlets - including KFC, Pizza Hut and Pret a Manger - should have visible calorie labelling.

Jill McDonald, chief executive officer and president of McDonald's UK, said: 'This move ... supports the principles we believe are important: giving our customers clear information to help them make decisions that are right for them and provide a choice on our menu.'

Health secretary Andrew Lansley welcomed the move, describing it as a 'great achievement'.

He revealed that one in six meals are eaten outside the home and that calorie labelling should help people to 'keep an eye on their waistlines'.

Research by consumer group Which? suggests that the majority of people want to see calorie information when dining out. Richard Lloyd, the organisation's executive director, said that all major national food chains should voluntarily provide calorie information or, if necessary, be forced to do so by the government.

Patients who take cholesterol-lowering statins benefit from a lasting reduction in their risk of dying from infection or respiratory illness, new research shows.

Scientists at Imperial College London have analysed data on patients involved in the Anglo-Scandinavian Cardiac Outcomes Trial (Ascot) - a major statin therapy trial that ended early in 2003 as the benefits of the drugs for preventing heart attacks and strokes were so apparent.

The latest analysis, published in the European Heart Journal, shows that patients who were prescribed statins during the trial are still benefiting from a reduced risk of death from infection and respiratory illness, eight years on.

Of the 4,605 UK patients who took part in the trial, overall mortality after 11 years of follow-up is 14 per cent lower among those who took statins, largely due to fewer deaths from infection and respiratory disease.

Lead researcher Professor Peter Sever, from the International Centre for Circulatory Health at Imperial College London, admitted that the result was 'very unexpected'.

He said: 'The benefits of statins for preventing heart attacks and strokes are well-established, but after long-term follow-up the most significant effects seem to be on deaths from other causes.

'It's quite remarkable that there is still this difference between the two groups, eight years after the trial finished.'

The scientist added that more research is now needed to explain how statins may help to prevent deaths from other illnesses.

There are now several different statins available in the UK, including atorvastatin, fluvastatin and simvastatin.

There has been an increase in rates of stroke-related hospital admissions among teenagers and young adults in the US, a new study in the Annals of Neurology shows.

Researchers at the Centers for Disease Control and Prevention (CDC) looked at data on US patients between 1995 and 2008.

They found that rates of hospitalisation for ischaemic stroke - caused by blood clots or the build-up of fatty deposits inside blood vessels - increased up to 37 per cent between 1995 and 2008 among 15 to 44-year-olds.

There was also a 31 per cent increase in hospitalisations for ischaemic stroke among five to 14-year-olds, and a 30 per cent rise among 15 to 34-year-olds.

Lead author Dr. Mary George, a medical officer with CDC's heart disease and stroke prevention division, confirmed: 'We identified significant increasing trends in ischaemic stroke hospitalisations among adolescents and young adults.

'Our results from national surveillance data accentuate the need for public health initiatives to reduce the prevalence of risk factors for stroke among adolescents and young adults.'

Dr. Lorna Laywood, a spokeswoman for the UK's Stroke Association, said that around 400 children have a stroke every year in the UK.

She revealed that the biggest risk factor is high blood pressure, while obesity, diabetes, poor diet and smoking also play a role. ADNFCR-554-ID-800717628-ADNFCR

August 26, 2011 - All women undergoing cesarean delivery should undergo thromboembolism prophylaxis at the time of delivery, according to an American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin published in the September 2011 issue of Obstetrics & Gynecology. The new bulletin, entitled "Thromboembolism in Pregnancy," aims to summarize evidence and recommendations regarding risk factors, diagnosis, management, and prevention of thromboembolism, especially venous thromboembolism (VTE), in pregnancy.

"VTE is a major contributor to maternal mortality in this country," coauthor Andra H. James, MD, said in a news release. "The risk of VTE is increased during pregnancy and the consequences can be severe. The recommendations explain how to monitor women for these events, address certain risk factors, and treat suspected or acute cases of VTE. It's important for ob-gyns to adopt these recommendations to help reduce maternal deaths."

Compared with nonpregnant women, pregnant women have a 4-fold to 5-fold increased risk for thromboembolism. About 80% of thromboembolic events during pregnancy are venous, with pulmonary embolism and other VTE responsible for 1.1 deaths per 100,000 deliveries, or 9% of all maternal deaths in the United States.

"In the developing world, the leading cause of maternal death is hemorrhage; however, in developed nations, where hemorrhage is more often successfully treated and prevented, thromboembolic disease is one of the leading causes of death," the Practice Bulletin authors write. "The prevalence and severity of this condition during pregnancy and the peripartum period warrant special consideration of management and therapy. Such therapy includes the treatment of acute thrombotic events and prophylaxis for those at increased risk of thrombotic events."

Physiologic and anatomic changes during pregnancy increase the risk for thromboembolism. Hypercoagulability, increased venous stasis, decreased venous outflow, uterine compression of the inferior vena cava and pelvic veins, reduced mobility, and changes in levels of coagulation factors normally regulating hemostasis all result in an increased thrombogenic state. Risk for deep vein thrombosis during pregnancy is greatest in the left lower extremity.

Other risk factors for VTE unrelated to pregnancy include a personal history of VTE, thrombophilia, obesity, hypertension, and smoking.The only specific Level A ACOG recommendation (based on good and consistent scientific evidence) is that compression ultrasonography of the proximal veins is the recommended initial diagnostic test when signs or symptoms suggest new onset deep vein thrombosis.

Level B ACOG recommendations and conclusions (based on limited or inconsistent scientific evidence) include the following:

• Heparin compounds are the preferred anticoagulants in pregnancy.
• To minimize postpartum bleeding complications, a reasonable strategy is to resume anticoagulation therapy no sooner than 4 to 6 hours after vaginal delivery, or 6 to 12 hours after cesarean delivery.
• Warfarin, low molecular weight heparin (LMWH), and unfractionated heparin are compatible with breast-feeding because they do not accumulate in breast milk and do not lead to anticoagulation in the infant.

Level C ACOG recommendations (based primarily on consensus and expert opinion) include the following:

• Women with a history of thrombosis who have not been thoroughly evaluated for possible underlying causes should receive testing for antiphospholipid antibodies, as well as for inherited thrombophilias.
• For women with acute thromboembolism during the current pregnancy, or for those at high risk for VTE, including women with mechanical heart valves, therapeutic anticoagulation is recommended.
• For women in whom restarting anticoagulation is planned after