Blue Cross Laboratories Ltd.

Diabetes Care. 2013 Mar 27. (Original)

Ahren B, Leguizamo Dimas A, Miossec P, et al.

OBJECTIVE Examine the efficacy and safety of lixisenatide (20 mug once daily, administered before the morning or evening meal) as add-on therapy in type 2 diabetes patients insufficiently controlled with metformin alone.

RESEARCH DESIGN AND METHODS: A 24-week, randomized, double-blind, placebo-controlled study in 680 patients with inadequately controlled type 2 diabetes (HbA1c 7-10% [53-86 mmol/mol]).

Patients were randomized to lixisenatide morning (n = 255), lixisenatide evening (n = 255), placebo morning (n = 85), or placebo evening (n = 85) injections.

RESULTS Lixisenatide morning injection significantly reduced mean HbA1c versus combined placebo (mean change -0.9% [9.8 mmol/mol] vs. -0.4% [4.4 mmol/mol]; least squares [LS] mean difference vs. placebo -0.5% [5.5 mmol/mol], P < 0.0001).

HbA1c was significantly reduced by lixisenatide evening injection (mean change -0.8% [8.7 mmol/mol] vs. -0.4% [4.4 mmol/mol]; LS mean difference -0.4% [4.4 mmol/mol], P < 0.0001).

Lixisenatide morning injection significantly reduced 2-h postprandial glucose versus morning placebo (mean change -5.9 vs. -1.4 mmol/L; LS mean difference -4.5 mmol/L, P < 0.0001). LS mean difference in fasting plasma glucose was significant in both morning (-0.9 mmol/L, P < 0.0001) and evening (-0.6 mmol/L, P = 0.0046) groups versus placebo.

Mean body weight decreased to a similar extent in all groups.

Rates of adverse events were 69.4% in both lixisenatide groups and 60.0% in the placebo group.

Rates for nausea and vomiting were 22.7 and 9.4% for lixisenatide morning and 21.2 and 13.3% for lixisenatide evening versus 7.6 and 2.9% for placebo, respectively. Symptomatic hypoglycemia occurred in 6, 13, and 1 patient for lixisenatide morning, evening, and placebo, respectively, with no severe episodes.

CONCLUSIONS In patients with type 2 diabetes inadequately controlled on metformin, lixisenatide 20 mug once daily administered in the morning or evening significantly improved glycemic control, with a pronounced postprandial effect, and was well tolerated.

Apr 12, 2013

The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) has recommended restrictions in the use of strontium ranelate (Protelos/Osseor) to reduce the risk for adverse cardiac events in postmenopausal women.

Strontium ranelate has been approved in Europe since 2004 for the treatment of osteoporosis to reduce the risk for vertebral and hip fractures in postmenopausal women. In 2012 the indication was expanded to include men at increased risk for fracture. It is not currently approved in the United States.

In a routine benefit-risk assessment of trials involving about 7500 patients, the PRAC found an increased risk for adverse cardiac events, including myocardial infarction (MI), in women receiving strontium ranelate compared with those who received placebo. However, there was no increased risk for death.

Because of concern about other serious adverse events such as venous thromboembolism and rare but serious skin reactions with strontium ranelate, the PRAC decided to move ahead with a more in-depth risk-benefit evaluation.

In the meantime, it is recommending the following restrictions:

• Strontium ranelate should only be used for the treatment of severe osteoporosis in postmenopausal women at high risk for fracture and severe osteoporosis in men at increased risk for fracture.
• Strontium ranelate should not be used in patients with current or past history of ischemic heart disease (such as angina or MI), peripheral arterial disease, or cerebrovascular disease).
• In addition, strontium ranelate should not be used in patients with hypertension that is not controlled by treatment.

These restrictions will be sent to the EMA's Committee for Medicinal Products for Human Use (CHMP), which will adopt a final opinion at its next meeting in late April. The European Commission, the executive branch of the European Union, will then issue a final decision.

"Pending confirmation from the Committee for Medicinal Products for Human Use (CHMP), this will be the first time that a [routine] assessment leads directly to a recommendation to restrict the use of a medicine," a PRAC question-and-answer document notes.

Among the nation's newest medical schools are 2 that stand out for the career path they are emphasizing: primary care.

Quinnipiac University's Frank H. Netter MD School of Medicine in North Haven, Connecticut, and the University of California–Riverside School of Medicine both will admit their first students in August. They hope to at least double the percentage of graduating physicians who typically choose primary care.

A study published online December 4 in JAMA found that only 21% of third-year residents planned to enter internal medicine.

Primary Care Shortage Critical in California

In California, the need for the medical school mirrors the dire need for primary care physicians in the surrounding counties.

The area surrounding the Riverside medical school, known as the Inland Empire, has 40 primary care physicians per 100,000 people, according to the California Health Care Almanac, which is far short of the federally recommended 60 to 80 primary care physicians per 100,000 population.

Riverside's Vice Chancellor for Health Affairs and Senior Executive Dean Phyllis Guze, MD, FACP, said that means people asking to see a primary care physician have to wait several months. "And that's just the people who have insurance."

The medical school's primary care focus will be evident in changes regarding where and with whom students learn.

First, most of the teaching will come in an ambulatory setting.

"Maybe 80% to 90% of traditional medical education has occurred in the hospital, whereas 93% of all medical care occurs in the ambulatory setting," Dr. Guze said.

In flipping that clerkship model, students from their first year will pair up with a physician in an ambulatory setting and follow particular families throughout their medical school years.

Another piece of the model will be working on a community service project. A student on a pediatric rotation might collaborate with community members working to improve immunization rates, and someone in an internal medicine rotation might staff a teenager pregnancy hotline, Dr. Guze said.

Often-cited reasons for low numbers of physicians choosing primary care include perceived lack of prestige compared with specialists and schedules that can be high-volume and chaotic. However, often the choice comes down to finances. Students commonly graduate with 6-figure debt loads and then do not make nearly as much as specialists make.

Dr. Guze said one way Riverside is battling that disparity is by offering a scholarship-to-loan program. Scholarships will be awarded on the basis of merit and need. If students practice primary care in the region, they keep the money as a scholarship. If they decide against primary care, the scholarship becomes a loan.

Quinnipiac Board Makes Personal Commitment

Quinnipiac has developed a similar program called the Primary Care Fellowship.

Bruce Koeppen, MD, founding dean of the Netter school, told Medscape Medical News that at least one fellowship will be offered in the charter class of 60 students, which begins in August. The fellowship includes a full tuition and fee waiver for 4 years. If the graduate practices in primary care for 4 years, he or she keeps the money. If not, it becomes a loan.

"We hope eventually that we will have the capacity to name every single student in every class a primary care fellow if that's their desire," Dr. Koeppen said.

Original funding for the fellowship came from a board member who said, according to Dr. Koeppen, "I'm committing $50,000 today on the condition that by the end of today 3 more of you match my gift."

"This was 4 in the afternoon. By 6 pm, we had $200,000 in the endowment," Dr. Koeppen said.

That support - from the board to the administration, as well as the faculty hired according to their support of primary care - is essential to the success of the mission, Dr. Koeppen said. Buy-in also extends to the partner hospitals.

"As we have signed up our affiliated hospitals, we have made sure that they fully support our mission in primary care, which means that their specialists will not talk it down and will support it. We hope we're creating a program where primary care is celebrated, not denigrated," he said.

Finding the Right Applicants

Identifying those students who are most likely to choose primary care for the long haul is the first challenge, said Henry Sondheimer, MD, senior director for medical education projects at the American Association of Medical Colleges (AAMC).

Those candidates often live in the area and come from rural backgrounds and are more often women and older students, he said.

"All our data at the AAMC shows that the effect of your medical education on your career choice is relatively small. The secret sauce is admissions," he said, and choosing students with the appropriate background will be key to these primary care programs' success.

Another measure of success for these schools will be to produce a different type of primary care physician, Dr. Sondheimer said. Primary care physicians of the future will more often work in multidisciplinary team settings and need to develop management and collaborative skills in addition to receiving an MD or DO.

The Commonwealth Medical College (TCMC) in Scranton, Pennsylvania, is among a few medical schools that opened in the past few years with an emphasis on primary care. TCMC opened in 2009 and replaced the traditional model of episodic rotations with one in which students are assigned to a single cohort of patients that they follow through their 4 years.

"We think that's critical to addressing the hidden curriculum," said Steven Scheinman, MD, the college's president and dean. "It's well-documented that students in medical school will come to objectify their patients and talk about them in the third person, even when they're in the room with them.

"A longitudinal relationship with a patient really makes them real to the student and not just an episodic learning opportunity," Dr. Scheinman said.

TCMC will graduate its first MDs next month, so future years will yield more clues as to whether the school can help strengthen the primary care workforce in the area.

Still, Dr. Scheinman said he knows medical schools are only part of the solution. "Medical schools can do as much as we can to get students to choose primary care, but we're up against lifestyle choices and reimbursement forces that are larger than us."

As part of its ongoing BeSafeRx: Know Your Online Pharmacy effort to protect consumers from the risks of fake online pharmacies, FDA has developed a new, easy-to-use interactive map tool that lets consumers locate a state-licensed online pharmacy, providing a quick way to ensure the site you order from is safe and legal.

Fake online pharmacies use sophisticated marketing efforts or phony web storefronts to appear legitimate, so FDA recommends you always confirm that an online pharmacy is licensed in the United States. Patients who buy medicines from these fraudulent websites may be putting their health at risk because the products may contain the wrong ingredients, or too little or too much of the active ingredient, or they might be made with other harmful substances. As a result, you may not receive the therapy you need, or you may experience unexpected side effects and possibly get worse.

That's why FDA launched the BeSafeRx: Know Your Online Pharmacy website, which offers resources for consumers, health professionals, and organizations on the risks of purchasing from a fake or fraudulent online pharmacy, how to identify them, and how to find legitimate online pharmacies from which to purchase medications. In addition to the new pharmacy map, you can find fact sheets, digital toolkits, videos, patient discussion guide, table tents, palm cards, stickers and other materials on the site.

Before you consider purchasing prescription medicines from an online pharmacy, especially one not associated with a health insurance plan or local "brick and mortar" pharmacy, check out the new interactive map and these additional resources at BeSafeRx: Know Your Online Pharmacy.

The U.S. Food and Drug Administration today approved Diclegis (doxylamine succinate and pyridoxine hydrochloride) to treat pregnant women experiencing nausea and vomiting.

Diclegis is a delayed-release tablet intended for women who have not adequately responded to conservative management of nausea and vomiting during pregnancy, such as dietary and lifestyle modifications. These modifications include eating several small meals instead of three large meals, eating bland foods that are low in fat and easy to digest and avoiding smells that can trigger nausea.

"Many women experience nausea and vomiting during pregnancy, and sometimes these symptoms are not adequately managed through recommended changes in diet and lifestyle," said Hylton V. Joffe, M.D., M.M.Sc., director of the Division of Reproductive and Urologic Products in the FDA's Center for Drug Evaluation and Research. "Diclegis is now the only FDA-approved treatment for nausea and vomiting due to pregnancy, providing a therapeutic option for pregnant women seeking relief from these symptoms."

Diclegis was studied in 261 women experiencing nausea and vomiting due to pregnancy. Study participants in the clinical trial were at least 18 years old and had been pregnant for at least 7 weeks and up to 14 weeks.

Women were randomly assigned to receive two weeks of treatment with Diclegis or a placebo.

The study results showed that women taking Diclegis experienced greater improvement in nausea and vomiting than those taking placebo. Additionally, observational (epidemiological) studies have shown that the combination of active ingredients in Diclegis does not pose an increased risk of harm to the fetus.

Diclegis is taken daily. Tablets must be taken whole on an empty stomach.

The recommended starting dose is two tablets taken at bedtime. If symptoms are not adequately controlled, the dose can be increased to a maximum recommended dose of four tablets daily (one in the morning, one mid-afternoon and two at bedtime).

Nausea and vomiting due to pregnancy usually improve after the first trimester. Health care professionals should reassess their patients for continued need for Diclegis as pregnancy progresses.

Drowsiness or sleepiness, which can be severe, is the most common side effect reported by women taking Diclegis. Women should avoid using Diclegis when engaging in activities requiring mental alertness, such as driving or operating heavy machinery, until cleared to do so by their health care provider.

Diclegis is marketed by Duchesnay Inc., based in Blainville, Québec, Canada.

The US Food and Drug Administration (FDA) today approved a novel glucose-lowering agent, canagliflozin (Invokana, Janssen Pharmaceuticals) for the treatment of adults with type 2 diabetes.

Canagliflozin is the first in a new class of drug, an oral inhibitor of sodium glucose cotransporter 2 (SGLT2). Inhibition of SGLT2 reduces resorption of glucose in the kidney, resulting in increased urinary glucose excretion, with a consequent lowering of plasma glucose levels as well as weight loss.

The authorization follows a 10 to 5 vote in favor of approval of canagliflozin by the FDA's Endocrinologic and Metabolic Drugs Advisory Committee in January. The majority of panel members who supported the drug cited the unmet need for new agents to treat the growing population of patients with type 2 diabetes and canagliflozin's absence of hypoglycemia, combined with the potential for weight loss, as deciding factors.

But the panel voted 8 to 7 at the same meeting that it had concerns about the cardiovascular safety of canagliflozin, most particularly a possible elevated risk for stroke. In the end, they deemed that current data were insufficient to be certain about this risk and concluded that longer-term follow-up will be required, including completion of the Canagliflozin Cardiovascular Assessment Study (CANVAS).

CANVAS is an ongoing study being conducted by Janssen in compliance with FDA guidance, issued in 2008, requiring cardiovascular-outcomes data for all new diabetes drugs. Final results of CANVAS are not expected until 2015.

In today's announcement, the FDA listed 5 postmarketing studies for canagliflozin that Jansen Pharmaceuticals must conduct as a condition for the drug's approval:

• A cardiovascular outcomes trial (CANVAS) -- An enhanced pharmacovigilance program to monitor for malignancies, serious cases of pancreatitis, and other adverse events
• A bone safety study
• A pediatric pharmacokinetic and pharmacodynamics study
• A pediatric safety and efficacy study
• Clinicians should not use canagliflozin to treat patients with type 1 diabetes, or patients with type 2 diabetes who have increased ketones in their blood or urine, or severe renal impairment or end-stage renal disease, or those receiving dialysis.

Vaginal yeast infection and urinary tract infection are the most common adverse events for canagliflizon. Patients may also experience dizziness or fainting, especially in the first 3 months of therapy, because canagliflozin is associated with a diuretic effect, which can reduce intravascular volume, leading to orthostatic or postural hypotension.

Others in Class: Dapagliflozin, Ipragliflozin, Empagliflozin

Canagliflozin is the first SGLT2 inhibitor to reach the market in the US, but another drug in this class, dapagliflozin (Forxiga, Bristol-Myers Squibb/AstraZeneca), is already available in Europe; it was approved there in November 2012.

The FDA denied approval of dapagliflozin in January 2012 because of concerns about a cancer signal.

Canagliflozin, which has also been submitted for approval in the European Union, does not appear to share that risk, with no signal for an increase in malignancy in about 8000 person-years of exposure.

A third SGLT2 inhibitor, ipragliflozin (Astellas Pharma) has been filed for marketing approval in Japan, and a fourth, empagliflozin (Eli Lilly/Boehringer Ingelheim), is in phase 3 trials and has just been filed for approval in the United States.

Scientists have shed light on the links between the accumulation of cholesterol in the eye and the development of a common cause of vision loss called age-related macular degeneration (AMD).

Researchers at Washington University School of Medicine found that white blood cells or 'macrophages' taken from people with AMD had low levels of cholesterol transporters, which help to move cholesterol out of cells.

As a result, these cells contained high levels of cholesterol, reducing their ability to block the growth of new blood vessels - a feature of AMD that causes bleeding and scarring in the central part of the eye.

When the team gave cholesterol-lowering eye drops to ageing mice, they found that the transport of cholesterol in their macrophages improved, leading to a reduction in the growth of new blood vessels.

Senior study author Dr Rajendra Apte, whose findings are published in the journal Cell Metabolism, said: 'Our increased understanding of cholesterol's role in the growth of ocular blood vessels helped us identify therapeutically modifiable pathways, opening up avenues for new treatments that may help us prevent blindness caused by macular degeneration.'

The expert added that the findings may also have relevance for other diseases involving abnormal blood vessel growth, such as cancers and atherosclerosis.

Today the Food and Drug Administration (FDA) approved a new formulation of a once-daily nonsteroidal anti-inflammatory drug (NSAID) for the treatment of postoperative pain and inflammation in patients who have undergone cataract surgery.

The newly approved 0.07% bromfenac ophthalmic solution (Prolensa, Bausch + Lomb) will likely replace the currently available 0.09% bromfenac ophthalmic solution.

Bromfenac is a critical ingredient in the formulation, as it facilitates ocular penetration of the NSAID. The newly approved drops are administered 1 drop daily beginning 1 day before surgery and continuing through the first 14 days postsurgery.

FDA approval was based on 2 randomized, double-masked studies in patients undergoing cataract surgery. The studies demonstrated the bromfenac ophthalmic solution 0.07% to be superior to vehicle for the reduction of inflammation and pain.

"The data show that once-daily dosing with Prolensa provides powerful and rapid control of inflammation and pain following cataract surgery, confirming the potency of this NSAID and the benefits of the new formulation," said Steven M. Silverstein, MD, founder of Silverstein Eye Centers in Kansas City, Missouri, in a Bausch + Lomb press release. "Prolensa reduces the amount of medication placed on the healing eye while maintaining a high degree of efficacy and ocular comfort."

The package insert will include warnings for sulfite allergic reactions, slow or delayed healing, and potential for cross-sensitivity. Adverse reactions (reported in from 3% to 8% of patients) include anterior chamber inflammation, foreign body sensation, eye pain, photophobia, and blurred vision.

Bausch + Lomb also offers a 0.09% bromfenac ophthalmic solution that was approved in 2010 for once-daily use.

The newly approved formulation represents a new, modified ophthalmic formulation. The safety profile of the new formulation is consistent with the safety profile of the 0.09% formulation.

It is expected, however, that patients will benefit from receiving the same amount of efficacy with a lower dose of medication.

The vast majority of clinical trials in the field of diabetes do not address key issues such as prevention or behavioral therapies, a study has shown.

Researchers at Duke University Medical Centre in the US analysed diabetes-related trials that were registered with ClinicalTrials.gov between 2007 and 2010.

They found 2,484 trials investigating listed interventions and discovered that 75% of these focused on treatments for diabetes, with just one in ten (10%) having a preventive purpose.

In light of their findings, which are published in the journal Diabetologia, the researchers say that diabetes trials around the world are failing to address key issues.

In addition, they point out that just 4% of trials targeted under-18s, while 59% of studies were designed to enrol 100 or fewer participants.

Lead researcher Dr Jennifer Green, from Duke University Medical Centre, concluded: 'The majority of diabetes-related trials include small numbers of participants, exclude those at extremes of age, are of short duration, involve drug therapy rather than preventive or non-drug interventions, and do not focus upon significant cardiovascular outcomes.'

She added that the current portfolio of clinical trials does not adequately address issues such as the prevention or management of diabetes, or the safety of therapies.

Bowel cancer rates among men have risen by almost 30% over the last 35 years, according to a report from Cancer Research UK.

The figures were revealed as the charity launched a new campaign, Make Bobby Proud, to raise awareness of the disease.

In 1975-77, the rate of bowel cancer diagnoses stood at 45 cases per 100,000 men, whereas 58 cases per 100,000 men were recorded in 2008-10. This represents a rise of 29%, while women have seen an increase of just 6% cent over the same time period.

'It's important to find out what's behind the rise and what we can do about it,' said Professor Matthew Seymour, professor of gastrointestinal cancer medicine at the University of Leeds and director of the National Cancer Research Network.

'The good news is that, thanks to research, we have seen huge improvements in bowel cancer survival over the last 40 years.'

Make Bobby Proud is named after England football legend Bobby Moore, who died of bowel cancer in 1993. The fundraising campaign will be run by Cancer Research UK and the Bobby Moore Fund.

Diabetes. Published online March 22, 2013. Abstract

Taking a cue from their US counterparts, European drug regulators announced Wednesday that they will investigate the findings of a recent study in the journal Diabetes suggesting that incretin mimetic drugs for type 2 diabetes increase the risk for pancreatitis and precancerous cellular changes called pancreatic duct metaplasia.

On March 14, the US Food and Drug Administration (FDA) announced that it will review the same research results on incretin mimetics. At that time, the study was unpublished, according to the FDA.

Incretin mimetics mimic intestinal hormones such as glucagon-like peptide-1 (GLP-1) that stimulate the release of insulin after a meal.

The study in Diabetes is the latest in a series that raises safety concerns about incretin mimetics - specifically, GLP-1–based therapies that include GLP-1 agonists and dipeptidylpeptidase-4 (DDP-4) inhibitors.

An article published online in JAMA Internal Medicine last month reported that people with type 2 diabetes who use the GLP-1 agonist called exenatide (Byetta, Amylin Pharmaceuticals) and the DDP-4 inhibitor called sitagliptin (Januvia, Merck) double their risk of being hospitalized for acute pancreatitis.

The European Medicines Agency (EMA), the European Union equivalent of the FDA, said in a press release that there is no need for patients to stop taking the incretin mimetics in question because it has not reached any conclusions in its review. Nor are there any changes to EMA recommendations on using the drugs. The agency noted that its initial evaluation of these drugs identified adverse effects involving the pancreas as a possible risk.

"Marked" Alpha Cell Hyperplasia

The study published in Diabetes analyzed transplant-grade pancreases obtained from 34 brain-dead organ donors, 20 with type 2 diabetes and 14 without. Of those with type 2 diabetes, 7 had received sitagliptin and 1 had received exenatide for a year or longer.

Lead author and pathologist Alexandra Butler, MD, and her colleagues write that pancreatic mass in patients with diabetes treated with an incretin mimetic grew 40% compared with that in patients with diabetes who did not receive such drugs. That change was accompanied by increased exocrine cell proliferation and dysplasia.

Furthermore, researchers observed "marked" alpha cell hyperplasia and glucagon expression of microadenomas and a neuroendocrine tumor, writes Dr. Butler, an assistant professor at the David Geffen School of Medicine at the University of California-Los Angeles.

The study represents an "I told you so" for the consumer watchdog group Public Citizen, which has asked the FDA to ban the GLP-1 agonist liraglutide (Victoza, Novo Nordisk). Sidney Wolfe, MD, director of Public Citizen's Health Research Group, said in a press release last week that the study's findings "are in accord" with a rapidly growing number of reports of pancreatic cancer in patients taking incretin mimetics.

"It is likely that they will all have to be removed from the market," said Dr. Wolfe.

MARCH 2013

Many people eat their way to high blood pressure (hypertension). It's also possible to eat your way out of it, according to the March 2013 Harvard Men's Health Watch.

The Dietary Approaches to Stop Hypertension (DASH) eating plan - low in animal fat and salt; abundant in blood-pressure-lowering nutrients-is scientifically proven to battle high blood pressure. It can reduce blood pressure by 10 points-about as much as adding a medication, says Dr. Deepak Bhatt, a professor of medicine at Harvard Medical School and chief of cardiology, VA Boston Healthcare System.

Here's the DASH plan in a nutshell: keep fat intake under 27% of total calories, eat many servings of fruits and vegetables, choose whole instead of processed grains, include low-fat or nonfat dairy products, and choose small portions of poultry, fish, and nuts as your primary source of protein rather than red meat.

The DASH diet includes abundant amounts of calcium, potassium, magnesium, and fiber. Potassium is particularly important.

"It's harder to control blood pressure-even with medications-if there isn't enough potassium in the diet," says Dr. Michelle Hauser, a clinical fellow in medicine at Harvard Medical School and a certified chef and nutrition educator. The DASH diet also is low in salt-the sodium in salt can boost blood pressure.

Like any lifestyle change, following the DASH plan takes some work. And it may not be right for everyone. If the DASH diet doesn't look like a good fit, try an overall heart-healthy Mediterranean-style diet. (Read about the heart benefits of a Mediterranean diet on the Harvard Health blog.) "The Mediterranean diet is not medically proven in the sense of lowering blood pressure by a specific number of points over two weeks, like the DASH diet," Dr. Hauser says. "But there are lots of studies showing that people eating their traditional foods in the Mediterranean areas of the world have less heart disease and less high blood pressure."

According to the latest statistics, about 1 in 3 US adults 20 years and older have prediabetes, but only 11% are aware of their status.

The finding is reported online March 22 in Morbidity and Mortality Weekly Report.

Awareness of prediabetes was low, "regardless of education level, income level, coverage by health insurance or other kind of healthcare plan, or healthcare use," write YanFeng Li, MD, from the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and colleagues.

During 2005 – 2006, only 7% of US adults were aware that they had prediabetes. In this report, Dr. Li and colleagues sought to determine whether this awareness had increased in 2009 – 2010.

They analyzed data from the National Health and Nutrition Examination Survey (NHANES), sample of the non-institutionalized US civilian population, for 3 time periods: 2005 – 2006, in which the examination response rate was 77%; 2007 – 2008, in which the examination response rate was 75%; and 2009 – 2010, in which the examination response rate was 77%.

The researchers identified 2603 participants with prediabetes, as defined as fasting plasma glucose (FPG) 100 to 125 mg/dL or glycated hemoglobin (HbA1c) of 5.7% to 6.4%.

They compared the prevalence of prediabetes awareness across a variety of factors, including age, race or ethnicity, sex, education level, poverty-to-income ratio, access to healthcare, having health insurance or other healthcare coverage at the time of interview, number of doctor visits in the past year, and having a usual source of healthcare such as a doctor's office or health clinic.

They also asked about family history of diabetes, use of medication for hypertension or hypercholesterolemia, and body mass index.

The analysis showed that the percentage of persons with prediabetes who were aware of their status was slightly higher in 2009 – 2010 than it was in 2005 – 2006 (P = .04), although the awareness remained low.

Specifically, the prevalence of awareness was lower among younger (aged 20 – 44 years; 5.1%) compared with people aged 45 to 64 years (10%) and those aged 65 years and older (11.9%) (P < .002 for both comparisons).

People with less than a high school education were less aware of their status than those with more than a high school education (prevalence 4.9% vs 8.7%; P = .003).

Normal-weight individuals were less aware of their status (prevalence 4.3%) compared with overweight (prevalence 7.9%, P = .045) and obese (9.9%, P = .004) individuals.

Awareness was also higher among those with a family history of diabetes compared with those without (10.4% vs 6.2%, P = .001), among those taking hypertension or hypercholesterolemia medication compared with those not taking such medication (13.9% vs 6.1%, P = .01), among those with health insurance or other coverage compared with those without (8.4% vs 4.7%, P = .008), and in people who reported having a usual source of healthcare that was either a clinic or doctor's office compared with those with no usual source (8.9% vs 4.4%, P = .01).

An editorial note points out that the findings in the report are subject to limitations. These include the fact that NHANES participants with impaired glucose tolerance were not included in the definition of prediabetes. "Had they been included, the overall estimate of awareness during 2009 – 2010 would have been 10.0% rather than 11.1%."

Other limitations include that the data on prediabetes awareness were self-reported and might be subject to recall bias as a result, the exclusion of military personnel and persons in nursing homes, the fact that the response rate to the surveys was about 75%, and the variability of the laboratory tests that were used in the analysis.

Despite these limitations, the fact remains that the prevalence of type 2 diabetes is increasing in the United States and that the disease can be prevented or delayed among those at high risk "by modest weight loss, good nutritional practices, and increased physical activity."

The note concludes by calling for improved identification and awareness of prediabetes.

These are "critical first steps to encourage those with prediabetes to make healthy lifestyle changes or to enroll in evidence-based, lifestyle-change programs aimed at preventing type 2 diabetes."

Dr. YanFeng Li and colleagues report no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published onlineMarch 22, 2013. Full article

People between the ages of 30 and 39 years are most likely to be affected by sudden death caused by an irregular heart rhythm, new figures show.

The latest report from the National Audit of Sudden Arrhythmic Death Syndrome (SADS) reveals that almost a quarter of deaths from the syndrome occur in 30 to 39-year-olds, with 32 being the average age at death.

Figures show that 58% of cases where the patient's sex is recorded involve men.

They also reveal that almost a third of people who died from SADS between July 2008 and January 2013 were resting at the time, with one in four dying while in bed or asleep.

Dr. Martin Goddard, chairman of the UK Cardiac Pathology Network, which manages the audit in collaboration with the Health and Social Care Information Centre, said: 'Today's report aims to raise awareness of SADS, not only for the benefit of cardiac specialists but for the public also.'

Amy Thompson, senior cardiac nurse at the British Heart Foundation, said that SADS is 'thankfully very rare'.

However, she noted that family members of those affected by the syndrome may also be at risk - something that coroners and pathologists should highlight so that doctors can carry out targeted screening where appropriate.

GPs will be expected to double the percentage of adults with type 2 diabetes who achieve NICE-recommended blood glucose, blood pressure and cholesterol levels in five years, under new targets set by the Government.

The UK Government said more should be done by GPs to make sure that risk factors were controlled in diabetes and set a target for 40% of patients with diabetes to be within NICE-recommended levels, which is double the current rate of 19.8% by 2018.

It also recommends a dramatic increase in the proportion of patients with diabetes being given nine basic care processes annually - such as foot checks and microalbuminuria tests - from 50% to 80% by 2018, possibly by bundling the QOF indicators together.

Pulse revealed last year that ministers had written to NICE to ask it to explore the practicality of raising QOF thresholds and creating a 'composite' indicator in QOF for diabetes worth over £5,000.

The targets were revealed in a response from the Treasury to a report published by the House of Commons Public Accounts Committee that was very critical of GP management of diabetes last year.

The PAC said too few patients were achieving the recommended levels for blood pressure, cholesterol and diabetes and called for QOF indicators to be bundled.

In its response, the Treasury said: 'It will never be appropriate for every person with diabetes to be within the recommended outcomes ranges defined by NICE, which are set for the UK population as a whole. The specific proportion cannot be defined, particularly for glucose control.

'However, the department agrees that more can be done to increase the proportion of people with diabetes achieving the recommended levels for blood glucose, blood pressure and cholesterol.'

The Treasury said it recommended changes to QOF, although this would be up to NICE's assessment of whether to bundle indicators and the NHS Commissioning Board.

It said: 'The current payment system is not driving the required outcomes. GPs are paid for each individual test they carry out rather than being rewarded for ensuring all nine tests are delivered.'

The QOF revisions – especially relating to microalbuminuria testing and the DM13 indicator – are expected to help achieve 'universal' annual coverage for the nine basic diabetes care processes, the Treasury added

Scientists have discovered that breast cancer DNA circulating in a woman's blood could be used to measure how well her disease is responding to treatment.

Researchers at the Cancer Research UK Cambridge Institute compared levels of three biomarkers in blood samples from women with advanced breast cancer with their CT scans.

They wanted to know whether levels of any of these biomarkers were linked to visible changes in the cancer on women's scans.

Analysis revealed that tumor DNA gave the most accurate reflection of changes taking place in the women's bodies.

Publishing their findings in the New England Journal of Medicine, the researchers suggest that blood tests to measure tumor DNA could be used to determine how well a woman is responding to treatment.

Co-lead author Professor Carlos Caldas said: 'This study offers a practical application of cancer genomics and highlights the potential of personalized cancer medicine.

'By understanding the point at which a cancer changes, we can select the most effective treatments and minimize side-effects for patients.'

Professor Peter Johnson, chief clinician at Cancer Research UK, which part-funded the study, said that the findings suggest an 'exciting way' to get information on a person's cancer and target their therapy.

Authors of a new consensus statement on menopausal hormone therapy (MHT) conclude that it is the most effective treatment for menopausal symptoms and that benefits are likely to outweigh the risks if it is prescribed before the age of 60 years or within 10 years after menopause.

The statement was published in the April issue of Climacteric and also in Maturitas.

The brief consensus was published on behalf of 7 major international and US societies working in menopause and women's health and summarizes the state of the science on MHT use.

Overall, Tobie J. de Villiers, MBChB, from MediClinic Panorama and Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa, and colleagues conclude that:

• the benefits of MHT generally outweigh the risks if used for women younger than 60 years or within 10 years after menopause.
• Dose and duration should be individualized, and personal risk factors such as "the risk of venous thromboembolism, stroke, ischemic heart disease and breast cancer" should guide use of MHT.

The benefits of MHT outweigh the risks for the treatment of symptoms associated with menopause if prescribed before the age of 60 years or within 10 years after menopause.

MHT may prevent osteoporosis-related fractures in "at-risk" women before the age of 60 years or within 10 years after menopause.

Review of randomized clinical trials and observational data shows that MHT using standard-dose monotherapy with estrogen may decrease coronary heart disease and all-cause mortality in women younger than 60 years and within 10 years of menopause.

Oral MHT increases the risk for venous thromboembolism and ischemic stroke, but the absolute risk is rare in women younger than 60 years.

Increased risk for breast cancer may be a concern with combination MHT using estrogen and progesterone and may be related to duration of use. The risk is small and decreases after treatment is discontinued.

Use of custom-compounded bioidentical hormone therapy is not recommended.

MHT should not be used in women who have a history of breast cancer.

"The primary indication for using oral MHT is for relief of menopausal hot flashes," Heidi D. Nelson MD, MPH, research professor in the Department of Medical Informatics and Clinical Epidemiology and the Department Medicine at Oregon Health & Science University in Portland, told Medscape Medical News. "Its use should be at the lowest dose and shortest duration necessary to improve symptoms and quality of life, and should be individualized. These points of agreement are clinically relevant to many women."

She continued, "[The authors'] statement about estrogen-alone MHT decreasing coronary heart disease and all-cause mortality in women younger than 60 and within 10 years of menopause is NOT based on strong evidence…………... They qualify this statement by phrasing it as 'may decrease,' but this could be misleading. However, it is reassuring that MHT does not increase heart disease in this age group."

The authors of the report conclude that these recommendations will be reviewed as new data become available.

The meeting of the consensus panel was supported by the participating societies only. The authors and Dr. Nelson have disclosed no relevant financial relationships.

Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association

Jeffrey R. Garber, MD, FACP, FACE, Rhoda H. Cobin, MD, FACP, MACE, Hossein Gharib, MD, MACP, MACE, James V. Hennessey, MD, FACP, Irwin Klein, MD, FACP, Jeffrey I. Mechanick, MD, FACP, FACE, FACN, Rachel Pessah-Pollack, MD, Peter A. Singer, MD, FACE, Kenneth A. Woeber, MD, FRCPE

Objective: Hypothyroidism has multiple etiologies and manifestations. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions. This paper describes evidence-based clinical guidelines for the clinical management of hypothyroidism in ambulatory patients.

Methods: The development of these guidelines was commissioned by the American Association of Clinical Endocrinologists (AACE) in association with American Thyroid Association (ATA).

AACE and the ATA assembled a task force of expert clinicians who authored this article. The authors examined relevant literature and took an evidence-based medicine approach that incorporated their knowledge and experience to develop a series of specific recommendations and the rationale for these recommendations.

The strength of the recommendations and the quality of evidence supporting each was rated according to the approach outlined in the American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Guidelines-2010 update.

Results: Topics addressed include the etiology, epidemiology, clinical and laboratory evaluation, management, and consequences of hypothyroidism.

Screening, treatment of subclinical hypothyroidism, pregnancy, and areas for future research are also covered.

Conclusions: Fifty-two evidence-based recommendations and sub-recommendations were developed to aid in the care of patients with hypothyroidism and to share what the authors believe is current, rational, and optimal medical practice for the diagnosis and care of hypothyroidism.

A serum thyrotropin (TSH) is the single best screening test for primary thyroid dysfunction for the vast majority of outpatient clinical situations.

The standard treatment is replacement with L-thyroxine.

The decision to treat subclinical hypothyroidism when the serum thyrotropin is less than 10 mIU/L should be tailored to the individual patient.

People who regularly drink green tea or coffee may benefit from some protection against stroke, new research suggests.

Scientists at Japan's National Cerebral and Cardiovascular Centre questioned more than 83,000 adults, aged 45 to 74 years, about their intake of green tea and coffee.

Participants were followed for about 13 years to see whether there was any association between levels of consumption and people's risk of having a stroke.

The researchers found that the more green tea or coffee an individual drank, the lower their risk of stroke.

In fact, people who drank at least one cup of coffee per day were about 20% less likely to have a stroke than those who rarely had coffee, while two to three daily cups of green tea was associated with a 14% reduction in risk.

Lead author Dr Yoshihiro Kokubo, whose findings are published in Stroke: Journal of the American Heart Association, concluded: 'You may make a small but positive lifestyle change to help lower the risk of stroke by adding daily green tea to your diet.'

The findings could have important implications for reducing people's risk of stroke, which currently affects more than 150,000 people in England alone each year.

A 114-year-old Japanese woman born the same year that radium was discovered was recognized as the world's oldest woman by Guinness World Records on Wednesday.

Misao Ookawa, who was born to a clothing merchant in 1898 and now lives in the western city of Osaka, received a certificate acknowledging her status and said she was pleased.

"Given everything, it's pretty good," she told a gathering at the nursing home where she resides.

Ookawa, who according to Japanese media has never had a major illness in her life, married in 1919 and has three children, four grandchildren and six great-grandchildren.

The award came as an early birthday present. She turns 115 on March 5.

Japan has more than 50,000 centenarians, according to government data released last year, reinforcing its reputation for longevity.

The world's oldest man is also Japanese - Jiroemon Kimura, aged 115.

The vast majority of UK doctors have handed out placebo (dummy) treatments to patients, a new study in the journal PLoS One has found.

Researchers at the universities of Oxford and Southampton found that 97% of doctors have used 'impure' placebo treatments, such as antibiotics for suspected viral infections.

This means the treatment was prescribed merely to reassure patients, even though the medic knew it was unlikely to have any effect.

Meanwhile, 12% of the 783 doctors taking part in the online survey admitted they had prescribed 'pure' placebos such as sugar pills or saline injections, which contain no active ingredients whatsoever.

Co-lead author Dr Jeremy Howick, from Oxford University, insisted that the prescribing of placebos 'is not about doctors deceiving patients'.

'The study shows that placebo use is widespread in the UK and doctors clearly believe that placebos can help patients,' he said.

Professor George Lewith, from the University of Southampton, revealed that previous research at the university has shown placebos to be helpful for many patients, long after their administration.

He explained that placebos work by releasing the body's own 'natural painkillers'.

'In my opinion ... further investigation is needed to develop ethical, cost-effective placebos,' he added.

JAMA Ophthalmol. Published online March 21, 2013.

Adults with "dry" age-related macular degeneration (AMD) developed a denser macular pigment layer after taking a daily oral supplement of carotenoid compounds and omega-3 long-chain polyunsaturated fatty acids, a German research group has found.

However, the clinical importance of this is unknown, Christin Arnold, Dipl-Troph, and colleagues from Friedrich Schiller University, in Jena, Germany, report in a paper published March 21 in JAMA Ophthalmology.

The randomized, double-blind, placebo-controlled, parallel clinical trial compared outcomes in 145 participants, aged 50 to 93 years, divided into 3 groups. All patients had non-exudative AMD. The trial was conducted for 12 months.

One group (n = 55) took a capsule containing 10 mg lutein, 1 mg zeaxanthin, 100 mg docosahexaenoic acid (DHA), and 30 mg eicosapentaenoic acid (EPA); another took a capsule containing twice those doses (n = 50); and the placebo group (n = 40) took an identical-looking dummy capsule.

The researchers report that after 1 month, plasma concentrations of the 2 carotenoids increased significantly in the treated groups and this level was maintained throughout the trial.

In addition, optical density of the macular pigment increased significantly (P < .05) in the treated groups, rising slowly through 12 months, but was nearly unchanged in the placebo group.

The pigment's density was slightly higher in the double-dose group than in the other treated group, but the difference was insufficient to support use of the higher doses of these nutritional supplements.

In an interview with Medscape Medical News, Arnold, who is a doctoral-degree candidate in nutritional sciences, pointed to the latter finding as most clinically relevant to physicians whose patients with dry AMD ask about taking supplements.

"Our patients responded to the supplementation in both groups, but we found that you did not need 20 mg of lutein. As a nutritionist, I feel better about the lower dose, because I prefer for people to get their nutrients from food as much as possible," Arnold explained. "There are toxicological studies showing that 20 mg is safe. But now that we know 10 mg is effective, we can say that patients should not be using the higher dose."

Clinically Useful?
Retinal researchers generally regard the macular pigment, which contains lutein, zeaxanthin, and their isomer, meso-zeaxanthin, as a defense against oxidative damage to the retina.

But the biological and clinical connections - if any - between the density of the macular pigment and AMD development or progression remain murky.

Emily Y. Chew, MD, PhD, deputy director of the Division of Epidemiology and Clinical Applications at the National Eye Institute, Bethesda, Maryland, told Medscape Medical News that the German group's study was small, had limited follow-up, and had no way to determine what the elevated pigment density means functionally for a patient with AMD.

"It's interesting data but it doesn't prove anything. It's awfully small numbers. It would be hard to come up with anything other than the fact that the macular pigment levels are different," Dr. Chew, who is an ophthalmologist and an epidemiologist, explained.

"They report that the optical density of the macular pigment increases, but so what? Does that improve your vision? Does that mean it's good? We don't know. So it's interesting but what does it mean?" she added.

Rather than looking at structural changes after supplementation, it is more important to determine whether the right nutritional supplements, in the right doses, prevent development and/or progression of AMD, Dr. Chew said.

She is chair of the second Age-Related Eye Diseases Study (AREDS2), the National Eye Institute's large randomized, controlled, multicenter clinical trial that is expected to report results this spring. AREDS2 tested the same supplements as were used in the German study, but at different doses and in different combinations. The AREDS2 dosing was 10 mg lutein, 2 mg zeaxanthin, 650 mg EPA, and 350 mg DHA.

The average follow-up in approximately 4000 participants was nearly 5 years, giving AREDS2 the statistical power to detect changes in clinical outcomes of a slow-moving disease, Dr. Chew noted.

"Our ultimate goal is to look at whether we can prevent progression to advanced disease, something that is very important to the patient," she said. "That's why we followed so many patients for so long."

The study was supported by Novartis GmbH and Carl Zeiss Meditec. The authors and Dr. Chew have disclosed no relevant financial relationships.

NEW ORLEANS - A large, international epidemiologic study reports that slurping back large amounts of sugary beverages was associated with an increased body-mass index (BMI), which in turn was linked with BMI-related deaths from diabetes, cardiovascular disease (CVD), and cancer.

Specifically, the researchers found that in 2010, 132,000 deaths from diabetes, 44,000 deaths from CVD, and 6000 deaths from cancer in the world could be attributed to drinking sugar-sweetened soft drinks, fruit juice, or sports beverages.

The study byGitanjali Singh, PhD, from Harvard School of Public Health, Boston, Massachusetts, and colleagues was reported at EPI|NPAM 2013, the Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions.

"It is a [surprisingly] large number of deaths - tens of thousands of deaths - that are being caused by consuming sugary beverages," Dr. Singh commented to Medscape Medical News. Three quarters of these BMI-related deaths were from diabetes, which "suggests that limiting sugary-beverage intake is an important step in reducing diabetes deaths," she noted.

"Uphill Battle" to Change Patient Habits, Public Policy

The study reinforces the need for clinicians to encourage patients to drink fewer sugary beverages, Dr. Singh said. In addition, even though "it's certainly an uphill battle [to change public policy] - it's one that…physicians, cardiologists, public-health scientists, [and] policy makers…really need to advocate for and show support for," she noted.

As part of the Global Burden of Disease study, the researchers obtained data from 114 national dietary surveys, representing more than 60% of the world's population.

Based on data from large prospective cohort studies, they determined how changes in consumption of sugary drinks affected BMI, and next, how elevated BMI affected CVD, diabetes, and 7 obesity-related cancers (breast, uterine, esophageal, gallbladder, colorectal, kidney, and pancreatic cancer).

Using data from the World Health Organization, they calculated the number of deaths from BMI-related CVD, diabetes, and cancer for men and for women aged 20 to 44, 45 to 64, and 65 years and older.

Average sugary-drink consumption varied tremendously - from less than 1 drink (8 oz) a day in elderly Chinese women to more than 5 drinks (40 oz) a day in younger Cuban men.

Most deaths (78%) from excess sugary drinks were in low- and middle-income countries.

Mexico, which has one of the world's highest per capita rates of drinking sweetened drinks, had the greatest number of deaths related to this risk factor: 318 deaths per million adults.

In contrast, Japan, with one of the lowest per-capita rates of imbibing these beverages, had the smallest number of deaths attributable to this risk factor: about 10 deaths per million adults.

In 2010, drinking sugar-sweetened beverages was associated with about:
38,000 deaths from diabetes in Latin American and Caribbean countries.
11,000 deaths from CVD in Eastern- and Central-Eurasian countries.
25,000 deaths in the United States.

"Sugar-sweetened beverages are a major cause of preventable deaths due to chronic diseases, not only in high-income countries, but also in low and middle-income countries," the group concludes.

Bottom Line: Advise Patients to Avoid Sugary Drinks

"The evidence base that sugar-sweetened beverages are associated with excess weight gain is well established; what these investigators have done is to take it a step further by saying the excess weight gain that is attributable to sugary drinks actually increases the risk of death from diabetes, CVD, and cancer," American Heart Association(AHA) spokesperson Rachel K. Johnson, PhD, from the University of Vermont, Burlington, commented.

Study strengths include its large scope, but since it was an epidemiologic study, it does not demonstrate cause and effect, Johnson noted. Nevertheless, "it is certainly a [biologically] plausible association, and we should take it seriously," she added.

According to Dr. Johnson, "The bottom line is to [advise patients to] avoid sugar-sweetened drinks, [since we have] more and more evidence that it's not a good choice."

It is "particularly problematic" that satiety mechanisms don't kick in with beverages in the same way as with solid foods. "If you have a sugary drink at 4 o'clock, you're not as likely to cut back on what you eat for dinner in the same way you would if you'd had a snack of solid food at 4 o'clock," she said.

The AHA recommends that adults don't exceed 450 calories (36 oz) a week from sugar-sweetened beverages.

In a 2012 statement position statement, the AHA and American Diabetes Association stated that non-nutritive artificial sweeteners can be a tool to help people lower their added sugar and calorie intake, as long as they don't eat extra calories to compensate for the lower calories in the diet drinks.

The government has been called upon to address variations in the prevalence of cardiovascular disease as a matter of urgency.

A new report by cholesterol charity Heart UK shows that regional, ethnic and socioeconomic inequalities still remain in the UK, despite efforts to ensure everyone receives a good standard of care.

In light of its findings, the charity is urging the government and newly formed health authorities to act quickly to reduce these inequalities and shrink the regional gaps in life expectancy.

Chief executive Jules Payne described the current situation as a 'scandal', insisting: 'Where you live or how much you earn should not affect your risk of cardiovascular disease.'

He added: 'By ensuring better prevention programs and risk factor management, we can reduce hospital admissions, cut premature deaths from cardiovascular disease, cut spiraling costs to the NHS and society, not to mention ease the impact on families.'

The charity's report was welcomed by Professor Huon Gray, national clinical director for heart disease.

He said the report would be of interest to all those involved in the prevention and care of cardiovascular disease.

Britain's older generations are increasingly choosing to spend their free time being physically active, a new survey suggests.

Skipton Building Society surveyed more than 600 older adults and found that the average respondent was fitter than they had been during their working lives.

Three-quarters (76%) of pensioners said they were being as active as possible, with four out of ten taking up new hobbies and interests.

The majority of respondents claimed they were exercising more than they had in their 20s, with hiking, cycling and swimming all emerging as popular pursuits.

Stacey Stothard, a spokeswoman for the building society, said that people now have a 'much brighter attitude' towards retirement than in the past.

'As such, people are embarking on activities which would once have seemed risky for a pensioner to try - such as zumba, dance classes and aerobics,' she revealed.

NHS guidelines state that adults over the age of 65 should aim to do both aerobic and muscle-strengthening exercises each week in order to maintain or improve their health.

Those who are generally fit and have no mobility-limiting health conditions are advised to do at least 150 minutes of moderate-intensity aerobic activity each week, along with muscle-strengthening exercises on two or more days per week.

The US Food and Drug Administration (FDA) has approved a new granulated formulation of the proton-pump inhibitor rabeprazole sodium for the treatment of gastroesophageal reflux disease (GERD) in children aged 1-11 years.

Rabeprazole sodium is manufactured by Eisai Co, Ltd, and sold under the name Aciphex in the United States, where it has been licensed since 1999. It is indicated for the treatment of GERD and duodenal ulcers and the eradication of Helicobacter pylori in adults, and for the short-term treatment of symptomatic GERD in adolescents aged 12 years and older.

The new pediatric formulation, Aciphex Sprinkle Delayed-Release Capsules 5 mg and 10 mg, was developed to be given to children by sprinkling granules of the drug contained in the capsules onto soft foods, milk, juice, or baby formula.

Data supporting the approval came from a multicenter, double-blind, parallel-group study of the 2 dosages in 127 children aged 1-11 years with endoscopically confirmed GERD. Overall, healing was achieved in 81% of the children during a 12-week treatment phase. Among those, the healing was maintained in 90% during a 24-week extension period.

The absence of a placebo group does not allow assessment of sustained efficacy through 36 weeks, according to a company statement.

During the first 12 weeks of treatment, adverse events, reported by 5% or more of the patients, included cough (14%), vomiting (14%), abdominal pain (12%), diarrhea (11%), pyrexia (10%), headache (9%), upper respiratory tract infection (8%), oropharyngeal pain (6%), and nasopharyngitis (5%).

During the 24-week extension, reported adverse events included upper respiratory tract infection (13%), vomiting (11%), abdominal pain (8%), diarrhea (6%), pyrexia (5%), nasopharyngitis (5%), pharyngitis streptococcal (5%), and sinusitis (5%).

"The pediatric clinical data submitted along with the application has met the FDA's Written Request requirements for pediatric exclusivity, with Eisai gaining six additional months of US market exclusivity for the drug, which will now expire on November 8, 2013," the company statement says.

The mastermind behind a massive healthcare fraud scheme centered in Detroit, Michigan, is behind bars, but the roundup of underlings continues with the recent federal indictment of 5 more physicians and 4 more pharmacists in the case.

In February, pharmacist Babubhai "Bob" Patel, RPh, was sentenced in a federal district court to 17 years in prison for running an operation that submitted nearly $20 million worth of fraudulent prescription claims to Medicare, Medicaid, and private insurers over 5 years in addition to illegally distributing millions of opioid painkillers and other controlled substances. Patel bribed physicians to write medically unnecessary scripts and steer patients to fill them at one of his 26 pharmacies, where the guiding principle, in Patel's words, was, "If you are strict, you never make money," according to court records. Patel's "marketers" recruited patients to participate in the scheme and rewarded them with narcotics for their cooperation.

A federal grand jury indicted Patel along with 4 physicians, 1 psychologist, 12 pharmacists, and 9 others in August 2011 on fraud and drug charges. Patel and 5 other defendants were convicted in a jury trial last year, and 15 more have pleaded guilty. That latter group includes Paul Petre, MD, and Mustak Vaid, MD.

Dr. Vaid pleaded guilty to conspiring to commit healthcare fraud, and Dr. Petre pleaded guilty to that charge as well as conspiring to distribute controlled substances. Prosecutors said both physicians also fraudulently billed Medicare for various services in the course of their bogus prescribing. Dr. Petre and Dr. Vaid now await sentencing, with the former looking at possibly 8.5 years in prison and the latter up to 6 months.

The 5 remaining defendants are scheduled to go to trial this summer.

On March 18, a follow-up indictment in the case was unsealed. It levelled the same charges as before as well as a new one - that Patel and his associates bribed physicians and others to refer patients to home health agencies under Patel's control. These agencies, in turn, would bill Medicare for services that were medically unnecessary and sometimes not provided.

Additional physicians named as defendants in the new indictment are Richard Utarnachitt, MD; Ruben Benito, MD; Javaid Bashir; MD; Carl Fowler, MD; and Rajat Daniel, MD. Prosecutors allege that all 5 physicians prescribed medications that were filled at Patel's pharmacies, and that Dr. Fowler and Dr. Daniel also referred patients to the home health agencies.

All the physicians have pleaded not guilty except for Dr. Fowler, who has yet to enter a plea.

"Little to Admire and Much to Condemn"

The case in Detroit fits the familiar pattern of physicians who allow a non-physician criminal boss to illegally profit from their medical licenses and billing numbers. And Babubhai Patel was a boss, said federal prosecutors in a memorandum to the judge on how he should sentence the pharmacist.

"Babubhai Patel is possessed of substantial ambition, drive, and organizational ability," wrote prosecutors. "One does not start and operate a large chain of independent pharmacies, employing tens if not hundreds of people, and billing over $60 million to various insurers without being a vigorous, disciplined, and capable organizer and businessman."

Patel aimed for a 25% profit margin in his pharmacies, prosecutors said, and took various steps to achieve it. His pharmacies would bill insurers for prescribed non-controlled drugs that were never dispensed. The drugs would either be returned to wholesalers or sold on the black market. When drugs were dispensed, pharmacists systematically shorted the pill count per bottle by 2 or 3 pills, a practice performed "at the explicit direction" of Patel.

The sentencing memorandum describes Patel as having "controlled" physicians as well as pharmacists. "The doctor is ours," Patel was heard to say during an intercepted telephone call about opioid narcotic prescriptions.

"The exhibits and testimony...in this case reveal Babubhai Patel displaying a grasping greed (and) a complete disregard for the law," prosecutors wrote. "A realistic assessment of Babubhai Patel's character finds little to admire and much to condemn."

Patel appealed for leniency, presenting the court with a packet of letters from family, friends, and associates that describe him as "a loving father, a respected member of the community, and magnanimous self-made man renown for his generosity." A number of letter-writers spoke of his leadership in a Hindu temple in suburban Detroit. A nephew informed the court that as a mentor, Patel had told him, "If you work hard and follow through with you (sic) goals, you can become anything."

Prosecutors had sought a 30-year prison sentence for Patel. On February 1, US District Senior Judge Arthur Tarnow handed down 17 years.

A study suggests it may be possible to encourage the regeneration of sensory hair cells in the ear to restore hearing in people with the most common form of hearing loss.

Sensorineural hearing loss is caused by loss of sensory hair cells in the cochlea which do not regenerate once lost.

But researchers at Massachusetts Eye and Ear and Harvard Medical School have shown that it is possible to use a drug to stimulate stem cells in the ears of mice to become new auditory hair cells, leading to improvements in the animals' hearing.

Publishing their discovery in the journal Neuron, the study authors say the technique could one day be used to treat hearing loss and reverse deafness in people.

Senior author Dr. Albert Edge explained: 'Hair cells are the primary receptor cells for sound and are responsible for the sense of hearing.

'We show that hair cells can be generated in a damaged cochlea and that hair cell replacement leads to an improvement in hearing.'

The scientist added that more research is needed, but that regeneration of sensory hair cells could have potential therapeutic applications in deafness.

A new hypothesis that focuses on reactive oxygen species (ROS) proposes that antioxidant levels within cancer cells are a problem and are responsible for resistance to treatment.

The theory destroys any reason for taking antioxidative nutritional supplements, because they "more likely cause than prevent cancer," according to Nobel laureate James Watson, PhD, from Cold Spring Harbor Laboratory, New York.

Dr. Watson, who shared the Nobel prize for unraveling the structure of DNA, regards this theory as being "among my most important work since the double helix," notes a press release from his institution, where he has been director since 1968.

The theory was published online January 8 in Open Biology.

Dr. Watson explains that the vast majority of agents used to directly kill cancer cells, including ionizing radiation, most chemotherapeutic agents, and some targeted therapies, work by generating - either directly or indirectly - ROS that block key steps in the cell cycle.

This generation of ROS creates a hypoxic environment in which cancers cells undergo a transformation from epithelial to mesenchymal cells (EMT).

These transformed cells almost inevitably posses very high amounts of antioxidants, which effectively block the effects of anticancer treatments, Dr. Watson notes.

Once a cancer becomes resistant to chemotherapy, it usually is equally resistant to ionizing radiation, he points out.

In addition, these transformed EMT cancer cells generate free-floating mesenchymal cells, which have the flexibility and movement that allows them to metastasize to other body locations (brain, liver, lung). "Only when they have moved do most cancers become life-threatening," Dr. Watson notes.

Interestingly, the widely used antidiabetic drug metformin has been shown to preferentially kill mesenchymal stem cells.

"In a still much unappreciated article published 3 years ago," metformin added to chemotherapy "induced prolonged remission if not real cures" in mouse models of cancer ( Cancer Res. 2009;69:7507-7511), Dr. Watson writes. He notes that clinical trials are currently looking to see if adding metformin to chemotherapy provides clinical benefits, but adds that diabetics who have been using metformin regularly have a reduced incidence of many cancers.

Resistance to Therapy From Antioxidants in Cancer Cells

Dr. Watson proposes that anticancer therapies work by generating ROS, which cause apoptosis. However, as cancer cells evolve, they produce antioxidant proteins that block this effect, such as glutathione, superoxide dismutase, catalase, and thioredoxin.

The fact that cancer cells largely driven by RAS and Myc are among the most difficult of cancers to treat could be due to their high levels of ROS-destroying antioxidants, Dr. Watson argues. High antioxidative levels might also explain the effective incurability of pancreatic cancer, he adds.

If this theory is correct, then drugs that lower antioxidant levels within cancer cells would be therapeutic.

In fact, the ROS-generating agent arsenic trioxide has been shown to reduce levels of glutathione and thioredoxin. Arsenic trioxide is currently being used to treat promyeloblastic leukemia, but this theory suggests that the drug could be useful in many major cancers.

Nutritional Antioxidants Could Be Harmful

One far-reaching implication of this theory is that antioxidants as nutritional supplements, including beta-carotene, vitamins A, C, and E, and selenium, could be harmful in cancer.

For years, such supplements have been widely hyped for cancer prevention and/or treatment, as has encouragement to eat colorful fruit and berries, which contain antioxidants.

The time has come to seriously ask whether antioxidant use more likely causes than prevents cancer.

However, Dr. Watson warns that recent data strongly hint that much of the untreatability of late-stage cancer might be the result of "its possession of too many antioxidants, [so] the time has come to seriously ask whether antioxidant use more likely causes than prevents cancer."

Many nutritional intervention trials have shown no obvious effectiveness in preventing gastrointestinal cancer or in lengthening mortality, he writes. "In fact, they seem to slightly shorten the lives of those who take them."

Hence, he concludes, "blueberries best be eaten because they taste good, not because their consumption will lead to less cancer."

Very Complex Process

Maurie Markman, MD, national director for medical oncology at the Cancer Treatment Centers of America, who writes theMedscape Markman on Oncology blog, was asked to comment on the theory.

"The importance of the critical relationship between oxidating activity and antioxidants in the normal functioning of cells has been recognized by many investigators, and it is not surprising that this process would be quite relevant in cancer. However, it must be emphasized that this is a very complex process and the balance between these powerful influences at the cellular level is certain to be very carefully controlled. Further, it should be noted that antioxidants are components of our normal diets. Finally, while a provocative concept, it is most unlikely that a simple approach to somehow removing antioxidants from the body will be a useful strategy in cancer management," he explained.

A diagnostic test currently used to detect signs of cervical cancer could also be used to spot ovarian and endometrial cancers, US scientists say.

Researchers at Johns Hopkins Kimmel Cancer Centre have developed a test to detect these forms of cancer from samples taken during routine Pap smear tests.

The test works by identifying cancer-specific genetic faults in cells that are shed from the ovaries or lining of the womb and that occur in smear test samples.

A pilot study assessing its effectiveness found that it detected 100 per cent of endometrial cancers and 41 per cent of ovarian cancers.

The researchers say larger studies are needed, but that their test could be used to detect ovarian and endometrial cancers when women are being screened for cervical disease.

'Our genomic sequencing approach may offer the potential to detect these cancer cells in a scalable and cost effective way,' said Dr Luis Diaz, whose findings are published in the journal Science Translational Medicine.

People who become depressed after suffering a stroke may be more likely to die early, a study has found.

Researchers at the University of Southern California's Keck School of Medicine looked at 10,550 people, aged 25 to 74, who were followed for 21 years.

Of these, 73 people had a stroke but did not develop depression, while 48 had a stroke and depression.

Among the remaining participants who did not have a stroke, 8,138 did not have depression and 2,291 were depressed.

The researchers found that the risk of dying from any cause was three times higher among people who had a stroke and depression than in people who had not had a stroke and were not depressed.

Meanwhile, people who had a stroke and depression were four times more likely to die from a stroke than those who had not had a stroke and did not have depression.

Study author Dr. Amytis Towfighi, whose findings were presented at the annual meeting of the American Academy of Neurology, revealed: 'Up to one in three people who have a stroke develop depression.

'This is something family members can help watch for that could potentially save their loved one.'

Children who regularly eat fast food may have an increased risk of asthma and eczema, new research has found.

Scientists at the University of Auckland carried out a study to see whether a high intake of certain foods influenced children's risk of developing these diseases.

Youngsters between the ages of 13 and 14 and parents of six to seven-year-old children took part in the study, completing questionnaires on dietary habits and symptoms of asthma and eczema.

The researchers found that children and teenagers who ate fruit at least three times a week were less likely to develop severe asthma than those who did not.

Meanwhile, those who ate fast food three or more times per week faced a significantly increased risk of severe asthma and eczema.

Publishing their findings in the journal Thorax, the study authors noted: 'If the association between fast foods and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is causal, then the findings have major public health significance owing to the rising consumption of fast foods globally.'

Malayka Rahman, a research analyst at Asthma UK, commented that the findings add to previous studies suggesting that a person's diet can contribute to their risk of developing asthma.

Women who eat plenty of strawberries and blueberries appear to benefit from a reduced risk of heart attack, new research has found.

Scientists at the Harvard School of Public Health in Boston, US, and the University of East Anglia in the UK studied 93,600 women, aged 25 to 42, who took part in a health study for 18 years.

Participants provided information on their diet every four years and the researchers found that those who ate three or more servings of strawberries and blueberries every week were up to a third less likely to have a heart attack.

It is thought that the link, which is published in the journal Circulation, may be due to the berries' high levels of naturally occurring flavonoid compounds - and other such fruits and vegetables might be beneficial too.

'Blueberries and strawberries can easily be incorporated into what women eat every week,' said senior author Dr. Eric Rimm.

He added that this simple dietary change could have a 'significant' impact on efforts to prevent heart attacks.

Victoria Taylor, senior dietician at the British Heart Foundation, welcomed the findings but claimed that more research is needed.

People with early Alzheimer's disease may benefit from using a new medical nutrition product that has just been launched in the UK.

Souvenaid was developed by scientists at Massachusetts Institute of Technology in the US and medical nutrition company Nutricia.

Designed to be consumed once a day, the drink contains a combination of naturally occurring nutrients such as omega-3 fatty acids, uridine, choline, phospholipids and B vitamins, at levels that are difficult to achieve from diet alone.

Clinical trials suggest that it may be effective in the early stages of Alzheimer's disease, as people with this common cause of dementia tend to have low levels of these nutrients that are required to keep the brain healthy.

Dr. David Wilkinson, a consultant in old age psychiatry and director of the Memory Assessment & Research Centre at Moorgreen Hospital near Southampton, revealed that our bodies become less efficient at processing essential nutrients as we get older.

'Alzheimer's disease sufferers often find it very difficult to get everything they need through diet alone and the nutritional intervention by the use of Souvenaid is a new area of research offering promising results for the management of early Alzheimer's disease,' he added.

Dr. Simon Ridley, head of research at the charity Alzheimer's Research UK, advised anyone who is considering using Souvenaid to discuss the product with their GP.

The risk of foot amputations among people with diabetes can be greatly reduced by giving them shoe inserts, regular foot checks and other simple interventions, a study has found.

Researchers at the University of Gothenburg in Sweden looked at 114 patients with diabetes, all of whom were at risk of developing ulcers that would increase the likelihood of amputation.

They found that shoe inserts, podiatry, patient information and regular check-ups all helped to prevent ulcers caused by overloading the foot sole, potentially reducing the number of amputations in this group of patients by more than 50 per cent.

Just 0.9 per cent of patients developed a foot ulcer during the first year of the study, compared with an expected rate of three to eight per cent.

Ulla Tang, a doctoral student at the university's Sahlgrenska Academy, confirmed: 'Our conclusion at the end of one year is that ... inserts effectively distribute pressure under the sole in order to minimize the risk of ulcers.'

The findings are due to be presented at the International Conference on Prosthetics and Orthotics in Hyderabad, India, this spring.

Women in England and Wales with a family history of breast cancer may be offered medication to prevent the disease, following the publication of new draft guidance for the NHS.

The National Institute for Health and Clinical Excellence (NICE) is consulting on proposals to offer up to five years' of treatment with tamoxifen to reduce the chances of breast cancer developing in women whose strong family history of the disease places them at a significantly increased risk.

Experts say this approach could cut the risk of disease in women with a sister and a mother or aunt diagnosed with breast cancer before the age of 50.

Professor Mark Baker, director of the institute's Centre for Clinical Practice, said that having a family history of breast, ovarian or a related cancer can 'significantly' increase a woman's risk of developing breast cancer at a young age.

'This is why it's wise for any person with a family history of cancer to receive appropriate investigations and screening that would otherwise be unnecessary if a family history did not exist,' he explained.

The announcement was welcomed by the charity Breakthrough Breast Cancer, whose chief executive Chris Askew described the move as a 'historic step'.

'It is the first time drugs have ever been recommended for reducing breast cancer risk in the UK,' he pointed out, adding: 'This is exciting as, even though most women do not have a significant family history of the disease, it's crucial that those who do have an array of options to help them control their risk.'

Women who experience migraine headaches with aura may face a heightened risk of heart disease, new research suggests.

Migraine with aura is characterised by a severe headache accompanied by visual disturbances such as flashing lights.

Researchers at the French National Institute of Health and Medical Research in Bordeaux (Inserm) and Brigham and Women's Hospital in Boston, US, looked at 27,860 women, including 1,435 who had migraine with aura.

There were 1,030 cases of heart attack, stroke or death from cardiovascular causes during the 15-year study period and the researchers observed that migraine with aura was the second strongest single contributor to heart attack and stroke risk, after high blood pressure.

The findings were presented at the annual meeting of the American Academy of Neurology by study author Dr. Tobias Kurth, who confirmed that migraine with aura 'came ahead of diabetes, current smoking, obesity and family history of early heart disease' in terms of its contribution to heart attack and stroke risk.

Dr. Kurth added that migraine patients may be able to reduce their risk of having a heart attack or stroke by not smoking, maintaining good blood pressure readings, exercising and achieving a healthy weight.

Shoe inserts and regular checks 'reduce risk of amputation in diabetes patients'

Last updated 18 January 2013

The risk of foot amputations among people with diabetes can be greatly reduced by giving them shoe inserts, regular foot checks and other simple interventions, a study has found.

Researchers at the University of Gothenburg in Sweden looked at 114 patients with diabetes, all of whom were at risk of developing ulcers that would increase the likelihood of amputation.

They found that shoe inserts, podiatry, patient information and regular check-ups all helped to prevent ulcers caused by overloading the foot sole, potentially reducing the number of amputations in this group of patients by more than 50 per cent.

Just 0.9 per cent of patients developed a foot ulcer during the first year of the study, compared with an expected rate of three to eight per cent.

Ulla Tang, a doctoral student at the university's Sahlgrenska Academy, confirmed: 'Our conclusion at the end of one year is that ... inserts effectively distribute pressure under the sole in order to minimise the risk of ulcers.'

The findings are due to be presented at the International Conference on Prosthetics and Orthotics in Hyderabad, India, this spring.

Text messages 'have potential to improve teen health' Last updated 21 January 2013

Text messages containing information on diet and exercise could be used to improve teenagers' health and wellbeing, research has found.

Researchers at the University of Arizona conducted a study to see whether or not teenagers were open to receiving this kind of text message.

They recruited 177 young people, aged 12 to 18 years, and found that the majority were happy to receive such messages.

However, the way in which these messages were worded made a big difference to whether or not teenagers were interested.

Writing in the Journal of Nutrition Education and Behaviour, the researchers revealed that teenagers did not want to be told what to do, so phrases such as 'you should' and 'never' ought to be avoided, along with messages asking 'did you know...'.

An example of a good message would be one referencing teenagers' age group, with interactive messages and those with fun quizzes or simple recipes also going down well with young people.

The study also underlined the fact that teens would want to receive no more than two such text messages per day.

Lead author Melanie Hingle, assistant research professor of nutritional sciences at the University of Arizona, noted: 'Kids are texting all the time, so it's a communication they're very familiar with and it appeals to them.

'We had kids at every step of the process working with us to help us to come up with topics and refine the voice and style [of the messages].'

The findings suggest that a text message-based intervention could encourage teenagers to adopt healthy lifestyle behaviours.

Text messages containing information on diet and exercise could be used to improve teenagers' health and wellbeing, research has found.

Researchers at the University of Arizona conducted a study to see whether or not teenagers were open to receiving this kind of text message.

They recruited 177 young people, aged 12 to 18 years, and found that the majority were happy to receive such messages.

However, the way in which these messages were worded made a big difference to whether or not teenagers were interested.

Writing in the Journal of Nutrition Education and Behaviour, the researchers revealed that teenagers did not want to be told what to do, so phrases such as 'you should' and 'never' ought to be avoided, along with messages asking 'did you know...'.

An example of a good message would be one referencing teenagers' age group, with interactive messages and those with fun quizzes or simple recipes also going down well with young people.

The study also underlined the fact that teens would want to receive no more than two such text messages per day.

Lead author Melanie Hingle, assistant research professor of nutritional sciences at the University of Arizona, noted: 'Kids are texting all the time, so it's a communication they're very familiar with and it appeals to them.

'We had kids at every step of the process working with us to help us to come up with topics and refine the voice and style [of the messages].'

The findings suggest that a text message-based intervention could encourage teenagers to adopt healthy lifestyle behaviours.

Many parents are failing to ensure their children are provided with a healthy and nutritious lunchtime meal as some are going to school with cold chips or a packet of biscuits in their lunchbox.

This is according to an online survey made up of 250 school, youth and health staff working with children in the UK, which indicates children are going without access to healthy food.

Of the teaching and classroom staff questioned, 47.5 per cent said they had seen a dramatic change in lunchbox contents following the global slowdown and tightening of household budgets.

Children's Food Trust chief executive-designate Linda Cregan said: 'It's a parent's responsibility to make sure their child eats well. But as this and other surveys have shown, the reality is that this can be an enormous struggle.'

As well as failing to provide children with healthy food, it was found that many are even going hungry, with 84.6 per cent of professionals claiming to have seen lunchboxes without enough in them.

Permanent tooth loss appears to be the nation's biggest confidence killer, according to a new survey from dental brand Corsodyl.

Researchers polled 2,000 British adults to discover their views on gum disease and tooth loss.

They found that 51% of respondents regarded tooth loss as the biggest threat to their confidence, compared with just 19% who cited changes in weight and 10% bad skin.

Despite this finding, the survey also found that just 18% of people would visit the dentist if they had problems with their gums.

More than one in ten thought spitting blood when brushing their teeth was normal and just one in five said they would start brushing their teeth more regularly if this happened.

Dentist Amit Rai commented: 'This new report highlights what I see in my practice on a daily basis - that some British adults seem to know little about the health of their gums.'

He urged people with gum disease to use a medicated mouthwash containing chlorhexidine as part of a good oral care routine in order to reduce the risk of future tooth loss.

Britons need to be on the lookout for signs of vascular disease, a common condition that accounts for 40% of deaths in the UK.

Vascular Disease Awareness Week (March 11th to 15th), organised by the Circulation Foundation, aims to draw attention to this condition which, despite being as common as cancer and heart disease, is not widely discussed.

Its symptoms - which include pain or cramping in the legs when walking - are often overlooked but can be a warning sign of imminent heart attack or stroke.

Experts say the best way to keep legs in shape and reduce the risk of vascular disease is to take moderate exercise on a regular basis.

Ian Franklin, a consultant vascular surgeon and chairman of the Circulation Foundation, said: 'Exercising more by walking greatly reduces the chance of a heart attack.

'Attention to diet and stopping smoking also make a big difference to whether early vascular disease progresses to something more serious.'

Mr. Franklin added that badly blocked arteries caused by vascular disease may require surgical treatment to prevent the onset of gangrene and septicaemia and reduce the risk of limb amputation or even death.

An ultrasound device designed to speed up the healing of bone fractures has been approved for use on the NHS in England and Wales.

The Exogen ultrasound bone healing system uses low-intensity pulsed ultrasound waves to stimulate the production of growth factors and proteins in the area of damaged bone tissue. This can help to increase the removal of old bone and promote the production of new bone.

Patients can use the device at home for 20 minutes each day, with the ultrasound waves delivered to the skin at the fracture site via a small transducer held in place by a strap.

The National Institute for Health and Clinical Excellence (NICE) recommends using the device to treat long bone fractures that have failed to heal after nine months. However, the evidence does not support its use to treat fractures before nine months.

Professor Carole Longson, director of the institute's Centre for Health Technology Evaluation, said she was 'pleased' to be able to support the device's use.

'Using Exogen for treating long bone fractures which have not healed after nine months is estimated to potentially save the NHS $1,164 per patient compared with standard management, as surgery would be avoided,' she revealed.

Professor Longson added that the device is also convenient for patients, as it can be used in their own home.

Arch Intern Med. 2012;():1-7.

Aaron S. Kesselheim, MD, JD, MPH; Alexander S. Misono, MD, MBA; William H. Shrank, MD, MSHS; Jeremy A. Greene, MD, PhD; Michael Doherty; Jerry Avorn, MD; Niteesh K. Choudhry, MD, PhD.

Background: Generic prescription drugs are bioequivalent to brand-name versions but may not have consistent color or shape, which can cause confusion and lead to interruptions in medication use.

We sought to determine whether switching among different-appearing antiepileptic drugs (AEDs) is associated with increased rates of medication nonpersistence, which can have serious medical, financial, and social consequences.

Methods: We designed a nested case-control study of commercially insured patients in the United States who initiated an AED.

Cases were patients who became non-persistent, defined as failure to fill a prescription within 5 days of the elapsed days supplied. Controls had no delay in refilling and were matched by sex, age, number of refills, and the presence of a seizure disorder diagnosis.

We evaluated the 2 refills preceding non-persistence and determined whether pill color and/or shape matched ("concordant") or did not match ("discordant").

We compared the odds of discordance among cases and controls using multivariate conditional logistic regression, adjusting for baseline characteristics, and drug type. We repeated our analysis among patients with a seizure diagnosis.

Results: The AEDs dispensed had 37 colors and 4 shapes. A total of 11 472 patients with nonpersistence were linked to 50 050 controls.

Color discordance preceded 136 cases (1.20%) but only 480 controls (0.97%) (adjusted odds ratio [OR], 1.27 [95% CI, 1.04-1.55]). Shape discordance preceded 18 cases (0.16%) and 54 controls (0.11%) (OR, 1.47 [95% CI, 0.85-2.54]).

Within the seizure disorder diagnosis subgroup, the risk of non-persistence after changes in pill color was also significantly elevated (OR, 1.53 [95%, CI 1.07-2.18]).

Conclusions: Changes in pill color significantly increase the odds of non-persistence; this may have important clinical implications.

Our study supports a reconsideration of current regulatory policy that permits wide variation in the appearance of bioequivalent drugs.

Glasses could soon become a thing of the past thanks to advances in laser eye surgery, an expert has claimed.

Milind Pande, a consultant eye surgeon at Vision Surgery & Research Centre in Humberside, says that a growing number of people over the age of 45 are choosing to have lens exchange surgery rather than wearing glasses.

The procedure replaces the natural lens of the eye with an artificial lens in the space of just 20 minutes, helping people to regain the vision of a 21-year-old.

Mr Pande revealed that the technique can be used on patients with presbyopia or ageing sight.

'The over-45s benefit from reducing their need for glasses, as many people of this age simply don't want to wear them.

'Whether you are 65 with a cataract or 45 with reading glasses, sight is rejuvenated and patients can often see as well as when they were 21.'

Mr Pande added that it is not unusual for a patient who has worn thick spectacles all of their life to be able to drive and read books without glasses following lens exchange surgery.

JAMA. 2012;308:2489-2496. Abstract

An intensive lifestyle intervention appears to be associated with a greater likelihood of achieving a partial remission of diabetes than standard support and education, according to the findings of an observational analysis.

Edward W. Gregg, PhD, from the Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues published their findings in the December 19 issue of JAMA.

The authors mention that although diabetes is considered a progressive, incurable disease, there is some evidence that it is reversible.

"[The] notion that type 2 diabetes is irreversible is supported by the strong association with genetics and family history, the high prevalence of microvascular complications, and the loss of beta cell mass and function frequently already present at diagnosis," the authors write.

"Despite these observations, 16% of US adults who report a previous diabetes diagnosis take no hypoglycemic medications, and studies of bariatric surgery suggest that many diabetes cases among obese patients can indeed resolve."

In the study, the authors analyzed data collected in the Action for Health for Diabetes (Look AHEAD) study, a randomized controlled trial comparing an intensive lifestyle intervention with diabetes support and education.

Among the 4503 adults included in the study, participants in the intensive lifestyle intervention group compared with those in the support and education group were more likely to experience at least a partial remission of diabetes at both year 1 (11.5% [95% confidence interval [CI], 10.1% - 12.8%] vs 2.0% [95% CI, 1.4% - 2.6%]; P < .001) and year 4 (7.3% [95% CI, 6.2% - 8.4%] vs 2.0% [95% CI, 1.5% - 2.7%]; P < .001).

The authors excluded participants who met the definition of non-diabetes at baseline (fasting glucose levels < 126 mg/dL and HbA 1c levels < 6.5% while taking no medication). The authors then performed multivariate analysis with adjustment for intervention group and variables such as age, race, and body mass index tertile.

The intensive intervention group was more likely to have a continuous, sustained remission for 2 years (9.2% vs 1.7; P < .001), 3 years (6.4% vs 1.3% ), or 4 years (3.5% vs 0.5%; P = .02).

Intensive intervention participants additionally lost significantly more weight after 1 year (8.6% vs 0.7%; P < .001) and 4 years (4.7% vs 0.8%; P < .001).

In multivariate analysis, a diabetes duration of between 2 and 7 years (odds ratio [OR], 0.43; 95% CI, 0.32 - 0.58; P < .001), an HbA 1c level higher than 7.6% (OR, 0.40; 95% CI, 0.27 - 0.60; P < .001), insulin use (OR, 0.23; 95% CI, 0.11 - 0.51; P < .001), and weight loss of between 1% and 6.5% (OR, 0.37; 95% CI, 0.26 - 0.53; P < .001) were associated with a lower likelihood of remission, whereas a 1-year fitness improvement of 17.9% or more was associated with a higher likelihood of remission (OR, 1.80; 95% CI, 1.14 - 2.86; P = .01).

The authors included the exploratory nature of the analyses, the lack of adjustment of P values for multiple comparisons, the less-than-ideal study population, and the more intensive intervention than commonly used in clinical and community settings as study limitations.

"In spite of these limitations, this is the largest study to our knowledge to examine the association of a lifestyle intervention with type 2 diabetes remission," the authors write. "Our findings suggest that an intensive lifestyle intervention may be associated with a partial diabetes remission in a subset of patients with type 2 diabetes, particularly those whose diabetes is of short duration, who have lower HbA 1c levels, and who do not yet require insulin therapy."

In a linked commentary, David E. Arterburn, MD, MPH, from the Group Health Research Institute in Seattle, Washington, and Patrick J. O'Connor, MD, MPH, from HealthPartners Institute for Education and Research in Minneapolis, Minnesota, noted that although diabetes prevention strategies should be more broadly applied, additional measures will be needed. "Research, education, and policy efforts need to be focused further upstream, toward primary prevention: reducing incident obesity in children, adolescents, and adults, especially among those with a family history of obesity or diabetes," they write. "Prevention of diabetes and obesity should be a rallying cry for all clinicians who care about the health of the nation."

These conclusions were echoed by K.M. Venkat Narayan, MD, from Emory University in Atlanta, Georgia. "These data, together with data from the diabetes prevention trials, clearly point to the importance of early initiation of intensive lifestyle interventions for people with prediabetes or diabetes," Dr. Narayan told Medscape Medical News by email.

"Everyone diagnosed with prediabetes or diabetes should be given intensive lifestyle intervention, similar to what was done in the Diabetes Prevention Program or the Look AHEAD trial."

One coauthor reported having board memberships with Eli Lilly, Boehringer Ingelheim, and Johnson & Johnson and receiving consultancy support from Pfizer and one coauthor received consultancy support from diaDexus. Dr. Arterburn received institutional grants from the National Institutes of Health, the Agency for Healthcare Research and Quality, the Department of Veterans Affairs, and the Informed Medical Decisions Foundation and payment for travel expenses from the Informed Medical Decisions Foundation. Dr O'Connor received institutional grants from the National Institutes of Health and the Agency for Healthcare Research and Quality and payment for lectures from the Montana Diabetes Program and the Centers for Disease Control and Prevention. He also reported institutional patents related to software to calculate medication effects. The remaining authors and Dr. Narayan have disclosed no relevant financial relationships.

Scientists believe that so-called 'silent strokes' may help to explain why some outwardly healthy patients develop Parkinson's disease.

Severe stroke is known to be associated with an increased risk of Parkinson's disease in some patients, but the latest research suggests that even small or silent strokes - where there are no outward signs of a stroke having taken place - may be linked to the disease.

Researchers at the University of Manchester's Faculty of Life Sciences found that a silent stroke can cause the death of dopaminergic nerve cells in the brain.

Lead researcher Dr Emmanuel Pinteaux said: 'At the moment we don't know why dopaminergic neurons start to die in the brain and therefore why people get Parkinson's disease.

'What we wanted to do in our study was to look at what happens in the brain away from the immediate area where a silent stroke has occurred and whether that could lead to damage that might result in Parkinson's disease.'

The findings, which are published in the journal Brain, Behaviour and Immunity, suggest that lifestyle changes aimed at reducing a person's risk of stroke may also decrease their likelihood of developing Parkinson's disease in the future.

People in England with cystic fibrosis (CF) and a specific gene fault will now have access to a new treatment called ivacaftor (brand name Kalydeco).

The four specialised commissioning groups (SCGs) confirmed that the NHS in England will fund the drug for all eligible patients aged six years and over.

Cathy Edwards, director of specialised commissioning in the north of England, who led the review project, confirmed: 'From January 1st 2013, ivacaftor will be made available to NHS patients aged six years and over with the G551D gene mutation in England as set out in the licensed indication.'

The decision means that approximately 270 people in England will have the opportunity to benefit from this new type of medicine.

Ed Owen, chief executive of the CF Trust, said he was 'delighted' by the decision.

'Today's decision is a fantastic early Christmas present for those affected by the G551D mutation,' Mr Owen claimed.

'But it's good news for the whole of the CF community too, as it provides a strong signal that the NHS is willing to fund future transformational therapies at a time when the future pipeline in drug development is looking so promising,' he added.

Simon Bedson, general manager of drug maker Vertex Europe, confirmed that the company will work with the NHS to help it implement the decision as quickly as possible.

Parents who are looking for reduced-calorie snacks for their children may benefit from new research from Cornell University in the US.

Scientists set out to determine whether certain types of snacks enabled children to feel full while consuming fewer calories.

They recruited 201 children for their study, giving each youngster a plate of crisps, a plate of vegetables, a plate of cheese, or a plate of vegetables and cheese while they watched cartoons on the TV.

The children were asked about their degree of fullness before eating and after watching cartoons.

Publishing their findings in Pediatrics journal, the study authors revealed that children who ate the combination of vegetables and cheese typically needed fewer calories in order to feel full than those who ate crisps.

Overweight and obese children ate 76 per cent fewer calories when given the cheese and vegetable snack, while normal-weight youngsters ate 60 per cent fewer.

The study authors concluded that a combination of vegetables and cheese 'can be an effective means for children to reduce caloric intake while snacking'.

Children should be given two cups of milk a day to optimise their levels of vitamin D and iron, new research suggests.

A high intake of milk is recommended to ensure children have adequate vitamin D levels, but too much can cause the body's iron stores to be depleted.

Researchers at St Michael's Hospital in Toronto therefore set out to determine the most appropriate level of milk consumption in healthy children between the ages of two and five years.

A total of 1,300 children took part in the study, which collected blood samples from the youngsters and dietary information from their parents.

The researchers found that children with a high intake of cow's milk tended to have higher vitamin D stores but lower iron stores.

'We saw that two cups of cow's milk per day was enough to maintain adequate vitamin D levels for most children, while also maintaining iron stores,' revealed lead author Dr Jonathon Maguire.

'With additional cow's milk, there was a further reduction in iron stores without greater benefit from vitamin D,' he added.

The findings, which are published in Pediatrics journal, suggest that two cups of milk per day may be best for preventing vitamin D and iron deficiency in children.

Orange juice could play an important role in achieving a healthy diet, new research has shown.

We all know that orange juice is good for us, but researchers at Louisiana State University Agricultural Centre in the US have discovered that people who drink 100 per cent orange juice tend to have better diets overall.

The team looked at data from the 2003-06 National Health and Nutrition Examination Survey (NHANES) and found that measures of overall diet quality were typically higher for adults who regularly consumed 100 per cent orange juice.

In addition, the study - which is published in Nutrition Journal - revealed that orange juice drinkers benefited from a higher intake of key nutrients, including vitamin C, potassium, magnesium and folate, and were less likely to be overweight than their non-juice-drinking counterparts.

Study co-author Dr Carol O'Neil, from the School of Human Ecology at Louisiana State University Agricultural Centre, said: 'A growing body of research has painted a clear picture that enhanced nutrient intake and better diet quality appears to be associated with drinking 100 per cent orange juice in adults.'

She added that drinking juice is associated with a higher intake of important nutrients that are 'generally under-consumed'.

Two cups of cow's milk daily appears to be the amount needed to provide adequate vitamin D and still maintain iron stores for most children, according to a new report.

Jonathon L. Maguire, MD, FRCPC, from the University of Toronto in Ontario, Canada, and colleagues report their findings in an article published online December 17 in Pediatrics.

According to the researchers, cow's milk consumption is known to increase vitamin D levels and decrease iron levels in children; however, "the amount of cow's milk intake required for sufficient stores of vitamin D and iron is poorly understood, and existing guidelines on consumption are unclear."

The current study sought to examine the association between cow's milk intake and vitamin D and iron stores in 1311 urban preschoolers who fit inclusion and exclusion criteria through the TARGet Kids! primary care practice–based research network in Toronto.

Parents of healthy children aged 2 to 5 years reported cow's milk consumption by responding to a standardized survey during primary care physicians' visits with their children between December 2008 and December 2010. Serum 25-hydroxyvitamin D and ferritin measurements were used as markers of vitamin D and iron stores, respectively. Complete sets of data were available for 76% of the children included.

"Children were excluded from this TARGet Kids! study if they had any chronic illnesses (other than asthma) or acute inflammation (C-reactive protein [CRP] >10 mg/L), [or] were on medications known to alter vitamin D or iron metabolism (ie, antiseizure medications)," the authors write.

Mean cow's milk intake was 460 mL each day. Mean 25-hydroxyvitamin D level was 88 nmol/L (95% confidence interval [CI], 87 - 89 nmol/L); 35% (95% CI, 33% - 38%) of the participants had 25-hydroxyvitamin D levels less than 75 nmol/L, and 6% (95% CI, 5% - 7%) of the participants had 25-hydroxyvitamin D levels less than 50 nmol/L. Mean ferritin was 31 mg/L; 4% (95% CI, 3% - 5%) of the participants had ferritin levels lower than 12 mg/ L.

Increasing cow's milk consumption was associated with decreasing serum ferritin ( P < .0001) and increasing 25-hydroxyvitamin D ( P ≤ .0001).

Each cup (250 mL) of cow's milk increased 25-hydroxyvitamin D levels an average of 6.5% and decreased serum ferritin levels, on average, by 3.6%.

According to the researchers, 2 cups, equivalent to 500 mL, of cow's milk per day seemed to be the amount needed to maintain 25-hydroxyvitamin D at levels > 75 nmol/L, without resulting in low serum ferritin for most children.

Also according to the researchers, children with darker skin pigmentation not receiving vitamin D supplementation during the winter required 3 to 4 cups of cow's milk per day to maintain 25- hydroxyvitamin D at the same levels. They also found that "[a]mong children using a bottle, cow's milk consumption did not increase median 25-hydroxyvitamin D and resulted in more dramatic decreases in median serum ferritin."

Study limitations include possible recall bias from the parent surveys, lack of generalizability because of the use of an urban setting for patient recruitment, and the inability because of the cross-sectional design to draw conclusions about causality.

"Our findings suggest that there is a trade-off between increasing 25-hydroxyvitamin D and decreasing serum ferritin with increasing milk intake," Dr. Maguire and colleagues conclude. Moreover, "bottle use, gender, season, vitamin D supplementation, skin pigmentation, and [body mass index] were significant modifiers of this trade-off." Vitamin D supplementation, current use of a bottle, summertime, light skin, and low body mass index were each associated with higher levels of 25-hydroxyvitamin D; the winter season was associated with increased ferritin levels.

According to the researchers, the findings are consistent with American Academy of Pediatrics recommendations of milk intake, depending on the clinical scenario.

They add that the findings highlight "the importance of vitamin D supplementation during the winter among children with darker skin pigmentation to maintain vitamin D stores."

Support for the TARGet Kids! program was provided by the Canadian Institutes of Health Research Institute of Human Development, Child and Youth Health; the Institute of Nutrition, Metabolism and Diabetes; and the St. Michael's Hospital Foundation. This study was supported in part by the Canadian Institutes of Health Research. The Paediatric Outcomes Research Team is supported by a grant from the Hospital for Sick Children Foundation. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 17, 2012. Abstract

Early menopause was associated with an increased risk of developing type 2 diabetes, according to results from a large, prospective study.

The results were published online December 10 in Diabetes Care by Judith S. Brand, MSc, from the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands, and colleagues.

"The findings of the current study are of interest in light of the high prevalence of type 2 diabetes among postmenopausal women. The direct effect of early menopause may be relevant for the prevention of diabetes in women. For example, early menopause might be a factor to take into account when considering diabetes screening or direct preventive action," the authors write.

The researchers used data from InterAct, which is a case-cohort study nested within the larger, prospective, 8-country European Prospective Investigation Into Cancer and Nutrition study. The current work is the first prospective study to investigate the relationship between menopausal age and reproductive lifespan and the development of diabetes, according to the investigators.

The analysis included 3691 postmenopausal women with diabetes and a representative subcohort of 4408 postmenopausal women with known age at menopause, including 235 women who developed type 2 diabetes during a mean follow-up of 11 years.

At study entry, the women in the subcohort had a mean age of 59.2 years and reported a mean age of 48.6 years at menopause.

After adjusting for known diabetes risk factors and reproductive factors, and using menopause at age 50 to 54 years as a reference, the hazard ratios for the development of type 2 diabetes were 1.32 (95% confidence interval [CI], 1.04 - 1.69) for women who went through menopause when they were younger than 40 years...,1.09 (95% CI, 0.90 - 1.31) for women who went through menopause at ages 40 to 44 years, and... 0.97 (95% CI, 0.86 - 1.10) for women who went through menopause at ages 45 to 49 years.

For those whose menopause occurred at or after age 55, the hazard ratio was 0.85 (95% CI, 0.70 - 1.03) compared with women who went through menopause at age 50 to 54 years.

Similarly, a shorter reproductive life span, defined as age of menopause minus age of menarche, was also associated with increased risk for type 2 diabetes, with a hazard ratio of 1.17 (95% CI, 0.98 - 1.39) for the fourth versus the first quartile.

An additional analysis, which adjusted for factors such as waist circumference, body mass index, smoking, hypertension, hyperlipidemia, and use of hormone replacement therapy, did not significantly change the results, nor did restricting the analysis to women who had not had hysterectomy and/or oophorectomy. In addition, the results were similar across the 8 countries, the authors note.

"Unique and Important"

Reasons for the association are not clear but may relate to duration of estrogen exposure and/or the menopausal shift toward androgenicity. "Alternatively, early menopause may represent a marker of premature ageing," the authors write.

Although these findings have potential clinical implications for diabetes screening and/or prevention, Brand and colleagues write, "beforehand, more studies are needed to evaluate whether timing of menopause has any added value in diabetes prediction and prevention."

Elsa Strotmeyer, PhD, MPH, assistant professor at the Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, told Medscape Medical News that the study's strengths included that it was a large, prospective cohort study "across many countries with extensive analyses adjusting for multiple potential mediators and confounders of the association."

In addition, Dr. Strotmeyer said, the analysis of reproductive lifespan was a "unique and important" aspect of the study, "since this is likely at better marker of total duration of endogenous estrogen exposure."

However, she added, the study was limited in that women who had not yet undergone menopause had been excluded from the larger cohort and that the age range of women in the excluded vs included groups was not clear. "Possibly, when the entire cohort of women is considered, the findings could change if age at menopause is different in the excluded vs included women for the analyses," Dr. Strotmeyer told Medscape Medical News.

Clinically, she said, the findings suggest that women who undergo menopause before age 40 years "may be a high-risk group to target for diabetes screening." However, she added, "only a small percentage of these women experienced menopause at such an early age."

Funding for the InterAct project was provided by the European Union FP6 programme. In addition, the InterAct investigators acknowledged funding from the University Medical Center Utrecht, the Medical Research Council and Cancer Research UK, the Spanish Ministry of Health, Navarre Regional Government and CIBER Epidemiologıa y Salud Pública, the Spanish Ministry of Health and Murcia Regional Government, Cancer Research UK, the Swedish Research Council, the Swedish Diabetes Association, and Swedish Heart-Lung Foundation, the German Cancer Aid and German Ministry of Research, the Danish Cancer Society, Compagnia di San Paolo, Asturias Regional Government, Västerboten County Council, AIRE-ONLUS Ragusa, AVIS-Ragusa, and the Sicilian Regional Government, Dutch Ministry of Public Health, Welfare and Sports, Netherlands Cancer Registry, Dutch Prevention Funds, Dutch Zorg Onderzoek Nederland, World Cancer Research Fund, Statistics Netherlands, and Imperial College Biomedical Research Centre. One investigator also received funding from Novo Nordisk. The other authors and Dr. Strotmeyer have disclosed no relevant financial relationships.

Diabetes Care. Published online December 10, 2012. Abstract

There is little scientific evidence that complementary therapies are effective for treating arthritis and other musculoskeletal conditions, a new report has found.

Arthritis Research UK analysed results from a large number of randomised clinical trials to assess the efficacy and safety of 25 different therapies for the treatment of arthritis, fibromyalgia and back pain.

Researchers found that many therapies had only been tested in a single study or had not been the subject of any reliable clinical trials.

Therapies that seemed to have the greatest likelihood of effectiveness included acupuncture for osteoarthritis, low back pain and fibromyalgia; massage for fibromyalgia and low back pain; tai chi for osteoarthritis; and yoga for back pain.

But therapies such as copper and magnetic therapy showed little sign of effectiveness for any musculoskeletal disorder.

Study author Dr Gareth Jones, from the University of Aberdeen, revealed that around one in four people use complementary or alternative therapies, with the figure likely to be higher for those with musculoskeletal conditions such as arthritis.

'The report aims to help people with musculoskeletal conditions and healthcare professionals by providing clear, scientific evidence about the safety and effectiveness of complementary therapies,' he said.

The government is launching a new campaign aimed at exposing the hidden 'nasties' in everyday foods... Created as part of the Change4Life initiative, the adverts mark the launch of a new healthy eating drive and involve a number of food manufacturers and retailers, including Asda, the Co-operative Food, Quorn, Uncle Ben's and Cravendale.

The ads have been created by Aardman, the creators of Wallace and Gromit, and are designed to encourage the public to think about the levels of salt, sugar and saturated fat that may be hiding in the foods they eat.

Public health minister Anna Soubry conceded that families may find it a 'challenge' to make healthier, more balanced meals on a budget.

'This new Change4Life campaign offers families free healthy recipes and money off those much-needed cupboard essentials to encourage everyone to try healthy alternatives,' she revealed.

The campaign urges people to sign up online, in exchange for which they will receive offers such as free milk and money off various healthy products.

A spokeswoman for the British Heart Foundation welcomed the goals of the new campaign.

The charity's senior dietician, Victoria Taylor, observed: 'If we're to lessen the heavy burden of obesity, this campaign must provide the spark for a continued, joined-up approach to the promotion of healthy eating and physical activity across the UK.'

A pill based on an ingredient in tomatoes could reduce the risk of heart disease and stroke, scientists have claimed.

Ateronon contains a chemical called lycopene, which is found in the skin of ripe tomatoes.

Previous studies have suggested that it may help to unclog arteries, but the latest research indicates that it may have far greater effects.

Scientists at Cambridge University found that the pill could help to improve the efficiency of blood vessels, boost blood flow and soften hardened arteries.

Ian Wilkinson, director of Cambridge's clinical trials unit, told the Cambridge News: 'We think these results are good news and potentially very significant, but we need more trials to see if they translate into fewer heart attacks and strokes.'

The findings could have important implications, as figures from the British Heart Foundation show that heart and circulatory diseases cause more than a quarter of all deaths in the UK, with an estimated annual cost of $19 billion to the economy.

When it comes to weight and fat loss, aerobic training leads to more effective results than resistance training, according to a new study.

Researchers at Bethesda in Maryland, US, took part in one of the largest randomised trials believed to have taken place comparing changes in body size with time spent exercising.

Published in the Journal of Applied Physiology, the study focused specifically on previously inactive overweight and obese non-diabetic adults.

A group of 234 adults was split into three groups - with the first conducting aerobic training, the second focusing on resistance training and the third incorporating both into their exercise regimes.

The results suggested that those who did resistance-only actually gained a little weight on average due to an increase in lean body weight, while the other two groups lost mass.

Exercise physiologist at Duke University Medical Center and lead study author Leslie Willis said: "Given our observations, it may be time to seriously reconsider the conventional wisdom that resistance training alone can lead to weight and fat loss.

In this 49-page report:

• 7 types of normal memory problems
• 10 ways to promote memory health
• How your overall health affects your memory
• Is it normal aging or dementia?

In many ways, our memories shape who we are. They make up our internal biographies - the stories we tell ourselves about what we've done with our lives. They tell us who we're connected to, who we've touched during our lives, and who has touched us. In short, our memories are crucial to the essence of who we are as human beings.

Memory loss affects the practical side of life. It's a problem when you have trouble remembering how to get from your house to the grocery store or how to do the tasks that make up your job. Losing your memory means both losing your ability to live independently and not being able to remember your past experiences.

It's not surprising, then, that concerns about loss of memory and thinking skills ranks among the top fears people have as they age.

And there's no getting around the fact that the ability to remember does change with age. Many of these changes are normal, and not a sign of dementia - the loss of brain function that accompanies Alzheimer's disease or poor blood flow in the brain. Unfortunately, some people have the more serious memory problems that are associated with dementia.

If your memory is still healthy - even if you're forgetting a bit more than you'd like - now's the time to commit to protecting your brain and keeping it healthy.

helps you understand the difference between normal, age-related changes in memory and changes caused by dementia. The report also offers tips on how to keep your brain healthy, and how to help improve your memory if you're living with age-related memory loss.

One of the key components of this memory-saving program is to keep the rest of your body healthy. Many medical conditions - from heart disease to depression - can affect your memory. Staying physically and mentally active turns out to be among the best prescriptions for maintaining a healthy brain and a resilient memory.

This report discusses new research on this subject and strategies that may help.

Hip replacement surgery may temporarily increase a person's risk of stroke, experts have warned.

Scientists in the UK, the Netherlands and Denmark looked at the timing of strokes in patients who underwent hip replacement surgery bewteen 1998 and 2007, compared with people who did not have the procedure.

More than 66,500 hip replacement patients were included in the analysis and the researchers found that these individuals were more likely to have a stroke in the two weeks following their operation.

Overall, there was a 4.7-fold increased risk of ischemic stroke and a 4.4-fold increased risk of hemorrhagic stroke in the two weeks following hip replacement surgery.

The risk of ischemic stroke remained high during the first six weeks following surgery, while the risk of hemorrhagic stroke was elevated for around 12 weeks.

Publishing their findings in Stroke journal, the study authors concluded that risk assessment of stroke 'should be considered during the first six to 12 weeks' for patients who have undergone hip replacement surgery.

Dr. Peter Coleman, a spokesman for the Stroke Association, told the BBC: 'This research suggests that hip replacement surgery could increase your risk of stroke and the results should be taken very seriously.'

A low-carbohydrate diet may help to reduce inflammation and decrease a person's chances of developing heart disease, new research suggests.

Scientists at Johns Hopkins University School of Medicine looked at overweight people, aged 30 to 65 years, over a six-month period.

Participants were split into two groups, with the first following a low-carbohydrate diet and the second adopting a low-fat regime.

The researchers found that both diets were associated with a reduction in systemic inflammation, potentially reducing people's risk of heart disease. In addition, people who followed the low-carbohydrate diet tended to lose more weight - and more abdominal fat - than those on the low-fat diet.

Colette Heimowitz, a spokeswoman for the low-carbohydrate Atkins diet, said there are misconceptions about the dietary regime, with many believing it to be non-heart-healthy.

'This is the first study of this scope that demonstrates a significant drop in the levels of all three measures of inflammation for those that lost weight and abdominal fat, with those following the Atkins diet losing more weight and belly fat,' she observed.'

The findings were presented at the American Heart Association's Scientific Sessions earlier this month (November 5th).

Supratherapeutic amounts of acetaminophen were given to at least 4% of adult in-patients studied, according to a retrospective review of the electronic medical records of 14,000 patients treated in 2 hospitals during a 3-month period.

Li Zhou, MD, PhD, a senior medical informatician in the Clinical Informatics Research & Development department at Partners HealthCare and an instructor in medicine at Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, and colleagues published their results online November 12 in the Archives of Internal Medicine.

Acetaminophen is one of the most widely used medications for relieving pain and reducing fever, but it is also the most common cause of acute liver failure, the authors note.

The study population comprised 14,411 patients (60.7%) who received acetaminophen. A total of 955 of 23,750 (6.6%) of all hospitalized adults were given in excess of 4 g/d (9.6% at hospital A and 4.2% at hospital B).

The recommended limit of 3 g/d was exceeded by 22.3% of patients 65 years or older and 17.6% of patients with chronic liver disease.

Averaged over the entire hospital stay, those who were given supratherapeutic dosing received more administrations per day (3.5 vs 1.5; P < .001) and a higher dose per administration (791 mg vs 651 mg; P < .001).

Almost half (45.9%) of the occurrences of supratherapeutic dosing were at least 5 g/d. …..About 40% of patients were given supratherapeutic dosing for at least 3 days and 4.0% for at least 10 days.

Preexisting chronic liver disease was associated with a decreased risk for supratherapeutic dosing (odds ratio [OR], 0.5 [95% confidence interval [CI], 0.4 - 0.7]), and osteoarthritis was associated with an increased likelihood of supratherapeutic dosing (OR, 4.2 [95% CI, 3.6 - 5.0]).

No difference in supratherapeutic dosing rate was found between those who were given multi-ingredient products and those who were not; however, a higher risk was found in patients who used single-ingredient products (OR, 3.4 [95% CI, 2.5 - 4.6]).

Patients who were given more than 1 type of acetaminophen-containing medication had higher supratherapeutic dosing rates (OR, 1.8 [95% CI, 1.5 - 2.1]). Almost one fifth (20.7%) of the 164 patients who received at least 3 different acetaminophen-containing products had supratherapeutic dosing.

In multivariate analysis, the strongest risk factors for supratherapeutic dosing were recurring scheduled administrations (hazard ratio [HR], 16.6 [95% CI, 13.5 - 20.6]), the number of different products given to a patient (HR, 2.4 for each additional product [95% CI, 2.0 - 2.9]), and the use of products that contain 500-mg acetaminophen (HR, 1.9 [95% CI, 1.5 - 2.3]). Investigators adjusted the multivariate analysis for age, sex, race, hospital, hospital unit, diagnosis, dosing instructions, and several other factors found to be statistically significant in the univariate analysis.

White patients (HR, 1.5 [95% CI, 1.3 - 1.7]), those with osteoarthritis (HR, 1.4 [95% CI, 1.3 - 1.6]), and patients admitted to the hospital (HR, 1.6 [95% CI, 1.4 - 1.8]) were more likely to receive excessive dosing.

The risk was lower among patients admitted to medicine or other units (HR, 0.6 [95% CI, 0.5 - 0.7]) and patients who had as-needed administrations (HR, 0.7 [95% CI, 0.6 - 0.9]).

"While no causal relationship can be inferred, patients who received supratherapeutic dosing were more likely to have statistically significant elevations in ALP [alkaline phosphatase] level, statistically insignificant elevations in ALT [alanine aminotransferase] level, but neither clinically nor statistically significant changes in other liver injury markers," the authors write.

Commitment to Change Needed

In an invited commentary, Walter H. Ettinger, MD, MBA, Department of Medicine, University of Massachusetts Medical School, Worcester, and Accretive Health Inc, Chicago, Illinois, writes, "[E]xcessive dosing of acetaminophen should be a 'never event.' The best way to prevent excessive dosing is to engineer a process and imbed it in the [electronic health record] such that it creates a hard stop that prevents ordering and administering more than 4 g/d of acetaminophen."

Hospitals need to be committed to reducing the time it takes to bring improvements to patients, and technology, such as electronic medical records, needs to be flexible enough to change to meet patient and provider needs.

"[T]o drive change and innovation we need a large investment in performance improvement and process engineering, business intelligence systems, and analytical capabilities to take full advantage of HIT [health information technology] and to move us toward the goal of becoming a rapid-learning health system," Dr. Ettinger explains.

The study was funded by the Partners-Siemens Research Council. The study authors have disclosed no relevant financial relationships. Dr. Ettinger is an employee of, and has stock options from, Accretive Health Inc.

International action is needed to tackle the problem of fake medicines, experts have claimed.

Writing in the British Medical Journal, Amir Attaran from the University of Ottawa and colleagues warn that patients around the world are losing their lives as a result of substandard and counterfeit medicines.

More than 10% of medicines in poor countries are thought to be counterfeit and fake drugs still cause problems in wealthier parts of the world.

Yet there is still no international agreement on how the problem should be tackled, the authors point out.

In their paper, they call for a global treaty to be drawn up to crack down on the trade of these potentially deadly drugs.

'We argue that tackling the challenges of poor quality, unsafe medicines requires a comprehensive global strategy on which all stakeholders agree,' they write.

The study authors also observe that an imminent change to the Framework Convention on Tobacco Control - a global public health treaty - will soon criminalise the illicit trade of tobacco products, making the law on cigarette counterfeiting tougher than the one on medicine falsification.

They argue that examples of successful global treaties should be adapted for medicines to protect the public's health.

Requiring a patient to fast for many hours before a lipid test may soon be a thing of the past.

Although present guidelines encourage doctors to test for total lipids and lipid subclass levels only when a patient has fasted for more than 8 hours, a report published online November 12 in Archives of Internal Medicine found that there may no longer be a need for a patient to fast. There is very little difference in lipid levels when measured in a fasting or non-fasting state, according to the research.

"The incremental gain in information of a fasting profile is exceedingly small for total and HDL-Cholesterol values and likely does not offset the logistic impositions placed on our patients, the laboratories, and our ability to provide timely counseling to our patients," J. Michael Gaziano, MD, writes in an accompanying editorial. "This, in my opinion, tips the balance toward relying on non-fasting lipid profiles as the preferred practices," writes Dr. Gaziano, who is with the Department of Medicine at Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.

Two other doctors agree. "Given the current lack of evidence for the superiority of fasting lipid testing, it is reasonable to consider nonfasting lipid testing in most individuals who present for a routine clinic visit," Amit Khera, MD, and Samina Mora, MD, write in a second editorial. Dr. Khera is with the Division of Internal Medicine and Dr. Mora is with the Department of Preventive Medicine and Cardiovascular Disease at Brigham and Women's Hospital and Harvard Medical School.

A few prior studies have also suggested that measuring all lipid subclasses when the patient has not fasted will produce acceptable results - even beneficial results in some cases because some non-fasting markers are better predictors of future cardiac events, study authors note. Most of those studies, however, had the limitation of pertaining only to certain groups of patients.

"Therefore, there was a need for a large-scale study of the association of fasting time with lipid levels in an unselected population," study authors Davinder Sidhu, MD, LLB, and Christopher Naugler, MSc, MD, Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada, write.

To investigate the relationship between fasting duration and lipid levels in a large community-based population, the authors designed the study as a cross-sectional analysis of laboratory data.

They used secondary data from Calgary Laboratory Services and examined the test results of every individual with lipid test panels between April 1, 2011, and September 30, 2011.

A policy change in 2011 allowed the laboratory to process samples for fasting lipid levels regardless of the duration of fasting time.

Fasting times ranged from 1 hour to more than 16 hours.

Lipid results included the mean levels of HDL cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol, and triglycerides. A total of 209,180 participants were included in the analysis. Authors used linear regression models to project average cholesterol levels at various fasting times.

The study found that variation among mean cholesterol subclass levels was less than 2% for total cholesterol and HDL-C, less than 10% for calculated LDL-C, and less than 20% for triglycerides among individuals with various fasting times. Only a minority of fasting intervals had statistically significant differences among cholesterol subclasss levels.

"While there are some circumstances in which a fasting level may be useful, most of the time it is probably not necessary," Dr. Gaziano stresses in his editorial.

But the study is not without limitations, he writes.
"The analyses assume that there is no systematic bias introduced by the timing of the blood draw," Dr. Gaziano notes in his editorial. "No information was available on medications or repeated measures. More data by age would have been helpful," he says.

Other limitations, according to the authors, are that the study did not examine individual meal choices before testing or control for recall errors of self-reported fasting time.

Future research, the authors suggest, should involve "examining repeated measurements with differing fasting times in the same individuals."

Dr. Mora was supported by the National Heart, Lung, and Blood Institute and by AstraZeneca. The study authors, Dr. Gaziano, and Dr. Khera have disclosed no relevant financial relationships. Dr. Mora has served as a consultant for Pfizer and Quest Diagnostics and has received speaking honoraria from Abbott, AstraZeneca, and the National Lipid Association for nonpromotional educational activities.

Arch Intern Med. Published online November 12, 2012. Full text Gaziano commentary Khera and Mora commentary

Britons are putting their future eyesight at risk by spending hours in front of television and computer screens, experts have warned.

A report commissioned by Optical Express suggests that over a quarter of adults have visited the optician because their eyes feel tired from looking at screens.

The survey also revealed that 69% of respondents wore prescription glasses or contact lenses.

Steve Schallhorn, an ophthalmic surgeon and chairman of Optical Express' International Medical Advisory Board, said there is 'no doubt that daily and prolonged use of screens can have a detrimental impact on eyesight'.

'If left unchecked, the UK could face considerable problems with eyesight across the country,' he warned.

Experts are particularly concerned about young people, many of whom spend the majority of their waking hours in front of a screen.

Adults are advised to visit an optician every two years to ensure any problems with their eyes are detected and that they have the right prescription if required, with Mr Schallhorn insisting that regular check-ups are 'vital' to maintain healthy eyes.

The prevalence of diabetes is rapidly increasing in all regions of the United States and Puerto Rico, according the findings of a retrospective study.

Linda S. Geiss, MA, from the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues published their findings in the November 16 issue of the Morbidity and Mortality Weekly Report.

To establish whether the increase in prevalence has been greater in specific US regions, the authors analyzed data collected between 1995 and 2010 by the Behavioral Risk Factor Surveillance System (BRFSS), which gathers data on health behaviors and conditions using state-based random telephone surveys. The prevalence of diabetes was calculated for each year as the percentage of people who said they had been told by a doctor that they had diabetes.

The analysis revealed that the age-adjusted prevalence of diabetes was at least 6% by 2010 in all 50 states, the District of Columbia, and Puerto Rico, whereas the prevalence exceeded this level in only 3 states, the District of Columbia, and Puerto Rico in 1995.

The overall median prevalence for the entire United States and Puerto Rico increased from 4.5% to 8.2% between 1995 and 2010.

The age-adjusted prevalence of diabetes was higher in the South (9.8%) than in the Midwest (7.5%), Northeast (7.3%), and West (7.3%).

In 2010, Alabama, Mississippi, South Carolina, Tennessee, Texas, West Virginia, and Puerto Rico had a diabetes prevalence of at least 10%, whereas 12 states had a prevalence of less than 7%. In addition, the age-adjusted prevalence increased by at least 50% in 42 states and by at least 100% in 18 states.

The authors note that the study was limited by the exclusion of people without landline telephones from BRFSS surveys, the fact that approximately one fourth of all adults with diabetes are undiagnosed, and the lack of differentiation between type 1 and type 2 diabetes in the surveys.

The authors indicate that strategies that target the entire population and high-risk groups are needed to reverse the increasing prevalence of diabetes across the country.

"With the goal of preventing or delaying the onset of type 2 diabetes in high-risk persons, the National Diabetes Prevention Program supports the nationwide implementation of evidence-based, community, lifestyle programs that promote modest weight loss, good nutritional practices, and increased physical activity among persons at high risk," the authors write.

"Continued surveillance of diabetes prevalence and incidence, its risk factors, and prevention efforts is important to measure progress toward reducing the incidence of diabetes across the United States."

The authors of the study are all Centers for Disease Control and Prevention employees.

Panidis D, Tziomalos K, Chatzis P, Papadakis E, Delkos D, Tsourdi EA, Kandaraki EA, Katsikis I.

Source
D Panidis, Aristotle University of Thessaloniki, Hippokration Hospital, Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Thessaloniki, Greece.

Abstract
OBJECTIVE: Insulin resistance (IR) is frequent in polycystic ovary syndrome (PCOS) and contributes to the increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) of this population.

Several markers of IR are used but most are expensive or have limited sensitivity and specificity.

Preliminary data suggest that the menstrual cycle pattern correlates with IR in PCOS but existing studies are small.

We aimed to assess the relationship between the type of menstrual cycle irregularities and IR in PCOS.

DESIGN: Prospective study.

METHODS: We studied 1,285 women with PCOS, divided according to the menstrual cycle pattern.

RESULTS: Patients with isolated secondary amenorrhea and those with secondary amenorrhea alternating with regular menstrual cycles were more insulin resistant than patients with regular cycles (Group D).

Patients with isolated oligomenorrhea were also more insulin resistant than Group D.

However, patients with oligomenorrhea alternating with regular cycles, secondary amenorrhea or polymenorrhea had comparable levels of markers of IR with Group D.

Moreover, patients with oligomenorrhea alternating with regular cycles were less insulin resistant than patients with secondary amenorrhea alternating with regular cycles.

Finally, patients with isolated polymenorrhea and those with polymenorrhea alternating with regular cycles had comparable levels of markers of IR with Group D.

CONCLUSIONS:
Amenorrhea is associated with more pronounced IR in PCOS, oligomenorrhea portends a less excessive risk for IR than amenorrhea whereas polymenorrhea appears to be even more benign metabolically.

Therefore, the type of menstrual cycle abnormality appears to represent a useful tool for indentifying a more adverse metabolic profile in PCOS.

Women in the UK are breastfeeding their infants for longer, new figures show.

A report from the Health and Social Care Information Centre (HSCIC) indicates that one in three women are still breastfeeding at six months, although many do not do so exclusively as recommended by health experts.

Figures reveal that 81 per cent of women who gave birth in 2010 started off breastfeeding, up from just 76 per cent in 2005.

Thirty-four per cent of mothers in 2010 were still breastfeeding by the time their infant was six months old, although just one per cent were doing so exclusively.

The report also shows that breastfeeding is more common in women over the age of 30, those in affluent areas, mothers who stayed in education beyond 18 years of age and members of minority ethnic groups.

Tim Straughan, chief executive of the HSCIC, said: 'Today's report gives a detailed account of the incidence and prevalence of breastfeeding across the UK and reveals that breastfeeding practices can vary according to a mother's ethnicity, education and affluence.

'Not only are more mothers initially breastfeeding at the time of their baby's birth, more of them are continuing to breastfeed for longer, which has known benefits to a child's long-term health.'

Health experts say that unless there are medical reasons for not doing so, breastfeeding is the healthiest way to feed a baby during the first six months of its life.

Physical activity is known to be good for the knees, but a new study suggests people must be careful not to do too little or too much.

Scientists at the University of California, San Francisco, say that both high and low levels of physical activity can speed up the degeneration of knee cartilage in middle-aged adults

The team used magnetic resonance imaging (MRI) to look at changes in cartilage among 205 middle-aged adults over a four-year period.

Presenting the findings at the annual meeting of the Radiological Society of North America, they revealed that frequent participation in running and other high-impact activities was associated with more degenerated cartilage.

However, low levels of activity were also associated with cartilage degeneration.

This suggests there may be an 'optimal level of physical activity to preserve the cartilage', according to Dr Thomas Link, professor of radiology and chief of musculoskeletal imaging at the university.

'Lower impact sports, such as walking or swimming, are likely [to be] more beneficial than higher impact sports, such as running or tennis, in individuals at risk for osteoarthritis,' he added.

Osteoarthritis is the most common type of arthritis in the UK, accounting for around one million GP consultations every year.

Reading, writing and playing games can help to preserve the structural integrity of the brain in older people, scientists have claimed.

Researchers at the Rush University Medical Centre and Illinois Institute of Technology in Chicago used magnetic resonance imaging (MRI) to generate data on the movement of water molecules through the brain in 152 people with an average age of 81 years.

Dr. Konstantinos Arfanakis explained that water is less able to move in directions perpendicular to the nerve fibres in healthy white matter tissue.

But when structures such as myelin are lost, the water has more freedom to move perpendicular to the fibres and this can be observed on scans.

The researchers observed a close link between the frequency with which an individual engaged in mental activities and the movement of water molecules in their brain.

'Several areas throughout the brain, including regions quite important to cognition, showed higher microstructural integrity with more frequent cognitive activity in late life,' said Dr. Arfanakis.

He added that reading, writing letters, visiting the library, attending plays or playing games 'are all simple activities that can contribute to a healthier brain'.

The findings were presented at the annual meeting of the Radiological Society of North America.

People should look after their gums to improve their chances of good overall health, dentists have claimed.

A recent study in the Journal of Periodontology found that people who stopped looking after their oral health were more likely to suffer from ill-health than those who maintained good dental care.

For instance, as well as being more likely to lose teeth, they appeared to face an increased risk of heart attacks, type-2 diabetes and obesity.

Commenting on the findings, the chief executive of the British Dental Health Foundation urged people to look after their teeth.

Dr. Nigel Carter said: 'This study demonstrates just how important it is that you look after oral health.

'What it does highlight is the relationship between gum disease and other related illnesses, and particularly the need for excellent gum health.'

People are advised to brush their teeth and floss twice a day, as well as paying regular visits to the dentist for check-ups.

Drugs that block proteins involved in inflammation could have the potential to treat Alzheimer's disease, a study suggests.

Researchers in Germany and Switzerland found that antibodies designed to block two inflammation-linked proteins helped to reduce features of Alzheimer's in laboratory mice.

The antibodies blocked the activity of a protein called p40, which is a common component of two messenger proteins called IL-12 and IL-23 in the brain.

These messenger proteins were found to be elevated in the brains of mice with Alzheimer's-like features;

but by stopping the p40 protein from working, the researchers were able to reduce brain levels of a hallmark Alzheimer's protein called amyloid and bring about improvements in the animals' cognitive problems.

Dr. Simon Ridley, from the charity Alzheimer's Research UK, described the field of inflammation as an 'exciting' area for dementia researchers.

Commenting on the latest study, which is published in the journal Nature Medicine, he said: 'This promising research adds further support for the role of the immune system in Alzheimer's, linking two inflammatory proteins to the disease in mice.'

However, the expert added that any new Alzheimer's drug would need to be tested rigorously in clinical trials before reaching patients.

People who are making short journeys should be encouraged to view walking or cycling as the norm, experts have claimed.

At present, two-thirds of men and nearly three-quarters of women do NOT do the recommended amount of physical activity.

With inactivity being the fourth leading risk factor for global mortality, public health experts are keen to persuade people to change their behaviours and move about more.

The National Institute for Health and Clinical Excellence (NICE) has published new guidance on the topic.

It says that schools, workplaces, local authorities and other organisations should encourage people to be more active, specifically through walking and cycling.

Professor Mike Kelly, director of NICE's Centre for Public Health Excellence, said: 'We want to encourage and enable people to walk and cycle more and weave these forms of travel into everyday life.

'This guidance is aimed at making it easier for people to do this, as well as explaining the benefits and helping to address some of the safety fears that some people may have.'

Dr. Harry Rutter, chair of the programme development group, said that the guidance could improve the quality of life for large numbers of people, 'now and in the future'.

The government has taken a step closer to cracking down on binge drinking by launching a consultation on its proposals.

Ministers are proposing a minimum price of 45p per unit of alcohol sold in England and Wales as part of a package of measures aimed at reducing problem drinking and its associated risks for health and society as a whole

In addition to the introduction of minimum pricing, the Home Office wants a ban on multi-buy promotions, such as two-for-one offers, and a new health-related objective for alcohol licensing.

This latter measure would mean licensing authorities would be able to consider alcohol-related health harms when managing problems relating to the number of premises selling alcohol in their area.

Damian Green, the government's policing minister, commented: 'The evidence is clear - the availability of cheap alcohol contributes to harmful levels of drinking.

'It can't be right that it is possible to purchase a can of beer for as little as 20p.'

Figures suggest that irresponsible drinking costs the taxpayer $21 billion per year, with hospitals admitting 1.2 million patients with alcohol-related problems last year alone.

CONTEXT: Multivitamin preparations are the most common dietary supplement, taken by at least one-third of all US adults.

Observational studies have not provided evidence regarding associations of multivitamin use with total and site-specific cancer incidence or mortality.

OBJECTIVE: To determine whether long-term multivitamin supplementation decreases the risk of total and site-specific cancer events among men.

DESIGN, SETTING AND PARTICIPANTS: A large-scale, randomized, double-blind, placebo controlled trial (Physicians`` Health Study II) of 14 641 male US physicians initially aged 50 years or older (mean [SD] age, 64.3 [9.2] years), including 1312 men with a history of cancer at randomization, enrolled in a common multivitamin study that began in 1997 with treatment and follow-up through June 1, 2011.

INTERVENTIONS: Daily multivitamin or placebo.

MAIN OUTCOME MEASURES: Total cancer (excluding nonmelanoma skin cancer), with prostate, colorectal, and other site-specific cancers among the secondary end points.

RESULTS: During a median (interquartile range) follow-up of 11.2 (10.7-13.3) years, there were 2669 men with confirmed cancer, including 1373 cases of prostate cancer and 210 cases of colorectal cancer.

Compared with placebo, men taking a daily multivitamin had a statistically significant reduction in the incidence of total cancer (multivitamin and placebo groups, 17.0 and 18.3 events, respectively, per 1000 person-years; hazard ratio [HR], 0.92; 95% CI, 0.86-0.998; P=.04).

There was no significant effect of a daily multivitamin on prostate cancer (multivitamin and placebo groups, 9.1 and 9.2 events, respectively, per 1000 person-years; HR, 0.98; 95% CI, 0.88-1.09; P=.76), colorectal cancer (multivitamin and placebo groups, 1.2 and 1.4 events, respectively, per 1000 person-years; HR, 0.89; 95% CI, 0.68-1.17; P=.39), or other site-specific cancers.

There was no significant difference in the risk of cancer mortality (multivitamin and placebo groups, 4.9 and 5.6 events, respectively, per 1000 person-years; HR, 0.88; 95% CI, 0.77-1.01; P=.07).

Daily multivitamin use was associated with a reduction in total cancer among 1312 men with a baseline history of cancer (HR, 0.73; 95% CI, 0.56-0.96; P=.02), but this did not differ significantly from that among 13 329 men initially without cancer (HR, 0.94; 95% CI, 0.87-1.02; P=.15; P for interaction=.07).

Conclusion: In this large prevention trial of male physicians, daily multivitamin supplementation modestly but significantly reduced the risk of total cancer.

TRIAL REGISTRATION(S): clinicaltrials.gov Identifier: NCT00270647.

The number of babies surviving after being born before 27 weeks' gestation has increased, new figures show.

A study funded by the Medical Research Council (MRC) looked at a group of babies born between 22 and 26 weeks' gestation in 2006, as well as babies born at the same stage in 1995.

Researchers at University College London and Queen Mary, University of London, found that the number of extremely premature babies admitted to intensive care increased by 44% between 1995 and 2006, while overall survival rose from 40 to 53%.

However, survival of babies born before 24 weeks - the legal limit for abortion - did not improve.

A second study assessing the same two groups of babies and published in the same issue of the British Medical Journal found that the proportion who experienced serious health problems and disability remained unchanged over the period.

Professor Neil Marlow, an MRC-funded researcher at the UCL Institute for Women's Health, said: 'Our findings show that more babies now survive being born too soon than ever before, which is testament to the highly-skilled and dedicated staff in our neonatal services.

'But as the number of children that survive pre-term birth continues to rise, so will the number who experience disability throughout their lives.'

There has been a decline in the number of people dying from cancer, even though more patients are being diagnosed with the disease, figures show.

Data from 2008-10 reveal that nearly 323,000 people are now diagnosed with cancer each year in the UK, the BBC reports.

The most common forms of the disease are breast, prostate, lung and colorectal (bowel) cancer.

Meanwhile, 156,200 people died from cancer each year during the period of analysis, according to the Office for National Statistics (ONS)

There were 431 new cases of cancer for every 100,000 men and 375 per 100,000 women in 2008-10, up from 403 per 100,000 men and 343 per 100,000 women in 2001-03.

Over the same period, death rates from the disease fell from 229 to 204 per 100,000 men, and from 161 to 149 per 100,000 women.

Earlier this year, ONS figures revealed that cancer is the biggest killer in England and Wales.

Macmillan Cancer Support responded to the figures, saying that NHS performance must be measured against one-year and five-year cancer survival rates.

Teenage girls who smoke may face an increased risk of the bone-thinning disease osteoporosis in later life, scientists have said.

Researchers at Cincinnati Children's Hospital Medical Centre looked at data on 262 girls, aged 11 to 19 years, to assess the impact of smoking on their future bone health.

They observed that girls who smoked tended to have lower bone mineral density in their lower spine and hip bone.

Although bone mass was equal for smokers and non-smokers at age 13, heavier smokers tended to accrue less bone mass in their hip and spine as they progressed through their teenage years.

'To our knowledge this is the first longitudinal study to test and demonstrate that smoking by girls, as well as symptoms of depression, have a negative impact on bone accrual during adolescence,' said Dr Lorah Dorn, principal investigator and director of research in the division of adolescent medicine at Cincinnati Children's Hospital.

The findings are published in the Journal of Adolescent Health and provide yet another reason to prevent children from taking up smoking.

While maintaining your fitness can help you live a long and fruitful life, it is essential to ensure you are not doing too much too fast.

That was the message delivered by US cardiologists Carl Lavie and James O'Keefe in an editorial article for in the healthcare journal Heart this week (November 29th).

While moderate exercise like running on a regular basis can prove beneficial to overall health, the pair warned that there is such a thing as doing too much.

The editorial explained: 'A routine of moderate physical activity will add life to your years, as well as years to your life.

'In contrast, running too fast, too far and for too many years may speed one's progress towards the finish line of life.'

The healthcare experts urged regular runners to limit themselves to somewhere between 30 and 50 minutes of cardiovascular exercise a day.

They also warned that fitness fanatics should avoid undertaking marathons on a regular basis, as this additional exercise could be putting their heart under undue pressure.

These warnings follow on from a recent study that warned too much exercise could be bad for our knees.

Sodium chloride (salt) is essential to the body. The sodium in salt helps transmit nerve impulses and contract muscle fibers. Working with potassium, it balances fluid levels in the body. But you only need a tiny amount of salt to do this, less than one-tenth of a teaspoon. The average American gets nearly 20 times that much.

The body can generally rid itself of excess sodium. In some people, though, consuming extra sodium makes the body hold onto water. This increases the amount of fluid flowing through blood vessels, which can increase blood pressure.

Most of the salt that Americans consume comes from prepared and processed foods. The leading culprits include snack foods, sandwich meats, smoked and cured meat, canned juices, canned and dry soups, pizza and other fast foods, and many condiments, relishes, and sauces - for starters. But enough comes from the salt shaker that it's worth finding alternatives.

Here are 5 ways to cut back on sodium when cooking or at the table:

• Use spices and other flavor enhancers. Add flavor to your favorite dishes with spices, dried and fresh herbs, roots (such as garlic and ginger), citrus, vinegars, and wine. From black pepper, cinnamon, and turmeric to fresh basil, chili peppers, and lemon juice, these flavor enhancers create excitement for the palate - and with less sodium.
• Go nuts for healthy fats in the kitchen. Using the right healthy fats - from roasted nuts and avocados to olive, canola, soybean, and other oils - can add a rich flavor to foods, minus the salt.
• Sear, sauté, and roast. Searing and sautéing foods in a pan builds flavor. Roasting brings out the natural sweetness of many vegetables and the taste of fish and chicken. If you do steam or microwave food, perk up these dishes with a finishing drizzle of flavorful oil and a squeeze of citrus.
• Get your whole grains from sources other than bread. Even whole-grain bread, while a healthier choice than white, can contain considerable sodium. And bread contains salt, not just for flavor but to ensure that the dough rises properly. You can skip that extra salt when you use whole grains outside of baking. Try a Mediterranean-inspired whole-grain salad with chopped vegetables, nuts, and legumes, perhaps a small amount of cheese, herbs and spices, and healthy oils and vinegar or citrus. For breakfast, cook up steel-cut oats, farro, or other intact whole grains with fresh or dried fruit, and you can skip the toast (and the extra sodium).
• Know your seasons, and, even better, your local farmer. Shop for raw ingredients with maximum natural flavor, thereby avoiding the need to add as much (if any) sodium. Shop for peak-of-season produce from farmers' markets and your local supermarket.

Reducing total fat intake through the diet can lead to small reductions in body weight among adults and a lower subsequent body mass index (BMI) as a result.

According to new research published in the British Medical Journal, the ideal amount of fat that should be included in the average diet is still unclear.

With the growing global obesity epidemic, the subject has taken on growing importance. Researchers looked at results from 33 randomised controlled trials from North America, Europe and New Zealand involving 73,589 participants in total.

Their analysis suggested that diets lower in total fat led to a typical reduction in body weight of 1.6kg after six months.

That was enough to lower BMI by 0.56kg/m2 and waist circumference by 0.5 per cent.

A correlation was found whereby every one per cent reduction in energy from fat resulted in a 0.19kg fall in body weight.

The researchers, who were commissioned by the World Health Organization, also found statistically significant reductions in cholesterol and blood pressure as a result of consuming lower-fat diets.

Pregnant women who fail to consume a healthy diet while they are expecting could end up contributing to the development of diabetes and metabolic syndrome in their children.

That is according to new research published in the European Journal of Clinical Nutrition, which suggests that unhealthy eating during pregnancy can lead to increased levels of insulin and glucose in babies.

Researchers from the Complutense University of Madrid analysed the effect on cell growth in unborn children that a mother's diet has.

Previous studies have already shown that when not enough food is consumed, glucose supply to babies is lowered resulting in reduced growth.

However, the new research suggests that when a poor diet is consumed, offspring are more likely to be predisposed to developing diabetes.

Babies of unhealthy mothers were shown to have 'diabetogenic profiles', meaning they had increased serum glucose and insulin levels, as well as a marker of insulin resistance.

The team wrote: "It is vital to make mothers aware of the importance of eating well during pregnancy with a balanced Mediterranean diet."

A small amount of sugar can help to reduce babies' pain when giving them injections, new research suggests.

Researchers at the Jordan University of Science and Technology in Irbid, Jordan, looked at the results of 14 previous studies that had involved 1,551 infants, aged one month to one year.

Overall, they found that babies given drops of a simple sugar solution before an injection tended to cry for a shorter time than those given water.

The Cochrane systematic review findings suggest that the sweet taste of sugar may help to reduce pain caused by injections.

It is thought that the sugar may trigger the release of pain-relieving chemicals or contact taste receptors that induce a comforting feeling.

Lead researcher Manal Kassab, from the university's Department of Maternal and Child Health, said: 'Giving babies something sweet to taste before injections may stop them from crying for as long.

'Although we can't confidently say that sugary solutions reduce needle pain, these results do look promising.'

The researcher added that more studies are now needed to investigate the optimal concentration, volume and method of administration in children under one year of age.

The Sensus Pain Management System, manufactured by NeuroMetrix, has been granted 510(k) clearance by the US Food and Drug Administration (FDA), the company announced.

The device is intended to relieve and manage symptoms of chronic intractable pain in the lower leg and foot that can occur with diabetic neuropathy.

The device is a transcutaneous electrical nerve stimulator and is worn on the upper calf under clothing.

"FDA clearance of the Sensus electrode represents the last step in the regulatory pathway for the Sensus Pain Management System," noted Shai N. Gozani, MD, PhD, president and chief executive officer of NeuroMetrix. "We believe that physicians treating patients with painful diabetic neuropathy, a severe and debilitating form of chronic pain, will find Sensus to be a useful therapeutic option."

The company states that they will be launching the device commercially before the end of the year.

People around the world have gained more than ten years of life expectancy since 1970, a major new study has found.

But they now spend more years living with illness and injury, the research in the Lancet medical journal shows.

Scientists at the University of Washington's Institute for Health Metrics and Evaluation (IHME) led a five-year study involving 486 experts in 50 different countries.

The international consortium of researchers discovered that fewer deaths now occur as a result of infectious diseases, maternal and child illness, and malnutrition than 20 years ago.

Fewer children are dying each year, but there has been an increase in the number of young and middle-aged adults suffering and dying from disease and injury.

Non-communicable diseases, such as heart disease and cancer, have now become the leading causes of death and disability worldwide, and more than nine million people died as a consequence of high blood pressure alone in 2010.

Professor Majid Ezzati, from Imperial College London's School of Public Health, commented: 'Overall we're seeing a growing burden of risk factors that lead to chronic diseases in adults, such' as cancer, heart disease and diabetes, and a decreasing burden for risks associated with infectious diseases in children.

People have received conflicting advice on whether or not they should limit the number of eggs they eat, but the latest research indicates that they are good for the cardiovascular system.

Scientists at the University of Connecticut looked at middle-aged men and women with metabolic syndrome - a cluster of conditions that are risk factors for heart disease and diabetes.

Participants either ate three whole eggs per day or an equivalent amount of egg substitute as part of a low-carb weight loss diet for 12 weeks.

The researchers found that the egg diet had no negative impact on blood cholesterol or low-density lipoprotein (LDL or 'bad cholesterol'), even though people on this dietary regime were eating twice as much cholesterol as they were before the study began.

Participants in both diet groups showed improvements in their levels of blood fats, including reduced triglycerides and increased high-density lipoprotein (HDL or 'good cholesterol').

Lead study author Dr. Maria Luz Fernandez, whose findings are published in Metabolism journal, said: 'Eating egg yolks was actually associated with enhanced health benefits in these high-risk individuals.

'Subjects consuming whole eggs had greater increases in HDL cholesterol and more significant reductions in the LDL/HDL cholesterol ratio than those who ate the cholesterol-free egg substitute.'

Eggs also provide a range of vitamins and minerals, including vitamin D, choline, lutein and zeaxanthin.

The next couple of weeks are bound to be something of a marathon for party lovers, with the non-stop calendar of drinking and late nights playing havoc with people's sleeping patterns.

In light of this, the Sleep Council has issued some tips to help people get enough sleep between now and the New Year.

Jessica Alexander, a spokeswoman for the organisation, said: 'The Christmas break gets longer each year which is tremendous in many ways, but it can play havoc with sleep routines.

'Over-indulgence during the festive period along with a change to the usual bedtime routine can lead to many people finding their sleeping patterns out of sync.'

People are advised to keep normal sleeping hours as far as possible, as this will programme their body to sleep better.

A restful sleeping environment is important, meaning the bedroom should be neither too hot nor too cold, and as quiet and dark as possible.

Televisions and other forms of technology should be kept out of the bedroom to ensure the room is seen solely as a place of rest.

Exercise is important too, as this helps to relieve stress. But vigorous exercise should not be attempted just before bedtime, as this could keep people awake for longer.

Many people with dementia do not die in the place they would choose because they do not have the opportunity to discuss their wishes with their families, research has found.

A report by the Alzheimer's Society claims that people with dementia face two key problems, with society's general unwillingness to discuss death being exacerbated by a lack of public understanding of dementia.

The charity's report argues that more people need to plan their end-of-life care in advance and discuss their wishes with their families.

This is particularly important for people with dementia, with just 6% of those who died in 2010 doing so in their own homes, compared with 21% of the general population.

Jeremy Hughes, chief executive of the Alzheimer's Society, described the charity's findings as 'hugely worrying'.

'Dementia is the third leading underlying cause of death in women and seventh in men; we cannot keep hiding from it,' he observed.

'People with the condition deserve to die with dignity, without pain, and in the place of their choosing as much as anyone else.'

Middle-aged people who walk briskly for as little as 75 minutes per week may live 1.8 years longer, even if they are overweight.

If they spend more time walking, running, swimming, cycling, or sweating in aerobics class, they may boost their life expectancy by 3.4 to 4.5 years.

Steven C. Moore, PhD, from the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, and coauthors report the findings of their pooled analysis online November 6 in PLoS Medicine.

More than 100 epidemiological studies have sought to clarify the role that physical fitness plays in lowering mortality risk. Dr. Moore and colleagues went a step further by looking at gains in life expectancy associated with varying durations of physical activity during leisure hours and at varying body mass index (BMI) measurements. The analysis comes as US physical activity levels have plummeted and waistlines have bulged.

The researchers pooled 6 prospective cohort studies, including 654,827 participants aged 21 to 90 years. With such a large sample size, the researchers were able to examine years of life gained after age 40 years, according to varying activity levels and with such added granularity as mortality hazard ratios by smoking status and race. Slightly more than half (56%) of the participants in the pooled analysis were women, 96.4% were white, 2.4% were black, and the median age was 61 years.

The researchers measured the energy cost of such leisure time activities as sports and exercise through their metabolic equivalent (MET).

Moderate- or vigorous-intensity activities, for example, rank 3 METs, which is about the same intensity as walking briskly.

"[P]articipation in even a low level of leisure time physical activity of moderate to vigorous intensity - i.e., 0.1–3.74 MET-h/wk [hours per week], equivalent to less than half the [World Health Organization]-recommended activity level and comparable to up to 75 min of brisk walking per week - was associated with reduced risk of mortality during follow-up relative to no such activity. Assuming a causal relationship, this level of activity would confer a 1.8-y gain in life expectancy after age 40, compared with no activity," Dr. Moore and colleagues write. "At the minimum recommended physical activity level - 7.5–14.9 MET-h/wk, equivalent to 150–299 min of brisk walking per week - the gain in life expectancy was 3.4 y. At approximately two times the minimum recommended level - 15.0–22.4 MET-h/wk, which is equivalent to brisk walking for 300–449 min/wk - the gain in life expectancy was 4.2 y."

Remarkably, the association between physical activity and life expectancy held for every BMI.

In contrast, low physical activity was associated with a lower life expectancy and greater risk for death, which grew by BMI grouping. At the most extreme, a sedentary lifestyle and high BMI edged close to the mortality risk of smoking.

Specifically, a normal-weight person who was inactive during leisure time lived an average of 4.7 fewer years compared with a normal-weight person who was active during leisure time.

Meanwhile, inactivity was associated with a loss of 7.2 years from the lives of people with high BMI (35 kg/m2 or higher) compared with normal-weight people meeting recommended physical activity levels. In comparison, long-term cigarette smoking reduces life expectancy by 10 years.

"Mammoth" Study Praised

Geoffrey Godbey, PhD, professor emeritus of recreation, park, and tourism management at Penn State University, University Park, Pennsylvania, told Medscape Medical News the study is "worthwhile" and that its "mammoth" sample size is one of its strengths. He also noted that the study rightly focuses on leisure time, the arena during which people move their bodies the most (more than during paid work or housework).

"They're looking at the right part of life, in terms of physical activity," Dr. Godbey said.

"Physical activity above the minimal level - at recommended levels, or even higher - appears to increase longevity even further, with the increase in longevity starting to plateau at approximately 300 min of brisk walking per week," the authors conclude.

"[A] lack of leisure time physical activity when combined with obesity is associated with markedly diminished life expectancy. Together, these findings reinforce prevailing public health messages and support them for a range of ages and backgrounds: both a physically active lifestyle and a normal body weight are important for increasing longevity."

Dr. Moore and colleagues are optimistic that their findings "may help convince currently inactive persons that a modest physical activity program is 'worth it' for health benefits, even if it may not result in weight control."

However, Dr. Godbey is not sure the findings will trickle down. People who are physically sedentary are "the most helped physiologically by 20 minutes per day of some kind of physical activity," he told Medscape Medical News. However, he added, this target population tends to be low-education, works in low-income jobs, shops in stores that lack fresh produce, lacks physicians or friends to coax them to exercise, and lives in neighborhoods that are too dangerous to go outside to exercise.

Study limitations include its reliance on self-reported leisure time physical activity, the tendency of overweight and obese participants to fudge by overreporting leisure time physical activity, and the study's focus on just the moderate- to vigorous-intensity leisure time physical activities. In addition, because it is an observational study, the researchers could not exclude the possibility of confounding by other ailments that afflicted the participants, their diets, and other factors.

The National Institutes of Health and the National Cancer Institute supported the study. One study author reported serving as a consultant to Virgin HealthMiles and serving on their Scientific Advisory Board. Among the studies included in the pooled analysis, the National Institutes of Health–AARP Diet and Health study and the US Radiologic Technologists study were supported by the National Cancer Institute; the Campaign Against Cancer and Stroke (CLUE) was supported by the National Institute of Aging and the National Cancer Institute; and the Swedish Women's Lifestyle and Health study is supported by the Swedish Research Council and Swedish Cancer Society.

Treatment goals for older adults with type 2 diabetes should take into account life expectancy and the presence of co-morbidities, according to a new consensus statement from the American Diabetes Association and the American Geriatrics Society.

The statement, which represents the opinion of the authors and not the official position of the organizations, was published online October 25 in both Diabetes Care and the Journal of the American Geriatrics Society.

"Older patients are extremely heterogeneous in terms of duration of diabetes, comorbidities, and life expectancy.

Individualization and consideration of patient preferences and goals, which are important for all patients with diabetes, are especially so in this age group," lead author M. Sue Kirkman, MD, senior vice president, Medical Affairs and Community Information at the American Diabetes Association in Alexandria, Virginia, told Medscape Medical News.

More than 25% of the US population aged 65 years and older has diabetes, yet those with multiple co-morbidities are typically excluded from randomized controlled treatment trials (RCTs), the authors note.

"Older adults are disproportionately burdened by diabetes and its acute and chronic complications.... There are problems both with overtreatment of some older patients and under-treatment of others," Dr. Kirkman said.

The statement provides a "framework" for consideration of treatment goals for glycemia, blood pressure, and dyslipidemia among adults aged 65 years and older with diabetes, based on 3 broad groupings:

• healthy, with few coexisting chronic conditions and intact cognitive and functional status;
• Complex/intermediate, with multiple coexisting chronic illnesses or 2 or more impairments in activities of daily living or mild to moderate cognitive impairment; and
• Very complex/poor health, in long-term care or with end-stage chronic illnesses or moderate to severe cognitive impairment or with 2 or more activities of daily living dependencies.

Life expectancy is taken into account for each group, and treatment goals are adjusted accordingly.

For example, an individual in the first group, with longer life expectancy, might be given a target hemoglobin A1c level of less than 7.5%.

In the second group, the target might shift to less than 8% to minimize the risk for hypoglycemia and falls.

For the third group, with limited remaining life expectancy and uncertain benefit of treatment, a goal of less than 8.5% might suffice.

Groupings Are General Guidelines

The authors stress that the groupings are just general concepts. Not every patient will fall into a particular category, and consideration of patient/caregiver preference is an important aspect of individualized treatment. In addition, a patient's status may change over time. "[One] can't use a one-size-fits-all mindset, or protocols driven by age alone," Dr. Kirkman said.

Indeed, according to Paul Jellinger, MD, a former president of the American Association of Clinical Endocrinologists, "It is important to not allow age itself dictate therapy....We have all seen patients in their 70s and 80s far healthier than many chronologically younger individuals. Individualizing therapy is the name of the game," he told Medscape Medical News.

"While one could argue with the specific A1c goals as outlined in this statement, the principle of higher goals for increasing comorbidities is quite appropriate," said Dr. Jellinger, who is professor of clinical Medicine at the University of Miami in Florida.

The statement also provides additional consensus recommendations regarding screening for and prevention of diabetes, management approaches and screening for complications, pharmacotherapy, and management in settings outside the home.

Among them:

Older adults should be screened for prediabetes and diabetes as long as they will be likely to benefit from identification of the condition and subsequent intervention.

Physical activity and medical nutrition therapy should be encouraged, using simple teaching strategies.

Older adults should be screened periodically for cognitive dysfunction, functional status, and fall risk.

Older patients should be assessed for hypoglycemia regularly, and their therapy changed if it occurs frequently or is severe.

Glyburide should be avoided….. Metformin is the preferred initial therapy for type 2 diabetes, as with younger adults, but doses might need to be lowered for patients with severe chronic kidney disease.

Use of sliding-scale insulin regimens alone is discouraged in settings outside the home.

Dr. Jellinger told Medscape Medical News, "I would try and avoid all sulfonylureas [SUs] - not just glyburide - in the elderly, since all SUs are associated with hypoglycemia, particularly in the elderly." However, "occasionally, the judicious use of very low doses of SUs may be helpful in otherwise healthy older patients with relatively short duration of diabetes."

Incretin-based therapies appear to be safe and effective in this population when metformin alone is inadequate or when metformin cannot be used, he added.

The statement concludes with a long list of research questions. Said Dr. Kirkman, "There's a lot we don't know, and a great need for real-world research studies that include patients often excluded from RCTs."

The consensus development conference was sponsored by the Association of Subspecialty Professors though a grant from the John A. Hartford Foundation, educational grants from Lilly USA, LLC, and Novo Nordisk, and sponsorships from the Medco Foundation and Sanofi aventis. Sponsors had no influence on the selection of speakers or writing group members, topics and content presented at the conference, or the content of this report. Dr. Kirkman is an employee of the American Diabetes Association and has no other disclosures. Other authors are partially supported by the Department of Veterans Affairs Geriatric Research, Education and Clinical Centers program; the National Institutes of Health; the US Department of Health and Human Services; the National Institute on Aging Claude D. Pepper Older Americans Independence Center; the National Institute of Diabetes and Digestive and Kidney Diseases; and the Chicago Center for Diabetes Translational Research. Several authors have a variety of financial relationships with one or more of the following companies: Novo Nordisk, Amylin, sanofi aventis, Regeneron, Novartis, Merck, Lilly, Roche, Takeda, GlaxoSmithKline, MannKind, Eisai, Bristol Meyers Squibb, Astra Zeneca, Pfizer, and Lexicon. Dr. Jellinger serves on the speaker's bureau for Novo Nordisk, Amylin, Merck, and Boehringer Ingelheim.

Thousands of Britons are at risk of having a stroke because they do not recognize the warning signs, a poll suggests.

One in ten people who have a transient ischaemic attack (TIA or 'mini-stroke') go on to have a full-blown stroke within a week if they do not seek treatment, yet an ICM poll of more than 2,000 people suggests that almost seven in ten Brits do not know the symptoms of a TIA.

60% of respondents had never even heard of TIA and 40% did not know that a TIA was a warning sign of a major stroke.

The survey, which was conducted on behalf of the Stroke Association, also revealed that while 87% of people would be concerned if they experienced the symptoms of a TIA, 74% would not go to hospital.

Jon Barrick, chief executive of the Stroke Association, said: 'The results of this poll are very concerning. Over 150,000 people have a stroke every year in the UK but up to 10,000 of these could be prevented if more people were aware of the symptoms of TIA and sought out emergency treatment.'

Mr Barrick added that anyone who experiences the symptoms of TIA - which are similar to those of a stroke but are only temporary - should go to hospital immediately in case they need potentially life-saving treatment.

Women who give up smoking before the age of 30 can avoid the vast majority of ill-health and increased risk of dying associated with tobacco use, a study has found.

Researchers at Oxford University looked at data from the Million Women Study, which recruited 1.3 million women, aged 50 to 65, between 1996 and 2001.

Participants were followed for around 12 years and the researchers looked at the benefits of giving up smoking in those who claimed to have smoked in the past.

They found that women who were still smokers three years after the start of the study were nearly three times as likely as non-smokers to die over the next nine years.

According to the researchers, two-thirds of all deaths in smokers in their 50s, 60s and 70s were caused by smoking.

Among those who had given up smoking around the age of 30, the excess risk of premature death was reduced by 97%.

Those who continued to smoke until they were 40 retained serious excess hazards for decades, although their risk of dying young was still substantially lower than that of women who continued to smoke into later life.

Professor Sir Richard Peto, whose findings are published in the Lancet medical journal, said: 'Whether they are men or women, smokers who stop before reaching middle age will on average gain about an extra ten years of life.'

Figures show that lung cancer - which is usually linked to smoking - accounts for around one-fifth of all cancer deaths in women.

People with a recent diagnosis of type-2 diabetes need timelier information on how to improve their lifestyle, a new study suggests.

Researchers at Queen's University Belfast found that many patients have to wait months before receiving advice on their diet.

Their study shows that patients need to be given more information during the period between their diagnosis and their referral to a patient education program.

One patient who was interviewed by the team admitted they had eaten 'very little' following their diagnosis, because they had been told to lower their blood sugar levels but did not know how to achieve this.

Dr. Michelle McKinley, whose findings are published in the journal Primary Health Care Research & Development, said that many patients with type-2 diabetes felt they were 'on their own' between diagnosis and the point when they received advice on how to self-manage their disease.

'It is important that we try to fill this gap with easily accessible information that is specifically designed for people with type-2 diabetes,' she added.

Many people are living with undiagnosed type-2 diabetes because the symptoms can be very mild in the early stages.

They include feeling very thirsty; urinating frequently; fatigue; unexplained weight loss; vaginal or penile itchiness; blurred vision; cramps; constipation; and skin infections.

Arthritis often stops people of working age from staying in employment, a survey has revealed.

The Arthritis Society in Canada polled 1,057 people with arthritis to shed light on the impact of the joint disease. Researchers found that one in three people had stopped working because of their condition, with nearly 60 per cent doing so between the ages of 18 and 54.

The 'Fit for Work' survey also revealed that 70 per cent of people suffered from work-related anxiety, often because they did not know whether they would be able to manage their symptoms, handle their responsibilities or earn a good enough income.

Janet Yale, president and chief executive officer at the Arthritis Society, said that the survey results were concerning, as they demonstrated 'the financial, physical, emotional and psychological toll' of arthritis.

Eating at least 2 servings of oily fish a week is moderately but significantly associated with a reduced risk for stroke, but taking fish oil supplements does NOT seem to have the same effect, suggest results of a large meta-analysis of relevant research.

"Consumption of fish and long-chain omega 3 fatty acids has been associated with a reduced risk of coronary heart disease [CHD] and sudden cardiac death," Oscar H. Franco, MD, PhD, professor of preventive medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands, told Medscape Medical News. "However, observational and experimental evidence supporting a similar benefit for cerebrovascular disease remain conflicting," he said.

To help clarify the value of fish intake on stroke risk, Dr. Franco and colleagues performed a systematic review and meta-analysis of 26 prospective cohort studies and 12 randomized controlled trials involving a total of 794,000 participants and 34,817 cerebrovascular outcomes.

"Observational findings in this meta-analysis show that consumption of both fish and long chain omega 3 fatty acids may modestly reduce the risk of stroke, whereas results were significant only for fish intake," he concluded.

They report their findings in an article published online October 30 in BMJ.

Fish Beats Fish Oil Pills

After adjusting for several risk factors, participants consuming 2 to 4 fish servings a week had a moderate but significant 6% lower risk for cerebrovascular disease compared with those having 1 or fewer fish servings a week (relative risk [RR], 0.94; 95% confidence interval [CI], 0.90 - 0.98).

Participants eating 5 or more fish servings a week had a 12% lower risk (RR, 0.88; 95% CI, 0.81 - 0.96).

In a dose-response meta-analysis, an increment of 2 servings per week of any fish was associated with a 4% reduced risk for cerebrovascular disease.

In contrast, there was no evidence for similar inverse associations with cerebrovascular disease for long-chain omega 3 fatty acids measured as circulating biomarkers in observational studies or fish oil supplements in primary and secondary prevention trials.

"We expected to find significant associations for fish intake and long-chain omega 3 fatty acids (both biomarkers and intake)," Dr. Franco said. "The beneficial effect of fish intake on cerebrovascular risk is likely to be mediated through the interplay of a wide range of nutrients abundant in fish," he added.

It is possible, the researchers say, that eating more fish curbs the intake of other foods, such as red meat, that are detrimental to vascular health; or higher fish intake may simply be an indicator of a generally healthier diet or higher socioeconomic status, both associated with better vascular health.

Having 1 or 2 Weekly Servings "Reasonable" Advice

The current findings are "in line with disappointing results" from controlled trials of supplementation with long-chain omega 3 fatty acids for the prevention of CHD, say the coauthors of a commentary published with the study.

"It seems that the additional benefit of supplementation in patients who are optimally managed may be small," write Janette de Goede and Johanna M Geleijnse, PhD, of the Division of Human Nutrition, Wageningen University, the Netherlands.

On the basis of available evidence, it is "reasonable to advise people that eating one or two portions of fish a week could reduce the risk of CHD and stroke," they write.

"Any benefit of long chain omega 3 fatty acid supplementation for the secondary prevention of CHD and stroke is likely to be small," they conclude. "However, it is possible that patients who are less than optimally medically treated or who have additional risk factors (for example, as a result of comorbidities such as diabetes) may benefit."

The study had no specific funding. The authors and editorial writers have disclosed no relevant financial relationships.

Older people who do regular exercise appear to benefit from a reduced risk of cognitive impairment and dementia, scientists say.

Researchers at the University of Lisbon in Portugal studied a group of 639 people in their 60s and 70s, almost two-thirds of whom said they were active for at least 30 minutes on at least three days per week.

Participants had MRI tests at the beginning of the study and again after three years to see whether they displayed any white matter changes - an indicator of cognitive decline - in the brain.

Publishing their findings in the journal Stroke, the study authors revealed that those who regularly did exercise benefited from a 40% reduction in their risk of vascular-related dementia, on average, as well as a 60% decrease in their likelihood of any type of cognitive decline.

Lead author Dr Ana Verdelho said: 'We strongly suggest physical activity of moderate intensity, at least 30 minutes three times a week, to prevent cognitive impairment.'

She added that this may be particularly important for people with high blood pressure, stroke or diabetes.

Dr Simon Ridley, head of research at Alzheimer's Research UK, said that the study was relatively small, but that there is a 'growing body of evidence for the benefits of exercise on the brain'.

Drying your clothes on the radiator could be bad for your health, experts have warned.

Scientists at the Mackintosh Environmental Architecture Research Unit (MEARU) in Glasgow looked at the health and economic problems associated with indoor drying….. They observed that the average load of washing releases approximately two litres of moisture into the air as it dries, accounting for up to a third of moisture in the air in poorly ventilated rooms.

This creates ideal conditions for growth of mould spores and the accumulation of dust mites, both of which can exacerbate asthma.

Professor Colin Porteous, a spokesman for MEARU, said: 'Because of increased awareness of the energy consumption of tumble dryers many people are choosing to dry clothes passively within their home.

'This results not only in a severe energy penalty, because of increased heating demand, but also a potential health risk due to higher moisture levels.'

To reduce the risk to health, consumers are advised to dry laundry outside or on a balcony whenever possible or to use a tumble dryer.

The gap in heart disease death rates for over-65s in the richest and poorest areas of the country has grown since the 1980s, new figures show.

Scientists at Imperial College London looked at death rates for men and women between the ages of 30 and 64 and in the over-65 age group.

They found that deaths from heart and circulatory disease fell in most parts of England between 1982 and 2006…. But the decline among over-65s was noticeably smaller in the most deprived areas, resulting in a wider gap between rich and poor people.

Researcher Dr Perviz Asaria, whose findings are published in the International Journal of Epidemiology, said: 'The extraordinary pressure on the NHS to make savings might jeopardise health services, including the crucial role of GPs, in poor communities.

'And if people's jobs are less stable, they may be forced to change their diet, or drink and smoke more.'

Mubeen Bhutta, policy manager at the British Heart Foundation, observed that the overall improvement in heart disease death rates 'has clearly not benefitted everyone equally'.

The expert said that eradicating inequalities must be at the heart of the government's new cardiovascular disease strategy, which is due to be published over the winter.

A new study has confirmed that bowel screening helps to detect cancers at an early and more treatable stage.

Researchers at the University of Glasgow looked at 394 people with bowel cancer, 288 of whom had been diagnosed through screening.

They observed that patients who were diagnosed through screening tended to be younger and had less advanced disease than those diagnosed in other ways.

They were also less likely to have aggressive biological characteristics that enable tumours to spread, such as high levels of inflammation in the blood and tumour growth into the blood vessels in the surrounding tissue.

Study author Dr David Mansouri, whose findings were presented at the NCRI Cancer Conference in Liverpool this week, said: 'Our new study tells us that as well as the bowel cancers being picked up through screening being less likely to have spread by the time they are diagnosed, there were also more patients with features that may increase the chances of survival.'

Hazel Nunn, head of evidence and health information at Cancer Research UK, said that the bowel screening programme saves thousands of lives each year.

She added that the new study is a useful reminder for older people to complete their bowel screening kit when it arrives in the post and to visit their doctor if they have concerns.

The number of deaths involving heart-related issues tends to increase in the winter, regardless of the climate, new research has found.

Researchers at Good Samaritan Hospital in Los Angeles, US, looked at death certificates from seven parts of the US with different climates between 2005 and 2008.

They found that between the summer low and the winter peak, total and cardiovascular deaths rose by 26 to 36%, on average, in all areas.

All seven areas exhibited very similar patterns of death rates, despite having very different climates.

'This was surprising, because climate was thought to be the primary determinant of seasonal variation in death rates,' said lead author Dr Bryan Schwartz, who presented the findings at the American Heart Association's Scientific Sessions.

The expert pointed out that in general, people do not live as healthily in winter as they do in summer, with the average person eating less well and taking less exercise.

'People should be extra aware that maintaining healthy behaviors is important in winter,' he added.

Research published in the British Medical Journal in 2010 found that chilly temperatures may be particularly risky for those with heart conditions.

Before you prescribe another drug, consider whether new symptoms might be caused by the medications the patient is already taking.

All Physicians and patients must note the following: RECOMMENDATIONS

• Consider the possibility that an adverse drug effect-rather than a new condition-is at play when a patient taking multiple medications develops a new symptom. C
• Use an online interaction checker, which can be accessed via a smart phone or tablet, to check for potential drug-drug interactions in patients on multiple medications. C
• Cross-check patients' medications with a list of their medical problems, with the goal of discontinuing any drug that duplicates the action of another or is age-inappropriate, ineffective, or not indicated for the condition for which it was prescribed. C

Strength of recommendation (SOR)

C: Consensus, usual practice, opinion, disease-oriented evidence, case series

Older adults are taking more medications than ever before.

Nearly 9 out of 10 US residents who are 60 years of age or older take at least one prescription drug, more than a third take 5 to 9 medications, and 12% take 10 or more. The increase is largely driven by newer medications to effectively treat a variety of medical conditions, and by practice guidelines that often recommend multidrug regimens.

People who regularly drink black tea may benefit from a reduced risk of type-2 diabetes, a study suggests.

Researchers in the UK, Switzerland and France analysed black tea sales figures for 2009 from 50 countries and linked these with information on the countries' rates of diabetes and cancer, as well as respiratory, infectious and cardiovascular diseases.

They observed that Ireland, the UK and Turkey had the highest rates of black tea consumption, while the lowest rates were recorded in South Korea, Brazil, China, Morocco and Mexico.

Publishing their findings in the journal BMJ Open, the study authors observed a link between high rates of black tea consumption and low rates of diabetes.

However, a high intake of black tea did not appear to reduce the risk of the other conditions studied.

'These original study results are consistent with previous biological, physiological and ecological studies conducted on the potential of [black tea] on diabetes and obesity,' the researchers wrote.

Psoriasis patients may be at an increased risk for type 2 diabetes, and the risk appears to be greatest among patients with severe psoriasis.

Compared with the general population, patients with mild psoriasis had a 49% increased risk of developing diabetes, and individuals with severe psoriasis had a 2.13-fold increased relative risk when compared with the general population, said Dr Ole Ahlehoff, post-doctoral fellow in cardiology at Copenhagen University Hospital Gentofte at the European Society of Cardiology meeting.

Older women who have survived cancer may benefit from leading a healthy lifestyle, including maintaining a healthy body weight, staying active and eating a balanced diet, research has found.

Scientists at the University of Minnesota looked at data on 2,080 women, all of whom had been diagnosed with cancer between 1986 and 2002 and were still alive in 2004.

They found that those who adhered most closely to official guidelines for body weight, exercise and diet were significantly less likely to die than those who followed them the least.

Dr. Maki Inoue-Choi, research associate in the university's School of Public Health, revealed: 'Elderly female cancer survivors who achieve and maintain an ideal body weight, stay physically active and eat a healthy diet have an almost 40 per cent lower risk for death compared with women who do not follow these recommendations.'

The findings were presented at an annual conference of the American Association for Cancer Research between October 16th and 19th.

Men who take a multivitamin supplement every day may benefit from a reduced risk of cancer, new research suggests.

Scientists at Brigham and Women's Hospital in the US studied nearly 15,000 over-50s, all of whom took a multivitamin or a placebo (dummy pill) every day for more than ten years.

The researchers found there were eight per cent fewer diagnoses of cancer among the men who took multivitamins than in the placebo group.

Multivitamin use was also associated with a reduction in the number of deaths from cancer.

Study co-author Dr Howard Sesso, an associate epidemiologist in the hospital's division of preventive medicine, said: 'Many studies have suggested that eating a nutritious diet may reduce a man's risk of developing cancer.

'Now we know that taking a daily multivitamin, in addition to addressing vitamin and mineral deficiencies, may also be considered in the prevention of cancer in middle-aged and older men.'

The findings are published in the Journal of the American Medical Association and further studies are now planned to shed light on the specific vitamins or minerals that may be responsible for the protective effect.

Research is also needed to show whether multivitamins have the same impact on women and younger men.

Patients who undergo bariatric (gastric band) surgery to treat obesity often benefit from a significant decrease in their risk of heart disease and stroke, a new study has found.

Researchers at the Cleveland Clinic in Ohio conducted a review of 73 studies involving almost 20,000 people with an average age of 42 years who had a gastric band fitted.

High blood pressure, diabetes and high levels of harmful blood fats were common before surgery.

Participants lost around half of their excess weight in the 4.5 years after their surgery.

At the same time, 63% of patients benefited from significant improvements in their blood pressure; 73% from a resolution or significant improvement in their diabetes; and 65% experienced a fall in blood fats.

According to the researchers, whose findings are published in the journal Heart, gastric band surgery appears to be effective at preventing cardiovascular events.

'The magnitude of effect on [cardiovascular] risk factors is impressive, and to date no pharmacological therapy for weight management or diabetes has shown a comparable effect over these short time periods,' they noted.

The Action for Health Diabetes (Look AHEAD) study, a trial comparing an intensive lifestyle-intervention program aimed at achieving and maintaining weight loss and fitness in patients with type 2 diabetes, has been stopped for futility.

A large cardiovascular-outcomes study funded by the National Institutes of Health that included 5145 adults with diabetes and a body mass index >25 kg/m2, Look AHEAD failed to show a difference in the rate of nonfatal MI, nonfatal stroke, death, or hospitalization for angina among patients randomized to an intensive lifestyle intervention and those randomized to a control arm consisting of education alone.

Despite significant reductions in weight and improvements in physical-fitness levels among patients with diabetes, investigators concluded that the intervention arm, which included individual sessions with a nutritionist and/or personal trainer, as well as group sessions and refresher courses, failed to provide any benefit in terms of cardiovascular outcomes.

Dr. Anne Peters (University of Southern California, Los Angeles), one of the study investigators, said in an interview that the trial was successful on one level-namely, that patients lost weight and improved their fitness.

Data published at four years showed that the intensive intervention led to weight loss of up to 10% in the first year and that patients maintained a 6.5% reduction in body weight in the following three years.

Over an 11-year follow-up period, the patients reported a 5% reduction in body weight from baseline, said Peters.

In addition, early data showed that treadmill fitness levels, hemoglobin A1clevels, systolic and diastolic blood pressure, HDL-cholesterol levels, and triglyceride levels were all significantly improved among patients in the lifestyle-intervention arm when compared with the control group.

The only cardiovascular risk factor that remained unchanged with treatment was LDL-cholesterol levels.

Despite the lack of cardiovascular benefit observed in Look AHEAD, Peters stressed that diabetic patients should not stop exercising or begin eating anything they wish.

"We do know that weight loss and exercise can prevent diabetes," said Peters. "I am a big advocate of prevention, both early prevention of obesity altogether, as well as prevention of diabetes in individuals who have become overweight. Lifestyle changes can help prevent diabetes. Once you have diabetes, I think weight loss and exercise can have benefits, but they are not going to reduce the risk for the primary outcome that we set for Look AHEAD, which was a risk for macrovascular events or death."

Women with a low intake of calcium may be more likely to develop a hormone disorder called primary hyperparathyroidism, a study suggests. The disorder occurs when there is excessive secretion of parathyroid hormone (PTH), placing patients at increased risk of fractures and kidney stones.

Researchers at Brigham and Women's Hospital and the Harvard School of Public Health studied a group of women to see whether the amount of calcium in their diet was linked to their risk of the hormone condition. They looked at data on more than 58,000 female nurses, who were aged between 39 and 66 years in 1986 and regularly completed surveys about their diet for the next 22 years.

During that time, 277 of the women developed primary hyperparathyroidism and the researchers observed that those with the highest intakes of dietary calcium were less likely to develop primary hyperparathyroidism than those with the lowest intakes.

Publishing their findings in the British Medical Journal, they concluded that an increased intake of calcium is 'associated with a reduced risk of primary hyperparathyroidism in women'.

There has been a noticeable increase in the number of children being admitted to hospital in England for throat infections since 1999, new figures show.

Researchers at Imperial College London looked at admission rates for children, aged 17 and under, with acute throat infections such as tonsillitis and pharyngitis between 1999 and 2010.

They found that the admission rate rose by 76% during that time, from 12,283 children in 1999 to 22,071 in 2010.

There was also a 115% increase in the number of short hospital stays lasting less than two days for acute throat infections.

Publishing their findings in the Archives of Disease in Childhood, the researchers noted that the rise in admissions for throat infections did not appear to be linked to the decline in tonsillectomy rates in recent years.

Lead researcher Dr Elizabeth Koshy, from Imperial College London's School of Public Health, said the findings were 'very concerning'.

She added: 'We think this is likely to be due to problems at the primary care and secondary care interface.

'Our study highlights the need to urgently address the issue of healthcare access, with improved models of integrated care within primary and secondary care, to avoid potentially unnecessary hospital admissions for relatively minor infections in the future.'

Women are more likely to die from a heart attack than men, French scientists say.

Researchers at the Centre Hospitalier Universitaire in Rennes looked at data from the ORBI registry (Brittany regional observational study on myocardial infarction), which has been collecting information on heart attack patients admitted within 24 hours of the onset of symptoms since July 2006.

They analysed data on 5,000 patients, 1,174 of whom were women, and observed that female heart attack patients tended to be older (69 years versus 61 years for men), and were more likely to have high blood pressure and less likely to have abnormal blood fat levels or be smokers.

Overall, the study authors found that women tended to be more likely to die following a heart attack and had longer treatment delays, less aggressive treatment, more complications and longer hospital stays.

Dr. Guillaume Leurent, who presented the findings at the Acute Cardiac Care Congress in Istanbul, said: 'These results suggest that women need to be more vigilant about chest pains and request medical help quickly to reduce ischemic time.'

He added that most women believe heart attacks are a male problem, meaning they 'may take longer to call an ambulance when they have chest pains'.

Maureen Talbot, the British Heart Foundation's senior cardiac nurse, agreed with this statement and cited the charity's own survey findings which show that 69% of women would need to experience three or more heart attack symptoms before seeking medical help.

'The truth is heart disease is the single biggest killer of women in the UK and it kills three times more women than breast cancer,' she revealed.

Children with a cough due to a common cold are unlikely to benefit from taking antibiotics, scientists say.

Researchers at Clinic Centre Private Hospital in Naples and the University of Bologna in Italy looked at 305 children who were suffering from an acute cough and cold.

Some of these children were given antibiotics while others received antitussives to relieve their cough.

The researchers found that children who were treated with antibiotics alone were less likely to recover from their cough than those given cough medicine alone.

Meanwhile, the recovery rate was the same for children who received both antitussives and antibiotics and those given antitussives alone.

The findings were presented at the annual meeting of the American College of Chest Physicians and lead study author Dr Francesco de Blasio said: 'Antibiotics show very little effectiveness at treating cough due to your average head cold.

'Few drugs are effective as cough suppressants and antibiotics are no more effective in relieving cough than the use of no medication.'

Performing general health checks and screening asymptomatic adults for diseases or their risk factors did NOT reduce either overall morbidity or mortality, according to a review published online October 17 in the Cochrane Database of Systematic Reviews.

The large number of participants and deaths in the studies, the long follow-up, and the absence of a reduction in cardiovascular and cancer mortality suggest that general health checks are unlikely to be beneficial, conclude Lasse T. Krogsbøll and colleagues, all from the Nordic Cochrane Centre in Denmark.

The review included data from 16 randomized studies from primary care or community settings comparing health checks or no health checks in adults "unselected" for disease or risk factors.

Fourteen studies (182,880 participants) had outcome data available for analysis. Nine trials provided data on total mortality (155,899 participants, 11,940 deaths). In those trials, the median follow-up time was 9 years, the authors note, which yielded a risk ratio of 0.99 (95% confidence interval [CI], 0.95 - 1.03) for the health check group compared with the non–health check group.

Eight trials provided data on cardiovascular mortality (152,435 participants, 4567 deaths; risk ratio, 1.03; 95% CI, 0.91 - 1.17), and 8 trials on cancer mortality (139,290 participants, 3663 deaths; risk ratio, 1.01; 95% CI, 0.92 - 1.12).

One trial revealed an increase in the diagnosis of hypertension and hypercholesterolemia with health checks. Another found an increase in self-reported chronic disease. Two of 4 trials found more people taking antihypertensive medication with health checks, and another found a 20% increase in the total number of new diagnoses per participant over the course of 6 years compared with the non–health check group.

Benefits Smaller, Harms Greater
In addition to the lack of clear benefit, general health checks potentially cause harm, the authors write. "Experience from screening programs for individual diseases have shown that the benefits may be smaller than expected and the harms greater," they note.

Among the harms they cite are the diagnosis of conditions that were never destined to cause symptoms or death and the risk for unnecessary treatment.

"While we cannot be certain that screening leads to benefit, all medical interventions can lead to harm," the authors note. The study, however, did not document harm.

The researchers "make an excellent point that a well person can go in for a general check-up and have screening done that can lead to a cascade of events that can lead to more harm than good," Glen Stream, MD, MBI, chair of the board of directors at the American Academy of Family Physicians, said.

However, "some of the methodology in the studies they reviewed were not all that strong," Dr. Stream told Medscape Medical News. He also noted, among other issues, the lack of specific data on harm caused by general health checks. "It makes you wonder if there's [just not] good information out there," he said.

The authors defined general health checks as screens of the general population for more than one disease or risk factor in more than one organ system. Screening methods varied considerably from study to study, including questionnaires, physical exams, blood assays, imaging, stool testing, and the assessment of cardiovascular risk factors.

Studies that enrolled people older than 65 years were excluded. Subgroup and sensitivity analyses did not change the findings, the authors said. The results, they add, are consistent with earlier reviews.

Health Checks a Recent Phenomenon
Health checks of healthy people are a recent phenomenon, the authors noted. The evolution of medicine and new diagnostic methods in the latter half of the twentieth century, they write, has "increased expectations that many diseases can be prevented or discovered before there is irreversible damage." However, studies such as this one suggest that these expectations may not be met, they add.

The authors of the study acknowledged other problems in most of the trials, citing lack of blinding and missing outcome data as the 2 most common issues. "Detection bias, biased reporting of subjective outcomes, and biased drop-out were major concerns in many of the trials," they add.

Despite this, the authors of the study were emphatic about the overall significance of their findings. "Public healthcare initiatives to systematically offer general health checks should be resisted, and private suppliers of the intervention do so without the support from the best available evidence," they conclude.

Dr. Stream does not agree. "They made a stronger conclusion than the evidence the presented in their discussion section would support, because they didn't demonstrate harm," he said.

From his point of view, he said, the study raises as many questions as answers. Are doctors merely measuring the wrong things? Is there a hidden benefit in establishing a doctor-patient rapport that benefits care when problems do arise? "It's a call-out to the research community," he said.

Part of the salary for Krogsbøll was supplied by Trygfonden. The other authors and commentator have disclosed no relevant financial relationships.

Background
Falls in elderly people are a major health burden, especially in the long-term care environment. Yet little objective evidence is available for how and why falls occur in this population. We aimed to provide such evidence by analysing real-life falls in long-term care captured on video.

Methods
We did this observational study between April 20, 2007, and June 23, 2010, in two long-term care facilities in British Columbia, Canada. Digital video cameras were installed in common areas (dining rooms, lounges, hallways). When a fall occurred, facility staff completed an incident report and contacted our teams so that we could collect video footage.

A team reviewed each fall video with a validated questionnaire that probed the cause of imbalance and activity at the time of falling.

We then tested whether differences existed in the proportion of participants falling due to the various causes, and while engaging in various activities, with generalised linear models, repeated measures logistic regression, and log-linear Poisson regression.

Findings
We captured 227 falls from 130 individuals (mean age 78 years, SD 10).

• The most frequent cause of falling was incorrect weight shifting, which accounted for 41% (93 of 227) of falls,
• followed by trip or stumble (48, 21%),
• hit or bump (25, 11%),
• loss of support (25, 11%), and
• collapse (24, 11%).

Slipping accounted for only 3% (six) of falls.

The three activities associated with the highest proportion of falls were:

• forward walking (54 of 227 falls, 24%),
• standing quietly (29 falls, 13%), and
• sitting down (28 falls, 12%).

Compared with previous reports from the long-term care setting, we identified a higher occurrence of falls during standing and transferring, a lower occurrence during walking, and a larger proportion due to centre-of-mass perturbations than base-of-support perturbations.

Interpretation
By providing insight into the sequences of events that most commonly lead to falls, our results should lead to more valid and effective approaches for balance assessment and fall prevention in long-term care

Women who start their periods early and finish them late may be more likely to develop certain types of breast cancer, research suggests.

Researchers at the University of Oxford examined data from 117 studies involving nearly 119,000 women with breast cancer and a further 300,000 without the disease.

They found that the increased risk associated with early periods and late menopause was more apparent for lobular than ductal cancers.

The increased risk associated with late menopause was also particularly noticeable for estrogen-sensitive cancers.

Their findings, which are published in the Lancet Oncology medical journal, also indicate that starting periods early has a greater impact on breast cancer risk than finishing them later.

Researcher Dr. Gillian Reeves said: 'We already knew that hormones associated with reproduction have a big impact on breast cancer risk and that starting periods early and having a late menopause increase risk, but these findings suggest that sex hormone levels may be more relevant for specific types of breast cancer - ER positive tumours and lobular, rather than ductal, tumours.'

Dr. Julie Sharp, Cancer Research UK's senior science information manager, said that the study adds to our understanding of the role that hormones play in the development of breast cancer.

'It's very interesting to see that these hormones play a bigger part in the development of certain types of breast cancer and this will be important for future work in this area,' she added.

People who need knee replacement surgery may be more likely to develop complications if they are obese, a study has found.

Researchers conducted a literature review to shed light on the links between obesity and complications following surgery.

They concluded that obese patients have a greater risk of complications, such as post-surgical infections, following a knee replacement.

As a result, they are more likely to need follow-up surgery to repair the damage to their joint.

Lead author Dr. Gino Kerkhoffs, an orthopaedic surgeon at the University of Amsterdam, said: 'Orthopaedic operations can technically be more difficult in obese people, and it is important for us to know whether there is a higher complication rate in the obese, and if the long-term outcome is worse.'

Overall, the study in the Journal of Bone and Joint Surgery indicates that obese patients are twice as likely to develop an infection as non-obese patients and face a nearly twofold increase in their long-term risk of needing revision surgery.

In light of their findings, the researchers say it is all the more important to encourage obese patients to lose weight prior to surgery.

Older people who take regular exercise may benefit from better protection against brain shrinkage than those who merely engage in mental or social activities, a study suggests.

Researchers at the University of Edinburgh looked at the medical records of 638 people, all of whom were born in 1936 and underwent MRI scans at 73 years of age.

Participants also provided information about their levels of exercise and their participation in social and mentally stimulating activities.

After three years, the researchers found that people who had done the most physical activity tended to show the least brain shrinkage - a process that can lead to memory problems.

Study author Dr Alan Gow, whose findings are published in Neurology journal, said that regular exercise in old age 'is potentially important to protecting the brain as we age'.

In contrast, 'our study showed no real benefit to participating in mentally and socially stimulating activities on brain size, as seen on MRI scans, over the three-year time frame'.

Professor James Goodwin, head of research at Age UK, described the findings as 'exciting' and insisted that it is never too late to exercise.

The daily use of multivitamins may reduce the risk for cancer in men, according to the results of a very large randomized trial.

After about 11 years, multivitamin use resulted in a modest but statistically significant reduction - specifically, an 8% reduction in total cancer incidence.

In an analysis that separated prostate cancer from all other cancers, "we did not see an effect for prostate cancer, but there was a 12% reduction in total cancers which was significant," said lead author John Michael Gaziano, MD, MPH. He was speaking at a press briefing ahead of a presentation at the Annual American Association for Cancer Research (AACR) Frontiers in Cancer Prevention Research meeting.

The study has also been published early online in the Journal of the American Medical Association to coincide with the meeting.

"Cancer mortality also went in the right direction - a 12% reduction which wasn't quite statistically significant but certainly a consistent finding," said Dr. Gaziano, a researcher at Brigham and Women's Hospital, Center for Older Adult Health, Boston, Massachusetts.

"Our main message is that the main reason to take a multivitamin is for nutritional deficiencies but it certainly appears that there may be a modest benefit in preventing cancer in men over the age of 50," he said.

A number of trials of individual vitamins, administered at high doses, have not shown any effect at preventing cancer, Dr. Gaziano explained.

Observational studies have also not provided evidence of an association between multivitamin use and a reduction in cancer incidence or mortality.

However, the current study is unique in a number of ways, the first being that it is the only large-scale placebo-controlled trial evaluating a multivitamin in the prevention of cancer.

It is also of long duration, he said. "This effort was 17 years in the making, from the time we wrote the first protocol and we have 11 years of follow up, with up to 14 years of treatment for some of the participants."

In addition, Dr. Gaziano pointed out that this study was well controlled. The participants who were randomized to the multivitamin arm were all taking the exact same brand and formulation (Centrum Silver), which has not necessarily been the case in other studies.

Conflicting Results
Previous studies have reported conflicting results. As reported by Medscape Medical News, 2 studies evaluating the association of multivitamins and breast cancer found opposite results - one study found an increased risk while the other found that multivitamins decreased the risk.

Another study reported more neutral results, in that multivitamin use had no influence on the risk for common cancers, cardiovascular disease, or overall mortality.

The lead author of that study, Marian L Neuhouser, MD, commented at that time that the "main message of our study is that postmenopausal women who take a multivitamin don't increase their risk for cancer or cardiovascular disease, but they don't decrease it either.

"These multivitamins are having no effect with regard to these particular disease outcomes," said Dr. Neuhouser, who is from the Fred Hutchinson Cancer Research Center, Seattle, Washington.

Reduction in Total Cancers
The data in the current study was drawn from the Physicians' Health Study II, a large-scale, randomized, double-blind, placebo-controlled trial that included 14, 641 male US physicians who were 50 years or older when the study began. The cohort included 1312 men with a history of cancer.

The multivitamin study began in 1997, with treatment and follow-up that continued through June 1, 2011.

The cohort included a large proportion of former smokers (40.0%) and a very low proportion of current smokers (3.6%) with a high rate of current aspirin use (77.4%).

"This was a population of healthy physicians," Dr. Gaziano said. "Over two thirds of them exercised regularly and only 4% smoked."

Adherence to the protocol was high in both the multivitamin and placebo group. At 4 years, it was 76.8% (vitamin) and 77.1% (placebo), P = .71; and at 8 years, adherence was 72.3% (vitamin) and 70.7% (placebo), P = .15. It remained high even at the end of the follow-up period, at 67.5% and 67.1%, respectively (P = .70).

During the study period, a total of 2669 men developed cancer, including 1373 cases of prostate cancer and 210 cases of colorectal cancer. A total of 2757 participants (18.8%) died during follow-up, and this included 859 (5.9%) from cancer.

Their results showed that men taking a daily multivitamin had a statistically significant reduction in the incidence of total cancer, as compared with placebo (17.0 and 18.3 events, respectively, per 1000 person-years; hazard ratio [HR], 0.92; P = .04).

However, when the cancers were considered separately, there was no significant effect. There was NO effect of the daily multivitamin on prostate cancer (multivitamin and placebo groups, 9.1 and 9.2 events per 1000 person-years; HR, 0.98; P = .76), colorectal cancer (1.2 and 1.4 events per 1000 person years; HR, 0.89; P = .39), or any other site-specific cancers.

Dr. Gaziano and colleagues noted that the total cancer rates in this cohort were probably influenced by the increased surveillance for prostate-specific antigen (PSA) and subsequent diagnoses of prostate cancer during the last 1990s.

"We had included participants with a prior history of cancer and we had prespecified an analysis that we would do, and there is an appearance of a stronger effect in those with a prior cancer," he said.

Among men with a baseline history of cancer, daily multivitamin use was associated with a reduction in total cancer (HR, 0.73; P = .02). However, this reduction was not significantly different from the cohort without a cancer history (HR, 0.94; P = .15; P for interaction = .07).

"We are continuing more analyses, looking at the nutritional status of the individuals," Dr. Gaziano said. "We hope to be able to continue following this cohort, some of whom we have been following for 30 years, so we can see the long term effects."

Researchers from the Linus Pauling Institute at Oregon State University, Corvallis, who have been studying related issues, commented that this data "conclusively shows that multivitamins are safe to take, help fill important nutritional gaps, reduce cancer risk and in turn will help cut health care costs."

"An 8 percent drop in overall cancer rates is not small," said Balz Frei, PhD, professor and director of the Linus Pauling Institute, in a statement.

"Given that more than 1.6 million new cancer cases are diagnosed in the U.S. each year, this translates into about 130,000 cancers prevented every year, and with it all the health care costs and human suffering," commented Dr. Frei, who was not involved in the study.

Dr. Frei also pointed out that the effect might be even higher in other population groups than seen in this study. "And it's worth noting that the research was done with 14,600 physicians," Dr. Frei said. "This highly-educated group has a better diet, knowledge base and health habits than the average person, so it's reasonable to believe that the impact of multivitamin use in the general population will be even greater."

11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, Presented October 17, 2012.

The study was supported by grants from the National Institutes of Health and the BASF Corporation.

Dr. Gaziano reports investigator-initiated research funding from the NIH, the Veterans Administration, and the BASF Corporation; assistance with study agents and packaging from BASF Corporation and Pfizer (formerly Wyeth, American Home Products, and Lederle); and assistance with study packaging provided by DSM Nutritional Products Inc. (formerly Roche Vitamins). Several other coauthors also report relationships with industry as noted in the paper.

October 11, 2012 (Orlando, Florida) - Hot flashes and night sweats appear to be linked to higher serum glucose levels and indicators of insulin resistance, according to data presented here at the North American Menopause Society 23rd Annual Meeting.

Emerging research signals a link between menopausal hot flashes and cardiovascular risk, Rebecca Thurston, PhD, from the University of Pittsburgh in Pennsylvania, told Medscape Medical News.

This latest finding, from the Study of Women's Health Across the Nation (SWAN), a large, longitudinal cohort study that follows women as they transition into menopause, adds insulin resistance to the other cardiovascular risk factors that have been linked to bothersome vasomotor symptoms in menopausal women.

"The SWAN findings show that vasomotor symptoms, particularly more frequent and severe vasomotor symptoms, may be a marker of underlying cardiovascular change for women," Dr. Thurston explained.

"We previously found increased atherosclerosis, elevated lipids, and elevated blood pressure in women with vasomotor symptoms; now we are showing elevated insulin resistance. These are all cardiovascular risk factors that fit together in the same puzzle," she said.

Dr. Thurston emphasized that it is premature to claim that there is a causal link between vasomotor symptoms and cardiovascular risk. However, the message for clinicians is that if a woman in their practice is having frequent vasomotor symptoms, particularly if the symptoms occur later, rather than earlier, after menopause, this might be a clue to do a more intense cardiovascular work-up.

"This is a reminder that as women are transitioning through menopause, their cardiovascular health is oftentimes changing, and usually not for the better," Dr. Thurston added.

Insulin Resistance Findings
The 3075 participants in SWAN study were 42 to 52 years of age at study entry, and completed questionnaires about hot flashes and night sweats. Their blood pressure, height, weight, fasting blood glucose, insulin, estradiol, and follicle-stimulating hormone levels were measured annually for 8 years.

Insulin resistance was calculated using the homeostasis model assessment (HOMA).

The researchers found that glucose levels and the degree of insulin resistance rose as the frequency of hot flashes rose.

Glucose levels were 33% higher in women who reported hot flashes 1 to 5 days per week than in those who reported no hot flashes (P = .2), and were 1.25% higher in women who reported hot flashes on 6 days or more per week (P = .0001).

Additionally, HOMA index scores were more than 2-fold higher in women who reported hot flashes 1 to 5 days per week (percent difference, 2.37; 95% confidence interval [CI], 0.36 to 4.43; P = .02) and in women who reported hot flashes 6 days or more per week (percent difference, 5.91; 95% CI, 3.17 to 8.72; P < .0001).

Again, Dr. Thurston, whose research has focused on the relation between vasomotor symptoms and the risk for cardiovascular disease, encourages clinicians to conduct cardiovascular check-ups on their patients who suffer vasomotor symptoms.

"Be aware of blood pressure [and] lipids. The glucose and insulin resistance findings represent another potential marker for cardiovascular risk. My message to clinicians treating these patients is that they should emphasize lifestyle changes, such as smoking cessation, physical exercise, and diet, in women who are having a lot of vasomotor symptoms," she said.

Would Estrogen Therapy Help These Women?
Vanessa M. Barnabei, MD, chair of obstetrics and gynecology at the University of Buffalo in New York, who was asked by Medscape Medical News to comment on this study, suggested that putting these women on estrogen therapy might improve their cardiovascular risk profile.

"If you put those women on estrogen, their insulin resistance probably will improve to some degree. There is something about the low or fluctuating estrogen levels that may be involved, which isn't surprising because it affects growth hormone and other parameters," Dr. Barnabei explained.

Dr. Thurston noted that it is unclear whether treating vasomotor symptoms will improve cardiovascular risk.

"We just don't know yet, but I think if we continue to see this kind of pattern, it may prompt us to find treatments. We are not great at predicting women's cardiovascular risk in midlife. Women do not get heart disease until their 60s and 70s. In midlife, all those traditional cardiovascular risk factors, things like our Framingham score, do not predict as well in women as in men. The overall goal of this line of research is to think about vasomotor symptoms and whether they provide an improvement in that risk prediction. We're not necessarily there yet, but this is the ultimate goal," Dr. Thurston said.

The SWAN study is sponsored by the National Institutes of Health (NIH), the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office of Research on Women's Health. Dr. Thurston and Dr. Barnabei have disclosed no relevant financial relationships.

North American Menopause Society (NAMS) 23rd Annual Meeting: Abstract S-24. Presented October 5, 2012.

Patients with bone cancer are not being diagnosed quickly enough, a charity has warned.

The Bone Cancer Research Trust (BCRT) is concerned that the disease is often misdiagnosed, as GPs wrongly attribute the symptoms to growing pains.

As a result, just 42% of people who develop primary bone cancer or 'osteosarcoma' survive for five years after receiving the correct diagnosis.

The charity wants GPs to send patients for x-rays more quickly to help boost survival rates, which have not improved over the past 25 years.

Dr. Harriet Unsworth, information and research officer at the BCRT, told the Press Association: 'Primary bone cancer symptoms can include painful bones or swollen joints, and this can easily be misdiagnosed by GPs as a sporting injury or growing pains.

'We need to urgently address the imbalance here and find ways to improve primary bone cancer patients' chances of survival.'

The charity's comments came after a report from the National Cancer Intelligence Network found that five-year survival rates for primary bone cancer have remained the same for the past 25 years in England, despite improvements for almost all other forms of cancer.

A compound found in tomatoes may help to reduce people's chances of having a stroke, scientists say.

Men with a high intake of lycopene - the chemical that gives tomatoes their bright red colour - were found to have a significantly reduced risk of stroke.

The discovery was made by scientists at the University of Eastern Finland in Kuopio, who studied more than 1,000 men over a 12-year period.

Participants with the most lycopene in their bloodstream were found to benefit from a 55% reduction in their risk of having a stroke during that time.

'This study adds to the evidence that a diet high in fruits and vegetables is associated with a lower risk of stroke,' said Dr.Jouni Karppi, whose findings are published in Neurology journal.

He added that lycopene acts by reducing inflammation and preventing blood clotting.

A spokeswoman for the Stroke Association told the BBC that all fruits and vegetables have health benefits 'and remain an important part of a staple diet'.

The intensity of exercise is more important than the duration for warding off metabolic syndrome, new research suggests.

Scientists at Bispebjerg University Hospital in Copenhagen, Denmark, studied a group of more than 10,000 men and women, aged 21 to 98 years, over a ten-year period.

They found that low levels of leisure-time physical activity and a slow walking speed were associated with an increased risk of metabolic syndrome.

Regular joggers were less likely to have metabolic syndrome than people who did not run.

However, large amounts of walking did not appear to reduce a person's risk of metabolic syndrome, with the intensity of exercise being more important than its duration.

Publishing their findings in the journal BMJ Open, the study authors concluded: 'Our results confirm the role of physical activity in reducing metabolic syndrome risk and suggest that intensity more than volume of physical activity is important.'

US scientists claim to have discovered a new link between unhealthy 'western' diets and atherosclerosis (narrowed arteries).

A diet high in saturated fat appears to raise levels of an enzyme called endothelial lipase (EL), which is associated with the development of atherosclerosis.

Meanwhile, eating large amounts of healthy omega-3 polyunsaturated fats seems to help bring down levels of this enzyme.

According to scientists at Columbia University Medical Centre, the findings suggest a new way to prevent heart disease.

'Our study identifies a new way in which the high-saturated-fat western diet could lead to the development of atherosclerosis, though of course, these results need to be confirmed in human studies,' said lead researcher Dr Richard Deckelbaum, who was alluding to the fact that the study was conducted in mice.

He added that the findings may help to explain some of the apparent cardiovascular benefits that have been attributed to omega-3 fatty acids.

Almost all adults are thought to have some degree of atherosclerosis, which has a number of risk factors such as smoking, lack of exercise and being overweight.

People with diabetes who develop foot ulcers may be more likely to die young, a study has found.

Researchers at St George's, University of London studied 17,830 people with diabetes, 3,095 of whom had been diagnosed with foot ulcers.

Publishing their findings in the journal Diabetologia, they revealed that those with ulceration had a higher death rate than those without.

For every 1,000 people per year with diabetic foot ulcers, there were an extra 58 deaths, many of which were from cardiovascular causes.

The discovery highlights the importance of early detection and effective management of patients with diabetes and foot ulcers, which can occur as a result of poor circulation and nerve damage in these individuals.

Bridget Turner, director of policy and care improvement at Diabetes UK, revealed that people with diabetes are more likely to be admitted to hospital with foot ulcers than with any other complication.

'Everyone should have swift access to multidisciplinary foot care teams, which have been shown to significantly reduce levels of risk,' she insisted.

People who regularly sit around for long periods of time may be more likely to develop diabetes and heart disease, a study has found.

Researchers at the University of Leicester and Loughborough University analysed the results of 18 previous studies involving almost 800,000 people.

They found that sitting for protracted periods of time was associated with a twofold increase in a person's risk of diabetes, heart disease and death.

These associations were still apparent in people who did the recommended amount of moderate-to-vigorous exercise in the times when they were not sitting down.

Lead researcher Dr Emma Wilmot, from the University of Leicester's Diabetes Research Group, said: 'The average adult spends 50 to 70% of their time sitting, so the findings of this study have far reaching implications.

'By simply limiting the time that we spend sitting, we may be able to reduce our risk of diabetes, heart disease and death.'

Commenting on the findings, which are published in the journal Diabetologia, a spokeswoman for the British Heart Foundation said that sitting down for long periods was already known to have a negative effect on heart health.

Senior cardiac nurse Maureen Talbot advised: 'After a long day at work, it's often tempting to head straight to the sofa. Ease the tension from your working day by heading out for a walk or trying out an exercise class.'

People with little time to exercise may benefit from doing short bursts of sprint interval training, a study suggests.

Sprint interval training involves short sessions of concentrated activity, interspersed with longer periods of recovery time.

Researchers at Colorado State University and the University of Colorado say that just 2.5 minutes of concentrated effort each day could lead people to burn as many as 200 extra calories.

Once the recovery periods have been taken into account, this means people could increase their cardiovascular fitness and improve their chances of weight loss by exercising for just 25 minutes per day.

Lead researcher Kyle Sevits, whose findings were presented at the Integrative Biology of Exercise VI meeting, said: 'Research shows that many people start an exercise programme but just can't keep it up.

'We hope if exercise can be fit into a smaller period of time, then they may give exercise a go and stick with it.'

Health experts advise adults to do a minimum of 30 minutes of moderate-intensity exercise on at least five days each week.

Healthcare costs are rising as demand for care increases, but a new study suggests that programs that promote healthy ageing could help to save money.

A report from the Economist Intelligence Unit (EIU), sponsored by Pfizer, found that healthcare costs decrease when governments invest in healthy ageing initiatives.

The report looked at a number of countries around the world, including the UK and the US, and concluded that immunization is one of the most cost-effective preventive measures for older people…. However, other measures are needed, such as education on nutrition, exercise and health screening.

Katherine Dorr Abreu, who edited the report, said: 'It's crucial for policymakers to consider measures that help ageing individuals remain active and healthy members of society to avoid the heavy burdens associated with the cost of long-term care.

'The EIU's report states preventive measures can have up to a fourfold return on investment and can help adults maintain an optimal quality of life as they age.'

Research released earlier this year (July 2012) by Age UK found that the majority of over-55s do not do the recommended amount of exercise each week.

BACKGROUND: The increasing prevalence of type 2 diabetes poses a major public health challenge.

Population-based screening and early treatment for type 2 diabetes could reduce this growing burden.

However, uncertainty persists around the benefits of screening for type 2 diabetes.

We assessed the effect of a population-based stepwise screening programme on mortality.

METHODS: In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5).

The study population consisted of 20 184 individuals aged 40-69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score.

In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA(1c)) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test.

The primary outcome was all-cause mortality.

All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081.

FINDINGS: Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001-06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up.

During 184 057 person-years of follow up (median duration 9.6 years [IQR 8.9-9.9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1.06, 95% CI 0.90-1.25).

We noted NO significant reduction in cardiovascular (HR 1.02, 95% CI 0.75-1.38), cancer (1.08, 0.90-1.30), or diabetes-related mortality (1.26, 0.75-2.10) associated with invitation to screening.

INTERPRETATION: In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years.

The benefits of screening might be smaller than expected and restricted to individuals with detectable disease.

FUNDING: Wellcome Trust; UK Medical Research Council; National Health Service research and development support; UK National Institute for Health Research; University of Aarhus, Denmark; Bio-Rad.

OBJECTIVE: To investigate the long term effect of hormone replacement therapy on cardiovascular outcomes in recently postmenopausal women.

DESIGN: Open label, randomised controlled trial.

SETTING: Denmark, 1990-93.

PARTICIPANTS: 1006 healthy women aged 45-58 who were recently postmenopausal or had perimenopausal symptoms in combination with recorded postmenopausal serum follicle stimulating hormone values.

502 women were randomly allocated to receive hormone replacement therapy and 504 to receive no treatment (control).

Women who had undergone hysterectomy were included if they were aged 45-52 and had recorded values for postmenopausal serum follicle stimulating hormone.

INTERVENTIONS: In the treatment group, women with an intact uterus were treated with triphasic estradiol and norethisterone acetate and women who had undergone hysterectomy received 2 mg estradiol a day.

Intervention was stopped after about 11 years owing to adverse reports from other trials, but participants were followed for death, cardiovascular disease, and cancer for up to 16 years.

Sensitivity analyses were carried out on women who took more than 80% of the prescribed treatment for five years.

MAIN OUTCOME MEASURES: The primary endpoint was a composite of death, admission to hospital for heart failure, and myocardial infarction.

RESULTS: At inclusion the women on average were aged 50 and had been postmenopausal for seven months.

After 10 years of intervention, 16 women in the treatment group experienced the primary composite endpoint compared with 33 in the control group (hazard ratio 0.48, 95% confidence interval 0.26 to 0.87; P=0.015) and 15 died compared with 26 (0.57, 0.30 to 1.08; P=0.084).

The reduction in cardiovascular events was not associated with an increase in any cancer (36 in treated group v 39 in control group, 0.92, 0.58 to 1.45; P=0.71) or in breast cancer (10 in treated group v 17 in control group, 0.58, 0.27 to 1.27; P=0.17).

The hazard ratio for deep vein thrombosis (2 in treated group v 1 in control group) was 2.01 (0.18 to 22.16) and for stroke (11 in treated group v 14 in control group) was 0.77 (0.35 to 1.70).

After 16 years the reduction in the primary composite outcome was still present and not associated with an increase in any cancer.

CONCLUSIONS: After 10 years of randomised treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke.

BACKGROUND: Low back pain is one of the most frequent ailments seen in primary care consultations.

OBJECTIVES: To test the feasibility, safety, and efficacy of a web-based multidisciplinary intervention for office workers with sub-acute, nonspecific low back pain.

STUDY DESIGN: Randomized controlled trial.

METHODS: The trial included 100 office workers with sub-acute low back pain.

The intervention group had access to both the study intervention and standard care. The control group had access to standard care only.

Standard care was defined as all existing non-web-based interventions offered by the University of Extremadura`s Preventive Medicine Service.

The web-based program was offered via the Preventive Medicine Service website.

The participants in the intervention group were asked to engage in the web-based program at their work site for 11 minutes each day, 5 days a week.

Primary outcomes were functional disability, as measured by the Roland-Morris Disability Questionnaire, and health-related quality of life, as measured by the European Quality of Life-5 Dimensions-3 Levels.

Secondary outcomes were the number of episodes of low back pain and trunk muscle endurance.

Outcomes were measured before and after the 9-month intervention period.

RESULTS:
Over the 9-month study, the score on the Roland-Morris Disability Questionnaire for the participants in the web-based intervention group improved by a mean of -7.36 points (95% confidence interval [CI]: -8.41, -6.31) compared to a worsening of 1.89 points (95% CI: 0.71, 2.65) in the control group.

The between-group difference in change on the Roland-Morris Disability Questionnaire over the study period was -9.25 points (95% CI: -10.57, -7.89). Similarly, over the 9-month study, the intervention group had a significant improvement in quality of life of 0.24 points (95% CI: 0.20, 0.29) compared to the control group.

CONCLUSION: A 9-month web-based intervention is feasible and effective to improve function and health-related quality of life and to decrease episodes of low back pain among office workers with a history of subacute, nonspecific low back pain.

LEVEL OF EVIDENCE: Therapy, level 1a.

Case-control study shows any analgesic, aspirin use may reduce risk of ovarian cancer

Use of any analgesic or aspirin correlates with a reduced risk of ovarian cancer, with the reduction significant only for use of any analgesic and serous ovarian cancer, according to a case-control study published in the September issue of ACTA Obstetricia et Gynecologica Scandinavica.

Henriette B. Ammundsen, from the Danish Cancer Society Research Center in Copenhagen, and colleagues examined the correlation between analgesic use and the risk of ovarian cancer, and whether the risk differed according to histological type. The study cohort included 756 women with epithelial ovarian cancer and 1,564 randomly selected control women, aged 35 to 79 years.

The researchers found a reduced risk of ovarian cancer to be associated with regular use of any analgesic or aspirin, but the reduction was not statistically significant.

The risk of ovarian cancer was not decreased with regular use of non-aspirin non-steroidal anti-inflammatory drugs, paracetamol, or other analgesics.

There was a statistically significant decrease in the risk of serous ovarian cancer, but not mucinous or other ovarian tumors, with use of any analgesic (odds ratio [OR], 0.72; 95 percent confidence interval [CI], 0.53 to 0.98) or aspirin (OR, 0.60; 95 percent CI, 0.36 to 1.00).

"In conclusion, the results of this case-control study indicate a possible protective effect of analgesic use in relation to development of ovarian cancer," the authors write. "Thus our results support findings from most previous studies."

A drug currently being tested in humans could help to protect against damage caused by stroke, scientists have claimed.

Researchers at the University of Calgary in Canada conducted a small clinical trial involving 185 patients at 14 hospitals in Canada and the US.

They found that people who were given a drug called NA-1 tended to develop fewer areas of damaged brain tissue in the days following surgery than those who received a placebo (dummy drug).

The treatment works by disrupting the activity of a protein involved in stroke damage.

Furthermore, the drug appeared to be safe for use in humans, according to a report in the Lancet medical journal.

Lead author Professor Michael Hill, from the University of Calgary's Hotchkiss Brain Institute, said: 'Safe drugs to provide tissue neuroprotection - defined as salvage of brain tissue by enhancing its resilience to the restricted blood flow that patients experience during these procedures - is a major unmet need in stroke treatment.

'Our research ... suggests that intravenous infusion of NA-1 reduces tissue damage in patients who suffer a small stroke after an operation to repair a brain aneurysm.'

The expert added that further research - including larger clinical trials - is now needed to determine the treatment's effectiveness.

Dr Peter Coleman, a spokesman for the Stroke Association, told the BBC that the drug 'appears promising'.

September 24, 2012 - Two large studies carried out in the United States provide striking perspectives on the continuing problem of antibiotic overuse.

Both articles were published online September 24 in the Archives of Internal Medicine. In the first article, the researchers studied geographic variations in antibiotic prescribing among older adults.

"Antibiotic use variation in the non-Medicare population has been investigated, but little is known about the antibiotic prescribing patterns among older adults," Yuting Zhang, PhD, from the Graduate School of Public Health, University of Pittsburgh, Pennsylvania, and colleagues write.

Medicare Part D drug benefits were instituted in 2006, and since then, considerable data on antibiotic prescribing for older adults have been accumulating. "However, to our knowledge, no study to date using Medicare Part D data has examined variation in antibiotic use among older adults," the researchers write.

Aiming to help fill that gap in knowledge, these researchers evaluated Medicare Part D data for the years 2007 through 2009.

Using the residential Zip codes of Medicare beneficiaries, the researchers checked for regional prescribing trends in several ways: state-by-state (plus the District of Columbia), by 4 national regions (Northeast, South, West, and Midwest), and by assessing data from the 306 Dartmouth Atlas of Health Care hospital referral regions. They also evaluated how antibiotic prescribing varied by seasonal quarters.

The investigators adjusted across all regions for differences in patient demographics and insurance status, as well as for clinical characteristics.

Antibiotics in Older Adults
The South accounted for the highest antibiotic use, with, on average, 21.4% of patients each quarter being prescribed an antibiotic. Patients in Western states received antibiotics the least, at about 17.4% of patients per quarter (P < .01).

Across all regions, antibiotic prescribing peaked during the first quarter (January - March), at 20.9%, and was lowest during the third quarter (July - September), at 16.9%, the researchers say (P < .01).

The variations, the researchers state, could not be explained by differences in the prevalence of infections between regions and across seasonal quarters.

Regions with high use of antibiotics often had lower rates of bacterial pneumonia, the authors report.

They note that geographic areas with high antibiotic use would likely benefit from programs aimed at reducing unnecessary usage of the drugs, and they emphasize that although seniors may be at higher risk for adverse outcomes when they have bacterial infections, they may also be at higher risk for adverse effects from antibiotics. "Therefore, it might be necessary to target some quality improvement initiatives toward this age group," they conclude.

Study limitations include the inability to control for disease severity and other factors that may have biased the data.

Antibiotics for Sinusitis
In the other study, presented in a research letter also published online September 24, a group of researchers studied national trends in antibiotic prescribing for adults in the United States who were diagnosed with acute sinusitis.

The principal finding was that even though most sinusitis is viral in origin and antibiotics are of little use in treating such infections, the prescribing of broad-spectrum antibiotics, such as quinolones and macrolides, is extremely common.

Tarayn Fairlie, MD, MPH, from the Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues note that up until 2012, amoxicillin was the recommended empirical treatment for acute bacterial sinusitis…. New guidelines now recommend amoxicillin-clavulanate.

"In light of recent studies and new treatment guidelines, we sought to examine visit rates and antibiotic prescribing patterns for adults with acute sinusitis in the United States," they write.

Using 2000 to 2009 data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, along with standard diagnostic criteria from the International Classification of Diseases, Ninth Revision, Clinical Modification, the authors estimated the annual number of acute sinusitis visits per 1000 adults in the United States.

As primary outcomes measures, they used the proportion of office visits for acute sinusitis in which any antibiotic was prescribed, as well as the proportion of antibiotic visits in which amoxicillin was prescribed.

They excluded visits that had concomitant diagnoses (eg, urinary tract infections) that might require antibiotics. Also excluded were visits that resulted in hospitalizations and visits in which patients were prescribed vancomycin or an aminoglycoside.

"In the present study, using a nationally representative data set of ambulatory visits, we found that more than 80% of patients diagnosed as having acute sinusitis receive an antibiotic, despite mounting evidence that the benefits of antibiotic treatment for sinusitis are limited," the authors write.

More specifically, they found that antibiotics were prescribed in 83% (95% confidence interval [CI], 78% - 86%) of visits for acute sinusitis and that that rate of prescribing did not change significantly during the study period (P = .85).

Amoxicillin, the recommended agent during the period studied, was prescribed in only 17% (95% CI, 12% - 23%) of cases. The other most commonly prescribed antibiotics were macrolides (29%), quinolones (19%), and amoxicillin-clavulanate (16%).

"Changes in prescribing behavior of health care providers for sinusitis are urgently needed to improve health care quality and stem the rising tide of antibiotic resistance in the United States," the authors conclude.

Translating Public Health Priorities
In an invited commentary by Ralph Gonzales, MD, MSPH, from the Department of Medicine and the Department of Epidemiology, University of California, San Francisco, and colleagues, the authors write, "We believe that the persistence of antibiotic overuse in the United States is a failure to translate national public health priorities and evidence into local practice and policies. We ask whether the application of recent implementation frameworks could help to guide more successful evidence translation and provide a sharper focus for future intervention activities."

With that idea in mind, they developed a checklist aimed at assessing the likelihood of clinicians being able to successfully translate evidence into practice when dealing with a specific problem area - in this case, antibiotic overuse. The checklist is adapted from 2 sources: a national study that empirically assessed high-performance medical delivery systems and a Consolidated Framework for Implementation Research.

The checklist contains 3 domains: Significance of the Problem Area, Organization and Stakeholder Readiness for Change, and Feasibility of Intervention. Each domain is composed of several questions. For each of the questions, these authors came up with a general summary rating (favorable, unfavorable, or neutral) describing the effect it might have on efforts to implement more judicious antibiotic use.

Hurdles exist in all 3 domains of the checklist, the authors say, but they also note that previous research has shown that coordinated, multidimensional interventions can help cut down on antibiotic overuse in local delivery systems. They reason, then, that particularly tough challenges in the first 2 domains (Significance of the Problem Area and Organization and Stakeholder Readiness for Change) may help explain why proven interventions have so far not been more widely disseminated and adopted.

"We need to find better ways to compel individuals and organizations to address the significance of the problem of antibiotic overuse and to increase the readiness for change and quality improvement of ambulatory practices in the United States," they conclude.

The Zhang study was funded in part by the Centers for Medicare and Medicaid Services, the Institute of Medicine, the National Institute of Mental Health, the Agency for Healthcare Research and Quality, the National Institute on Aging, and the American Federation for Aging Research. The authors of both studies and the editorialists have disclosed no relevant financial relationships.

Hamilton, ON - Dr Richard Smith (UnitedHealth, London, UK), a longtime editor of BMJ, doesn't know his own blood pressure or LDL levels, but he believes he's keeping cardiovascular disease at bay by taking a polypill every day. Smith, who was enrolled in one of the early polypill trials, says he's done this since he was 56 years old.

"If I had to go to the doctor every three months to get my blood pressure measured and my lipids measured and have to go back to have my drugs titrated, I couldn't be bothered with all that," he said. "Because I get [my polypills] through the post, and I just take it every night, it's extremely simple."

Low-dose combination tablets go by many names-the term "polypill" was trademarked by an enterprising US pharmacist.

Cardiovascular researchers working in this area have settled on "polypharmacy" or single-tablet multidrug combination therapy, but like its name, the ideal makeup for a polypill is still largely undecided.

Proponents of the polypharmaceutical approach, where a single tablet contains a statin, ACE inhibitor, beta blocker, diuretic, and aspirin, say it might one day form the cornerstone of primary-and secondary-prevention treatment for cardiovascular disease.

Smith was just one high-profile name attending the Global Summit on Combination Polypharmacy for Cardiovascular Disease, organized by Dr Salim Yusuf (McMaster University, Hamilton, ON).

Calling cardiovascular disease the biggest epidemic the world has ever known, "bigger than HIV," affecting nearly one in three individuals, Yusuf believes the magnitude of the problem and the ensuing worldwide shortage of cardiologists and specialists to treat cardiovascular morbidities cry out for new treatment paradigms.

"This is not about a pill," Yusuf told heartwire. "This is about a strategy to reduce cardiovascular disease by 50% globally in a cost-effective manner."

The two-day summit took place this week at the McMaster University Population Health Research Institute and included some of cardiology's biggest names grappling with the medical, scientific, legal, regulatory, economic, and social issues of trying to get polypharmacy treatments on the market for patients with existing cardiovascular disease, as well as for those at high risk for cardiovascular disease.

The Wald and Law BMJ paper

The polypill concept gained notoriety in a 2003 paper by Sir Nicholas Wald andDr Malcolm Law (University of London, UK) in BMJ that provocatively claimed a combination polypill with a statin, three blood-pressure-lowering medications at half doses, an ACE inhibitor, aspirin, and folic acid could reduce the risk of ischemic heart disease by 88% and stroke by 80%.

The British doctors raised the possibility of one day using the drug to treat all patients with cardiovascular disease as well as those 55 years of age and older, without measuring any risk factors.

"There is merit in the idea of treating all patients 55 years of age and older with a polypill, but right now there is too much resistance," Yusuf told heartwire. "That is a bridge that we might cross five years from now, but it will be debated. If you start to think of prevention and treatment paradigms, think about LDL cholesterol. The targets have been coming down and treatment has become more aggressive. And the targets have been getting closer and closer for the whole population. Right now, the low-hanging fruit is in secondary prevention for the implementation of the polypill, high-risk primary prevention for research, and the whole population for the future."

Dr. Sidney Smith (University of North Carolina, Chapel Hill), the president of theWorld Heart Federation, told heartwire that one of the greatest challenges is simply getting patients to change their lifestyle, including stopping smoking, increasing physical activity, and eating healthier foods.

The challenge after that monumental task is get these same individuals to adhere to those changes.

"I personally do not think that taking medication should be a substitute for changing lifestyle," said Smith. "Now, in many areas, the cost of medication, when it is needed, is high and in many instances patients need to take more than one pill.

I think the broadest initial application for a multidrug pill, the so-called polypill, will be in populations that are at high risk or have known disease and in countries that are low income or middle income and developing.

Large populations of patients, such as in China and India, where the economies are developing and the healthcare systems are not set up to practice individualized medicine as we see in the US, might be best suited to the delivery of multidrug therapy by other healthcare workers."

Dr. Srinath Reddy (Public Health Foundation, India) agreed there is concern the use of the polypill would overshadow the needed changes to lifestyle and diet.

He said the use of the polypill raises the specter of two competing visions of society. In the first, social and personal changes are used to bring about intergenerational benefits, such as tobacco-cessation programs, so that each successive generation has a lower risk of cardiovascular disease than the one preceding it. The other vision would be a more medicalized society, one in which ailments and disease are treated with drug therapies. While such a strategy has the potential to reduce the risk of cardiovascular disease and stroke, it provides no health benefits to the following generations.

Experts all gathered in one room

Throughout the meeting, the major discussions surrounding polypharmacy centered on who should be treated, what doses and formulations should be included in the polypill, how would the drug get approved by various regulatory agencies, who should administer medical treatment, and how the drugs would be distributed in low- to middle-income countries that lacked sufficient healthcare infrastructure.

Aside from these massive hurdles, the experts agreed that adherence to medical treatment, whether the drug was in a single pill or treatment requiring multiple tablets, remains the elephant in the room.

Dr. Valentin Fuster (Mount Sinai School of Medicine, New York) noted that adherence to medical therapy declines 40% in the first six months after starting treatment. Fuster cited data from the Prospective Urban Rural Epidemiology (PURE) study showing large treatment gaps between affluent and underdeveloped countries with regard to proven secondary-prevention therapies. In addition, data from other trials, including the soon-to-presented FREEDOM trial of patients with diabetes mellitus, shows that just one in five patients had their cardiovascular risk factors controlled at follow-up. Similar rates of risk-factor control were observed in COURAGE and BARI 2D.

"We have a problem," said Fuster. "We can talk about any intervention we want, from stents to surgery to anything at all, but 80% of people are not reaching the risk-factor profile they are supposed to reach." The abysmal control of risk factors is occurring in clinical trials, Fuster pointed out, including the FREEDOM trial, where investigators were reminded every week to make sure patients were taking statins, aspirin, and other medications.

The underlying assumption of polypharmacy for cardiovascular disease is that a single drug with multiple compounds would improve risk-factor control because patients would be more likely to adhere to one medication. That, however, has not yet been proven in clinical trials. As Smith pointed out, adherence is a complex issue involving access, cost, and patient motivation, among other things. In the MI FREEE trial, for example, eliminating the copay for evidence-based cardiovascular medicines resulted in an adherence rate of less than 50%, a figure that was significantly higher than patients who had to make copayments, but low nonetheless.

Dr. Susan Shurin (National Heart, Lung, and Blood Institute, Bethesda, MD), who spoke on the North American perspective of incorporating combination polypharmacy into a national strategy, believes that the development of a polypill belongs in the hands of the pharmaceutical companies and not the US government, but if such a multidrug strategy is to be approved or sanctioned, researchers would have to show the treatment had a "high impact" in that access and adherence were better and the single-combination tablet solved a problem the other generically available medicines could not.

Some of the concerns about the polypill 

Despite acknowledging the gap between ideal and real-world risk factor control across all types of cardiovascular disease and the fact that 15% of the world's population consumes 90% of the medicine, a discrepancy that afflicts poor and middle-income countries most, many of the summit's speakers said there are concerns about the limitations of single-drug polypharmacy.

In fact, resistance to the polypill often comes from physicians who are concerned about side effects, the inability to titrate the individual drugs, and the risks if a patient misses multiple days of treatment or if they decide to take "drug holidays."

While titrating the doses of drugs, especially blood-pressure drugs, can further reduce individual risk factors, the net result would be a minimal reduction in overall clinical events, argued the researchers, and simply not worth the trade-off of increased side effects. Dr Anthony Rodgers (George Institute, Sydney, Australia) called such fiddling with doses "rapidly diminishing marginal returns in the pursuit of perfection."

At the extreme end of the polypill debate-prescribing the medicine to patients 55 years of age and older regardless of risk factors-many physicians would be reluctant to ignore cardiovascular risk scoring systems in favor of a one-size-fits-all approach to healthcare.

Former BMJ editor Smith, however, argues that age alone can be used to treat a vast majority of patients. "If you go around and use complicated risk-scoring systems, like Framingham, or use just age, in men and women, you end up treating almost the same people," said Smith. "There are some differences, but there aren't that many." And the simplicity of the concept, he pointed out, ultimately reduces costs. 

To heartwire, Smith said he believes, as do other physicians, that there is currently enough available evidence to approve a polypill today for secondary prevention given that each individual component of the drug has been shown to reduce cardiovascular risk factors and clinical events.

In secondary prevention, the collective wisdom is that treatment with a polypill would reduce clinical events by 50% to 60%.

In primary prevention, however, the panelists, speakers, and audience members all agreed that more research needs to be done. The state of evidence right now is that there is sufficient rationale for starting new trials, but many expect outcome studies will be needed for a primary-prevention polypill to see the regulatory light of day.

The next stages

During the summit, Dr. Norman Stockbridge (Food and Drug Administration, Bethesda, MD) noted that the agency has not previously approved anything like the polypill. While there are at least 44 two-drug combinations for hypertension, there is no precedent for a three-, four-, or five-drug combination tablet.

He added that the polypill concept also changes the practice of medicine, whereby physicians maximize the effectiveness of one drug before moving on to another.

Dr. Peter Mol (Medicines Evaluation Board, Utrecht, the Netherlands) said that regulatory agencies in Europe would likely want confirmatory clinical trials, and these studies vary depending on how the drug is to be used (first- vs second-line therapy).

Currently, there are a host of ongoing clinical trials, including the 600-patient FREEDOM study in patients with diabetes and the 4000-patient FOCUS study. One study, Use of a Multidrug Pill in Reducing Cardiovascular Events (UMPIRE), scheduled to be presented at the American Heart Association meeting in November, is part of a collaborative effort called Single Pill to Avert Cardiovascular Events (SPACE) being run by the George Institute in Sydney, Australia. Other trials in the SPACE collaboration include the Kanyini Guidelines Adherence with the Polypill (GAP) study, which is completed but unpublished, and the Improving Adherence Using Combination Therapy (IMPACT) trial, which is ongoing in New Zealand.

The HOPE-3 study is also testing polypharmacy in patients at moderate risk for cardiovascular disease (based on age and one other risk factor) and will include cardiovascular death, nonfatal MI, and stroke as the primary outcome. TIPS-3 is ongoing, and TIPS-4 is scheduled to launch in three months.

Another possibility of gaining regulatory approval is to bypass the agencies altogether and appeal to the World Health Organization to get a multidrug combination tablet on the "Essential Medicines" list.

Before that, however, there is a need to develop a consensus statement about the unmet healthcare need, the safety and efficacy of the polypill in the intended population, including the minimum data required for secondary-prevention patients, and its relative cost-effectiveness compared with other agents.

Related links

• Latest from PURE: 40% of adult population worldwide has hypertension 
• PURE: CV drugs underused in poor nations, rural populations 
• Experts debate merits of polypill
 
• New polypill data predict a halving of CV events
 
• WHO trial shows acceptability of polypill in a developing country
 
• New polypill trial begins in Europe; others planned
 
• First polypill data show promise; larger trials next step 

Norwegian scientists have claimed that a compound found in red wine could provide a major aid to long-term weight loss.

Researchers from the Norwegian University of Life Sciences conducted the study, which looked at the way in which bees behaved after being fed the composite.

Known as resveratrol, previous studies have pointed to the potential for the compound to help fight both obesity and some age-related diseases.

In this instance, researchers found that when bees were fed the compound, they opted to eat considerably less afterwards.

The insects would usually consume any sugary foods available, but after consuming resveratrol, they showed a particular disinterest in both sugar and diluted sugar solutions, according to the study which was published in the Agining Journal.

Brenda Rascon, one of the researchers behind the study, said: 'It's possible resveratrol may be working by some mechanism that is related to caloric restriction - a dietary regimen long-known to extend lifespan in diverse organisms.'

University students are having to contend with an increasing number of stresses during their academic lives, new research has revealed.

The study, conducted by price comparison firm Gocompare.com, looked at the top ten causes of stress for those currently in higher education.

Conducted over the course of August by Vision Critical, the study saw 1,003 UK students canvassed on the pressures they faced day-to-day.

The results threw up some interesting results, with 65% of respondents citing exam pressure as their main stress, while another 61% pointed to money worries.

Financial and economic pressures were a prominent fixture of the list, with 48% of those surveyed admitting they felt stressed about finding a job after graduation, while another 48% were worried about running up a large student debt.

John Miles, Gocompare.com's business development director, said: "Having to perform the juggling act of managing their own finances, staying on top of domestic chores, maintaining long-distance relationships and excelling in their studies can have the effect of overwhelming some.

'If students do begin to feel stressed, then don't suffer in silence - seek help from a student counselor or GP,' he added.

A number of notable molecular similarities have been identified in certain forms of ovarian and breast cancer, according to new research from Washington University in the US.

The findings, which were published in the Nature journal earlier this week, pointed to genomic similarities between serous ovarian cancer and basal-like subtype breast cancer, along with similarities in the genetic mutations of these disorders.

Researchers used data from the comprehensive study The Cancer Genome Atlas, which saw information on 825 patients suffering the disease catalogued for use in work of this kind.

US academic and study researcher Dr. Matthew Ellis described the findings as a "road map for how we might cure breast cancer in the future".

It is hoped that by uncovering a molecular link between the two types of the disease, medical scientists will be able to provide more effective for these related subtypes.

The findings come as figures produced by Cancer Research UK show the predicted number of deaths from both diseases is set to fall substantially by 2030.

The development of Type 2 diabetes may be linked to a higher level of bacteria in the intestines of those with the metabolic disease, researchers have found.

Academics from Copenhagen University examined the intestinal bacteria of 345 Chinese test subjects to reach their conclusion.

The findings, which were published in the Nature journal, showed that of the entire test group, the 171 people that had type 2 diabetes possessed a number of biological indicators pointing to the condition.

As study leader professor Jun Wang explained: 'We have demonstrated people with type 2 diabetes have a high level of pathogens in their intestines.'

The research also found that individuals with type 2 diabetes were also more resistant to a number of medicines, due to the difference in the balance of bacteria in their body.

Analysing intestinal bacteria could prove useful in determining a person's susceptibility to the diabetic condition which has strong links to obesity, a growing problem across the world.

Eating cherries could actually help to lower the risk of suffering gout attacks, new research from the US has claimed.

Academics from Boston University conducted the study, which was published in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR).

They were keen to assess the effectiveness of consuming the fruit (Cherries), which has long been linked with offering urate-lowering and anti-inflammatory properties to the joint swelling disorder.

To test the theory, researchers recruited 633 people who were suffering gout, who were then tracked over a year via an online system.

During that time, these individuals were asked about when their gout began along with the symptoms, medications and risk factors - including their cherry and cherry extract in the two days before suffering the problem.

The research showed that consuming cherries reduced the risk of gout attacks by around 35% compared with those who did not eat the fruit.

Lead author Dr. Yuqing Zhang, Professor of Medicine and Public Health at Boston University, said: 'The gout flare risk continued to decrease with increasing cherry consumption, up to three servings over two days.'

They also found that the risk of gout flares was 75% lower when cherry consumption was combined with allopurinol, a uric-acid reducing drug.

Picking up the early signs of lung and breast could be a simple case of undergoing a blood test, researchers in the US have claimed.

New findings produced by scientists at the Kansas State University, have pointed to the potential of a procedure that sees the prospective patient's blood mixed with dye and certain amino acids.

The result should then be indicated in the data, with cancers producing a specific pattern or signature which the enzyme patterns help to distinguish.

To verify the accuracy of their research, the team tested the method on 32 participants at various stages of the disease, while 12 people with no form of cancer were tested as a control group.

The analysis highlighted a 95 per cent success rate for detection, with the team behind the system now planning to develop a system to help detect bowel cancer.

Professor Deryl Troyer, one of those behind the new method said: 'We see this as the first step into a new arena of investigation that could eventually lead to improved early detection of human cancers.'

The findings come days after data from Cancer Research UK pointed to a notable drop in death rates among those with the disease over the next 18 years.

Teenagers could be increasing their risk of diabetes by staying up late, new research has shown.

The findings come from the University of Pittsburgh's department of psychiatry, with the study published in the latest issue of the journal SLEEP.

In order to reach their conclusions, the sleeping patterns and insulin resistance levels of 245 healthy teenagers were closely examined.

High levels of insulin resistance have been linked to the development of diabetes, but the study showed that by getting more sleep, some teenagers lowered their resistance to the substance - thus reducing the risk of the disease.

Karen Matthews, the lead author of the research, said: 'We found that if teens that normally get six hours of sleep per night get one extra hour of sleep, they would improve insulin resistance by nine per cent.'

Results also indicated that higher insulin resistance was associated with those sleeping less - regardless of other factors.

The research comes a week after scientists at Copenhagen University discovered a potential link between the development of Type-2 diabetes and an increase in the level of intestinal bacteria found in the human body.

A type of sleeping pill commonly used across the UK could increase the risk of elderly people developing dementia within a 15-year-period.

New research from the University of Bordeaux and academics at Harvard, which was published in the British Medical Journal, highlighted the potential risk for those taking benzodiazepine.

A study of 1,063 men and women who shared an average age of 78 and were dementia free was conducted, with findings showing that those who took the drug were at a 50% increased risk in less than 20 years.

Analysing data collected over 20 years; researchers found that 253 of the test subjects developed dementia – with 30 of this group using benzodiazeprine.

The study concluded that for every 100 people studied for a year 4.8 who took the sleeping medication developed the degenerative disease compared with 3.2 who had not (50% higher risk).

Lead author Sophie Billioti de Gage said: "Our data adds to the accumulating evidence that use of benzodiazepines is associated with increased risk of dementia".

If proven, the researcher admitted that the link could be of major public concern.

Low levels of vitamin D and high levels of parathyroid hormone could be linked to increased mortality in older adults, according to a new study.

Published in the Endocrine Society's Journal of Clinical Endocrinology and Metabolism, the research was conducted by Dr Stephen B Kritchevsky, the professor of internal medicine and transitional science at the Wake Forest School of Medicine in the US.

The findings were based on the analysis of 2,638 people aged 70 to 79 years, who were asked to fast for 12 hours, at which point a blood sample was taken to determine vitamin D levels.

Participants were subsequently contacted by researchers every six months to obtain an update on their medical condition. While health factors and time of year were taken into account, the study found that levels of vitamin D less than 30ng/ml were associated with a significantly increased rise of death.

Dr Kritchevsky said: 'We observed vitamin D insufficiency (defined as blood levels 20 ng/ml), in one third of our study participants.'This was associated with nearly a 50 percent increase in the mortality rate in older adults.'

Low levels of vitamin D have been directly associated with a number of diseases including cancer and cardiovascular problems.

Individuals with rheumatoid arthritis may be at an increased risk of developing venous thromboembolism, new research from Sweden has warned.

The study, which was published in the October issue of JAMA, assessed more than 45,000 residents of the Scandinavian country that suffered from this variety of the joint inflammation disorder.

Some 37,856 patients with the problem came from the National Patient Register and had been diagnosed with the condition between 2000 and 2005 along with 169,921 matched controls.

A further 7,904 patients from the national rheumatology register and 37,350 controls, who were diagnosed between 1997 and 2009, were also assessed as part of the study.

The findings showed that patients with rheumatoid arthritis had a 5.9 per cent risk of developing venous thromboembolism (VTE), a type of blood clot found within veins, per 1,000 person-years, compared with 2.7 per cent among those without the disorder.

Those with this type of arthritis also had an increased risk of VTE in the first year following diagnosis, with a percentage rate of 3.8 per cent per 1,000 person-years compared with 2.4 per cent among control cases.

"The results of this study suggest that patients with RA are at increased risk of VTE (both deep vein thrombosis and pulmonary embolism) and that the risk of VTE increases shortly after RA diagnosis," the study said.

The female hormone estrogen could play an important role in wound repair, according to a new study from scientists at the University of Manchester's Healing Foundation Centre.

Researchers examined tissue samples taken from younger and older men in order to assess the various differences in the genes that were involved in healing.

They discovered that the main variations were related to the presence of estrogen, with the hormone more prominent in the young test subjects.

This goes some way to explaining why wounds do not heal as quickly or effectively as we get older, with estrogen levels dropping with age.

Senior research fellow doctor Matthew Hardman said: 'We knew that estrogen was important in healing, but we didn't realise it played such a pivotal role. Our discovery could lead to a new treatment for people with non-healing wounds.'

The research, which was funded by Age UK, could provide a major boost to elderly people, by offering a viable treatment for chronic wounds.

But while estrogen is unlikely to be supplied to patients, given the dangerous side effects of the hormone, the researchers are developing a treatment using similar compounds.

Breast cancer drug Tamoxifen is one such example, with a trial of 30 volunteers aged over 65 set to take place in the next few months.

Over 22,000 of cancers developed each year in the UK could be as a result of people being either overweight or obese, according to a new study.

The findings are based on research conducted by the World Cancer Research Fund (WCRF), which indicates that being too fat may heighten the risk of developing breast, pancreatic, womb, kidney, bowel, gall bladder or oesophagus cancer.

According to the charity's Continuous Update Project, which collates data from recent prevention studies, around one in five of the 123,000 weight-related cancer cases in the UK could be prevented.

This number includes approximately 7,752 breast cancer cases, 5,753 incidents of bowel cancer and 2,978 womb-related cancers. Meanwhile, an alarming 1,257 cases of pancreatic cancer may be caused by being overweight.

Professor Alan Jackson, chairman of the WCRF panel behind the figures, said: 'A significant number of cancer cases could be prevented by people maintaining a healthy body weight.'

Excess body fat can affect cancer risk in a number of ways, with these cells often releasing proteins or cytokines which cause inflammation and encourage the development of cancerous cells.

Being overweight can also increase blood levels of insulin and related hormones that encourage cells to grow and develop at a quicker rate, which can also increase the likelihood of tumour development.

Fat is also a source of estrogen, which can cause breast and womb cancer.

New research has highlighted the potentially damaging effect that high blood pressure during pregnancy may eventually have on the child's IQ.

The study, which was part funded by the British Heart Foundation, saw researchers examine the medical records of 398 women who gave birth to a son between the years of 1934 and 1944.

As part of the analysis, these grown up children were then assessed for maths reasoning and English language skills along with visual and spatial awareness.

These thinking ability tests took place when the test subjects were aged 20 and then again at an average age of 69.

What researchers found was that the individuals who had mothers with high blood pressure while pregnant, scored lower in the tests at the age of 69, in comparison with those from mothers that showed no signs of high blood pressure during pregnancy.

Commenting on the research, the charity's associate medical director professor Jeremy Pearson said the findings 'further emphasises the importance of early recognition and treatment of raised blood pressure in pregnancy.'

The findings come just over a week after US academics identified a link between snoring during pregnancy and high blood pressure.

Just one in six people enjoy good health when they enter retirement, a new study has found.

Researchers at the MRC Unit for Lifelong Health and Ageing studied data on more than 2,500 people who were born in 1946 and whose health was followed since birth.

Participants were assessed for 15 different conditions between the ages of 60 and 64 and the researchers found that the majority had at least one health problem.

The average person had two medical conditions, with just over half having high blood pressure and one in three recording a body mass index (BMI) in the obese range.

A quarter of participants had high cholesterol, with a similar proportion having type-2 diabetes or its precursor, and almost one-fifth had a mental health problem.

Writing in the journal PLoS One, Dr Mary Pierce observed: 'Our research shows that medical conditions - some of which could lead to serious disability or even death - are common among baby boomers.'

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said that conditions such as high blood pressure and cholesterol are 'blighting' this generation's retirement years.

'It is vital that plans are put in place to help care for this generation and to deal with increasing demands on the health and social services,' she claimed.

September 7, 2012 (Las Vegas, Nevada) - Low doses of naproxen in a fine powder provide pain relief, but not statistically better relief than standard formulations of the drug, a new study shows.

The submicron particles are designed to be more bioavailableBoth these are huge benefits for patients seeking pain relief , allowing lower doses and theoretically fewer adverse reactions.

"We can give a lower dose by mechanically manipulating the drug," co-author Bill H. McCarberg, MD, adjunct assistant clinical professor at the University of California, San Diego, told Medscape Medical News.

The results were reported here at PAIN Week by Clarence L. Young, MD, chief medical officer of Iroko Pharmaceuticals, which licensed from iCeutica a technique called SoluMatrix to mill more finely nonsteroidal anti-inflammatory drugs (NSAIDs).

He paired the results on naproxen with results from a similar trial on submicron diclofenac, findings of which the company presented in May at the American Pain Society 31st Annual Scientific Meeting, as reported by Medscape Medical News at that time.

The company previously referred to the particle size as "nano" but changed the characterization to "submicron" because it did not fit the technical definition of nano, said Dr. McCarberg.

Lowest Dose, Shortest Duration
NSAIDs can cause cardiovascular, gastrointestinal, and renal adverse reactions, and these effects are more likely with higher doses, Dr. McCarberg said.

The US Food and Drug Administration (FDA) has issued a Public Health Advisory stating that NSAIDs should be administered at the lowest effective dose for the shortest duration consistent with individual patient treatment goals.

Smaller particles have greater surface area per dose and therefore are more bioavailable, so in theory, a smaller dose might achieve the same effect, said Dr. McCarberg.

To test this approach, researchers recruited more than 450 patients experiencing moderate to severe pain within 6 hours of wisdom tooth extractions. They randomly assigned patients to receive one of the following: diclofenac 18 mg or 35 mg, naproxen 200 mg or 400 mg, celecoxib 400 mg (as an active control), standard formulation naproxen 250 mg or 450 mg, or placebo.

Compared with the placebo group, a higher proportion of all other groups rated their pain relief as "some," "a lot," or "complete" during the 12 hours after random assignment (P < .001).

The proportions of patients rating their pain relief in this range for each group in the submicron particle naproxen trial were as follows:

Results in the submicron particle diclofenac phase 2 trial were reported as follows:

All groups took a single dose of the assigned medication.

Differences between submicron formulations and reference active medications were not statistically significant.

Dr. Young acknowledged that the study does not show that submicron formulations achieve equivalent pain relief at a lower dose compared with standard formulations. However, he said that the drugs make take effect more quickly.

he mean time to pain relief for nano-formulated naproxen 400 mg was just over an hour vs more than 3 hours for placebo (P < .002) and an hour and a half for standard naproxen 500 mg, Iroko said in a press release. The company did not report whether the difference between the standard formulation and the submicron formulation was statistically significant.

Adverse reactions were similar in the various groups.

Chronic Use?
Commenting on the study, Srinivas Nalamachu, MD, co-director of the Pain Management Institute in Overland Park, Kansas, pointed out that if reducing adverse reactions is the main point of milling the drug as a finer powder, then its success remains to be shown, because the most common serious adverse reactions occur with chronic use, and this drug was given only in a single dose.

In response, Dr. McCarberg said, "If bioavailability predicts side effects, we would have the same side effects - ulcers and so on."

However, the submicron drugs produce a lower overall serum concentration, he said. "If blood level predicts side effects, then you would get fewer side effects with this formulation."

Also, the drug in submicron formulation may have less contact with the stomach, which might further reduce adverse reactions, said Dr. McCarberg.

Longer-term trials have not been conducted.
Dr. McCarberg has disclosed that he is an advisor to Iroko Pharmaceuticals, and Dr. Young has disclosed that he is an employee of that company. Dr. Nalamachu has disclosed no relevant financial relationships.

Birmingham, AL - Women who experience early menopause-before their 46th birthday-are twice as likely to suffer from coronary heart disease and stroke as women who don't enter menopause prematurely, and this finding is independent of traditional risk factors

These new data from the Multiethnic Study of Atherosclerosis (MESA) add to previous work in this field by extending the results to females of all ethnicities-prior research has found a similar association in white women, say Dr Melissa Wellons (now at Vanderbilt University, Nashville, TN; at the University of Alabama, Birmingham when this study was conducted) and colleagues in their paper in the October 2012 issue of Menopause.

If physicians know a patient has entered menopause before her 46th birthday, they can be extra vigilant in making recommendations and providing treatments to help prevent heart attacks and stroke.

"Our findings demonstrate a moderate association between early menopause and future CHD and stroke. This adds to the body of evidence that early menopause may identify the at-risk woman who may benefit from aggressive CVD primary prevention," they state.

"If physicians know a patient has entered menopause before her 46th birthday, they can be extra vigilant in making recommendations and providing treatments to help prevent heart attacks and stroke," says senior author Dr Dhananjay Vaidya (Johns Hopkins University School of Medicine, Baltimore, MD) in a statement. "Our results suggest it is also important to avoid early menopause if at all possibleHow???
Except by not removing ovaries in otherwise healthy women undergoing hysterectomy This answers the question above

Events low but association exists in all ethnicities 
Wellons and colleagues say that early menopause has been associated with increased CVD events in some predominantly white populations, but not consistently so. They decided to investigate this phenomenon with data from MESA, an ethnically diverse cohort of US men and women aged 45 to 86 years enrolled in 2000-2002 and followed until 2008.

The association between a personal history of early menopause (either natural or surgical removal of ovaries at an age <46 years) and future coronary heart disease and stroke was assessed in 2509 women (987 white, 331 Chinese, 641 black, and 550 Hispanic) who were free of CVD at baseline.

Of the women, 693 (28%) reported either surgical or natural early menopause (with the latter defined as 12 months of amenorrhea following the final menstrual period). Women with early menopause had worse CHD and stroke survival (log rank p=0.008 and p=0.0158).

And in models adjusted for age, race/ethnicity, MESA site, and traditional cardiovascular risk factors, this risk for CHD and stroke remained (hazard ratio 2.08 and 2.19, respectively). The number of events, however, was small-only 50 CHD events and 37 strokes.

Adjusting for the traditional risk factors did not include family history of MI, however, and when this was accounted for, the statistical significance of the relationship between early menopause and CVD disappeared, although "the pattern was still similar," Wellons told

"There are many possible reasons for this," she says. "It could be that family history is a modifier of the relationship-that early menopause and CVD are genetically linked and run in families together but one does not cause the other. Or it could be that early menopause does contribute pathophysiologically to CVD but having another family member with CVD is still the better predictor of future events as compared with early menopause."

Don't overlook younger women; avoid early oophorectomy
Vaidya stresses that it's important that doctors do not overlook younger women who "are often not targeted for prevention, because CVD is thought to be attacking women only in old age."

AndHow???
Except by not removing ovaries in otherwise healthy women undergoing hysterectomy This answers the question above

key to reducing risk will be strategies to prevent early menopause, such as avoidance of smoking-smokers reach menopause, on average, two years before nonsmokers-and oophorectomy, "which may have significant public-health relevance for the prevention of CVD in women," say the researchers.

They add that since the debate about cardiovascular risks with hormone-replacement therapy (HRT), which began with the WHI study, rates of elective oophorectomy have fallen, and the American College of Obstetrics and Gynecology suggested in 2008 that this practice be avoided in premenopausal women.

Wellons says they did look at use of HRT in their study: "We did not find that the patterns in the relationship between early menopause and CVD were significantly different between women taking and not taking HRT," she notes.

Sources

• Wellons M, Ouyang P, Schreiner PJ, et al. Early menopause predicts future coronary heart disease and stroke: The Multi-Ethnic Study of Atherosclerosis.Menopause

Answer (Mayo Clinic)
from Maria Collazo-Clavell, M.D.
Caffeine impairs insulin action, but doesn't necessarily affect blood sugar (glucose) levels in young, healthy adults.

However, if you have type 2 diabetes, the impact of caffeine on insulin action may be associated with a small, but detectable rise in blood sugar levels, particularly after meals.

About 250 milligrams of caffeine - or the equivalent of 2 to 2 1/2 cups (473 to 591 milliliters) of plain, brewed coffee - a day may cause this effect.

If you have type 2 diabetes and you're struggling to control your blood sugar levels, limiting the amount of caffeine in your diet may provide a benefit.

Question
Glucosamine: Does it affect blood sugar?
Is it safe to take glucosamine supplements if I have diabetes?
Answer (Mayo Clinic)
from Maria Collazo-Clavell, M.D.

Even though glucosamine is technically a type of sugar, it doesn't appear to affect blood glucose levels or insulin sensitivity.

Some preliminary research had suggested that glucosamine might worsen insulin resistance, which can contribute to increases in blood sugar in people with type 2 diabetes. But subsequent studies refuted these findings.

Glucosamine is one of the most popular dietary supplements sold in the United States, although study results have been mixed regarding its ability to reduce osteoarthritis pain.

While glucosamine doesn't appear to affect glucose levels or insulin sensitivity, the supplement can interact with other medications you might be taking - such as warfarin (Coumadin), a blood thinner.

A blend of sesame and rice bran oil appears to be particularly good at lowering blood pressure, research suggests.

Scientists at Fukuoka University Chikushi Hospital in Chikushino, Japan, studied 300 people with mild to moderately high blood pressure.

They found that those who cooked with a blend of sesame and rice bran oils typically benefited from a significant drop in blood pressure, as well as improved cholesterol levels.

This combination of oils was almost as effective as a commonly prescribed medicine for high blood pressure.

The findings were presented at a scientific meeting of the American Heart Association and reveal that the best results were seen in those people who used the blend of oils alongside blood pressure medication.

Dr Devarajan Sankar, a research scientist at Fukuoka University Chikushi Hospital, said: 'Rice bran oil, like sesame oil, is low in saturated fat and appears to improve a patient's cholesterol profile.

'Additionally, it may reduce heart disease risk in other ways, including being a substitute for less healthy oils and fats in the diet.'

NHS figures suggest that around three in ten people have high blood pressure.

Cochrane Database Syst Rev. Published online September 12, 2012.

September 18, 2012 - Topical diclofenac is about as effective as oral diclofenac in knee and hand osteoarthritis (OA), is probably as effective as other oral NSAIDs, and might be a safer choice for elderly patients and others at risk for gastrointestinal adverse effects, according to an intervention review published online September 12 in the Cochrane Database of Systematic Reviews.

Sheena Derry, PhD, and colleagues from the University of Oxford in the United Kingdom based their conclusions about topical NSAIDs on a review of randomized, double-blind studies with placebo or active comparators in which at least a single treatment was a topical NSAID used to treat chronic pain caused by OA, and in which treatment lasted at least 2 weeks. The analysis included data from 7688 participants in 34 studies, 23 of which compared a topical NSAID with placebo.

"Topical NSAIDs were significantly more effective than placebo for reducing pain due to chronic musculoskeletal conditions," the authors conclude. "Direct comparison of topical NSAID with an oral NSAID did not show any difference in efficacy." Topical NSAIDs were associated with more local adverse events, such as mild rash, but with fewer gastrointestinal adverse events than oral NSAIDs.

For topical diclofenac, the number needed to treat (NNT) for at least 50% pain relief vs placebo was 6.4 for diclofenac solution and 11 for diclofenac gel formulation. There were insufficient data to calculate NNTs for other individual topical NSAIDs.

"The results presented here show clearly that high quality large studies demonstrate efficacy of topical NSAIDs in 12 week studies, with NNTs similar to those of oral NSAIDs," the authors write.

Coauthor R. Andrew Moore, from the Pain Research Unit at Oxford University, told Medscape Medical News that in view of the low NNT for diclofenac solution, it would be reasonable for clinicians to view that formulation as good first-line therapy for hand or knee OA, especially in elderly patients.

"It is what [the National Institute for Health and Clinical Excellence] in the UK suggest in their excellent OA guideline," Dr. Moore said. "This [is] nothing new for us, but then we have been looking at the evidence on topical NSAIDs for almost 20 years.... [And] what we said then is true now. Truer, perhaps."

Experimental data suggest that creams are generally less effective than gels or sprays, according to the authors. "One of the features of topical NSAIDs is that formulation has the potential to play a big part in efficacy," Dr. Moore said. The authors write, "It is probable that topical NSAIDsMoA

exert their action both by local reduction of symptoms arising from periarticular structures, and by systemic delivery to intracapsular structures.

Tissue levels of NSAIDs applied topically certainly reach levels high enough to inhibit cyclooxygenase-2. Plasma concentrations found after topical administration, however, are only a fraction (usually much less than 5%) of the levels found in plasma following oral administration.

Topical application can potentially limit systemic adverse events by increasing local effects, and minimizing systemic concentrations of the drug. We know that upper gastrointestinal bleeding is low with chronic use of topical NSAIDs." Roy Altman, MD, professor emeritus, Division of Rheumatology, University of California, Los Angeles, reviewed the study forMedscape Medical News. "I think this Cochrane review was well done and carefully reported," Dr. Altman said. "The data are convincing. Their results are concordant with our results from the literature and consistent with our recommendations of the American College of Rheumatology guidelines published earlier this year. I suspect topical NSAIDs will eventually be approved for over-the-counter use, as they are in Europe. That will dramatically increase their use."

This study was supported by Oxford Pain Research in the United Kingdom. Dr. Deery and one coauthor have received research support from charities, government, and industry sources at various times. One coauthor has received research, consulting, and lecture fees from various pharmaceutical companies related to analgesics and other healthcare interventions. Dr. Altman has disclosed no relevant financial relationships.

Aims: To systematically review the evidence for the effect of vitamin D supplementation on glycaemia, insulin resistance, progression to diabetes and complications of diabetes.

Methods: Systematic review and meta-analysis. We searched databases including MEDLINE, EMBASE and the Cochrane Library for randomized controlled trials comparing vitamin D or analogues with placebo. We extracted data on fasting glucose, glycaemic control, insulin resistance, insulin/C-peptide levels, micro- and macrovascular outcomes and progression from non-diabetes to diabetes. Studies were assessed independently by two reviewers according to a pre-specified protocol.

Results Fifteen trials were included in the systematic review. Trial reporting was of moderate, variable quality.

Combining all studies, no significant improvement was seen in fasting glucose, HbA(1c) or insulin resistance in those treated with vitamin D compared with placebo.

For patients with diabetes or impaired glucose tolerance, meta-analysis showed a small effect on fasting glucose (-0.32 mmol/l, 95% CI -0.57 to -0.07) and a small improvement in insulin resistance (standard mean difference -0.25, 95% CI -0.48 to -0.03). No effect was seen on glycated haemoglobin in patients with diabetes and no differences were seen for any outcome in patients with normal fasting glucose.

Insufficient data were available to draw conclusions regarding micro- or macrovascular events; two trials failed to show a reduction in new cases of diabetes in patients treated with vitamin D.

Conclusions:
There is currently insufficient evidence of beneficial effect to recommend vitamin D supplementation as a means of improving glycaemia or insulin resistance in patients with diabetes, normal fasting glucose or impaired glucose tolerance.

The provision of free bus passes appears to be good for seniors' health, a new study suggests.

Researchers at Imperial College London looked at four years' worth of data from the UK National Travel Survey to see whether over-60s with bus passes - which offer free local travel after 9:30 on weekdays and all day on weekends - encourage physical activity.

They found that people with a bus pass were more likely to walk frequently, cycle and use public transport.

Older people seemed to benefit from the scheme, regardless of whether they were poor or wealthy.

The findings, which are published in the American Journal of Public Health, suggest that bus passes play an important role in maintaining older people's levels of physical activity.

'Given the need to encourage older people to be physically active, it's good news that the provision of free bus passes seems to be having a positive impact,' said lead researcher Sophie Coronini-Cronberg.

She added that the government should make sure it understands the scheme's value to society before looking at reforming it.

As you've gotten older, have you noticed that you often find yourself marching around the house in a huff, searching for misplaced car keys or eyeglasses, or you just cannot remember the name of that new neighbor you met when walking the dog? It's frustrating, to be sure, but not inevitable - and there are things you can do to help keep your memory sharp.

"Most people get a little more forgetful with aging, but there are some simple things you can do to prevent memory slips and help your brain to learn and remember better," says Dr. Anne Fabiny, chief of geriatrics at Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School.

Memory-boosting tips:
Dr. Fabiny suggests the following tips and tricks:

• Follow routines, such as leaving your car keys, glasses, and cell phone in the same place every day so that finding them becomes a "no brainer."
• Slow down and pay attention to what you are doing to give your brain's memory systems enough time to create an enduring memory.
• Avoid distracting or noisy environments and multitasking - the major memory busters in today's fast-paced society.
• Get enough sleep, reduce stress, and check with your doctor to see if any of your medications affect memory - all potential memory spoilers.

Is it forgetfulness or Alzheimer's?
Worried that your minor memory slips mean you are headed toward Alzheimer's disease? That's probably not the case. Like it or not, science shows that the ability to learn new information and recall it may decline somewhat after 50.

"You just can't pull things out of your memory the way you used to at the same speed," Dr. Fabiny says.

But forgetfulness can be a serious issue if it's starting to interfere with daily tasks and routines, such as managing your healthcare and finances.

To read more about ways to improve your memory, purchase the Special Health Report, Improving Your Memoryfrom Harvard Medical School.

A combination of blood tests may be able to detect any low-level damage to the heart that may otherwise have no obvious symptoms, a study has found.

Researchers at the University of Dundee, led by professor Allan Struthers, carried out a study using the blood tests of 300 people known to suffer from high blood pressure or cholesterol.

Funded by the British Heart Foundation and published in the Journal of the American College of Cardiology, the findings showed that any positive blood tests were usually associated with damage to the heart at an early stage.

In total 102 of the 300 participants were found to have 'silent' heart disease, following scans, with the results from these examinations correlating with those of the blood test.

These kinds of tests are already used in patients with more obvious, developed heart diseases and are designed to note the presence of the molecules troponin and B-type natriuretic peptide, which are both released when the heart is damaged or under stress.

British Heart Foundation medical director professor Peter Weissberg described the findings as 'an important step in the right direction'.

'The next steps will be to confirm how reliable the tests are, and show that early treatment of people who test positive can improve their outlook,' he added.

Research from the US has suggested that the introduction of attractive names could encourage young children to eat more vegetables.

Scientists from the Cornell University examined how a simple change in names helped boost the appeal of these health foods, with 147 students aged eight to 11 years olds from five ethnically and economically diverse schools canvassed in the study.

In the first instance, carrots were advertised across lunchroom menus as 'X-ray Vision Carrots' over three consecutive days.

Incredibly, the researchers found that 66% of the carrots were eaten, compared with the 32% eaten when they were labelled 'Food of the Day' and the 35% consumed when they were unnamed.

An additional study saw researchers change the names of beans and broccoli in one school's lunchroom to 'Silly Dilly Green Beans' and 'Power Punch Broccoli', while a neighbouring school's menu titles were left unchanged.

Once again, the findings showed that sales of these vegetables climbed 99% in contrast with a 16% decline at the control school.

Brian Wansink, the lead author of the study said: 'These results demonstrate that using attractive names for healthy foods increases kid's selection and consumption of these foods and that an attractive name intervention is robust, effective and scalable at little or no cost.'

Over three quarters of the UK public are unaware of the serious implications of severe heart failure and the terrifying impact the condition can have.

That is according to a new survey from the British Heart Foundation, which highlighted the startling level of ignorance when it came to this health issue.

Approximately 750,000 people in the UK are currently facing up to the condition but despite the widespread nature of severe heart failure many are simply unaware of the effect it can have.

In fact, over a third of those surveyed by the charity stated that they thought heart failure meant your heart simply stopped working, whereas the reality is that your heart will continue to beat but is unable to pump properly.

This can leave some suffering from the condition struggling to breathe, with their lungs slowly filling with liquid.

The statistics come as the British Heart Foundation launches a new awareness campaign designed to highlight the horrifying effects of the disorder.

To do so, the charity is using the image of a drowning man to illustrate the feeling sufferers are likely to have as their lungs fill with fluid.

NEW YORK (Reuters Health) Sep 20 - Smokers and people who regularly breathe others' cigarette fumes are worse at remembering things on their to-do lists than are people with no tobacco exposure, a small study says.

Problems with so-called prospective memory may not only lead to embarrassment if a person forgets to meet with their friends - it can also have more-serious consequences such as forgetting to take one's medication, British researchers wrote in a paper online August 23rd in Addiction.

The study doesn't prove that smoke damages memory, but is nonetheless a cause for concern, the researchers say.

"This research extends what is already known about the effects of smoking and second-hand smoke, suggesting there is not only health effects from it, but cognitive consequences too," said Tom Heffernan, the study's lead author from Northumbria University at Newcastle-upon-Tyne.

Heffernan and his colleague recruited 27 current smokers, 24 people who reported regular exposure to second-hand smoke and 28 people who said they were never exposed to smoke, whether first- or secondhand. All were between 18 years old and 30 years old.

The researchers had each person complete the Cambridge Prospective Memory Test, which included time-based tasks, such as returning a key to the researchers when seven minutes were left on the clock, and event-based tasks such as handing over the key when a certain word was said.

Each person received points for the tasks they completed depending on how many prompts the researchers had to give them. Total scores ranged from zero to 18 points for each test, with higher scores meaning better memory.

For the time-based activities, there was a statistically reliable difference between the scores of each group.

People without any exposure to tobacco smoke scored 16.3 points on average, while those who breathed second-hand smoke scored 13.7 points and smokers scored 11.6 points.

For event-based activities, the smoke-free subjects again did better than smokers, but only marginally better than those exposed regularly to second-hand smoke.

Exactly what the findings mean in real life, and what's responsible for them, is unclear. And while the study suggests there is a link between smoking and memory problems, Heffernan warns that these are results from just one study.

"I think we need to confirm these findings using other methods," he told Reuters Health.

The rates of people dying from cancer in the UK could fall as much as 17 per cent by 2030, according to figures released by Cancer Research UK.

In 2010, an estimated 170 people in every 100,000 died from some form of cancer, but this figure is predicted to drop to 142 in every 100,000 by 2030.

The charity put the improved survival rates down to:

• improved treatments,
• earlier diagnosis along, and
• reduction in the number of cancers related to smoking.

Death rates among ovarian cancer sufferers are expected to see the biggest reduction, with a fall of over 40 per cent seeing the rate drop from 9.1 per cent to 5.3 per cent by 2030.

The data also suggests that there will be a 28% reduction in the number of people in every 100,000 dying from breast cancer in women, with declines of 23% for bowel cancer and 16% for prostate cancer predicted.

Some death rates are set to increase though, with the death rate for oral cancer set to climb from 2.9 to 3.5%, while liver cancer mortality rates could climb from 4.2 to 5.9% per 100,000.

Cancer Research UK epidemiologist at Queen Mary, University of London Professor Peter Sasieni said: 'What's really encouraging is that the biggest cancer killers - lung, breast, bowel, and prostate - are part of this falling trend.'

Individuals with a genetic a predisposition to obesity could be more at risk to the harmful effects of sugary soft drinks than others.

That is according to the findings of a study conducted by the Harvard School of Public Health, which was published in the New England Journal of Medicine.

The research saw information from over 33,000 adults that took part in three studies beginning in the 1980s and 1990s analysed by the US researchers. Over the course of this research, participants were quizzed on their food and drink intake every four years.

These test subjects also had their genomes analysed to assess for the presence of any of the 32 genetic markers that are linked to obesity – in order to provide them with a score reflecting their predisposition to being extremely overweight.

And while those with a higher genetic predisposition to obesity were the heaviest, the link between genetics and obesity was stronger among those regularly consuming soft drinks.

The new study suggests people with a genetic predisposition to obesity are more susceptible than others to the harmful effects of sugar-sweetened beverages, researchers said.

They found that for every ten-point increase in genetic risk score, the likelihood of being obese climbed 35 per cent among those drinking less than one soft drink beverage a month.

However, those who drank one to four servings per month has an increased of 59% while those drinking one or more servings daily saw a rise of 235%.

Study researcher Lu Qi said: "For those who carry high genetic risk, their risk of obesity could be lessened by [making] healthier beverage choices."

The British Skin Foundation has launched a new survey aimed at shedding light on the impact of acne in the UK.

Acne is a common problem, affecting up to eight in ten people between the ages of 11 and 30… While most cases occur between the ages of 14 and 19, some people experience acne well into adulthood.

Bevis Man, a spokesman for the British Skin Foundation, said: 'Judging from the emails and phone calls we get, we know there are a large number of people out there who are deeply affected by acne, yet don't always have an obvious person or place to turn to about it.'

The expert suggested that for many people, simply feeling able to talk about their acne could be as important as treating the condition's physical symptoms.

A previous survey by the charity, conducted in July 2012, revealed that half of people with skin diseases have experienced verbal abuse, while 17% have self-harmed as a result of their condition.

Experts hope that by shedding light on the emotional implications of acne in particular, they may be able to offer appropriate support where needed.

Dr Bav Shergill, consultant dermatologist at Brighton and Sussex Universities Hospitals NHS Trust, commented: 'All too often the impact of skin disease is underestimated, and this survey will hopefully help draw attention to this fact.'

The U.S. Food and Drug Administration today approved the production and use of Choline C 11 Injection, a Positron Emission Tomography (PET) imaging agent used to help detect recurrent prostate cancer.

Choline C 11 Injection is administered intravenously to produce an image that helps to locate specific body sites for follow-up tissue sampling and testing in men with recurrent prostate cancer. PET imaging with Choline C 11 Injection is performed in patients whose blood prostate specific antigen (PSA) levels are increasing after earlier treatment for prostate cancer.

An elevated PSA result suggests that prostate cancer may have returned, even though conventional imaging tests, such as computerized tomography (CT), have not shown any signs of cancer. PET imaging is not a replacement for tissue sampling and testing.

Choline C 11 Injection must be produced in a specialized facility and administered to patients shortly after its production. While PET imaging with Choline C 11 Injection has been performed at a few facilities over the past several years, none of these facilities were approved by the FDA to manufacture the agent.

The Food and Drug Administration Modernization Act directed the agency to establish appropriate approval procedures and current good manufacturing practice requirements for all PET products marketed and used in the United States. The Mayo Clinic is now the first FDA-approved facility to produce Choline C 11 Injection.

The U.S. Food and Drug Administration today approved the production and use of Choline C 11 Injection, a Positron Emission Tomography (PET) imaging agent used to help detect recurrent prostate cancer.

The Mayo Clinic is now the first FDA-approved facility to produce Choline C 11 Injection.

Half of all Britons of south Asian, African and African Caribbean descent develop type-2 diabetes by the time they are 80, a study has found.

Researchers at Imperial College London followed almost 5,000 middle-aged Londoners for more than 20 years to investigate the links between ethnic origin and diabetes risk.

They found that African, African Caribbean and European people tended to be diagnosed at around 66 to 67 years of age…. However, south Asian men were typically five years younger when they were diagnosed with diabetes.

Furthermore, the study - which is published in the journal Diabetes Care - revealed that by the age of 80, twice as many south Asian, African and African Caribbean Brits had developed diabetes, compared with those of European origin.

Overall, just one in five people of European descent develop diabetes by this age, compared with approximately half of all south Asians, Africans and African Caribbeans.

Dr. Therese Tillin, from Imperial College London's National Heart and Lung Institute, said that the finding 'highlights the astonishingly high risk of diabetes in middle-aged people in our ethnic minorities and the importance of early diagnosis and careful management..

Dr. Helene Wilson, from the British Heart Foundation, which part-funded the study, added that controlling weight can have a 'significant protective effect' on a person's chances of developing type-2 diabetes and heart disease.

People who drink heavily may face an increased risk of suffering a stroke at a relatively early age, compared with those who do not drink heavily, a study has found.

Researchers at the University of Lille Nord de France studied 540 people with an average age of 71, all of whom had suffered a type of stroke called an intracerebral haemorrhage, which is caused by bleeding in the brain.

Of these, 25 per cent were classified as heavy drinkers, as they consumed three or more alcoholic beverages each day.

The researchers found that heavy drinkers typically experienced their stroke at 60 years of age - 14 years before people who did not drink heavily.

Study author Dr Charlotte Cordonnier, whose findings are published in Neurology journal, said: 'Our study focuses on the effects of heavy alcohol use on the timeline of stroke and the long-term outcome for those people.

'It's important to keep in mind that drinking large amounts of alcohol contributes to a more severe form of stroke at a younger age in people who had no significant past medical history.'

Stroke affects approximately 150,000 people in the UK each year, according to figures from the Stroke Association.

September 10, 2012 - Researchers have found that patient education with behavioral support, lower out-of-pocket expenses, and case management all improved adherence to treatment for various chronic health conditions. The results of this systematic literature review were published online September 10 in the Annals of Internal Medicine.

The primary aim of the review was to assess the effectiveness of patient, policy, provider, and systems interventions aimed at improving adherence to self-administered medications for chronic diseases (eg, hyperlipidemia, diabetes, asthma, and multiple sclerosis). Meera Viswanathan, PhD, from Social, Statistical, and Environmental Sciences, RTI International, Durham, North Carolina, and colleagues included 73 articles on adherence intervention trials conducted between 1994 and June 2012. Of the 73 articles, 68 (representing 62 trials) evaluated the effect of patient, provider, or systems interventions on medication adherence.Overall, "33 [of the 62 trials] (53%) reported improvement in medication adherence. Of these 33 trials, 18 (29%) reported improvements in at least 1 health outcome, 8 (13%) reported no improvements in health outcomes, and 7 (11%) did not evaluate changes in health outcomes," the authors write. "The remaining 29 trials (47%) showed no improvement in medication adherence."

The researchers note that despite finding evidence of effective strategies to improve medication adherence for conditions such as hypertension, heart failure, depression, and asthma, not all interventions led to improved outcomes for all conditions. Collaborative care interventions, for example, did not provide evidence of benefit for patients with hypertension; however, this intervention did appear effective for patients with diabetes and/or depression.

"Certain intervention types may provide the most benefit for patients with a specific clinical condition," the authors write. The researchers also found that the most consistent evidence for improved outcomes was improved medication adherence among patients with hypertension, heart failure, depression, and asthma. Decreases in systemic blood pressure were noted among patients with hypertension who received both case management and face-to-face education by pharmacists, and "a pharmacistled multicomponent adherence intervention reduced emergency department visits and improved patient satisfaction" among patients with heart failure. Among the studies that evaluated policy interventions, the researchers found that such interventions that reduce patients' out-of pocket expensesWe can quote this in our promotion to drive home the point of affordable medicines

also appeared to have a beneficial effect on medication adherence among patients being treated for cardiovascular disease and diabetes.

Interventions Tested Across Clinical Conditions
Seven intervention approaches were tested across different clinical conditions: education; case management; reminders; pharmacist-led, multicomponent approaches; collaborative care; a combination of telephone-based counseling, care management, and reminders; and decision aids. The researchers found that among these interventions, education/behavioral support and case management were the most effective at improving medication adherence and significantly affecting health outcomes across a variety of conditions. Conversely, when tested under conditions including diabetes, multiple sclerosis, depression, and musculoskeletal disease, interventions that included telephone counseling, care management, and monitoring failed to show significant improvements to medication adherence.

The authors acknowledge study limitations such as the fact that studies were limited to adults with chronic conditions in the United States and that heterogeneity among the studies precluded quantitative data pooling. "Poor medication adherence produces large downstream health care costs," Dr. Viswanathan and colleagues write. "Thus, policymakers contemplating changes in health policy should take note of our assessment, from 5 consistent studies (moderate-strength evidence), that reducing patients' out-of-pocket costs improves medication adherence. Compared with other effective interventions, such as case management and collaborative care, which are relatively complex and labor-intensive, reducing copayments can potentially improve adherence for large numbers of geographically diverse patients."

Funding for this study was provided by the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online September 10, 2012.

People who take ibuprofen or paracetamol several times a week could face an increased risk of hearing loss, scientists have warned.

A study involving 62,261 women, aged 31 to 48 years, found that those who used one of these painkillers several times a week were more likely to have hearing loss than those who rarely used the drugs.

'If individuals find a need to take these types of medications regularly, they should consult with their health care professional to discuss the risks and benefits and to explore other possible alternatives,' said Dr.Sharon Curhan from Brigham and Women's Hospital in the US.

The study revealed that, compared with women who used ibuprofen less than once per week, those who took it on two to three days per week had a 13 per cent increased risk of hearing loss.

This rose to 21 per cent for those who used ibuprofen four to five times a week, and 24 per cent for those using it even more regularly.

A similar trend was seen for paracetamol, but not for aspirin.

The findings are published in the American Journal of Epidemiology and indicate that ibuprofen and paracetamol may affect the flow of blood to the ear or reduce levels of factors that protect the hearing.

Community pharmacists play an important role in ensuring medicines' safety by querying large numbers of prescription items, a study has found.

Data compiled by the organisation Pharmacy Voice show that pharmacists intervene in almost two million prescriptions each year, with more than two in every 1,000 items requiring checks.

In many cases, these queries relate to the dose, quantity or strength of the medicine in question.

This means that thousands of people could be saved from serious harm by these routine prescription checks.

Rob Darracott, chief executive of Pharmacy Voice, which compiled data from more than 4,400 pharmacies across England, said: 'These data show the value of safety checks carried out in pharmacies, and the importance of information transfer between prescriber, patient and pharmacist.'

He added that pharmacies perform a range of vital functions that often go unnoticed, but that are 'no less important for that'.

As well as querying prescription items, pharmacists also provide lifestyle advice, support people to use their medicines correctly and make emergency referrals to hospital if deemed necessary.

Women with type-2 diabetes have an increased risk of developing breast cancer, a new review has concluded.

Researchers at the International Prevention Research Institute (i-PRI) in Lyon, France, looked at the results of 40 previous studies, all of which had assessed the possibility of a link between diabetes and breast cancer.

Overall, they found that post-menopausal women with type-2 diabetes appeared to have a 27% increased risk of breast cancer.

In contrast, no link was found between breast cancer and type-1 diabetes, and women with type-2 diabetes did not appear to have an increased risk of cancer prior to the menopause.

Lead author Professor Peter Boyle, whose findings are published in the British Journal of Cancer, said: 'Our study found a significantly increased risk of breast cancer in women who had diabetes, which was restricted to those of post-menopausal age.'

He suggested that being overweight - which is often associated with type-2 diabetes - may affect hormones that fuel cancer growth.

Martin Ledwick, Cancer Research UK's head information nurse, advised women to try to maintain a healthy weight.

September 13, 2012 - Topical over-the-counter muscle and joint pain relievers, such as Bengay, Capzasin, Flexall, Icy Hot, and Mentholatum, may in rare instances cause serious burns, a new alert from the US Food and Drug Administration (FDA) warns.

A Drug Safety Communication from the FDA's MedWatch safety information and adverse event reporting program points out that the products have been reported to "cause rare cases of serious skin injuries, ranging from first- to third-degree chemical burns, where the products were applied."

To date, more than 43 reported cases of burns associated with the use of these products have been reported, the FDA says. "This is a very small number of cases when compared to the number of people who purchase these products," FDA chemist Reynold Tan, PhD, emphasized.

The alert notes that the products may produce a sensation of warmth or coolness when applied to the skin, but they should not burn. "These products should not cause pain or skin damage; however, there have been rare cases of serious burns following their use. Some of the burns had serious complications requiring hospitalization," the statement adds.

People using these products should be aware for signs of skin injury, such as pain, swelling, or blistering of the skin, and should stop using the product and seek medical care if injury occurs.

Healthcare professionals should counsel patients about how to use the products appropriately and inform them about the risk for serious burns, the FDA recommends.

Topical joint and muscle pain relievers may contain single agents or combinations of products, including menthol, methyl salicylate, or capsaicin, and may be formulated as creams, lotions, ointments, and patches.

"According to the available data, a majority of the more severe burns occurred with the use of a menthol or menthol/methyl salicylate combination product," the FDA notes.

"Most of these cases involved products that contain higher concentrations of menthol and methyl salicylate (greater than 3% menthol or 10% methyl salicylate). Few of the cases involved capsaicin."

Healthcare providers and consumers should report any adverse events to MedWatch, the FDA's safety information and adverse event reporting program, by telephone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm, or by mail to 5600 Fishers Lane, Rockville, Maryland 20852-9787.

People with stressful jobs are 23% more likely to have a heart attack than those with less demanding working lives, a study has found.

Researchers at University College London analysed 13 previous studies involving almost 200,000 employees in Belgium, Denmark, Finland, France, The Netherlands, Sweden and the UK.

They found that people who reported significant levels of job strain had a 23% increased risk of heart attack during the average 7.5-year follow-up period.

This association remained after factors such as lifestyle, age, sex and socioeconomic status had been taken into account, according to a report of the study in the Lancet medical journal.

Lead researcher Dr Mika Kivimaki said: 'Our findings indicate that job strain is associated with a small but consistent increased risk of experiencing a first coronary heart disease event such as a heart attack.'

Professor Peter Weissberg, medical director of the British Heart Foundation, said that work-related stress was already known to increase a person's risk of developing heart disease.

But he claimed: 'Eating a balanced diet, taking regular exercise and quitting smoking will more than offset any risk associated with your job.'

Surgeons in Sweden have carried out the first successful mother-to-daughter womb transplants, raising hopes for women who have had their uterus removed but still wish to have children.

Doctors at the University of Gothenburg removed wombs from two women and transplanted them into their daughters, both of whom are in their 30s.

One of the women had been born without a uterus, while the other had hers removed during treatment for cervical cancer.

The procedures were completed without complications, although only time will tell whether the women will be able to achieve pregnancies and carry a baby to full term.

Michael Olausson, one of the surgeons involved, told the Associated Press: 'We are not going to call it a complete success until this results in children. That's the best proof.'

Mats Brannstrom, professor of obstetrics and gynaecology at the University of Gothenburg, revealed that more than ten surgeons took part in the operations.

He confirmed: 'Both patients that received new uteri are doing fine but are tired after surgery.'

September 14, 2012 - Fifty-two evidence-based recommendations for the optimal evaluation, treatment, and follow-up of patients with hypothyroidism have been released in an effort to help clinicians provide patients with optimal care.

Jointly developed by the American Association of Clinical Endocrinologists and the American Thyroid Association, the recommendations were published online simultaneously in Endocrine Practice and Thyroid.

Of particular note for primary care clinicians:
Clinicians are advised to consult with an endocrinologist when treating hypothyroidism in infants and pediatric patients, women who are or plan to become pregnant, patients with heart disease, and those with other endocrine diseases such as adrenal or pituitary disorders, as well as patients for whom it is "difficult to render and maintain a euthyroid state"; those with a goiter, nodule or structural changes to the thyroid; or those who have an "unusual constellation of thyroid function test results."

Although a serum thyrotrophin hormone (TSH) test is the single best screening test for hypothyroidism, clinicians should be aware that it is insufficient for assessing hospitalized patients or when central hypothyroidism is either present or suspected.

The standard treatment for hypothyroidism is individually tailored replacement levothyroxine; there are no data to support the clinical efficacy of over-the-counter products marketed for "thyroid support" or "to promote thyroid health."

Levothyroxine and levotriiodothyronine combinations, including desiccated thyroid, should not be used in women who are pregnant or trying to conceive.

Mild TSH elevations in the elderly may be a normal manifestation of aging and do not necessarily indicate hypothyroidism.

"The guidelines address a wide-ranging number of issues that clinicians encounter in treating a disorder that affects millions of men worldwide and an even far greater number of women," Charles H. Emerson, MD, said in a news release Dr. Emerson is editor-in-chief of Thyroid and professor emeritus of medicine at the University of Massachusetts Medical School in Worcester. "They deal firmly with the problem of inappropriate thyroid hormone administration, both as it concerns individuals who should not be taking thyroid hormone, and patients with hypothyroidism who are given or self-administer suboptimal doses or dangerous formulations for their condition," he added.

One author has received speaker and program development honoraria from Abbott Nutrition. The remaining authors have disclosed no relevant financial relationships.

September 17, 2012 - Hundreds of lives might be saved worldwide if the clot stabilizer tranexamic acid (TXA) were used promptly in all instances of traumatic bleeding, not just among the most severely injured, according to results from a study published online September 11 in the British Medical Journal.

The study aims to quell a longstanding debate, which erupted with the initial publication of the randomized, multicenter Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage 2 (CRASH-2) trial, regarding use of the antifibrinolytic agent in trauma bleeding.

In this newest analysis, Ian Roberts, MB BCh, FRCP, professor of epidemiology and public health at the London School of Hygiene and Tropical Medicine in the United Kingdom, and colleagues used data from 13,273 trauma patients who were enrolled in CRASH-2 and treated with either TXA or placebo within 3 hours of injury. The researchers stratified the patients into 4 groups according to their risk for death at baseline: less than 6%, from 6% to 20%, from 21% to 50%, and more than 50%.

The researchers found that TXA reduced the odds of bleeding death by about 30% overall. The drug reduced the odds of thrombotic events by the same proportion, with a reduction of both fatal and nonfatal thrombotic events (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.53 - 0.89; P = 0.005).

If the benefit of TXA is assumed to be the same in all risk strata, the authors calculate that 17% of all deaths among patients with a lower than 6% risk for death at baseline could be avoided, 36% of deaths among patients with a 6% to 20% mortality risk could be avoided, 30% of deaths among patients with a 21% to 50% mortality risk might be avoided, and 17% of deaths among patients with a mortality risk of greater than 50% could be avoided.

When the authors analyzed mortality according to the baseline risk for death, they found a reduction in all-cause mortality for each risk strata, although the results for patients with a risk for death at baseline of lower than 6% were not statistically significant. The OR for death in the hospital within 4 weeks of injury or death from bleeding among the treatment group when all strata were combined was 0.85 (95% CI, 0.78 - 0.93). In the entire survey group, 14% (929) of the 6684 patients who received TXA died. In the placebo group, 16% (1053) of the 6589 patients died.

In those with a lower than 6% risk, 33 (1%) of 2487 patients in the treatment group and 40 (2%) of 2353 patients in the placebo group died, for an OR of 0.78 (95% CI, 0.49 - 1.23).

In the group with a risk for death between 6% and 20%, 223 (8%) of the 2682 treatment group patients died compared with 266 (10%) of the 2713 patients in the placebo group, for an OR of 0.83 (95% CI, 0.70 - 1.00).

Of the patients with a baseline risk for death of from 21% to 50%, 281 (31%) of the 908 patients in the treatment group died compared with 337 (36%) of the 940 patients in the placebo group, for an OR of 0.80 (95% CI, 0.69 - 0.94).

Among the patients who were more than 50% likely to die from their injuries, 392 (65%) of the 607 patients in the treatment group died, as did 410 (70%) of the 583 patients in the placebo group, for an OR of 0.77 (95% CI, 0.68 - 0.87).

Although the earlier CRASH-2 findings of efficacy led to widespread incorporation of TXA in trauma treatment, the authors write, "These protocols generally focus on the care of the most severely injured." Severely injured patients may have the most to gain from the treatment, the authors write, but using TXA in the far larger group of lower-risk patients may lead to even more saved lives.

One reason for resistance to broader use of TXA was the focus of many on the absolute risk reduction in the CRASH-2 study, Lt. Col. Andrew P. Cap, MD, PhD, chief of the Coagulation and Blood Research Program, US Army, told Medscape Medical News. Dr. Cap was not associated with this study or the earlier CRASH-2 research.

Absolute risk for death fell by only 1%, Dr. Cap said. "But what you should look at is the relative risk reduction, which depends on the underlying risk of mortality," he added. Those results were stunning, with a 9% relative risk reduction for all-cause mortality and a 15% relative risk reduction for death resulting from bleeding, he said.

The new study could eliminate this focus on absolute risk among CRASH-2 critics, Dr. Cap said. "What they're doing is responding to criticism by calculating it all out for the different strata of risk. Their conclusions are, guess what, everybody benefits. There are many lower-risk patients who could still benefit. By not treating these patients with TXA, we could be missing an opportunity to benefit a lot of patients," he said.

"The point is that everybody keeps saying the CRASH-2 study is inadequate to make determinations whether we should use the drug because we don't know who to give it to. But in CRASH-2, the needed-to-treat number was about 67 patients, which is very favorable. That's a fabulous number. That makes tranexamic acid look like a slam dunk."

The antifibrinolytic agent, invented in Japan in the 1960s, helps prevent clot breakdown and has also been shown to reduce postoperative blood loss.

In addition to reducing mortality, TXA reduced risks from unwanted clotting leading to heart attacks in all risk groups, according to the new analysis. Those treated with TXA saw a significant reduction in the odds of thrombotic events, both fatal and nonfatal, with an OR of 0.69 (95% CI, 0.53 - 0.89; P = .005). There was also a reduction in arterial thrombotic events (OR, 0.58; 95% CI, 0.40 - 0.83; P = .003). However, the risk for venous thrombotic events was not significantly reduced (OR, 0.83; 95% CI, 0.59 - 1.17; P = .295).

"Taken together, these data suggest that tranexamic acid can be administered safely to a wide spectrum of patients with traumatic bleeding and that its use should not be restricted to those with the most severe haemorrhage," the authors write.

The research team is taking a unique approach to promoting its findings by creating a manga comic to tell the story of how TXA can prevent death.

In 2011, Dr. Roberts also was behind the creation of a short video about the drug's benefits.

In a press release, Dr. Roberts says, "Health professionals are inundated with information and treatment guidelines so it can be difficult to keep track of all the latest developments. Our research has demonstrated how lives can be saved by this cheap and effective drug and the new paper shows that it can benefit all levels of severity, if given within three hours of injury. We want to make sure that message comes through loud and clear and we hope this comic will get people interested and talking about TXA."

The London School of Hygiene and Tropical Medicine has received funding from Pfizer, the manufacturer of TXA. The authors and Dr. Cap have disclosed no relevant financial relationships.

The number of complaints about doctors has reached a record high, a new report has found.

A total of 8,781 complaints were submitted to the General Medical Council (GMC) in 2011, representing a 23% increase from 2010, when just 7,153 complaints were received.

According to the GMC, complaints have been increasing since 2007, with patients more prepared to raise concerns and having a better idea of how to go about complaining.

The report also revealed that the likelihood of the GMC investigating a doctor increased from one in 68 in 2010 to one in 64 last year.

Niall Dickson, chief executive of the GMC, said: 'We're committed to enhancing patient safety and improving the quality of medical care across the UK.

'We hope this report will shed further light on the issues and challenges facing the medical profession in promoting high quality healthcare across the UK.'

Mike Farrar, chief executive of the NHS Confederation, underlined the importance of patient feedback.

He added: 'It is essential doctors listen to their patients' experiences - good and bad - to improve professionally.'

September 17, 2012 - A new study shows that the effects of atenolol and metoprolol tartrate, 2 commonly used treatments for hypertension, are virtually identical in terms of preventing stroke, myocardial infarction (MI), and heart failure.

"[W]e found no differences in CV event rates when comparing patients without a history of CV events who were initiating treatment with either atenolol or metoprolol tartrate," study authors, led by Emily D. Parker, MPH, PhD, of HealthPartners Institute for Education and Research, Minneapolis, Minnesota, conclude.

"These findings suggest that hypertension trial outcomes with atenolol may not relate to unfavorable characteristics of this particular drug."

Their findings were published online August 27 in the Archives of Internal Medicine.

Down-Regulated

β-Blockers are highly effective after a heart attack for preventing death or further heart attacks and in treating congestive heart failure.

Until recently, they were a first-line therapy for hypertension, but newer evidence suggests that these drugs have only a weak effect on stroke and no effect on coronary heart disease.

As a consequence of this growing body of research, β-blockers are now relegated to third- or fourth-line treatment for uncomplicated hypertension.

However, because most of the evidence comes from trials in which atenolol was the β-blocker used, it is unclear whether the results pertain just to this drug or to the entire class, the researchers write.

The new results are derived from the Hypertension Registry of the Cardiovascular Research Network (CVRN), which includes all adult patients enrolled in 3 large integrated healthcare plans in Minnesota, Colorado, and California.

The analysis used electronic prescription records, including those of 120,978 adult patients with hypertension but no history of cardiovascular events, who began treatment with either atenolol or metoprolol tartrate between 2000 and 2009.

Atenolol and metoprolol tartrate are both widely used β-adrenergic receptor blockers that increase vagal tone and reduce sympathetic outflow……. However, whereas metoprolol is lipid soluble and tends to have highly variable bioavailability and a short plasma half-life, atenolol is more water soluble, shows less variance in bioavailability, and has a longer plasma half-life.

During the study period, atenolol was used in about 10-fold more patients than metoproplol tartrate.

During that time, 3317 incident MIs, 3272 incident HF hospitalizations, and 3664 incident strokes occurred. The hazard ratios (HRs) for these outcomes indicated no significant differences between treatments.

Risk for Clinical Event With Metoprolol vs Atenolol

Propensity Score

To address the potential for bias, the authors performed a propensity score for the probability of being prescribed metoprolol tartrate based on known risk factors. This analysis showed almost exactly the same results.

The findings were also unchanged with a sensitivity analysis that excluded participants who had an event in the first 12 months to further remove those with CVD.

Notably, the researchers found no statistically significant differences in the 2 drugs in lowering systolic blood pressure (in both groups, the change was 9.8 mm Hg; P = .82).

It did show a small but statistically significant difference in change in diastolic blood pressure (5.9 mm Hg for atenolol vs 5.5 mm Hg for metoprolol tartrate; P = .005).

The authors stressed that the study results should be interpreted cautiously, because there have been no trials comparing these 2 β-blockers directly. Limitations of the study include the fact that atenolol was only compared with 1 other β-blocker, and participants were not randomized.

Well Designed

Although the study was well designed and adequately addressed the question of whether 1 β-blocker was better than the other, most questions involving the effectiveness of drug therapies need to be answered though double-blind, randomized controlled trials, commented James S. Floyd, MD, from the Cardiovascular Health Research Unit and the Department of Medicine, University of Washington, Seattle.

"It was a high-quality study with a careful design, with a finding that metoprolol did not appear to be any better than atenolol for the primary prevention of heart disease," said Dr. Floyd in an interview. "But in general, it's either not possible or it's very difficult to do credible observational studies that address the most pressing clinical questions about the effectiveness of drug therapies."

The study does not address the question of whether doctors should use a β-blocker as first-line therapy for hypertension, a question that has been answered in the past by several randomized clinical trials, but it does "provide information about whether there are differences between the 2 commonly used β-blockers in the United States for the treatment of hypertension," said Dr. Floyd.

The study does, however, have limitations. In an editorial accompanying the main article, Dr. Floyd and coauthor Bruce M. Psaty, MD, PhD, outlined some of the weaknesses of this kind of study that relies on administrative data.

They noted that some potential confounding variables are not well captured by administrative codes, and information on others, for example, smoking and lipid levels, is simply not available. As well, relying on baseline β-blocker use ignores discontinuation during follow-up or the use of additional antihypertensive therapies, they said.

Although these are the kinds of limitations inherent in most observational studies, they illustrate "why we don't know for sure" whether the 2 β-blockers are exactly the same, said Dr. Floyd.

"I wouldn't say we now know that it doesn't matter which one you use, but I think this study gives us some evidence that they're perhaps similar."

The study was funded by the National Heart, Lung and Blood Institute (NHLBI), and subcontract to HealthPartners Institute for Education and Research. The study authors have disclosed no relevant financial relationships. Dr. Psaty was supported in part by grants from the NHLBI. Dr. Floyd was supported by a grant from the NHLBI.

Arch Intern Med. Published online August 27, 2012. Abstract, Editorial

August 29, 2012 (Munich, Germany) - Preliminary data from a work fitness program suggests that prevention strategies might be more effective if they target individuals in the workplace rather than the doctor's office.

The program, started in 2005, reduced the rates of smoking, improved blood pressure control, reduced the incidence of metabolic syndrome, and improved the 10-year predicted risk of cardiovascular disease, according to researchers.

"The workplace is the ideal setting for primary and secondary prevention, because there we can get access to all patients at risk," said Dr Johannes Scholl (Prevention First, Ruedesheim, Germany) during a presentation closing out the European Society of Cardiology 2012 Congress. "Close cooperation between respective departments of occupational medicine and specialist prevention clinics is the basis for good compliance and success."

For Scholl, the workplace is better suited for primary and secondary prevention, as many younger patients, including those with undetected hypertension and elevated cholesterol levels, are not frequent users of primary-care physicians. As a result, many of their cardiovascular risk factors go untreated.

Fit in Life, Fit on the Job:

Initiated in 2004 and known as the "Fit in Life, Fit on the Job" program, Boehringer Ingelheim employees in Germany were enrolled through the department of occupational medicine. During their index visit, physical examinations and family-history assessments were performed, and all biometric data recorded. Two weeks later, employees went to the Prevention First clinic for a more complete assessment, including baseline carotid intima-media thickness (IMT) measurements, fitness testing to maximal exhaustion, and a full cardiovascular risk assessment.

After these examinations, individuals were shown their 10-year and longer-term risk of cardiovascular disease and prescribed comprehensive nutritional and exercise recommendations.

"Unlike many other companies, not only executives came to the health checkups, but it was a program for all employees 40 years or older," said Scholl.

Based on data from 312 men and 223 women included in the program, mean age 50 years old, more than half of patients had high blood pressure and approximately one-third had metabolic syndrome. The mean body-mass index in men was 27 and 25.6 in women.

The results showed that after a mean follow-up of 3.4 years, the number of male and female smokers declined by 39% and 17.5%, respectively. At baseline, 28.6% of men and 38.2% of women had their blood pressure under control, but these numbers increased significantly--up to 42.8% in men and 54.2% in women--when individuals participated in the workplace prevention program. The prevalence of metabolic syndrome declined 34% in women and 44% in men during the follow-up period, a reduction that would translate into a large reduction in the prevalence of diabetes, according to the investigators. Approximately 25% of men and women had an improvement in their 10-year risk of cardiovascular disease as assessed by the Framingham risk score.

For Scholl, one of the strengths of the program was the inclusion of all employees, not just executives. The executives led the charge with testimonials and encouraged all of Boehringer to participate, however.

One of the downsides of presenting such preliminary data is that researchers are currently unaware of the economic benefits of the program. For example, it is unknown whether getting employees healthier and more active reduces absenteeism or improves productivity, an important bottom-line factor that will determine the long-term continuance of the program. Scholl said the researchers are planning on performing such economic analysis when more than 3000 patients have at least one follow-up visit.

August 28, 2012 - Children with type 1 diabetes mellitus show lower levels of serum vitamin D than those without the disease, even in a subtropical region of Australia, where sunlight is in abundance, according to a study published online August 23 in Pediatric Diabetes.

Vitamin D, synthesized in the skin through ultraviolet B radiation, is considered to be particularly important in the inflammatory process of type 1 diabetes, helping to modify an immune response that destroys pancreatic islet cells.

Previous studies have shown low levels of 25-hydroxy vitamin D (25OHD), measured in serum as a marker of vitamin D status, among people with type 1 diabetes. However, most of those studies have been conducted at high latitudes in northern Europe, where sunlight exposure can be limited part of the year.

In their study, Ristan M. Greer, PhD, from Queensland Children's Medical Research Institute at the University of Queensland, Australia, sought to determine whether the same effect would be seen in a region where residents typically have much more sunlight exposure.

The researchers evaluated the serum 25OHD levels of 56 children with type 1 diabetes and 46 control participants without the disease, all of whom lived in Brisbane, Australia, located at 27.5°S latitude, where sunlight exposure is abundant.

The authors found serum 25OHD levels to be significantly lower in children with type 1 diabetes compared with children without diabetes (mean, 78.7 [95% confidence interval, 71.8 - 85.6] nmol/L vs 91.4 [95% confidence interval, 83.5 - 98.7] nmol/L, respectively; P = .02). These levels remained lower after adjustment for covariates, including mean ambient ultraviolet radiation index, as the majority of participants with type 1 diabetes had their vitamin D measured in the fall and winter, whereas the control patients were assessed in the spring and summer months.

Children with type 1 diabetes had lower self-reported levels of outdoor exposure and mean ultraviolet exposure; however, there were no significant differences between the 2 groups in terms of vitamin D receptor polymorphisms, which have been linked with autoantibodies and diabetes-related complications, according to the authors.

The children who had newly diagnosed type 1 diabetes (n = 14), defined as a duration of 30 days or less, had the lowest vitamin D levels, showing levels of 1,25-dihydroxy vitamin D (1,25(OH)2D), the active form of 25OHD, that were lower than those seen in the control patients (median, 89 [interquartile range, 68 - 122 pmol/L] vs 121 [interquartile range, 108 - 159] pmol/L, respectively; P = .03) or in children with established diabetes (median, 137 [interquartile range, 113 - 153] pmol/L; difference between those with newly diagnosed type 1 diabetes vs those with established diabetes P = .01).

The study showed no difference between the groups in terms of the proportion of children who were considered 25OHD deficient: 3 of the 46 children vs 5 of the 56 children with type 1 diabetes (P = .73).

"Our study shows that even at relatively low latitude in an environment of abundant [ultraviolet] exposure, paediatric patients with diabetes have low vitamin D compared to their peers, the effect being more marked in those newly diagnosed, but still present in those with established diabetes," the authors note

Which Comes First: Diabetes or Low Vitamin D Levels?

The findings raise important questions about the precise role of vitamin D in type 1 diabetes, which could be better assessed with serum vitamin D measurements taken at serial intervals before the onset of diabetes, the authors assert.

"Such studies could establish whether low vitamin D is a consequence of diabetes, in which case steps must be taken to avoid consequences such as low bone density and susceptibility to other diseases in later life," they write.

[A]lternately[, studies could determine] whether low vitamin D is a risk factor for diabetes, in which case preventive action could be taken for those at risk due to environment, family history, or genetic background," they conclude.

The study was funded by a grant from the Royal Children's Hospital Foundation, Queensland.

Men who eat a moderate amount of chocolate may benefit from a reduced risk of stroke, scientists have said.

Researchers at Sweden's Karolinska Institute gave food questionnaires to more than 37,000 men, aged 49 to 75.

Over the next ten years, 1,995 of the men had a first stroke.

On average, men who ate the most chocolate - equivalent to a third of a cup of chocolate chips each week - had a 17 per cent lower risk of stroke than those who ate none at all.

Study author Dr Susanna Larsson, whose findings are published in Neurology journal, said: 'This is the first of its kind study to find that chocolate may be beneficial for reducing stroke in men.'

The researchers added that the beneficial effect may be due to the antioxidant, anti-clotting and anti-inflammatory properties of the flavonoid chemicals in chocolate.

A recent study, published in the journal Stroke, found no association between a person's total intake of flavonoids and their risk of stroke.

However, the researchers at the University of East Anglia observed that a particular subclass of chemicals found in citrus fruits, called flavanones, appeared to be linked with a reduced risk of ischaemic stroke.

BACKGROUND: Statins have uncertain benefits in persons with chronic kidney disease (CKD) because individual trials may have insufficient power to determine whether treatment effects differ with severity of CKD.

PURPOSE: To summarize the benefits and harms of statin therapy for adults with CKD and examine whether effects of statins vary by stage of kidney disease.

DATA SOURCES: Cochrane and EMBASE databases (inception to February 2012).

STUDY SELECTION: Randomized trials comparing the effects of statins with placebo, no treatment, or another statin on mortality and cardiovascular outcomes.

DATA EXTRACTION: Two independent reviewers extracted data and assessed risk of bias.

DATA SYNTHESIS: Eighty trials comprising 51 099 participants compared statin with placebo or no treatment.

Treatment effects varied with stage of CKD. Moderate- to high-quality evidence indicated that statins reduced all-cause mortality (relative risk [RR], 0.81 [95% CI, 0.74 to 0.88]), cardiovascular mortality (RR, 0.78 [CI, 0.68 to 0.89]), and cardiovascular events (RR, 0.76 [CI, 0.73 to 0.80]) in persons not receiving dialysis.

Moderate- to high-quality evidence indicated that statins had little or no effect on all-cause mortality (RR, 0.96 [CI, 0.88 to 1.04]), cardiovascular mortality (RR, 0.94 [CI, 0.82 to 1.07]), or cardiovascular events (RR, 0.95 [CI, 0.87 to 1.03]) in persons receiving dialysis.

Effects of statins in kidney transplant recipients were uncertain.

Statins had little or no effect on cancer, myalgia, liver function, or withdrawal from treatment, although adverse events were evaluated systematically in fewer than half of the trials.

LIMITATIONS: There was a reliance on post hoc subgroup data for earlier stages of CKD.

CONCLUSION: Statins decrease mortality and cardiovascular events in persons with early stages of CKD, have little or no effect in persons receiving dialysis, and have uncertain effects in kidney transplant recipients.

Older people who lead an active lifestyle can add up to six years on to their life expectancy, a study has found.

Researchers at Sweden's Karolinska Institute studied data on more than 1,800 people, aged 75 and older, who were followed for 18 years. During the follow-up period, 92% of the participants died, although half lived past their 90th birthday.

The researchers found that survivors tended to be female and highly educated, with a healthy lifestyle, good social network and high uptake of leisure-time activities than non-survivors.

Analysis revealed that maintaining a physically active lifestyle had the strongest effect on survival.

On average, a healthy lifestyle added five years to women's lives and six years to those of men.

Publishing their findings in the British Medical Journal, the study authors concluded: 'Our results suggest that encouraging favourable lifestyle behaviours even at advanced ages may enhance life expectancy, probably by reducing morbidity.'

The study follows new figures from the Office for National Statistics, which show that Britons are enjoying good health for longer.

The majority of children in England have no idea how much exercise they should be doing to stay healthy, research suggests.

Figures published by the British Heart Foundation (BHF) indicate that eight out of ten children underestimate the amount of exercise they need to take.

Just 10% of children knew they needed to do at least 60 minutes of physical activity each day in order to stay fit and reduce their risk of heart disease and diabetes in the future.

Lisa Purcell, the BHF's physical activity project manager, said: 'A nation of couch kids has been watching the Olympics from the comfort of the sofa instead of getting active themselves.

'But with the Olympics and Paralympics on our doorstep, this summer holiday really is the perfect time for kids to try out a variety of activities and find the ones they enjoy the most.'

The charity has teamed up with England cricketer Ravi Bopara to help children understand why they need to maintain a good level of fitness.

'It's shocking that childhood obesity is still such a big issue for the UK and that so few children realize how active they need to be to stay fit,' the sportsman observed.

September 6, 2012 - A human fibroblast-derived dermal substitute (Dermagraft, Shire Regenerative Medicine) has been approved by Health Canada as a class 4 medical device for the treatment of diabetic foot ulcers, according to a manufacturer press release.

The product is currently available in the United States, where it received approval as a class 3 medical device in September 2001 and will be available in Canada in the first quarter of 2013. Health Canada's approval of the dermal substitute, which was granted on August 21, is based on a Canadian device license application, submitted by Shire Regenerative Medicine in 2011.

According to the manufacturer, an estimated 2.7 million people in Canada (or 7.6% of the Canadian population) had diabetes as of 2010, with projections estimating that 4.2 million (10.8% of the Canadian population) will carry this diagnosis by the year 2020. Similarly, in 2008, the Canadian Association of Wound Care predicted that 345,000 of those patients with diabetes will develop a foot ulcer in their lifetime, at a cost to the Canadian healthcare system of more than $150 million each year.

The dermal substitute is manufactured from human fibroblast cells derived from newborn foreskin tissue.

The product is indicated for use in the treatment of full-thickness diabetic foot ulcers with greater than 6 weeks' duration, which extend through the dermis but do not have tendon, muscle, joint capsule, or bone exposure.

"During the manufacturing process, the human fibroblasts are seeded onto a bioresorbable scaffold. The fibroblasts proliferate to fill the interstices of this scaffold and secrete human dermal collagen, matrix proteins, growth factors, and cytokines to create a three-dimensional human dermal substitute containing metabolically active, living cells," the manufacturer states.

Potential adverse events include infection, injury, blisters, osteomyelitis, cellulitis, and peripheral edema.

September 7, 2012 (Las Vegas, Nevada) - Low doses of naproxen in a fine powder provide pain relief, but not statistically better relief than standard formulations of the drug, a new study shows.

The submicron particles are designed to be more bioavailable Both these are huge benefits for patients seeking pain relief, allowing lower doses and theoretically fewer adverse reactions.

"We can give a lower dose by mechanically manipulating the drug," co-author Bill H. McCarberg, MD, adjunct assistant clinical professor at the University of California, San Diego, told Medscape Medical News.

The results were reported here at PAIN Week by Clarence L. Young, MD, chief medical officer of Iroko Pharmaceuticals, which licensed from iCeutica a technique called SoluMatrix to mill more finely nonsteroidal anti-inflammatory drugs (NSAIDs).

He paired the results on naproxen with results from a similar trial on submicron diclofenac, findings of which the company presented in May at the American Pain Society 31st Annual Scientific Meeting, as reported by Medscape Medical News at that time.

The company previously referred to the particle size as "nano" but changed the characterization to "submicron" because it did not fit the technical definition of nano, said Dr. McCarberg.

Lowest Dose, Shortest Duration

NSAIDs can cause cardiovascular, gastrointestinal, and renal adverse reactions, and these effects are more likely with higher doses, Dr. McCarberg said.

The US Food and Drug Administration (FDA) has issued a Public Health Advisory stating that NSAIDs should be administered at the lowest effective dose for the shortest duration consistent with individual patient treatment goals.

Smaller particles have greater surface area per dose and therefore are more bioavailable, so in theory, a smaller dose might achieve the same effect, said Dr. McCarberg.

To test this approach, researchers recruited more than 450 patients experiencing moderate to severe pain within 6 hours of wisdom tooth extractions. They randomly assigned patients to receive one of the following: diclofenac 18 mg or 35 mg, naproxen 200 mg or 400 mg, celecoxib 400 mg (as an active control), standard formulation naproxen 250 mg or 450 mg, or placebo.

Compared with the placebo group, a higher proportion of all other groups rated their pain relief as "some," "a lot," or "complete" during the 12 hours after random assignment (P < .001).

The proportions of patients rating their pain relief in this range for each group in the submicron particle naproxen trial were as follows:

Submicron particle naproxen 200 mg, 84.0% (42/50)
Submicron particle naproxen 400 mg, 94.1% (48/51)
Naproxen 250 mg, 82.0% (41/50)
Naproxen 500 mg, 90.2% (46/51)
Placebo, 41.2% (21/51)

Results in the submicron particle diclofenac phase 2 trial were reported as follows:

Submicron particle diclofenac 18 mg, 83.7% (41/49)
Submicron particle diclofenac 35 mg, 84.3% (43/51)
Celecoxib 400 mg, 58.8% (30/51)
Placebo, 25.5% (13/51)
All groups took a single dose of the assigned medicatio

Differences between submicron formulations and reference active medications were not statistically significant.

Dr. Young acknowledged that the study does not show that submicron formulations achieve equivalent pain relief at a lower dose compared with standard formulations. However, he said that the drugs make take effect more quickly.

The mean time to pain relief for nano-formulated naproxen 400 mg was just over an hour vs more than 3 hours for placebo (P < .002) and an hour and a half for standard naproxen 500 mg, Iroko said in a press release. The company did not report whether the difference between the standard formulation and the submicron formulation was statistically significant.

Adverse reactions were similar in the various groups.

Chronic Use?

Commenting on the study, Srinivas Nalamachu, MD, co-director of the Pain Management Institute in Overland Park, Kansas, pointed out that if reducing adverse reactions is the main point of milling the drug as a finer powder, then its success remains to be shown, because the most common serious adverse reactions occur with chronic use, and this drug was given only in a single dose.

In response, Dr. McCarberg said, "If bioavailability predicts side effects, we would have the same side effects - ulcers and so on."

However,the submicron drugs produce a lower overall serum concentration,he said."If blood level predicts side effects, then you would get fewer side effects with this formulation."

Also, the drug in submicron formulation may have less contact with the stomach, which might further reduce adverse reactions,said Dr. McCarberg.

Longer-term trials have not been conducted.

Dr. McCarberg has disclosed that he is an advisor to Iroko Pharmaceuticals, and Dr. Young has disclosed that he is an employee of that company. Dr. Nalamachu has disclosed no relevant financial relationships.

Many older people do not realise they have had a heart attack and therefore do not receive the recommended treatment, a new study suggests.

Researchers at the US National Institutes of Health looked at data on 936 people, aged 67 to 93 years, to compare the prevalence of recognised and unrecognised heart attacks.

MRI heart scans were performed to assess participants' heart health and the researchers found that 17% had previously had a heart attack that had not been diagnosed…. This compared with 9.7% of participants who knew they had suffered a heart attack.

People with diabetes were more likely to have had an Point with noting by all Diabetics. They should be concerned with keeping their sugars under check and also monitor their heart health at least once each year. This should be communicated to doctors – esp. GPs

unrecognised heart attack (21%) than those without diabetes (14%).

Publishing their findings in the Journal of the American Medical Association, the study authors noted that the use of cardiacPoint with noting by all Diabetics. They should be concerned with keeping their sugars under check and also monitor their heart health at least once each year.

This should be communicated to doctors – esp. GPs

medications - such as aspirin, beta-blockers and cholesterol-lowering statins - was 'significantly less' in patients who had suffered an unrecognised heart attack than those who had been diagnosed.

'Roughly half of those with unrecognised myocardial infarction (heart attack) were taking aspirin, whereas less than half were taking statins or beta-blockers,' they reveale

Dr. Andrew Arai, who conducted the research, told ABC News: 'The fact that there were more people with unrecognised heart attacks than recognised heart attacks suggests it's a big problem.'

People with tuberculosis (TB) may benefit from taking large doses of vitamin D, a study suggests.

Researchers at Queen Mary, University of London found that giving patients high doses of vitamin D alongside antibiotics helped them to recover more quickly than with antibiotics alone.

A total of 95 patients were treated, with 44 receiving vitamin D alongside standard antibiotic treatment for eight weeks, while the remaining 51 were given a placebo (dummy drug).

A number of inflammatory markers in the blood were found to fall more quickly in patients who were receiving vitamin D….. In addition, the bacterium responsible for TB was cleared more We should communicate the data to CPs and Chest Physicians rapidly from patients' sputum if they had been taking vitamin D.

On average, the bacteria were cleared in 23 days among vitamin D users, compared with 36 days for those on the placebo.

Lead researcher Dr. Adrian Martineau, whose findings are published in the Proceedings of the National Academy of Sciences, described the results as 'very significant'.

'They indicate that vitamin D may have a role in accelerating resolution of inflammatory responses in tuberculosis patients,' he claimed.

The expert added that high-dose vitamin D could also have a role to play in the treatment of other lung infections, such as pneumonia.

A new study has cast doubt on the widely held assumption that all obese people are metabolically unhealthy.

Research conducted at the University of South Carolina in the US suggests that a significant proportion of obese people are in fact healthy and fit…… They are no more likely to die from cardiovascular disease than their normal-weight counterparts.

The research team recruited participants between 1979 and 2003 and tracked their health over time.

They found that almost half (46 per cent) of obese participants were metabolically healthy.

When compared with metabolically unhealthy obese individuals, obese people who were healthy were 38% less likely to die from any cause and between 30 and 50% less likely to develop or die from cardiovascular disease or cancer.

The researchers observed no significant differences between metabolically healthy but obese people and those with a normal weight.

Study author Dr Francisco Ortega, whose findings are published in the European Heart Journal, said: 'There appears to be a sub-set of obese people who seem to be protected from obesity-related metabolic complications.'

However, Amy Thompson, senior cardiac nurse at the British Heart Foundation, urged people to keep an eye on their weight as obesity is a risk factor for coronary heart disease 'in the majority of cases'.

There has been an increase in the number of non-smokers being diagnosed with lung cancer, new research shows.

A team at the French College of General Hospital Respiratory Physicians looked at data on 7,610 new cases of lung cancer in France in 2010, including 6,083 with non-small-cell lung cancer.

They found that 11.9% of cases involved non-smokers, up from 7.9% ten years previously.

In addition, the study revealed an increase in the number of women developing lung cancer - 24.4% of patients in 2010 were female, compared with just 16% in 2000.

The findings were presented at the annual congress of the European Respiratory Society yesterday (September 4th).

Lead author Dr Chrystele Locher said: 'Not only has there been an increase in the number of women and non-smokers contracting the disease, but there has also been an increase in the number of cases diagnosed in stage four of the illness.'

Dr. Locher noted that the World Health Organisation recently classified diesel fumes as carcinogenic, but called for more research 'to understand other factors that could contribute to lung cancer in non-smokers'.

Lung cancer is the second most common form of cancer in the UK, with around 41,400 people diagnosed each year.

Men who have children at a late age appear to be more likely to pass gene flaws on to their offspring, a study has found.

Researchers at deCODE Genetics in Reykjavik, Iceland, looked at mutation rates in 78 groups of parents and their children.

Fathers involved in the study ranged in age from 20 to 40 and the researchers found that a man's age at conception had a major influence on the rates of genetic faults in their children.

For each additional year of a father's age at the time of conception, the number of new or 'de novo' mutations increased by around two.

These types of genetic defect can be passed from one parent to their child, although they are not passed down through subsequence generations.

Writing in Nature journal, Dr. Augustine Kong and colleagues said: 'Men transmit a much higher number of mutations to their children than women.'

Dr. Allan Pacey, an andrology expert and chairman of the British Fertility Society, suggested that the children of older fathers should not be unduly concerned.

But he added: 'Information like this is important to understand and should remind us that nature designed us to have our children at a young age and, if at all possible, men and women should not delay parenthood if they are in a position not to.'

August 26, 2012 (Munich, Germany) - In TRILOGY ACS, one of the few studies to focus on high-risk patients with acute coronary syndrome (ACS) who are medically managed without revascularization, the newer antiplatelet agent prasugrel (Effient, Lilly/Daiichi-Sanyo) has failed to show a reduction in major cardiovascular events compared with clopidogrel.

The results were reported here at the European Society of Cardiology (ESC) 2012 Congress by Dr. Matthew Roe (Duke Clinical Research Institute, Durham, NC), who is also lead author of the simultaneous online publication in the New England Journal of Medicine.

"This trial does not suggest a priori that prasugrel should be used for medically managed patients, because the results are neutral," senior author Dr Magnus Ohman (Duke Clinical Research Institute) told heartwire in an interview. Ohman discussed the findings at a press conference early Sunday morning.

But there was a surprising twist, says Ohman. The study was a median of 17 months in length, longer than most previous trials in ACS, he noted, and "the most striking thing is that there appears to be a time-dependent treatment effect."

While there was no difference in the rate of the primary composite end point or its separate components between those who received prasugrel and those who got clopidogrel in the first year of the study, thereafter the curves began to diverge, he explains.

Prasugrel appeared to reduce the risk of events from 12 months onward, "an unexpected finding," says Ohman, which means that "the trial raises more questions than it answers and is going to require a lot more analysis."

This trial does not suggest a priori that prasugrel should be used for medically managed patients, because the results are neutral. And prasugrel therapy did appear to be safe, even with the extended treatment employed in TRILOGY ACS, he says, noting that there was "no signal for increased rate of bleeding," with prasugrel.

In addition, the 5-mg dose of prasugrel-which was used in those aged 75 and over and in those weighing less than 60 kg--also appeared to be safe in this regard.

Prasugrel is already approved for use during PCI in the setting of ACS, based primarily on the strength of the TRITON-TIMI 38 trial, in which it significantly reduced ischemic events compared with clopidogrel, but at the expense of an increase in major (and fatal) bleeding.

Prasugrel is NOT currently recommended for ACS patients undergoing conservative, noninvasive (medical) management. Discussant of the study, Dr. Raffaele De Caterina (G d'Annunzio University, Chieti, Italy) told the meeting that this guideline should not be changed on the basis of the TRILOGY ACS results.

Mixed Reaction to TRILOGY ACS Findings
There was a mixed response among cardiologists asked by heartwire to comment on the TRILOGY ACS results. Dr. Doug Weaver (Henry Ford Hospital, Detroit, MI) said: "We are in an era when, in order to accept increased costs for therapy, we have to show increased value. So I would say that prasugrel doesn't pass muster to replace what's now generic clopidogrel. I don't think it's going to have much impact, and [Ohman] pointed that out."

Dr. Gordon Tomaselli (Johns Hopkins University, Baltimore, MD) commented: "I agree with [Ohman]. I don't think it's going to change practice in this group. It's not going to make prasugrel be used much more than a drug that is off patent and is very inexpensive."

But Dr. Elliott Antman (Brigham and Women's Hospital, Boston, MA) begs to differ. Antman was principal investigator of the TRITON-TIMI 38 trial but was not involved in TRILOGY ACS. "It would be superficial to regard this as an overall negative result," Antman told heartwire . "It's absolutely correct to say the primary end point didn't show a statistically significant difference between prasugrel and clopidogrel in those ACS patients managed medically, but there are several fascinating and potentially important observations."

One of these is the fact that, in TRILOGY ACS, the 5-mg dose of prasugrel used in patients aged 75 years and older and in those under 60 kg in weight appears to be safe, because there was no increased risk in bleeding, something that was seen in these patient groups when they took 10 mg of prasugrel in TRITON.

This finding, says Antman, is verification of what pharmacokinetic and pharmacodynamic studies have suggested and has practical applications, because a 5-mg dose of prasugrel is available.

Weaver agrees with Antman on this point. "From the clinician's standpoint, those are very important data. If you remember, the dose of 5 mg was based on a statistical model--no patient data--so now we have some patient data that validate it is safe. There was no increase in strokes and major bleeding. We do use prasugrel in some patients, so the safety part is very important for clinicians, but it's not going to make headlines."

De Caterina also thought this was important, stating that the TRILOGY ACS results demonstrate "the successful adoption of the modified regimen [of 5 mg]" in the >75 and <60-kg patient groups.

And Antman believes this finding will play well with regulatory authorities. "The FDA is very interested in dose modification," he notes. He also says he "would not be surprised" if Lilly/Daiichi-Sankyo filed for a supplemental new drug application for prasugrel for medically managed ACS. "Of course, they will need to look carefully at the data."

Time-Dependent Effect With Multiple Recurrent Ischemic Events, Too

The trial raises more questions than it answers and is going to require a lot more analysis. In the double-blind, randomized TRILOGY ACS trial, patients were eligible if they were selected for a final treatment strategy of medical management without revascularization within 10 days of their index ACS event. The study was conducted from June 2008 through September 2011, and participants were enrolled at 966 sites in 52 countries.

Roe explained that around 40% to 60% of ACS patients worldwide are managed medically, for a multitude of reasons--for example, because of poor renal function, diabetes, or advanced age. Hence, as a patient group, they are at higher risk than the overall ACS population, he notes.

The 7243 ACS patients age <75 years taking aspirin were randomized to 30 months of treatment with prasugrel 10 mg daily or clopidogrel 75 mg daily (prasugrel 5 mg was employed for those weighing <60 kg). There was a secondary analysis of patients aged >75 years (n=2083), who also received 5 mg of prasugrel or clopidogrel.

"We believed it was important to follow people for more than one year," Ohman noted, adding, "I'm glad that we did, because much of the information came after one year."

Through a median follow-up of 17 months, the primary end point of cardiovascular death, MI, or stroke among those <75 years occurred in 13.9% of those treated with prasugrel vs 16.0% of those treated with clopidogrel (hazard ratio 0.91; p=0.21). Similar results were observed in the overall population.

The researchers also performed a prespecified analysis of multiple recurrent ischemic events (all components of the primary end point), which hinted at a lower risk with prasugrel than clopidogrel among those under 75 years (HR 0.85; p=0.044). Again, this suggested a time-dependent treatment effect in favor of prasugrel, says Ohman, "with much of the reduction in recurrent events being after one year," which he notes is "consistent with the time dependence seen with the primary end point."

The primary end point and the outcome of multiple recurrent ischemic events are the only efficacy end points for which results were reported for the overall population, says Ohman, explaining that most of the findings with regard to those aged 75 and over will be presented at a future date, most likely at the Canadian Cardiovascular Congress in October.

What About Ticagrelor?
Tomaselli commented to heartwire that "the elephant in the room" is ticagrelor (Brilinta, AstraZeneca). He also commented about how the TRILOGY ACS results play out with regard to this other new antiplatelet agent. "I don't think this changes the choice between prasugrel and clopidogrel, but the real issue is how does ticagrelor fit into this?"

De Caterina compared and contrasted the findings of TRILOGY ACS with those of a subgroup analysis of the Platelet Inhibition and Patient Outcomes (PLATO) study in ACS patients who were managed medically, published in the BMJ in 2011 [2]. There are two important things to note here, he said. First, he reiterated the higher overall risk of medically managed ACS patients, and second, the fact that "there is an important difference in favor of ticagrelor in noninvasive, medically managed patients."

Safety Profile of the Two Treatments Similar
Roe emphasized there were no differences between rates of GUSTO severe/life-threatening and TIMI major, fatal, and intracranial bleeding between the prasugrel and clopidogrel groups in participants <75 years and the overall population.

But those in the prasugrel group did have slightly higher rates of non-CABG-related GUSTO severe/life-threatening or moderate bleeding (1.4% vs 1% with clopidogrel; p=0.06) and TIMI major or minor bleeding (1.9% vs 1.3% with clopidogrel; p=0.02).

The frequency of nonhemorrhagic serious adverse events was similar by treatment except for a higher frequency of heart failure in the clopidogrel group. There was no difference between the two groups in terms of cancers.

TRILOGY ACS was supported by Eli Lilly and Daiichi Sankyo. Roe reports receiving grant support from Eli Lilly, Bristol-Myers Squibb, Hoffmann-La Roche, Novartis, Schering-Plough, and KAI Pharmaceuticals; consulting fees from Eli Lilly, Daiichi Sankyo, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Janssen Pharmaceuticals, KAI Pharmaceuticals, Sanofi, Helsinn Pharmaceuticals, Regeneron, Novartis, AstraZeneca, and Orexigen; and lecture fees from AstraZeneca and Janssen Pharmaceuticals. Ohman reports receiving grant support and travel expenses from Daiichi Sankyo and Eli Lilly; consulting fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals, Liposcience, Merck, Pozen, Hoffman-La Roche, Sanofi, the Medicines Company, and WebMD; grant support from Gilead Sciences; and lecture fees from Gilead Sciences, Boehringer Ingelheim, and the Medicines Company. Disclosures for the coauthors are listed in the paper.

August 27, 2012 - Low vitamin D levels and bone mineral density may be risk factors for forearm fracture, according to results of a case-control study of 150 African American children, published online August 27 and in the September issue of Pediatrics.

"Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits," write Leticia Manning Ryan, MD, MPH, from the Children's National Medical Center in Washington, DC, and colleagues."

Forearm fractures are on the rise among children. The authors note they are unique injuries that have been associated with low bone mineral density in both adults and white children, but the links between bone mineral density, serum vitamin D status (25-hydroxvitamin D), and risk for forearm fracture have not been studied in African-American children.

Factors associated with risks for forearm fracture, such as poor dietary intake of calcium and dairy products, are more common in African American children than in white children, the authors note. African-American children are also more likely than white children to be obese - another demonstrated risk factor for forearm fractures.

"Although African American children may be a vulnerable subset of the pediatric population, the relationship between forearm fracture risk and bone health has not been investigated in this group," the authors write.

From December 2005 to May 2011, the authors recruited 150 African American children aged 5 to 9 years. About half (n = 76) had sustained forearm fractures; the other half (n = 74) had not.

The researchers measured height and weight, bone mineral density, and 25-hydroxvitamin D status in both groups of children. They interviewed the children and their parents to find out about the children's diets and to get sociodemographic data and medical history. They also asked about how much outdoor play time the children engaged in each week, using that quantified measure as a proxy for exposure to the sun.

The authors report that the 2 groups were the same in terms of age, sex, parental education levels, season of enrollment, and the amount of time they spent playing outdoors.

Children with fractures had lower whole-body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio, 0.38; 95% confidence interval [CI], 0.20 - 0.72) than children without fractures. Children with fractures also were more likely to be overweight (49.3% vs 31.4%; P = .03).

Compared with the control patients, children with fractures were also more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio, 3.46; 95% CI, 1.09 - 10.94), the authors report.

Another statistically significant difference in the 2 groups was that the children with fractures consumed more???

dietary calcium than children in the control group. However, the authors say, that probably reflects higher overall caloric intake in that group. In fact, the authors state, "when the daily calcium intake was expressed as a proportion of daily kilocalorie intake (as calcium nutrient density), there was no longer a significant difference present between the groups."

"To our knowledge," the authors write, "this is the first study in which the association between lower [bone mineral density] and increased odds of forearm fracture risk has been shown in African American children, a pediatric population that may be at higher risk for bone health deficiencies and fractures."

They say their results add to the growing body of literature suggesting that forearm fractures during childhood may be a marker of deficient bone health.

Limitations of the current study include single site design, lack of non–English speaking participants, potential recall and reporting bias, a greater number of subjects with asthma in the control group, and no measurement of pubertal status.

"Because forearm fracture rates in children are increasing and bone health status in childhood may directly impact adult bone health, opportunities to intervene during childhood???

should be pursued," they conclude.

This study is funded in part by the National Institutes of Health National Center for Research Resources, the Children's National Medical Center General Clinical Research Center, the Children's National Medical Center Board of Visitors, and the DC-Baltimore Research Center on Child Health Disparities. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 27, 2012.

BACKGROUND: Hormone therapy (HT) is widely used for controlling menopausal symptoms and has also been used for the management and prevention of cardiovascular disease, osteoporosis and dementia in older women.

This is an updated version of a Cochrane review first published in 2005.

OBJECTIVES:
To assess the effects of long term HT on mortality, cardiovascular outcomes, cancer, gallbladder disease, fractures, cognition and quality of life in perimenopausal and postmenopausal women, both during HT use and after cessation of HT use.

SEARCH METHODS: We searched the following databases to February 2012: Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO.

SELECTION CRITERIA: We included randomised double-blind studies of HT versus placebo, taken for at least one year by perimenopausal or postmenopausal women. HT included oestrogens, with or without progestogens, via oral, transdermal, subcutaneous or intranasal routes.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. We calculated risk ratios (RRS) for dichotomous data and mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). Where findings were statistically significant, we calculated the absolute risk (AR) in the intervention group (the overall risk of an event in women taking HT).

MAIN RESULTS: Twenty-three studies involving 42,830 women were included.

Seventy per cent of the data were derived from two studies (WHI 1998 and HERS 1998).

Most participants were postmenopausal American women with at least some degree of co-morbidity, and the mean participant age in most studies was over 60 years.

None of the studies focused on perimenopausal women.

In relatively healthy postmenopausal women (that is generally fit, without overt disease) combined continuous HT significantly increased the risk of a coronary event (after one year`s use: AR 4 per 1000, 95% CI 3 to 7), venous thrombo-embolism (after one year`s use: AR 7 per 1000, 95% CI 4 to 11), stroke (after three years` use: AR 18 per 1000, 95% CI 14 to 23), breast cancer (after 5.6 years` use: AR 23 per 1000, 95% CI 19 to 29), gallbladder disease (after 5.6 years` use: AR 27 per 1000, 95% CI 21 to 34) and death from lung cancer (after 5.6 years` use plus 2.4 years` additional follow-up: AR 9 per 1000, 95% CI 6 to 13).

Estrogen-only HT significantly increased the risk of venous thrombo-embolism (after one to two years` use: AR 5 per 1000, 95% CI 2 to 10; after 7 years` use: AR 21 per 1000, 95% CI 16 to 28), stroke (after 7 years` use: AR 32 per 1000, 95% CI 25 to 40) and gallbladder disease (after seven years` use: AR 45 per 1000, 95% CI 36 to 57) but did not significantly increase the risk of breast cancer.

Among women aged over 65 years who were relatively healthy and taking continuous combined HT, there was a statistically significant increase in the incidence of dementia (after 4 years` use: AR 18 per 1000, 95% CI 11 to 30).

Among women with cardiovascular disease, long term use of combined continuous HT significantly increased the risk of venous thrombo-embolism (at one year: AR 9 per 1000, 95% CI 3 to 29).

Women taking HT had a significantly decreased incidence of fractures with long term use (after 5.6 years of combined HT: AR 86 per 1000, 95% CI 79 to 84; after 7.1 years` use of estrogen-only HT: AR 102 per 1000, 95% CI 91 to 112).

Risk of fracture was the only outcome for which there was strong evidence of clinical benefit from HT.

There was no strong evidence that HT has a clinically meaningful impact on the incidence of colorectal cancer.

One trial analysed subgroups of 2839 relatively healthy 50 to 59 year old women taking combined continuous HT and 1637 taking estrogen-only HT versus similar-sized placebo groups. The only significantly increased risk reported was for venous thrombo-embolism in women taking combined continuous HT: their absolute risk remained low, at less than 1/500. However, other differences in risk cannot be excluded as this study was not designed to have the power to detect differences between groups of women within 10 years of the menopause.

AUTHORS' CONCLUSIONS:

• HRT is not indicated for primary or secondary prevention of cardiovascular disease or dementia,
• nor for preventing deterioration of cognitive function in postmenopausal women.
• Although HRT is considered effective for the prevention of postmenopausal osteoporosis, it is generally recommended as an option only for women at significant risk, for whom non-estrogen therapies are unsuitable.
• There are insufficient data to assess the risk of long term HRT use in perimenopausal women or postmenopausal women younger than 50 years of age.

BACKGROUND: People with no previous cardiovascular events or cardiovascular disease represent a primary prevention population.

The benefits and harms of treating mild hypertension in primary prevention patients are not known at present.

This review examines the existing randomised controlled trial (RCT) evidence.

OBJECTIVES: Primary

OBJECTIVE: To quantify the effects of antihypertensive drug therapy on mortality and morbidity in adults with mild hypertension (systolic blood pressure (BP) 140-159 mmHg and/or diastolic BP 90-99 mmHg) and without cardiovascular disease.

SEARCH METHODS:
We searched CENTRAL (2011, Issue 1), MEDLINE (1948 to May 2011), EMBASE (1980 to May 2011) and reference lists of articles. The Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE) were searched for previous reviews and meta-analyses of anti-hypertensive drug treatment compared to placebo or no treatment trials up until the end of 2011.

SELECTION CRITERIA: RCTs of at least 1 year duration.

DATA COLLECTION AND ANALYSIS: The outcomes assessed were mortality, stroke, coronary heart disease (CHD), total cardiovascular events (CVS), and withdrawals due to adverse effects.

MAIN RESULTS: Of 11 RCTs identified 4 were included in this review, with 8,912 participants.

Treatment for 4 to 5 years with antihypertensive drugs as compared to placebo did not reduce total mortality (RR 0.85, 95% CI 0.63, 1.15).

In 7,080 participants treatment with antihypertensive drugs as compared to placebo did not reduce coronary heart disease (RR 1.12, 95% CI 0.80, 1.57), stroke (RR 0.51, 95% CI 0.24, 1.08), or total cardiovascular events (RR 0.97, 95% CI 0.72, 1.32).

Withdrawals due to adverse effects were increased by drug therapy (RR 4.80, 95%CI 4.14, 5.57), ARR 9%.

AUTHORS' CONCLUSIONS:
Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs.
Treatment caused 9% of patients to discontinue treatment due to adverse effects.
More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms.

BACKGROUND: Treatment of hypertension in patients with diabetes mellitus (DM) has been shown to improve cardiovascular outcomes; however, the value of intensive blood pressure (BP) targets remains uncertain.

We sought to determine the effectiveness and safety of treating BP to intensive targets (upper limit of 130 mm Hg systolic and 80 mm Hg diastolic) compared with standard targets (upper limit of 140-160 mm Hg systolic and 85-100 mm Hg diastolic) in patients with type 2 DM.

METHODS Using electronic databases, bibliographies, and clinical trial registries, we conducted a systematic review and meta-analysis to identify randomized trials enrolling adults diagnosed as having type 2 DM and comparing prespecified BP targets. Data on study characteristics, risk for bias, and outcomes were collected. Random-effects models were used to pool relative risks and risk differences for mortality, myocardial infarction, and stroke.

RESULTS: The use of intensive BP targets was not associated with a significant decrease in the risk for mortality (relative risk difference, 0.76; 95% CI, 0.55-1.05) or myocardial infarction (relative risk difference, 0.93; 95% CI, 0.80-1.08) but was associated with a decrease in the risk for stroke (relative risk, 0.65; 95% CI, 0.48-0.86).

The pooled analysis of risk differences associated with the use of intensive BP targets demonstrated a small absolute decrease in the risk for stroke (absolute risk difference, -0.01; 95% CI, -0.02 to -0.00) but no statistically significant difference in the risk for mortality or myocardial infarction.

CONCLUSION:Although the use of intensive compared with standard BP targets in patients with type 2 DM is associated with a small reduction in the risk for stroke, evidence does not show that intensive targets reduce the risk for mortality or myocardial infarction.

People who use cholesterol-lowering statin drugs may benefit from a reduced risk of pancreatitis, a condition involving inflammation inside the pancreas, new research suggests.

Researchers at the University of Glasgow analysed the results of 28 previous clinical trials involving 190,000 patients.

Overall, they found that statins were associated with a 20 per cent reduction in the risk of pancreatitis in people with raised blood fat levels.

Conversely, another group of drugs called fibrates - which are commonly given to patients with elevated blood fat levels - were found to be associated with an up to 40 per cent increased risk of the condition.

It is thought that this may occur as a result of an increase in patients' chances of developing gallstones.

Dr. David Preiss, senior clinical lecturer fellow, said: 'Our research challenges the belief that fibrates are a good option for people with moderately raised blood fat levels.

'Statins appear to be a better option, not only because they reduce the risk of heart attacks but also because they may reduce pancreatitis risk.'

A spokesman for the British Heart Foundation welcomed the findings, which are published in the Journal of the American Medical Association.

Associate medical director Professor Jeremy Pearson described the research as 'one of several recent studies to underline the safety and effectiveness of statins'.

A device that traps blood clots and mechanically removes them from the blood vessel could help to restore blood flow to the brain in people who have suffered a stroke, research suggests.

Scientists have tested two innovative new mechanical flow restoration devices and believe they could significantly improve the treatment of stroke patients who are unable to benefit from drug treatment.

The devices consist of thin wires which are inserted through the groin into the affected blood vessel, where they trap and remove the blood clot responsible for the stroke and thereby open up the blockage.

According to the trial results, which are published in the Lancet medical journal, patient outcomes can be significantly improved by using the Solitaire or Trevo devices.

Writing in a comment piece in the Lancet, Philip Gorelick, from the Hauenstein Neuroscience Centre in the US, described the devices as 'major steps forward in the successful treatment of acute ischemic stroke'.

Dr. Clare Walton, a spokeswoman for the Stroke Association, commented that clot retrieval devices are better at removing blood clots than clot-busting drugs, which do not work for all patients.

She told the BBC: 'We are very excited about this potential new treatment and look forward to further developments.'

High doses of vitamin B3 may help to enhance the immune system's ability to fight infections, new research suggests.

Scientists at the Cedars-Sinai Medical Centre in the US discovered that high doses of the nicotinamide form of the vitamin stimulated a gene called CEBPE.

This in turn made white blood cells more capable of combating antibiotic-resistant staphylococcus infections, including methicillin-resistant Staphylococcus aureus (MRSA).

The findings, which are published in the Journal of Clinical Investigation, could have important implications as scientists want people to rely less on antibiotics in the future.

Dr. George Liu, a pediatric infectious disease doctor at Cedars-Sinai's Maxine Dunitz Children's Health Centre, described the findings are 'exciting'.

He added: 'Our research indicates this common vitamin is potentially effective in fighting off and protecting against one of today's most concerning public health threats.'

Vitamin B3 is found in a number of foods, including meat, fish, wheat and maize flour, eggs and milk.

The nutrient is also important for helping to produce energy from the foods we eat, as well as maintaining a healthy nervous and digestive system.

A significant proportion of Britons admit they would not know how to care for a person with dementia.

Research conducted by Bupa Care Homes revealed that 37 per cent of people would not know how best to support a friend or relative with the condition, which currently affects some 800,000 people in the UK.

Common worries include not understanding what lies ahead as the condition progresses and not knowing what to do in relation to the person's finances or legal affairs.

The poll of almost 2,000 adults, which was conducted by Ipsos Mori on behalf of Bupa, suggests that families need more advice on caring for a loved one with dementia.

To improve the situation, Bupa has launched a new 'Understand Dementia' hub which features a series of new films, as well as information on the condition.

Professor Graham Stokes, director of dementia care at Bupa Care Homes, revealed: 'When families bring a loved one to our care homes, they often tell us how they struggled for many years caring for them - sometimes on their own, with little support.

'Supporting families and friends of those living with dementia is important so I'm delighted we're launching the new hub, which can be a one-stop shop for information and advice.'

Jeremy Hughes, chief executive of the Alzheimer's Society, expressed his concern at the findings.

He insisted that getting a diagnosis of dementia need not be a frightening experience, adding that a 'huge' amount of support and information is available for those with dementia and their carers.

How much sodium do you consume each day? If you're like most Americans, it's a pretty safe bet you'll have eaten far more salt than current health guidelines recommend.

Nine out of 10 of us eat too much salt, and most of that isn't coming from the salt shaker, according to a recent report from the Centers for Disease Control and Prevention (CDC).

Why worry about salt?
Your body works to maintain a delicate balance of sodium and water. When we eat salt (sodium) the body pulls in or holds onto to extra fluid to keep this balance. The extra fluid increases blood volume. "If there's more fluid in your blood vessels, there's more circulating blood volume, and that raises blood pressure," explains Dr. Helen Delichatsios, assistant professor of medicine at Harvard Medical School. Having high blood pressure increases your risk for a heart attack or a stroke.

A study published in the journal Stroke linked high salt intake with an increased risk of stroke. Stroke risk increased for each additional 500 mg of salt the participants consumed a day. That's not hard to do. One ounce of processed American cheese has 422 mg of sodium!

How much you need
Our bodies need sodium, so salt itself isn't bad. It's the amount of salt we eat that's concerning.
The average American eats about 3,300 mg of salt daily, but U.S. guidelines recommend that most people get less than 2,300 mg of salt a day.
Those of us who are ages 51 or older should eat even less, keeping intake to 1,500 mg a day. That's just over 1/2 teaspoon of salt.
For more on developing healthy heart habits, purchase the Health Special Report from Harvard Medical School, Hypertension, with its special section "Conquering Your Salt Habit".

Where salt hides
The list of salty foods seems obvious: potato chips, popcorn, soup and other canned foods, hot dogs. Yet sodium lurks in foods you wouldn't expect. The CDC's list of top sodium offenders includes breads and rolls, pizza, poultry, sandwiches, cheese, and pasta dishes.
More than 40% of our daily sodium intake comes from go-to foods like these. Since sodium is everywhere, how can you cut back?
Start by reading food labels. Look at the amount of sodium per serving, and also at the percentages of daily recommended sodium allowance. Consider using products labeled "salt free" or "no salt added," or "low-sodium."
Try not to add sodium to the foods you eat. Other seasonings, such as garlic, cumin, and vinegar, can add flavor to your food without compromising your heart health. Avoid condiments such as soy sauce, ketchup, teriyaki sauce, and salad dressings, which tend to be loaded with sodium. At restaurants, ask to have your food prepared without salt.
Even if you've come to rely on salt to enhance the taste of your food, you can unlearn this unhealthy habit. "It is possible to train your taste buds, "Dr. Delichatsios says. "If you reduce your amount of salt over time, food won't taste bland to you."

August 17, 2012 - The US Food and Drug Administration (FDA) today approved the first generic version of pioglitazone hydrochloride (Actos, Takeda Pharmaceuticals) to improve blood glucose control in adults with type 2 diabetes.

Mylan Pharmaceuticals has received a green light from the FDA to market generic 15-mg, 30-mg, and 45-mg tablets of the best-selling drug. Use of the drug should be coupled with diet and exercise.

"Generic versions of this widely used product will offer Affordable treatment options for patients who must manage this chronic and potentially serious condition," said Gregory Geba, MD, MPH, director of the Office of Generic Drugs in the FDA's Center for Drug Evaluation and Research, in a press release.

• Pioglitazone comes with a boxed warning that states the drug can cause or exacerbate heart failure, especially in certain patient populations.

Consequently, clinicians should monitor patients when they start the drug or switch to a higher dose.

• In addition, using pioglitazone for more than 1 year might be linked to an increased risk for bladder cancer, according to the drug's label.

Adverse events most commonly reported by patients taking the drug include cold-like symptoms, headache, sinus infection, muscle pain, and sore throat.

More information about today's FDA announcement is available on the agency's Web site.

August 14, 2012 (Boston, Massachusetts) - Data from two prospective cohort studies have identified the ABO blood group as a risk factor for the development of coronary heart disease.

Individuals with blood groups A, B, or AB were 5% to 23% more likely to develop coronary heart disease compared with subjects with O blood type, and the associations were not altered by multivariate adjustment of other risk or dietary factors.

The analysis, led by Dr. Meian He(Harvard School of Public Health, Boston, MA), included 62073 women from the Nurses' Health Study (NHS) and 27428 men from the Health Professionals Follow-up Study (HPFS) and is published in the September 2012 issue of Arteriosclerosis, Thrombosis, and Vascular Biology.

In the NHS and HPFS, the incident rates of coronary heart disease per 100,000 person-years were 125, 128, 142, and 161 for women with type O, A, B, and AB, respectively, and 373, 382, 387, and 524 for men with type O, A, B, and AB, respectively.

Compared with individuals with O blood type, individuals with blood group A, B, or AB had a respective 5%, 11%, and 23% increased risk of developing coronary heart disease in an age-adjusted model.

These associations were not significantly altered in the multivariable-adjusted risk model.

Age-Adjusted Hazard Ratios (95% CI) for Coronary Disease by ABO Blood Type

The researchers also performed an analysis examining the risk of coronary heart disease in patients with non-O blood type.

Compared with individuals with O blood type, those with A, B, and AB had a 9% increased risk of developing coronary heart disease, and this risk was unaltered after adjustment for other risk factors.

Similarly, a combined analysis of NHS and HPFS with four other prospective studies, an analysis that included 114648 subjects, found there was a 6% increased risk of coronary heart disease for those with non-O blood type compared with individuals with O blood.

In total, just over 6% of the coronary heart disease cases were attributable to the A, B, or AB blood types, according to the researchers.

In terms of possible underlying mechanisms for the increased risk, He et al note that in non-O individuals, plasma levels of factor VIII-von Willebrand factor (vWF) are approximately 25% higher than in individuals with type O blood type.Elevated levels of factor VIII-vWF have been previously identified as a risk factor for coronary heart disease.

"The vWF has an important role in hemostasis and thrombosis by mediating platelet adhesion to the vascular wall, especially under high shear stress conditions," explain He and colleagues. "Along with fibrinogen, vWF also participates in platelet aggregation and plays a role in the development of atherosclerosis." In addition, the A blood group has been shown to have higher levels of total and LDL cholesterol.

References

1. He M, Wolpin B, Rexrode K, et al. ABO blood group and risk of coronary heart disease in two prospective cohort studies. Arterioscler Thromb Vasc Biol 2012; 32:2314-2320.

People who are obese and have other metabolic abnormalities such as high blood pressure may experience a faster rate of cognitive decline than their healthier counterparts, scientists have found.

Researchers at French research institute Inserm and University College London assessed 6,401 people, with an average age of 50 at the start of the study.

Participants' body mass index (BMI) and metabolic risk factors were recorded at the start of the study and their memory and other cognitive skills were assessed three times over a ten-year period.

Publishing their findings in Neurology medical journal, the study authors revealed that 31 per cent of participants had two or more metabolic abnormalities, such as high blood pressure, low HDL cholesterol, high blood sugar or high triglycerides.

They found that individuals who were both obese and had metabolic abnormalities experienced a 22.5 per cent faster rate of cognitive decline than those with a normal weight and no metabolic abnormalities.

However, even those obese people who were metabolically normal showed an accelerated rate of decline.

Study author Dr. Archana Singh-Manoux commented: 'More research is needed to look at the effects of genetic factors and also to take into account how long people have been obese and how long they have had these metabolic risk factors ... to give us a better understanding of the link between obesity and cognitive function.'

Jessica Smith, research officer at the Alzheimer's Society, described the study as 'robust'.

She said that the results back up existing evidence that obesity during mid-life increases a person's risk of developing dementia.

Consumers who want a natural drink to keep them hydrated while they exercise may want to consider coconut water.

A new study by scientists at Indiana University Southeast in the US suggests that the drink is ideal for those engaging in light exercise.

The researchers found that coconut water contains up to 1,500mg of potassium per litre, compared with up to 300mg per litre for two commercial sports drinks.

Potassium is important during exercise, as it helps to rid the body of muscle cramps, according to researcher Dr Chhandashri Bhattacharya.

Dr. Bhattacharya, who presented the findings at a national meeting of the American Chemical Society, said: 'Coconut water is a natural drink that has everything your average sports drink has and more.

'It's a healthy drink that replenishes the nutrients that your body has lost during a moderate workout.'

However, the researchers also found that coconut water is lower in sodium than commercial sports drinks, making it less suitable for those engaging in strenuous exercise, who lose more sodium when they sweat.

Coconut water is also a healthy option thanks to its low levels of fat, carbohydrates and calories.

The spouses of people who suffer a heart attack (AMI) need to be monitored for depression, a new study suggests.

Researchers at Duke University Medical Centre in the US found that spouses of heart attack patients face an increased risk of depression, anxiety and suicide after the event….. This even seems to be the case in instances where the heart attack patient survives.

Study author Dr.Emil Fosbol, who looked at data on tens of thousands of people in Denmark, revealed: 'We found that more than three times the number of people whose spouses died from an AMI were using antidepressants in the year after the event, compared with the year before.'

Among those whose spouse survived a heart attack, subsequent use of antidepressants was still 17 per cent higher than before the event.

Dr. Fosbol claimed that the findings, which are published in the European Heart Journal, suggest that the impact of an unexpected heart attack is similar to post-traumatic stress disorder for the partners of patients.

In light of this, healthcare services should 'consider the care needs for spouses too', he added.

Maureen Talbot, senior cardiac nurse at the British Heart Foundation, observed that a heart attack can affect the whole family.

'It is essential they receive the emotional and practical support they need during this often traumatic time,' she said.

A compound found in green tea could help to combat cancer when delivered directly to tumors, scientists have said.

Researchers at the University of Strathclyde in Glasgow discovered that by delivering an extract called epigallocatechin gallate directly to skin cancer lesions in the lab, they were able to shrink or eliminate the growths within one month.

Previous studies that used conventional intravenous delivery of the extract had failed to achieve these results.

But the new method of administration ensures that the chemical reaches the cancer and led to shrinkage in almost two-thirds of tumours.

Dr. Christine Dufes, a senior lecturer at the Strathclyde Institute of Pharmacy and Biomedical Sciences, commented: 'These are very encouraging results which we hope could pave the way for new and effective cancer treatments.

'This research could open doors to new treatments for what is still one of the biggest killer diseases in many countries.'

The findings are published in the journal Nanomedicine and could have important implications, as figures show that skin cancer is on the rise in the UK.

August 21, 2012 - Despite opposing results from early observational studies, a new meta-analysis suggests that statins may reduce the risk of developing pancreatitis among patients with normal to slightly elevated triglyceride levels.

Findings from the study, conducted by David Preiss, MD, PhD, from BHF Glasgow Cardiovascular Research Centre in the United Kingdom, and colleagues, were published in the August 22/29 issue of JAMA.

Patients with pancreatitis can experience a range of outcomes, from mild, self-limiting episodes to severe or fatal events. Hypertriglyceridemia is the third most common cause of pancreatitis, but the medicines prescribed to lower triglyceride levels carry their own worries. Studies have linked pancreatitis to use of statins, which, as a class, represented $20.1 billion in US sales last year, according to IMS Health, a healthcare information company.

In addition, fibrates, which are prescribed to patients with moderate to severe hypertriglyceridemia, may increase the risk for pancreatitis for patients whose triglyceride levels fall below 400 mg/dL, the threshold used for the prescribing guidelines.

Dr. Preiss and colleagues sought to determine the association between incident pancreatitis and lipid-lowering statins and fibrates by conducting meta-analyses of relevant, published and unpublished, large, randomized clinical trials.

The researchers included 28 randomized clinical trials (21 statin-related trials and 7 studies evaluating fibrates) that involved at least 1000 patients, with a minimum follow-up of 1 year. Unpublished data from the Helsinki Heart Study and its smaller ancillary study were included in the analysis.

Results From Statin and Fibrate Studies
Twenty-one randomized clinical trials of statin therapy provided data on 153,414 participants who were followed up for a mean of 4.3 years. Some 465 participants developed pancreatitis, of whom 204 were assigned statins (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65 - 0.95; I², 0%; P = .01) compared with 261 who received placebo.

In 7 randomized clinical trials of fibrate therapy involving 40,162 participants who were followed up for a mean of 5.3 years with baseline averages of triglycerides ranging from 145 to 184 mg/dL; 144 participants developed pancreatitis, of whom 84 were assigned fibrates (RR, 1.39; 95% CI, 1.00 - 1.95; I², 0%; P = .053)

"This report of pooled randomized trial data demonstrates that use of statin therapy was associated with a reduction in the number of patients developing pancreatitis," the authors write. "However, we did not demonstrate an association between use of fibrate therapy and risk of pancreatitis," they add.

Vijay P. Singh, MD, an assistant professor in the Division of Gastroenterology, Hepatology, and Nutrition at the University of Pittsburgh's School of Medicine in Pennsylvania, told Medscape Medical News it is "an interesting study."

"It simply says control your triglycerides and your risk of pancreatitis goes down," Dr. Singh said. "The statins are showing their benefit.... They're doing what they're supposed to do."

Dr. Singh questioned why Dr. Preiss and colleagues focused their discussion on a narrow band of slightly elevated triglyceride levels (145 - 184 mg/dL) when some of the studies' inclusion criteria admitted patients with levels as high at 750 mg/dL.

Focus on Pancreatic Cancer?
Although the authors suggest that their "hypothesis generating" results could be followed up with a trial comparing fibrates and statins for preventing pancreatitis in patients with severe hypertriglyceridemia, Dr. Singh says chronic pancreatitis also carries the risk of causing pancreatic cancer.

"Maybe they should look at pancreatic cancer," he told Medscape Medical News. "That is the thing that has no treatment and is a 99% killer."

Among the study's limitations, pancreatitis was not a prespecified end point in the trials, which had been designed to investigate the effect of lipid-modifying therapies on cardiovascular events. The study authors were unable to separate reports of pancreatitis into acute and chronic cases, and they lacked access to individual patient data. Because the trials under study tended to exclude patients with marked hypertriglyceridemia, the findings may not be generalizable to those patients.

"In those with slightly elevated triglyceride levels, statins appear better supported by the available data than fibrates for preventing pancreatitis," the authors conclude. "Lifestyle modifications also remain important to improve lipid profiles in such individuals."

Although the meta-analysis was not funded by external sources, one author received grant support from the British Heart Foundation and the majority of trials included in the meta-analysis were funded partly or wholly by industry. Authors report receiving honoraria from Pfizer; receiving consultant fees from Amgen Inc, Pfizer, Merck, Genzyme, Vascular Biogenics, ISIS, Boston Diagnostics, and AstraZeneca; receiving speakers' honoraria, honoraria for advisory board participation, consulting fees, or research or travel grants from Abbott/Solvay, Schering Plough, Pfizer Canada, Merck, AstraZeneca, Amgen, Roche, Sharpe & Dohme, Bristol-Myers Squibb, Eli Lilly, Pfizer, Solvay, and Novartis; participating in clinical trials funded by Pfizer; and being listed as a co-inventor on patents held by the Brigham and Women's Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease and diabetes that have been licensed to AstraZeneca and Siemens. Dr. Singh has disclosed no relevant financial relationships.

The sense of balance typically worsens with age. It can be further compromised by certain medical conditions and medications; uncorrected vision problems; or a lack of flexibility.

Poor balance often leads to falls, which can cause head and other disabling injuries. Hip fractures, in particular, can lead to serious health complications and threaten independence.

A combination of activities such as walking, strength training, and specific workouts can improve balance and prevent falls, especially in older adults.

Walking helps build lower-body strength, an important element of good balance. Walking is safe exercise for most people and, in addition to improving balance, counts toward your aerobic activity goals. If health problems make walking especially difficult for you, a physiatrist or physical therapist can suggest other options.

A good walking plan should be designed to safely boost physical activity whether you're sedentary or fairly active. The minutes count, not the miles.

Here's how to tailor a walking plan to your needs:
If you aren't in the habit of exercising, start at the beginning. If you normally use a cane or walker, be sure to do so. As you feel stronger and more comfortable, gradually add more minutes to your walks.

If you already exercise, start with a walking plan that best matches your current routine and build from there. If the plan seems too easy, add time, distance, or hills. Aim for at least 150 minutes of walking per week, but don't hesitate to add more.

For more information on improving balance and preventing falls, along with detailed exercise plans and routines, purchase Better Balance from Harvard Medical School.

Children who are given antibiotics in early life could face an increased risk of obesity in the future, new research suggests.

Scientists at NYU School of Medicine in the US looked at the effects of antibiotic use among 11,532 British children between 1991 and 1992.

They found that those given antibiotics before five months of age tended to have a higher body mass index (BMI) for their height in later childhood than those who were not.

By 38 months of age, children who had been given antibiotics in the first five months of life had a 22 per cent increased risk of being overweight.

However, when antibiotics were given between six and 14 months of age, there was no significant increase in body mass.

The findings, which are published in the International Journal of Obesity, suggest that very early exposure to antibiotics may be associated with an increased risk of becoming overweight.

'We typically consider obesity an epidemic grounded in unhealthy diet and exercise, yet increasingly studies suggest it's more complicated,' said Dr Leonardo Trasande, associate professor of paediatrics and environmental medicine at the NYU School of Medicine.

'Microbes in our intestines may play critical roles in how we absorb calories and exposure to antibiotics, especially early in life, may kill off healthy bacteria that influence how we absorb nutrients into our bodies and would otherwise keep us lean.'

Men who regularly lift weights may benefit from a reduced risk of developing type-2 diabetes, new research suggests.

Scientists at the Harvard School of Public Health looked at the links between weight training and diabetes risk in more than 32,000 men.

Participants were assessed every two years over an 18-year period, during which time there were 2,278 new cases of type-2 diabetes.

The researchers found that men who did weight training for at least 150 minutes per week benefited from a 34 per cent reduced risk of type-2 diabetes, compared with those who did none.

In addition, men who did aerobic exercise for at least 150 minutes per week benefited from a 52 per cent reduction in risk.

Writing in the Archives of Internal Medicine, the study authors concluded that weight training 'serves as an important alternative for individuals who have difficulty adhering to aerobic exercise'.

Further research is now needed to determine the optimum amount of weight training for diabetes risk reduction, as well as to find out whether women enjoy the same benefits as men.

An Australian research team claims to have made a breakthrough in the search for a vaccine against malaria.

Scientists at the Burnet Institute discovered that people with a 'natural' immunity to malaria develop antibodies that target a protein called PfEMP1.

This protein is produced by the organism responsible for most cases of malaria, Plasmodium falciparum.

Senior author Professor James Beeson, head of the institute's Centre for Immunology, said that the findings - which are published in the Journal of Clinical Investigation - represent a major advance, as it may be possible to develop a vaccine that targets this protein.

'A vaccine against malaria is urgently needed to reduce this disease globally and currently there is no licensed malaria vaccine available,' the professor noted.

'The new findings support the idea that a vaccine could be developed that stimulates the immune system so that it specifically mounts a strong response (or attack) against the PfEMP1 protein that malaria produces.'

Malaria mainly affects people living in Africa, south and central America, Asia and the Middle East, although UK travellers who do not take anti-malaria medicines when visiting these areas are at risk.

People with certain blood types may have a higher risk of developing heart disease than those with other groups, a study has found.

Researchers at the Harvard School of Public Health in Boston analyzed data on more than 89,000 men and women, aged 30 to 75, who had participated in one of two large studies in the US.

They found that people with blood type AB - the rarest type - had a 23 per cent increased risk of coronary heart disease, compared with type O. Blood type B was associated with an 11 per cent increase in risk; and type A carried a five per cent increased risk.

The findings are published in the journal Arteriosclerosis, Thrombosis and Vascular Biology and suggest that a person's blood type could give an indication of their cardiovascular risk.

Senior study author Dr. Lu Qi said: 'It's good to know your blood type the same way you should know your cholesterol or blood pressure numbers.

'If you know you're at higher risk, you can reduce the risk by adopting a healthier lifestyle, such as eating right, exercising and not smoking.'

Around 44 per cent of people in the UK are blood type O, compared with just four per cent who are blood type AB.

Taking up weight lifting could help guard against the possible onset of type 2 diabetes, it has been revealed.

With millions of people around the world tuning in to watch weight-lifters go for gold in London, research has shown that taking up the discipline can reduce the risk of developing the condition by up to a third.

Furthermore, according to the study carried out at the Harvard School of Public Health and the University of Southern Denmark, combining weight training with regular bouts of aerobic exercise can reduce the risk by as much as 66 per cent.

While such a boost was only noted when participants carried out 150 minutes of weights and 150 minutes of other exercise per week, the team are confident that even those people who aren't dedicated athletes can enjoy the benefits.

'This study provides clear evidence that weight training has beneficial effects on diabetes risk over and above aerobic exercise, which are likely to be mediated through increased muscle mass and improved insulin sensitivity,' Professor Frank Hu wrote in the journal Archives of Internal Medicine.

At the London Games, Behdad Salimikordasiabi won gold in the super-heavyweight weight-lifting competition, making him the strongest man of 2012.

People with low back pain may benefit from attending group yoga classes and the approach could be a cost-effective use of NHS resources, new research suggests.

Scientists at the University of York studied the effects of a 12-week group yoga programme to see whether it was more effective than standard GP care at relieving chronic or recurrent low back pain.

A total of 156 patients took part in the yoga classes that focussed on improving back function, while a further 157 people received standard care.

The researchers found that yoga participants had fewer days off work (four days, on average) as a result of back pain than those in the control group (12 days).

The cost associated with time off work was just $374 per yoga group member, compared with $1,202 for those receiving standard care.

Overall, the researchers concluded that if the cost of offering specialist yoga could be maintained at less than $300 per patient for 12 classes, then the approach would be cost-effective.

Chief investigator Professor David Torgerson, from York's Department of Health Sciences, said: 'While yoga has been shown as an effective intervention for treating chronic and low back pain, until now there has been little evidence on its cost-effectiveness.

'We conclude that 12 weekly group classes of specialised yoga are likely to provide a cost-effective intervention for the treatment of patients with chronic or recurrent low back pain.'

The study is published in Spine journal and was funded by Arthritis Research UK, whose medical director, Professor Alan Silman, welcomed the findings.

'We'd hope that on the back of this, more people with back pain are encouraged to take up the yoga programme,' he added.

NEW YORK (Reuters) Aug 09 - A controversial experimental cure for type 1 diabetes, using a tuberculosis vaccine invented nearly a century ago, appeared to temporarily vanquish the disease in a handful of patients, according to a report from a scientist long criticized by her peers.

There is no guarantee the results from this early-stage trial, published on Wednesday in PLoS One, will stand up in larger studies, which are now under way. Other diabetes researchers criticized it for going beyond the evidence in its claims about what caused the observed effects.

If the findings do hold up, however, they would mean that the generic bacillus Calmette-Guerin (BCG) vaccine, in use since 1921, can regenerate insulin-secreting cells in the pancreas.

"We think we're seeing early evidence of effectiveness," said immunology researcher Dr. Denise Faustman of Massachusetts General Hospital, who led the trial. "This simple, inexpensive vaccine attacks the autoimmunity underlying type 1 diabetes."

"We found that even low doses of the vaccine could transiently reverse type 1 diabetes, and this was in patients who have had the disease for 15 years," Dr. Faustman said. The effect lasted for about one week. "Our measurements showed that autoimmune T cells that destroy the islet cells died, and we saw evidence that insulin production was restored."

Other diabetes experts have doubts. "There is a bit of magical thinking here," said Dr. Domenico Accili of the Naomi Berrie Diabetes Center at Columbia University Medical Center. The idea that BCG wipes out autoimmune cells "is totally unproved."

The study is nevertheless within the mainstream of current efforts to cure diabetes, said cellular immunologist Dr. Raphael Clynes of the Berrie Center, who was not involved in the research.

"Folks had presumed that by the time patients had overt diabetes, all their islet cells had been destroyed," Dr. Clynes said. "We now know there are preserved islet cells many years out. The presumption is, if you can get rid of the inflammatory, autoimmune response, the islet cells could regenerate."

Faustman's research on lab mice, begun in the 1990s, suggested that one way to get them to regenerate was with tumor necrosis factor. TNF is difficult to obtain commercially, but the BCG vaccine increases the body's production of it.

Raising levels of TNF through the vaccine cured type 1 diabetes in mice, Dr. Faustman reported a decade ago: With the autoimmune T cells out of the picture, islet cells regenerated and began producing healthy amounts of insulin. The journal that published the study insisted Dr. Faustman not use the word "regeneration," so controversial was the idea that islets could come back to life. She substituted "restoration."

By 2006, other scientists - including some who had attacked Dr. Faustman's claims of regeneration - had replicated key findings of her mouse studies, laying the foundation for the clinical trial.

Three patients with longstanding diabetes received two injections of BCG, four weeks apart. Three others received saline injections.

In two of the three BCG patients, levels of islet-attacking T cells fell, the scientists reported on Wednesday. Dead autoimmune cells were released into the bloodstream, a hint that TNF was killing them as intended. A measure of insulin production rose. The only placebo patient with similar results had become infected with the Epstein-Barr virus, which also triggers production of TNF.

The scientists also reported marked increases in C-peptide levels, a marker of the body's own insulin production. (They did not measure insulin itself because insulin made by the pancreas cannot be distinguished from the injected form.) "It wasn't to the level where they could throw away their syringe, but it was a significant elevation," said Dr. Faustman. "And this was in patients 15 years out: Their islet cells weren't dead, as most people said."

The restored insulin production lasted only a week. In the trial for which Dr. Faustman is recruiting the first of hundreds of patients she therefore plans to give more frequent BCG shots.

Dr. Faustman has already faced significant challenges to her theory. The Juvenile Diabetes Research Foundation rejected her funding requests and circulated a 2003 letter from two of her colleagues at Harvard Medical School, casting doubt on her work and apologizing to diabetics for "having their expectations cruelly raised" by stories about her research.

Reaction to this study was not much better. "The paper shows that BCG is associated with a transient improvement in a couple of patients, but it's hard to conclude that TNF is the causative factor," said Columbia's Dr. Clynes.

"It's certainly interesting and worth further investigation," said JDRF Chief Executive Jeffrey Brewer. "But it's really important to be careful about how we interpret early results." Curing type 1 diabetes may finally be within reach, he said, "but it will be a marathon, not a sprint."

Dr. Faustman's team says the study was funded "by philanthropic grants only."

Compounds in cocoa may help to bring down people's blood pressure, scientists say.

Researchers in Melbourne and Adelaide reviewed 20 trials involving 856 people, all of which had looked at the effects of eating dark chocolate or cocoa powder.

They found that people who were given a daily serving of dark chocolate or cocoa powder for up to eight weeks typically benefited from a slight fall in blood pressure.

The findings are published in the Cochrane Library and suggest that the antioxidant flavanol compounds found in cocoa may help to reduce blood pressure, potentially by boosting levels of nitric oxide which relaxes the blood vessel walls.

Lead researcher Karin Ried, from the National Institute of Integrative Medicine in Melbourne, said: 'Although we don't yet have evidence for any sustained decrease in blood pressure, the small reduction we saw over the short term might complement other treatment options and might contribute to reducing the risk of cardiovascular disease.'

The study follows recent research in Circulation journal, which found that a daily serving of flavanol-rich cocoa could help to protect neurons in the brain and reduce the risk of mild cognitive decline.

BMJ. Published online August 7, 2012.

August 8, 2012 - Embedding balance and strength movements into everyday activities such as "carrying the groceries from the car to the porch while walking sideways" may help older people prevent falls and improve overall strength and balance, according to a study published online August 7 in the British Medical Journal.

Lindy Clemson, PhD, head of occupational therapy in the Faculty of Health Sciences, University of Sydney, New South Wales, Australia, and colleagues conducted a 3-group randomized trial in which residents of Sydney older than 70 years who had 2 or more falls or 1 injurious fall within the previous year were recruited and randomly assigned to one of the following interventions: a novel activity-integrated exercise program called Lifestyle integrated Functional Exercise (LiFE), a structured exercise program, or a gentle exercise control program. Exclusion criteria included "moderate to severe cognitive problems, inability to ambulate independently, neurological conditions that severely influenced gait and mobility, resident in a nursing home or hostel, or any unstable or terminal illness that would affect ability to do exercises."

The researchers recruited 317 people in Sydney between February 2006 and December 2007 and then randomly assigned 107 participants to the LiFE program, 105 to the structured program, and 105 to the gentle exercise program. They performed follow-up at 6 months and 12 months after study participants started their programs. Participants reported any falls they experienced on daily calendars that were mailed monthly to the researchers; weekly exercise logs to assess adherence were also mailed in each month.

"The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90 in the structured programme and 2.28 in the control group," the researchers write.

"We recorded a clinically important reduction of 31% in the rate of falls for participants in the LiFE programme compared with the control programme (incidence rate ratio 0.69 (95% confidence interval 0.48 to 0.99), n=212)." They did not find a significant reduction in falls between the structured and the control group.

During the trial, as recorded at the 12-month follow-up, participants in the LiFE group experienced 172 falls, participants in the structured group experienced 193 falls, and participants in the control group experienced 224 falls. LiFE participants also showed improvements in balance, ankle strength, daily activity measures, and adherence rates.

Rather than a structured program, LiFE movements can occur at any time and be incorporated into normal daily activities such as "ironing while standing on one leg, talking on the phone while heel standing...[and] squatting in the supermarket to select an item from a lower shelf rather than bending," the researchers write. During the trial, LiFE and structured groups received 5 instructional sessions with 2 booster visits, plus 2 telephone calls during a 6-month time frame and a program manual. The control group received 3 visits and 2 calls.

The control group receiving less visit time could be a limitation to the study, the researchers write, and the number of participants was less than they preferred. Nonetheless, "The LiFE program provides an additional choice to traditional exercise and another fall prevention programme that could work for some people."

In addition, the researchers conclude, "[I]t challenges allied health professionals to expand their focus when working with older people to find opportunities to incorporate balance and strength training into daily life."

In an accompanying editorial, Meg E. Morris, PhD, from the Department of Physiotherapy at the University of Melbourne, Victoria, Australia, writes, "The current trial suggests that for fall prevention programmes in older people to be effective, therapeutic exercises, education, and physical activities need to be sustainable, enjoyable, and effective over the long term. … The belief that falls should be accepted and tolerated as part of the ageing process is a myth that needs dispelling. Many falls can and should be prevented."

This study was supported by a grant from the National Health and Medical Research Council. The authors and the editorialist have disclosed no relevant financial relationships.

Diabetes sufferers who are overweight, or even obese, when they are diagnosed with the condition generally tend to live longer than those people who are of a normal, healthy weight when diagnosed.

That's the surprise conclusion of a new study into the link between a person's weight and their life expectancy when living with diabetes, with the scientists involved labelling it an 'obesity paradox'.

Publishing their findings in the Journal of the American Medical Association, the team from Northwestern University in Chicago explain that a higher BMI may serve to protect the body from the effects of diabetes, though the reason behind this is still unknown.

'If you are normal weight, you may be at higher risk from diabetes, especially if your fitness status is not so good,' noted study leader Dr. Hermes Florez.

However, the experts were also keen to advise people to always strive to stay in good shape, regardless of whether they have been diagnosed with type 2 diabetes or not.

According to Diabetes UK, type 2 diabetes accounts for up to 95 per cent of all instances of the condition, with people over the age of 40 at greatest risk of developing this.

Lancet Oncol. 2012;13:817–26, 750-751. Abstract, Editorial

August 6, 2012 - A new biomarker for diagnosing hepatocellular carcinoma (HCC) - especially early-stage disease - has "great potential," according to Chinese researchers who have published a new study in the August edition of Lancet Oncology.

The marker, known as Dickkopf-1 (DKK1), can be measured in the blood. It has previously been shown to be minimally expressed in normal tissue and over-expressed in hepatocellular carcinoma (HCC) tissue, say the authors, led by Qiujin Shen, MD, of the Shanghai Jiao Tong University School of Medicine in China.

HCC is the third leading cause of cancer death worldwide and has a "dismal" outcome, with a 5-year survival rate of only 3% to 5%, they point out. The cancer is typically diagnosed after symptoms develop.

Thus, there is a great need for tools to diagnose the disease early, especially among high-risk candidates such as patients with chronic liver disease.

The current standard for surveillance of high-risk patients is abdominal ultrasound, according to an editorial that accompanies the study.

But this approach has great limitations, including the need for "state-of-the-art equipment" and "expert assessment of images," say editorialists Alejandro Forner, MD, of the University of Barcelona, and Jordi Bruix, MD, of the Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas in Spain.

Tumor biomarkers are "attractive potential alternative tools," say the pair, because they are noninvasive and objective.

But DKK1 has "a long way to go" before it can be a diagnostic or screening tool, they say.

Nevertheless, in the new retrospective study of 424 HCC patients and 407 non-HCC control participants from Chinese centers, Dr. Shen and colleagues made some important progress.

They confirmed that levels of DKK1 were "significantly higher" in patients with HCC than in control participants. They also showed that serum DKK1 was better than another marker currently used in these patients, serum α-fetoprotein (AFP), in tumors that had already been detected by imaging, histopathology, or both.

The specificity of DKK1 was 85% to 90% across subanalyses, which is well short of the 100% specificity that is desired for cancer diagnosis markers, but DKK1 might nonetheless be a good surveillance tool in patients at risk for the disease, according to the editorialists.

The marker "might be acceptable for surveillance, since high sensitivity is preferred to high specificity to avoid excessively high false-negative rates," they write.

The marker now has some "appealing data" but still "needs further investigation before it can be accepted in practice guidelines," they write.

One of the needs to be addressed in a validation study is related to establishing a baseline DKK1 measurement, which was not done in the new study, say the editorialists. "Sera collected in studies at baseline and during follow-up in patients undergoing screening will be instrumental to test whether measurement of DKK1 in serum can detect HCC before imaging," they write.

The study authors also offer an important caveat about the new findings - that they may be specific to the Chinese. "We based our study in clinical centres in China where most cases of HCC are related to cirrhosis or HBV infection. This pattern differs from that in the USA, Europe, and Japan. Thus, the diagnostic value of DKK1 still needs further investigation," they write.

Study Details
Culling patients from a number of Chinese centers, the investigators looked at DKK1 in the main test cohort as well as a validation cohort of 209 patients with HCC, 73 with chronic HBV infection, 72 with cirrhosis, and 99 healthy control participants.

Using receiver operating characteristics (ROC) curves, they showed that the optimum diagnostic cutoff was 2.153 ng/mL (area under curve [AUC], 0.848; 95% confidence interval [CI], 0.820 - 0.875); sensitivity was 69.1%, and specificity 90.6% in the test cohort, with similar figures in the validation cohort. Also, there were similar results for early-stage HCC in both cohorts.

DKK1 maintained diagnostic accuracy for patients with HCC who were AFP-negative in terms of the AUC, sensitivity, and specificity: 0.841 (95% CI, 0.801 - 0.882], 70.4%, and 90.0% in the test cohort; there were similar findings in the validation cohort. Again, this also held true for early-stage HCC. This finding is important, say the authors, because 30% to 40% of all patients with HCC are AFP-negative, which makes diagnosis and assessment of treatment response "difficult." However, "combined testing of DKK1 and AFP concentrations in serum could improve results," they write.

Raised concentrations of DKK1 in serum allowed for a differentiation of HCC from chronic HBV infection and cirrhosis for the 3 measures in the test cohort: 0.834 [95% CI, 0.798 - 0.871], 69.1%, and 84.7%; there were similar findings in the validation group.

This is important because the researchers found that in most AFP-positive patients with chronic HBV infection or cirrhosis, results were negative for DKK1. Thus, "patients with these chronic non-malignant diseases could be distinguished from those with HCC," they point out.

This is no small clinical issue, the authors suggest. Around 2 billion people have been infected with HBV worldwide, and about 350 million have chronic infections. AFP concentrations are raised in 11% to 58% of patients with chronic hepatitis or cirrhosis in the absence of HCC. "Therefore, measurement of DKK1 in serum can help to make a differential diagnosis of HCC in patients in these high-risk populations," the authors say.

The study was funded by the National Key Basic Research Programme of China, the National Key Sci-Tech Special Projects of Infectious Diseases, the National Natural Science Foundation of China, and the Research Fund for the Doctoral Programme of Higher Education of China. The authors of the study and the editorialists have disclosed no relevant financial relationships.

The World Health Organisation (WHO) has taken the opportunity of World Hepatitis Day (July 28th) to urge governments to step up their efforts to tackle viral hepatitis.

Around one million people die from the infection each year, while a further 500 million are thought to have chronic illness as a result of the virus, which can lead to liver cancer and cirrhosis.

Dr. Sylvie Briand, a spokeswoman for WHO's Pandemic and Epidemic Disease Department, revealed: 'The vast majority of people infected with hepatitis are unaware, undiagnosed and untreated.

'Only by increasing awareness of the different forms of hepatitis, and how they can be prevented and treated, can we take the first step towards full control of the disease and save thousands of lives.'

WHO is launching a new global framework in a bid to tackle the disease, including efforts to raise awareness, transform scientific evidence into policy and action, prevent transmission and improve screening, care and treatment.

Hepatitis types B and C are the leading causes of liver cirrhosis and cancer and spread via infected blood or unprotected sex.

According to the British Liver Trust, one in 12 people are living with either hepatitis B or C.

August 6, 2012 - Honey is more effective than a placebo in controlling nighttime cough in children with upper respiratory infections (URI), according to the results from a new randomized placebo-controlled, double-blind trial. The results were published online August 6 in Pediatrics.

The World Health Organization recommends honey as a nighttime treatment for coughing in young children with URIs. However, prior studies either tested only a single type of honey or were not blinded.

In the current study, children with URIs and nocturnal cough were given either 1 of 3 different honey products or a placebo 30 minutes before bedtime, based on a double-blind randomization plan.

The primary outcome evaluated was a subjective change in cough frequency, based on parent surveys.

Secondary outcomes measured included a change in cough severity, the effect of the cough on sleep for both the child and the parent, and the combined score on the pre- and post-intervention surveys.

Herman Avner Cohen, MD, from the Pediatric Ambulatory Community Clinic, Petach Tikva, Israel, and colleagues compared symptom scores for each treatment group before and after the intervention and found that patients in all 3 honey groups demonstrated significant improvement compared with patients treated with placebo. There were no significant differences among the different types of honey.

"The results of this study demonstrate that each of the 3 types of honey (eucalyptus, citrus, and labiatae) was more effective than the placebo for the treatment of all of the outcomes related to nocturnal cough, child sleep, and parental sleep," the authors write.

The researchers enrolled 300 children with URIs, aged 1 to 5 years, who were seen at 1 of 6 general pediatric community clinics between January 2009 and December 2009. Patients were eligible if they had a nocturnal cough attributed to the URI. Children were excluded if they had symptoms of asthma, pneumonia, laryngotracheobronchitis, sinusitis, and/or allergic rhinitis. Patients who used any cough or cold medication or honey in the previous 24 hours were also excluded.

Parents were asked to evaluate the children the day of presentation, when no medication had been given, and then again the day after a single dose of 10 g of eucalyptus honey, citrus honey, labiatae honey, or placebo (silan date extract) had been administered before bedtime. Pre- and post-intervention subjective assessments were obtained using a 5-item Likert-scale questionnaire regarding the child's cough and sleep difficulty. Only those children whose parents rated severity as at least a 3 (on a 7-point scale) for at least 2 of the 3 questions related to nocturnal cough and sleep quality on the pre-intervention questionnaire were included.

Of the 300 patients enrolled, 270 (89.7%) completed the single-night study. The median age of these children was 29 months (range, 12 - 71 months). There was no significant age difference among the treatment groups. Symptom severity was also similar among all 4 treatment groups.

Adverse events were reported for 5 patients and included stomachache, nausea, and vomiting and were not significantly different between the groups.

The authors acknowledge the limitations of the study, including the subjective nature of the survey and the fact that the intervention period was limited to a single dose. In addition, they note that some of the improvement measured may be attributed to the natural progression of URIs, which may improve with supportive care and time.

"On the basis of our findings, honey can be offered as an alternate treatment to children >1 year of age," note Dr. Cohen and colleagues.

"Honey may be a preferable treatment of cough and sleep difficulties associated with childhood URI," they conclude.

Funding for this study was provided by a research grant from the Israel Ambulatory Pediatric Association, Materna Infant Nutrition Research Institute, and the Honey Board of Israel. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 6, 2012. Madden article, McNally article, Editorial

August 6, 2012 - According to 2 recent studies, two thirds of children admitted to pediatric intensive care units (PICUs) may be deficient in vitamin D, which may make them vulnerable to more severe illness. The studies were published online August 6 in Pediatrics.

The first study was conducted by Kate Madden, MD, an assistant in critical care medicine in the Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine at Children's Hospital Boston and the Department of Anesthesia at Harvard Medical School in Boston, Massachusetts, and colleagues.

Dr. Madden and coauthors analyzed the vitamin D levels of 511 severely or critically ill children who were admitted to the PICU from November 2009 to November 2010 to determine the prevalence of vitamin D deficiency in severely ill children and determine factors that influence admission 25-hydroxy vitamin D (25(OH)D) levels.

Vitamin D deficiency is common in critically ill adults and is associated with sepsis and more severe critical illness, but the associations between vitamin D deficiency and pediatric critical illness have not yet been determined.

The children had 25(OH)D levels analyzed on blood that was taken as soon after PICU admission as possible, either by drawing fresh blood or by testing leftover plasma that was refrigerated in the hospital laboratory. Severity of illness was determined within the first 24 hours by using the Pediatric Risk of Mortality III score.

The median 25(OH)D level of the children studied was 22.5 ng/mL (interquartile range [IQR], 16.4 - 31.3 ng/mL), 71.2% of the patients had insufficient 25 (OH)D (<30 ng/mL), and 40.1% were 25(OH)D deficient (10 - 19.9 ng/mL in 33.1% and <10 ng/mL in 7%).

A total of 13 (2.5%) children died during hospitalization, and the median 25(OH)D level was 19.4 ng/mL (IQR, 16.6 - 31.4 ng/mL).

Serum 25(OH)D levels were considerably lower in the 51 children who had severe septic shock but were not associated with the primary reason for PICU admission. Patients with lower respiratory tract infection had the same median 25(OH)D levels (22.5 ng/mL) as patients without.

Almost half (46.6%; n = 238) of the patients were admitted with life-threatening infections, and 25(OH)D levels were not lower in this group unless they had septic shock (n = 51, 10.0%; median 25(OH)D level, 19.2 ng/mL [IQR, 12.6 - 24.8 ng/mL]; P = .0008).

In multinomial logistic regression analysis, lower admission 25(OH)D levels were associated with higher illness severity on the Sequential Organ Failure Assessment cardiovascular (CV-SOFA) tool, with a 5 ng/mL decrease in 25(OH)D corresponding to a 1.13-fold increase in odds of placing in the next higher category of CV-SOFA score (95% confidence interval [CI], 1.01 - 1.27; P = .03). This relationship continued after adjusting for severe septic shock (OR, 1.16; 95% CI, 1.02 - 1.31; P = .02).

Multivariate analysis found a correlation between age and race and vitamin D deficiency, with school-age children and those with dark skin being more likely to have low 25(OH)D levels.

Factors that were protective included vitamin D supplementation, formula intake, and summer season.

"We hypothesize that higher 25(OH)D levels may decrease the severity of critical illness brought on by an overwhelming insult such as infection or injury," the authors write.

"Given the high rate of vitamin D deficiency in critically ill children and the essential role of vitamin D in healthy bone development, we recommend screening critically ill children with risk factors for vitamin D deficiency and identifying effective repletion strategies," the authors write.

Lower Levels Associated With More Severe Illness

The second study was conducted by J. Dayre McNally, MD, PhD, a pediatric intensivist in the Department of Pediatrics at Children's Hospital of Eastern Ontario and an associate investigator at Children's Hospital of Eastern Ontario Research Institute in Ottawa, Ontario, Canada, and colleagues.

The researchers conducted a secondary analysis of data collected during a prospective cohort study from 2005 to 2008 in 7 tertiary-care PICUs in Canada (Adrenal Insufficiency in Pediatric Critical Illness Study [AIP]). For this study, data from only 6 centers were studied, as 1 center declined permission.

For the 326 patients, the mean total 25(OH)D (D2 + D3) was 43.2 nmol/L (SD, 19.4). The mean 25(OH)D2 was 3.2 nmol/L (SD, 1.6), and the mean 25(OH)D3 was 40.2 nmol/L (SD, 19.5).

The prevalence of vitamin D deficiency (25(OH)D2 plus 25(OH)D3 < 50 nmol/L) among the children was 69% (95% CI, 64% - 74%). Another 23% (95% CI, 19% - 28%) had a concentration between 50 and 75 nmol/L.

Lower mean 25(OH)D levels were found in patients requiring catecholamine infusion (45 ± 19 nmol/L vs 38.5 ± 16 nmol/L; P = .006) and more than 40 mL/kg fluid bolus on the day of PICU admission (44.7 ± 19.6 nmol/L vs 34.5 ± 18.5 nmol/L; P = .001).

Patients who were mechanically ventilated had lower 25(OH)D levels compared with patients who did not require mechanical ventilation (47.2 ± 19.9 nmol/L vs 41.7 ± 19.1 nmol/L; P = .02).

25(OH)D levels were significantly lower in patients with at least 1 hypocalcemic episode compared with patients with normal or minimally reduced calcium levels (51.0 ± 20.6 nmol/L vs 36.6 ± 15.9 nmol/L; P = .001).

The researchers found no significant relationship between 25(OH)D levels and serum albumin (Spearman correlation coefficient, −0.08; P = .48). There was a moderate association between albumin and preexisting illness (Spearman correlation coefficient, 0.57; P < .001).

Multivariate regression analysis showed that a 25(OH)D level less than 50 nmol/L was independently associated with a PICU stay of an additional 1.92 days (95% CI, 0.2 - 3.7; P = .03) and an increasing illness severity, as measured by the Pediatric Risk of Mortality tool.

"[T]his study provides evidence that critically ill children commonly have 25(OH)D concentrations <50 nmol/L and that lower levels are associated with hypocalcemia, catecholamine need, significant fluid bolus administration, and longer length of stay. Subsequent prospective interventional trials are required to establish whether rapid restoration of vitamin D body stores has an impact on critical illness disease course and outcome," the authors write.

Steven A. Abrams, MD, a professor of pediatrics at Baylor College of Medicine and an attending physician in the Section of Neonatology at Texas Children's Hospital in Houston, and Jorge A. Coss-Bu, MD, an associate professor in the Section of Critical Care Medicine at Baylor College of Medicine and an attending physician at Texas Children's Hospital, commented on the studies in an accompanying editorial.

These data support programs and interventions aimed at preventing vitamin D deficiency, they write, adding that, "at a minimum, comprehensive efforts to ensure that children receive at least the recommended intake of vitamin D (400 IU/day for infants, 600 IU/day for children aged > 1 year) should be developed and emphasized."

They continue, "[T]hese studies move forward and to the front concerns regarding vitamin D status in critically ill children. They do not yet tell us the best way of assessing or treating low serum 25(OH)D levels in a PICU setting but point us to a program of public health and research on this topic, with clear identification of final outcomes and their clinical significance, focusing on both efficacy and safety of any proposed interventions."

One study author serves as a consultant for Diasorin Inc. The other authors and editorialists have disclosed no relevant financial relationships.

A novel topical spray containing human skin cells could help to accelerate the healing process for leg ulcers, research suggests.

The spray, currently known as HP802-247, contains a unique formula of living human cells which coat the open wound and release growth factors.

Researchers in the US and Canada have conducted a phase-II clinical trial with the treatment, which involved 228 patients over a 12-week period.

The trial found that it achieved a 52 per cent greater likelihood of wound closure than compression bandages alone.

Study author Dr William Marston, professor of surgery at the University of North Carolina School Of Medicine, said: 'In the past, some chronic venous leg ulcers were treated with skin grafts, which occasionally could break down and also required the patient to heal a partial thickness wound at the skin graft harvest site.

'During this study, unique living cells were sprayed on the patient's wound, which interacted with the patient's cells for improved wound healing.'

The findings are published in the Lancet medical journal and will lead to a phase-III clinical trial in the near future.

People who lose just a modest amount of weight can achieve health benefits that last a decade, even if they regain the weight during that time, research has found.

Scientists at Brown University in the US studied 3,000 overweight people, all of whom had impaired glucose tolerance and were advised to make lifestyle changes.

They found that losing an average of 14lb reduced people's changes of developing type-2 diabetes by 58 per cent.

Importantly, the benefits of this level of weight loss for participants' health lasted for up to ten years, even if they put the weight back on again during that time.

'Weight losses of just ten per cent of a person's body weight (or about 20 lb in those who weigh 200 lb) have also been shown to have a long-term impact on sleep apnoea, hypertension and quality of life, and to slow the decline in mobility that occurs as people age,' said Dr. Rena Wing, professor of psychiatry and human behaviour at Brown University's Alpert Medical School.

The research was presented at the annual convention of the American Psychological Association.

Changes in gut microbes that would ordinarily be deemed unhealthy may actually be beneficial during pregnancy, research suggests.

Scientists at Cornell University assessed microbes in the gut during pregnancy and found that a woman's body appears to use them to alter the metabolism in a way that supports foetal growth.

These changes can cause weight gain, abnormal glucose metabolism and inflammation in women who are not pregnant.

But during pregnancy, the metabolic changes appear to be healthy.

Senior study author Ruth Ley, whose findings are published in Cell journal, said: 'In the context of pregnancy, these metabolic changes in the mother are healthy, because they promote energy storage in fat tissue and help support the foetus.

'Outside of pregnancy, however, these changes can lead to the development of type-2 diabetes and other health problems.'

The human gut contains up to 1,000 different species of bacteria which perform a range of useful functions.

UK scientists have identified a gene that appears to be involved in both normal prostate growth and the development of prostate cancer.

A research team at the University of Edinburgh's MRC Centre for Reproductive Health found that the Decorin gene may normally slow cancer growth.

The scientists showed that the level of Decorin 'was reduced in tumours compared to normal prostate cells', according to Dr Axel Thomson who led the research.

'If our suspicions are verified then this could mean that, in the future, measurement of Decorin levels could become a reliable diagnostic test for prostate cancer and also help determine how aggressive the disease is,' Dr Thomson revealed.

The study is published in the journal PLoS One and was funded by the Medical Research Council and the charity Prostate Cancer UK.

Dr. Kate Holmes, head of research at Prostate Cancer UK, said that this type of early stage research is 'vital' for improving scientists' understanding of the development of prostate cancer.

Older people who have cataract surgery may benefit from a reduced risk of hip fracture, new research suggests.

Scientists at the American Academy of Ophthalmology and the University of California, Los Angeles (UCLA) analysed the medical records of 400,000 patients who had cataract surgery to see whether they fractured a hip during the year after the procedure.

They also looked at data on patients who had cataracts but did not have them treated.

The researchers found that cataract surgery among people with vision loss was associated with a significantly reduced risk of fractures.

Overall, the procedure was associated with a 16 per cent decrease in patients' chances of having a hip fracture within a year.

Lead researcher Dr. Anne Coleman, from UCLA's Jules Stein Eye Institute, said: 'Our study suggests that people should never be regarded as 'too old' to have their cataracts removed.

'In fact, the greatest reduction in hip fracture risk was in patients who had cataract surgery when they were in their 80s.'

Most people develop a cataract over time, as changes in the lens of the eye occur in the majority of over-65s.

Almost ten per cent of women who have a caesarean section operation subsequently develop a surgical site infection, new figures show.

Research conducted by the Health Protection Agency (HPA) looked at 4,107 women who had a caesarean operation in England in 2009.

Analysis revealed that 394 of these women (9.6 per cent) developed an infection following their operation.

This is far higher than the infection rate following hysterectomies, which is just 6.6 per cent.

However, the vast majority (88 per cent) of infections following a caesarean operation were minor and cleared up within a few days.

The research, which is published in the British Journal of Obstetrics & Gynaecology, also shows that surgical site infections are more common among women who are overweight or obese.

Dr. Elizabeth Sheridan, head of healthcare associated infections at the HPA, said: 'Given that one in four women deliver their baby by caesarean section, these infections represent a substantial burden.

'Women choosing to have caesarean section for non-medical reasons should be aware of the risk of infection, particularly if they are overweight.'

Gail Johnson, education and professional development advisor at the Royal College of Midwives, said that obesity in pregnant women 'needs addressing'.

UK medical schools provide little training on the promotion of physical activity to patients, a study has found.

Researchers at University College London sent a survey to each of the UK's 31 medical schools, inviting their curriculum leads or directors to provide information on key aspects of education on the promotion of physical activity.

Publishing their findings in the British Journal of Sports Medicine, they describe the survey results as 'alarming', with 'widespread omission of basic teaching elements'.

Just four of the 31 medical schools said they included physical activity in each year of their undergraduate courses, with five schools not including any specific teaching on physical activity at all.

Only half of the medical schools include the chief medical officer's guidance on physical activity in their curricula, while the average amount of time spent teaching physical activity is just four hours.

The study authors warned that tomorrow's doctors will be left ill-equipped to promote physical activity to their patients.

'A basic understanding of the benefits of physical activity, how to effectively promote it (with behaviour change techniques) and combat sedentary behaviour for different age groups underpin the ability of future doctors to manage modern non-communicable chronic diseases and follow clinical guidelines,' they concluded.

The findings are undoubtedly a concern, particularly as a recent report in the Lancet medical journal revealed that around one in three adults do not take enough exercise.

A drug used to treat immune deficiency may also be beneficial for people with Alzheimer's disease, scientists have found.

A phase-II clinical trial involving intravenous immunoglobulin (IVIG) revealed that the treatment helped to stabilise symptoms in people with mild to moderate Alzheimer's disease for around three years.

Twenty-four people took part in the first 18 months of the trial, with 16 patients continuing for the remaining 18 months at a set dose of 0.4g per kg.

Researchers at Weill Cornell Medical College in the US found that people who took this dose every two weeks for the full 36 months showed no signs of cognitive decline, as well as no deterioration in memory, daily functioning or mood.

The team are now carrying out a phase-III trial to confirm the treatment's safety and efficacy.

Professor Clive Ballard, director of research at the Alzheimer's Society, welcomed the findings.

He said: 'This is probably the most exciting drug we know about that is currently in the late stages of research.

'If the phase-III trials are successful and it can be made cost-effective, this drug could be on the shelves within ten years.'

The study, which was presented at the Alzheimer's Association International Conference, was also welcomed by Alzheimer's Research UK.

Director of research Dr Eric Karran said that large-scale trials are now needed to determine the treatment's potential

July 23, 2012 - The European Medicines Agency has for the first time recommended approval of a gene therapy, for the treatment of lipoprotein lipase (LPL) deficiency.

The agency's Committee for Medicinal Products for Human Use (CHMP) recommended marketing authorization under "exceptional circumstances" for alipogene tiparvovec (Glybera, uniQure).

The drug was designated an "orphan medicine" on March 8, 2004, and is recommended for use in a restricted group of adults with familial LPL deficiency who have severe or multiple pancreatitis attacks despite dietary fat restrictions.

LPL deficiency is a rare genetic disease that results from a defect in the gene for LPL, an enzyme that breaks down fats. This causes excessive fat particles to accumulate in the blood, leading to pancreatitis attacks.

Glybera is made from an adeno-associated viral vector (AAV1) that has been modified so that it carries a gene for LPL but does not replicate. It is injected into a muscle, where it corrects the LPL deficiency by enabling muscle cells to produce LPL.

Immunosuppressant drugs are typically given as well to reduce the immune system's response against the medication.

James Wilson, MD, PhD, a professor of pathology and laboratory medicine at the University of Pennsylvania in Philadelphia, commented on this development for Medscape Medical News. Dr. Wilson's laboratory discovered the vector (AAV) that was used. The vector is owned by the University of Pennsylvania and was licensed to another company that then provided it to the manufacturer, he explained, adding that he has no relationship with uniQure.

"What the clinical trials have shown is that the number of pancreatitis episodes are decreased, and pancreatitis can be fatal, so it's a potentially fatal disease for which it may help these patients," Dr. Wilson said.

The CHMP has worked in consultation with the European Medicines Agency's Committee for Advanced Therapies (CAT). The CHMP initially issued a negative opinion about the drug on June 23, 2011, recommending refusal of marketing authorization because of insufficient evidence of long-term benefit in the patients studied.

After re-examination in October 2011, the CAT determined that additional postmarketing studies would have adequately addressed concerns about the medication's long-term benefits, but the CHMP again recommended refusal of marketing authorization.

After a request from the European Commission, the CHMP considered the medication for use in a restricted group of patients with more severe illness, and in April 2012 the committee reiterated its position that marketing authorization should be denied.

The CHMP then decided to conduct a second evaluation of this restricted group, with input from the CAT. Several factors were considered, including data that showed a reduction in the number of pancreatitis episodes and the extreme rarity of the disease, and the CHMP concluded that the medicine's benefits outweigh the risks in patients with severe disease, a group whose medical need is largely unmet.

In addition, the committee recommended that marketing authorization be granted under exceptional circumstances, which means that the company that markets the gene therapy will need to set up a registry to monitor patient outcomes and provide ongoing data to the agency.

A restricted access program will also be in place to ensure appropriate use of the medication.

"I don't believe they have approached the [US Food and Drug Administration] yet, but I know that they're speaking to potential partners to do that," said Dr. Wilson.

"This is the first approved gene therapy product in a Western country, and I believe that it's going to be an important impetus with investors in the biopharmaceutical industry to get in the game.

One of the concerns of biopharm has been regulatory uncertainty over whether a European or US regulator would actually approve a product, and what the barriers would be, and apparently this group has overcome that," said Dr. Wilson.

"I believe it's a true milestone, because the ultimate development of an emerging new technology is whether it can be commercialized, and this shows that it can, so I'm sure there will be many more," Dr. Wilson said.

Dr. Wilson has disclosed no relevant financial relationships.

Cutting the population's intake of salt could help to reduce the number of cases of stomach cancer, experts claim.

Research conducted by the World Cancer Research Fund (WCRF) suggests that the average person consumes 8.6g of salt per day... This is 43 per cent more than the recommended daily amount of 6g per adult per day.

The charity claims that around one in seven cases of stomach cancer could be prevented if everyone reduced their intake of salt to this recommended level, as a high intake of salt is one of the risk factors for the disease.

Kate Mendoza, head of health information at the charity, said: 'Stomach cancer is difficult to treat successfully because most cases are not caught until the disease is well-established.

'This places even greater emphasis on making lifestyle choices to prevent the disease occurring in the first place - such as cutting down on salt intake and eating more fruit and vegetables.'

Research published in December 2011 calculated that almost four-fifths of cases of stomach cancer in men and seven in ten cases in women may be linked to lifestyle and environmental factors.

The UK's flu vaccination programme is to be extended to include all children, the government has said.

Health secretary Andrew Lansley has decided to accept immunisation experts' recommendations to extend the flu vaccine to all children, free of charge.

At present, only those children in at-risk groups - such as those with asthma, heart conditions or cerebral palsy - are eligible to receive the flu vaccine on the NHS.

But the government intends to offer a nasal spray vaccine to all children between the ages of two and 17 years at a cost of more than $100 million per year.

Once up and running, the scheme would vaccinate up to nine million children over a six to eight-week period, potentially leading to a 40 per cent drop in the number of people affected by seasonal flu.

Chief medical officer Professor Dame Sally Davies confirmed: 'We accept the advice of our expert committee that rolling out a wider programme could further protect children.

'We will look at the recommendations in detail to decide how best to develop and deliver the programme.'

Professor Adam Finn, professor of paediatrics at the University of Bristol, told the Press Association that the decision to vaccinate healthy schoolchildren was a 'good idea'.

Around one in four very elderly people have undiagnosed heart problems that could easily be treated, a study suggests.

Researchers at Newcastle University carried out heart scans on a group of 376 people, aged 87 to 89 years. They found that 26 per cent had a heart problem that had not previously been diagnosed, such as impairment of left ventricular systolic function….. Affected people tend to feel breathless and may develop heart failure, but the condition can be treated with existing medicines.

'This is a group of people who are routinely excluded from trials of treatment on the grounds of their age,' said co-lead author Dr. Joanna Collerton, senior clinical research associate at Newcastle's Institute for Ageing and Health.

'What we have discovered is that very many more people in this age group have heart problems compared to those in younger age groups.'

The study is published in Heart journal and was funded by the British Heart Foundation.

Dr. Shannon Amoils, a research advisor at the charity, added that there are probably 'many more very elderly people' with heart problems that limit their daily activities than was previously supposed.

People of south Asian origin tend to have higher levels of blood sugar than white Europeans, a study has shown.

Researchers at the University of Leicester looked at 1,352 people from India, Pakistan, Bangladesh and Sri Lanka, as well as 4,688 white Europeans.

They found that south Asians tended to have higher levels of three measures of blood sugar, even after risk factors that influence sugar levels had been taken into account.

The findings, which are published in the journal Diabetes Care, may help to explain why south Asian have an unusually high risk of developing type-2 diabetes and tend to develop the disease at an earlier age than Caucasians.

Lead researcher Dr. Samiul Mostafa, from the University of Leicester's department of cardiovascular sciences, said: 'Our study suggests the main measures of glucose used in diagnosis of type-2 diabetes are all higher in south Asians, independent of risk factors which cause diabetes such as obesity, blood pressure, smoking and gender.'

The expert added that south Asians 'should be monitored more closely for type-2 diabetes', and that more research is needed to explain why people from these countries are more likely to develop the disease.

According to Diabetes UK, type-2 diabetes often appears from the age of 25 in south Asian and black people, compared with over the age of 40 among Caucasians.

Abstract

A reduction of either blood pressure or glycemia decreases some microvascular complications of type 2 diabetes, and we studied here their combined effects.

In total, 4733 older adults with established type 2 diabetes and hypertension were randomly assigned to intensive (systolic blood pressure less than 120 mm Hg) or standard (systolic blood pressure less than 140 mm Hg) blood pressure control, and separately to intensive (HbA1c less than 0.060) or standard (HbA1c 0.070-0.079) glycemic control.

Prespecified microvascular outcomes were a composite of renal failure and retinopathy and nine single outcomes.

Proportional hazard regression models were used without correction for type I error due to multiple tests.

During a mean follow-up of 4.7 years, the primary outcome occurred in 11.4% of intensive and 10.9% of standard blood pressure patients (hazard ratio 1.08), and in 11.1% of intensive and 11.2% of standard glycemia control patients.

Intensive blood pressure control only reduced the incidence of microalbuminuria (hazard ratio 0.84), and intensive glycemic control reduced the incidence of macroalbuminuria and a few other microvascular outcomes.

There was no interaction between blood pressure and glycemic control, and neither treatment prevented renal failure.

Thus, in older patients with established type 2 diabetes and hypertension, intensive blood pressure control improved only 1 of 10 prespecified microvascular outcomes.

None of the outcomes were significantly reduced by simultaneous intensive treatment of glycemia and blood pressure, signifying the lack of an additional beneficial effect from combined treatment.

A third (34 per cent) of young adults, aged 16 to 24 years, suffer from back pain, a new poll suggests.

A poll of Britons by research firm Mintel looked at the rates of back pain across the nation.

Researchers found that young adults experience almost as much back pain as older people, with 38 per cent of over-65s complaining of problems.

Overall, around two-fifths of Britons across all age groups are affected by back pain, which has been linked to high levels of sedentary behaviour.

Mintel spokeswoman Michelle Strutton described the widespread nature of back pain, particularly among young people, as 'pretty alarming'.

She revealed: 'Too much time sitting weakens muscle tone and this can lead to back pain.

'Many of Britain's youngsters lead a sedentary lifestyle and lack of sport may well be contributing to back pain, as well as poor posture.'

Ms Strutton added that back pain is among the nation's top five ailments, which also include colds and flu, headaches, sore throats and coughs.

People with short-term back pain may benefit from taking painkillers such as paracetamol or ibuprofen, while an active lifestyle is likely to aid recovery in most cases.

Increasing women's use of vitamin supplements could have a significant impact on the health of both mothers and their unborn babies, scientists have claimed.

A review by scientists at King's College London looked at the evidence for vitamin supplementation, as well as recommendations on the practice in pregnancy.

Researchers found that supplement use among pregnant women is low in the UK, despite the fact that women need more vitamins such as folic acid at this time.

According to a recent review, less than half of mothers take folic acid supplements around the time of conception, increasing their baby's chances of having neural tube defects.

The review, which is published in the Obstetrician & Gynaecologist (TOG), also recommends a multivitamin with low doses of vitamins C and E during pregnancy, while expectant women at risk of vitamin D deficiency should be identified and urged to take ten micrograms of vitamin D per day.

Dr. Lucy Chappell, a senior lecturer in maternal and foetal medicine at King's College London, said that the 'significant' rate of unplanned pregnancies in the UK adds to the problem.

'If any woman is concerned about vitamin deficiency or would like advice on which supplements might benefit them, they should contact their GP,' she advised.

The reviewers also claimed that the benefits of providing free supplements to all pregnant women would outweigh the costs, and that this approach should be considered.

Jason Waugh, editor-in-chief of the TOG journal, commented that 'some supplementation can be beneficial' for women who are trying for a baby or are in the early stages of pregnancy.

He added that pregnant women should also eat a range of foods and lead an active lifestyle.

The National Institute for Health and Clinical Excellence (NICE) has published new guidance on identifying and treating people at high risk of developing type-2 diabetes.

Health experts say simple steps can be taken to prevent the disease from developing; however, many people do not realise they are even at risk.

The new guidance says that certain groups of people - including over-40s, those between the ages of 25 and 39 from certain ethnic backgrounds, and adults with conditions that put them at risk - should be encouraged to have a risk assessment for diabetes and offered advice on preventing or delaying its onset if necessary.

In addition, NICE suggests that risk assessments should be made available in workplaces, pharmacies, libraries and even job centres to ensure ease of access.

Professor Mike Kelly, director of the institute's Centre for Public Health Excellence, said: 'Our new guidance includes some large-scale recommendations, such as the setting up of a new accreditation body to oversee effective practice in type-2 diabetes prevention.

'This guidance will help people to identify their own personal risk and highlights that by losing weight, being more active and improving their diet, they can prevent or delay type-2 diabetes.'

People with any of the main symptoms of diabetes are also advised to see their doctor.

Symptoms include passing urine frequently; increased thirst; extreme tiredness; unexplained weight loss; genital itching; recurrent thrush; slow wound healing; and blurred vision.

People over the age of 50 may benefit from taking a 'Polypill' made up of four components designed to reduce their risk of heart attack and stroke, research suggests.

The pill, which contains three blood pressure-lowering medicines and a cholesterol-lowering statin, was trialled by scientists at Queen Mary, University of London among over-50s with no previous history of cardiovascular disease.

They found that the pill reduced people's blood pressure by an average of 12 per cent, while levels of low-density lipoprotein (LDL or 'bad cholesterol') typically fell by 39 per cent.

Publishing their findings in the journal PLoS One, the study authors concluded that the pill may help to achieve large reductions in two of the main causes of heart attack and stroke.

Principal investigator Dr David Wald said: 'The health implications of our results are large.

'If people took the Polypill from age 50, an estimated 28 per cent would benefit by avoiding or delaying a heart attack or stroke during their lifetime; on average, those who benefit would gain 11 years of life without a heart attack or stroke.'

The findings were welcomed by Natasha Stewart, senior cardiac nurse at the British Heart Foundation.

However, she noted that there are still 'many questions to answer before this 'wonder drug' is prescribed by doctors'.

Populations in coastal areas tend to be healthier than those living inland, new research suggests.

Scientists at the University of Exeter looked at UK census data for 2001, which involved more than 48 million people.

They found that the proportion of people who reported their health as 'good' was larger in coastal areas than inland regions.

The study also revealed that the link between coastal living and good health was particularly apparent in economically deprived communities.

Lead study author Dr Ben Wheeler, whose findings are published in the journal Health and Place, said: 'We know that people usually have a good time when they go to the beach, but there is strikingly little evidence of how spending time at the coast can affect health and wellbeing.'

He added that while the latest study does not prove that living by the coast causes improvements in health, it does suggest a 'positive effect'.

Previous studies have revealed a link between living in the countryside and improved health.

People who drink just a moderate amount of alcohol in later life may face an increased risk of cognitive decline, new research suggests.

Researchers at the University of California, San Francisco, followed more than 1,300 women, aged 65 and older, for 20 years.

Participants provided information on their alcohol consumption at regular intervals throughout the study and were assessed for mild cognitive impairment and dementia at the end.

The researchers found that women who said they drank more in the past than at the beginning of the study had a 30 per cent increased risk of developing cognitive impairment.

Women who were moderate drinkers between years ten and 16 of the study were 60 per cent more likely to develop cognitive impairment than non-drinkers.

In contrast, those who drank moderately up to years 6-8 of the study had a similar risk to non-drinkers.

Furthermore, women who started as non-drinkers but took up drinking over the course of the study had a 200 per cent increased risk of cognitive impairment.

Dr. Tina Hoang, whose findings were presented at the Alzheimer's Association International Conference, said: 'In this group of older women, moderate alcohol consumption was not protective [against cognitive decline].

'It may be that the brains of oldest old adults are more vulnerable to the effects of alcohol, but it is also possible that factors associated with changing alcohol use related to coping or loss could be involved.'

Meanwhile, a separate study by scientists at the University of Exeter found that older adults who binge drink also increase their risk of cognitive decline.

People who lose weight tend to visit the doctor less frequently, a new study has shown.

Researchers at Concordia University in Canada studied data on more than 60,000 people, all of whom had taken part in the 2010 Community Health Survey.

They found that obese patients tend to have more appointments with their doctor than normal-weight individuals.

In fact, obese people visit the doctor more frequently than smokers with a healthy weight, despite the known effects of tobacco on health.

The findings highlight the pressure that obesity places on healthcare systems in Canada and other western nations, such as the UK.

Dr. James McIntosh, a professor in Concordia University's economics department, commented: 'The fact that obesity is more serious than smoking helps people understand the gravity of the problem because they already have some kind of intuitive understanding of how bad smoking is.'

The researchers also calculated that if everyone involved in the study lost weight so that they were no longer obese, the number of doctor visits would decrease by 10%.

This does not even take into account the decrease in visits that would be expected as a result of fewer cases of obesity-related type-2 diabetes.

Being overweight is one of the main risk factors for type-2 diabetes, according to the national charity Diabetes UK, alongside high blood pressure and a family history of the disease.

Physical inactivity causes almost one in ten premature deaths around the world, new research suggests.

Scientists estimated the proportion of non-communicable diseases that could be prevented if inactive people became active.

Publishing their findings in the Lancet medical journal, they reveal that nine per cent of premature mortality - approximately 5.3 million deaths - were caused by physical inactivity in 2008.

Physical inactivity was found to cause six per cent of cases of coronary heart disease, as well as causing seven per cent of the burden of disease from type-2 diabetes, ten per cent of breast cancer and ten per cent of bowel cancer.

Even decreasing inactivity levels by just ten per cent could prevent more than 533,000 deaths each year, the researchers say.

In addition, eliminating physical inactivity could increase the average person's life expectancy by 0.68 years.

'Physical inactivity has a major health effect worldwide,' the study authors wrote.

'Decrease in or removal of this unhealthy behaviour could improve health substantially.'

Amy Thompson, senior cardiac nurse at the British Heart Foundation, observed that the findings were not surprising.

'Being physically active can have huge benefits for your health,' she added.

July 18, 2012 - Two researchers have developed a new metric, called A Body Shape Index (ABSI), for determining how obesity can predict the risk of premature mortality, they report in a study published online today in PLos One.

Nir Y. Krakauer, PhD, assistant professor of civil engineering at City College of New York City, and Jesse C. Krakauer, MD, an endocrinologist with Middletown Medical in Middletown, New York, analyzed the records of 14,105 non-pregnant adults aged 18 years or older who were included in the National Health and Nutrition Examination Survey 1999-2004 and followed up for 5 years. During follow-up, 828 deaths were recorded.

The researchers developed the ABSI based on waist circumference (WC), adjusted for height and weight, where high ABSI indicates that WC is higher than average for a given height and weight and body volume is more centrally concentrated. ABSI is not correlated, however, with height, weight, or body mass index (BMI). Their formula is WC divided by BMI^2/3height^1/2.

Using linear regression methods and Cox proportional hazard modeling, the authors calculated that death rates increased with above-average ABSI by 33% per standard deviation (95% confidence interval [CI], 20% - 48%). They found that 22% (95% CI, 8% - 41%) of the study population's mortality hazard was attributable to ABSI compared with 15% (95% CI, 3% - 30%) attributable to BMI and 15% (95% CI, 4% - 29%) attributable to WC.

The associations held up after adjusting for other death risk factors including smoking, diabetes, high blood pressure, and serum cholesterol levels, as well as for age, sex, BMI, and white and black ethnicities, but not for Mexican ethnicity. The ethnic difference suggests that more study is needed to determine the limits of ABSI's utility, they write.

"ABSI clearly has distinct impacts on mortality compared to BMI and WC," the researchers write.

"Applying ABSI along with BMI as a predictor variable separates the influence of the component of body shape measured by WC from that of body size," they explain.

"[H]igh ABSI may correspond to a greater fraction of visceral (abdominal) fat compared to peripheral tissue."

The World Health Organization ranks overweight and obesity as the fifth leading cause of death, behind high blood pressure, tobacco use, high blood glucose, and physical inactivity, and according to the organization, the prevalence of overweight and obesity is more than 50% of adult populations in high- and middle-income countries.

The researchers cite National Institute of Health guidelines that put overweight and obesity as the second leading cause of preventable death in the United States, behind tobacco use.

In recent research, they write, WC has emerged as a complement to BMI for predicting obesity risk because BMI does not account for the difference between muscle and fat accumulation or for fat locations such as abdominal fat. However, using WC as a predictor of abdominal fat is limited because it is dependent on size (namely, height and weight) and correlates closely with BMI.

The researchers conclude, "Body shape, as measured by ABSI, appears to be a substantial risk factor for premature mortality in the general population derivable from basic clinical measurements. ABSI expresses the excess risk from high WC in a convenient form that is complementary to BMI and to other known risk factors."

In a journal news release, Dr. Nir Krakauer comments, "Measuring body dimensions is straightforward compared to most other medical tests, but it's been challenging to link these with health. Our results give evidence that the power-law scaling of [WC], weight, and other body measurements can be used to develop body shape indices that point to added risk."

The study, however, does not conclude anything regarding whether any interventions to reduce ABSI would reduce mortality risk independently, a question that would require randomized controlled trials to answer.

Dr. Jesse Krakauer is employed by Middletown Medical. Dr. Nir Krakauer has disclosed no relevant financial relationships.

People who suffer from insomnia should try not to worry too much, as this can exacerbate the problem.

About a third of people are thought to experience bouts of insomnia, which means they have difficulty sleeping for long enough to feel refreshed the next morning.

The problem can be caused by a number of conditions, such as depression and alcohol misuse, but it may also be brought on by stress and anxiety - and worrying about lack of sleep can undoubtedly make things worse.

Social Psychologist Dr Sandra Wheatley said people should 'try and look on the bright side' and make a note of how much sleep they are actually getting.

'You will perhaps be surprised by just how much sleep you are getting,' Dr. Wheatley suggested.

'That in itself can be reassuring because frequently you will find that by worrying about how little sleep you're having, it can affect your ability to sleep continuously.'

Other self-help techniques include setting a specific time to wake each day, avoiding napping during the daytime, taking daily exercise, and avoiding tea and coffee in the four hours prior to bedtime.

Women with breast cancer who are obese tend to have higher levels of oestrogen than those with a normal weight, even after taking hormone-suppressing drugs, a study has found.

Researchers at the Institute of Cancer Research (ICR) in London discovered that while hormone-suppressing drugs did reduce levels of oestrogen in obese postmenopausal women, those with a high BMI still had significantly higher levels than those with a healthy weight.

The findings, which are published in the Journal of Clinical Oncology, suggest that obesity may have an effect on a person's response to treatment for breast cancer.

As a result, doctors may want to consider other treatment approaches for obese women with types of breast cancer that require oestrogen to grow.

Senior author Professor Mitch Dowsett, from the ICR and the Royal Marsden, said that the findings were 'consistent with previous suggestions that aromatase inhibitors might be slightly less effective in these women'.

He added: 'Our findings are based on laboratory studies, so we would need to carry out clinical trials to tell us whether women with a higher BMI would benefit from changes to their treatment.'

The study was part-funded by the charity Breakthrough Breast Cancer, whose head of research Dr. Julia Wilson said that 'size does matter when it comes to breast cancer treatment'.

She added: 'We can improve survival for obese women if we know which drugs are more likely to work for them, and avoid those which are less likely to succeed.'

People who are allergic to eggs may benefit from consuming a small amount of egg each day, new research suggests.

The concept, known as oral immunotherapy, has already been shown to be useful in treating children's allergies to milk and peanuts.

Now, a study at Johns Hopkins Children's Centre and other institutions in the US indicates that it may also have a role to play in overcoming egg allergies.

The researchers gave escalating doses of egg to 40 children, 35 of whom experienced an improvement in their symptoms.

The remaining five participants dropped out of the study, with four of them experiencing allergic reactions related to the treatment.

Of the 35 children who experienced an improvement in their symptoms, 11 benefited from a complete long-term elimination of their egg allergy.

Dr. Robert Wood, director of allergy and immunology at Johns Hopkins Children's Centre, said: 'More than a quarter of the children in our study lost their egg allergies altogether, but we also saw dramatic improvements in those who didn't, which in and of itself is an important therapeutic achievement.

'These children went from having serious allergic reactions after a single bite of an egg-containing cookie to consuming eggs with minimal or no symptoms.'

However, some children lost their tolerance to egg after discontinuing daily treatment - a finding that highlights the importance of daily exposure to the allergen.

Lindsey McManus, a spokeswoman for the charity Allergy UK, described the development as 'very exciting'.

But she told the BBC: 'We would echo the warning in the report that this should never be tried at home due to the risk of serious allergic reactions.'

More older people should be given drugs to lower their cholesterol and blood pressure, a study suggests.

At present, these preventative measures are often only prescribed to people between the ages of 40 and 74 years.

But researchers at the universities of Oxford and Birmingham say that older people should also be given the drugs to reduce their risk of cardiovascular disease.

The scientists looked at almost 37,000 patients, aged 40 and over, who were free of cardiovascular disease at the start of the study.

They found that for every additional five years of age, the chances that a person was prescribed blood pressure medication increased. This was true up to the age of 85, after which prescribing decreased.

For statins, prescribing rates started to fall from the age of 75.

Writing in the British Medical Journal, the study authors say there is no evidence that prescribing statins is harmful in older patients.

They call for prescribing guidelines to be modified and for 'a simple trial of use of statins in people over the age of 80'.

June Davison, the British Heart Foundation's senior cardiac nurse, said doctors should consider how prescribing drugs to prevent cardiovascular disease could help reduce disability and increase life expectancy among the older population.

'Available evidence would suggest that older people can benefit from heart protective drugs, but more research is needed,' she added.

A renewed focus on tackling pneumonia and diarrhoea could help to narrow the survival gap between the richest and poorest children around the world, a report has claimed.

Unicef says that pneumonia and diarrhoea are the two biggest killers of children under the age of five.

More than two million under-fives die from one of these two illnesses each year, with almost 90 per cent of deaths occurring in sub-Saharan Africa and south Asia.

The organisation has called for countries around the world to increase their commitment to tackling the two illnesses and boost levels of funding.

Anthony Lake, executive director of Unicef, said that pneumonia and diarrhoea 'hit the poorest hardest', but that there are effective ways of preventing and treating both illnesses.

'Scaling up simple interventions could overcome two of the biggest obstacles to increasing child survival [and] help give every child a fair chance to grow and thrive,' he claimed.

These interventions include increasing vaccine coverage; encouraging breastfeeding and washing hands with soap; improving access to safe drinking water and sanitation; and handing out oral rehydration salts and antibiotics (and Zinc supplementation).

US scientists have discovered that a simple blood test could help doctors to diagnose early-stage breast cancer, as well helping to inform decisions about individual patients' treatment.

Researchers at the University of Texas looked at 302 people with early-stage, operable breast cancer.

They discovered that 24 per cent of these patients had circulating tumour cells (CTCs) in their blood - something that has previously only been observed in women with more advanced forms of breast cancer.

The researchers also found that women with CTCs in their blood were more likely to die during the five-year study period than those without CTCs - ten per cent versus just two per cent.

Their findings, which are published in the Lancet Oncology medical journal, indicate that women with early-stage breast cancer who test positive for CTCs may benefit from more aggressive treatment.

Lead researcher Professor Anthony Lucci, from the University of Texas' department of surgical oncology, said: 'The growing body of published work, including our study, suggests that assessment of circulating tumour cells might provide important prognostic information in these patients.'

Writing in an accompanying comment, Professor Justin Stebbing from Imperial College London observed that clinical practice is unlikely to change until further studies have been carried out.

Scientists have discovered why patients with multiple sclerosis (MS) do not benefit from a class of drugs that are effective in other autoimmune diseases.

Researchers at Oxford University found that a genetic variant involved in MS is responsible for the ineffectiveness of anti-tumour necrosis factor (anti-TNF) therapies, which can actually exacerbate MS patients' symptoms.

The team looked at a particular version of a gene called TNFRSF1A, which influences a person's risk of developing MS.

They found that the gene variant causes the TNFR1 protein encoded by the gene to be abnormally short, meaning it is unable to sit on the surface of cells and bind TNF there.

'Now we know that the functional effect of the TNFRSF1A gene variant mirrors that of TNF blocking drugs, and this promotes MS risk,' said Adam Gregory, one of the study's authors.

The findings are published in Nature journal and were welcomed by Nick Rijke, director of policy and research at the MS Society.

He told the BBC: 'This important study has shown that some of your genes can play a part in deciding whether or not you respond to a treatment.

'In the future this could help ensure that people with MS are offered the drug treatments that are most likely to work for them.'

Scientists have discovered why patients with multiple sclerosis (MS) do not benefit from a class of drugs that are effective in other autoimmune diseases.

Researchers at Oxford University found that a genetic variant involved in MS is responsible for the ineffectiveness of anti-tumour necrosis factor (anti-TNF) therapies, which can actually exacerbate MS patients' symptoms.

The team looked at a particular version of a gene called TNFRSF1A, which influences a person's risk of developing MS.

They found that the gene variant causes the TNFR1 protein encoded by the gene to be abnormally short, meaning it is unable to sit on the surface of cells and bind TNF there.

'Now we know that the functional effect of the TNFRSF1A gene variant mirrors that of TNF blocking drugs, and this promotes MS risk,' said Adam Gregory, one of the study's authors.

The findings are published in Nature journal and were welcomed by Nick Rijke, director of policy and research at the MS Society.

He told the BBC: 'This important study has shown that some of your genes can play a part in deciding whether or not you respond to a treatment.

'In the future this could help ensure that people with MS are offered the drug treatments that are most likely to work for them.'

A summer campaign has been launched by the government in Wales to encourage parents not to smoke in cars when children are present.

Fresh Start Wales hopes to reduce children's exposure to cigarette smoke by highlighting the dangers it poses.

According to health experts, second-hand cigarette smoke increases children's chances of developing a number of conditions, including asthma, ear infections and cot death.

As the summer holidays approach and families prepare to spend more time together, the government is underlining these dangers and urging parents to keep their cars smoke-free.

'While families may be in the car more frequently, we don't want to see a rise in children's exposure to second-hand smoke,' said Dr Tony Jewell, Wales' chief medical officer.

The expert noted that second-hand smoke contains more than 4,000 potentially harmful chemicals and that these toxins linger in cars for hours.

'We believe that parents want to protect their children and, once they are fully aware of the risks, they will choose not to smoke in front of them,' Dr Jewell added.

Last year (July 2011), the Welsh government announced that it may consider introducing a ban on smoking in cars when children are present if its public awareness campaigns are not successful.

Controversial chemicals found in some personal care products could increase women's chances of developing diabetes, scientists say.

Researchers at Brigham and Women's Hospital analysed the levels of chemicals called phthalates in urine samples from 2,350 women, all of whom took part in the National Health and Nutrition Examination Survey in the US.

They found that women with high levels of phthalates in their urine were more likely to have diabetes than those with low concentrations.

However lead researcher Dr. Tamarra James-Todd, whose findings are published in the journal Environmental Health Perspectives, conceded that more research is needed.

She revealed: 'We know that in addition to being present in personal care products, phthalates also exist in certain types of medical devices and medication that is used to treat diabetes and this could also explain the higher level of phthalates in diabetic women.'

Phthalates are found in a number of products, including packaging, detergents, medical devices, textiles and food products.

However, many manufacturers in Europe and the US have stopped using them due to health concerns.

Parents should consider giving children supplements, including vitamin D, to ensure their nutritional needs are met, an expert has claimed.

Dr. Carrie Ruxton, a qualified child nutritionist, claimed that eight out of ten parents do not realise the importance of vitamin D for toddlers. As a result, the average child of this age gets less than a third of the vitamin D they need for health.

'Mums and dads know about calories and getting toddlers to eat food, but I don't think they really understand the variety of foods and nutrients that toddlers need from those foods,' Dr. Ruxton revealed.

'The government in fact recommends that all toddlers are given a daily vitamin supplement, and that's for all toddlers, regardless of whether they're good or fussy eaters.'

However, the nutrition expert emphasised that giving toddlers a vitamin supplement each day does not let them 'off the hook', as parents still need to put together a balanced diet for their children, including fruit, vegetables, meat and dairy products.

Children and young adults who undergo computed tomography (CT) scans may face an increase in their risk of developing leukaemia and brain tumours, a study has found.

Researchers at Newcastle University and the US National Cancer Institute looked at more than 175,000 children and young adults to study the effects of radiation exposure from CT scans on their subsequent risk of developing cancer.

They found that young people who had undergone CT scans of their head before 22 years of age faced a three-fold increase in their risk of brain tumours over the next ten years.

Those who had a similar dose of radiation to their bone marrow had a three-fold increased risk of developing leukaemia.

Lead author Dr Mark Pearce, from Newcastle University, emphasised that CT scans 'should be used when their immediate benefits outweigh the long-term risks'.

'However, now we have shown that CT scans increase the risk of cancer, we must ensure that when they are used they are fully justified from a clinical perspective,' he added.

The findings are published in the Lancet medical journal and show that the absolute risk of leukaemia and brain tumours among children and young people who have undergone repeated CT scans remains low, according to Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health.

Dr. Cass added: 'This research further confirms the need to keep doses as low as possible and only scan when absolutely necessary.'

There are fears that many professional football players could be risking their health and careers by taking large quantities of painkilling and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen.

Professor Jiri Dvorak, chief medical officer of Fifa, told the international football organisation's website that research suggests around half of players - from under-17s through to senior internationals - are using painkillers and anti-inflammatory drugs.

While some take them under prescription to ease existing pain, Professor Dvorak believes others use them before games to reduce any potential discomfort - a practice that he warned could be 'dangerous'.

'[Players] have to understand that if discomfort or pain is being suffered, it means that something is not functioning correctly,' the expert pointed out.

'By masking symptoms through painkillers, you could be covering something which could be important in the long run.'

Professor Dvorak also noted that repeated use of these medicines can be 'particularly dangerous' for professional sportspeople, as their kidneys work harder during high-intensity exercise and are therefore more vulnerable to damage from strong drugs.

The deputy director of the World Anti Doping Laboratory in Cologne recently told the BBC that painkillers 'fulfil all requirements of a doping substance' because they enhance performance by switching off pain and reducing post-training recovery time.

June 4, 2012 (Milan, Italy) - After a series of negative trial results, the concept of raising high-density lipoprotein (HDL) as a therapeutic approach to reducing cardiovascular risk looks to be in a sorry state. But lipid experts at the recent European Atherosclerosis Society (EAS) 2012 Congress were adamant that the HDL hypothesis was not yet dead and that it is imperative that research in this direction continue.

At a session on the subject, Dr Alan Tall (Columbia University, New York) summarized the situation: "The HDL hypothesis is certainly under attack. And there have been a lot of setbacks. But we mustn't throw the baby out with the bathwater. I think we need a new, modified HDL hypothesis."

Dr. Philip Barter (Heart Research Institute, Sydney, Australia), who is one of the leading HDL researchers worldwide, is fervent in the belief that HDL-based therapeutics will still be successful. "I am not convinced that the recent negative reports disprove the HDL hypothesis," he told heartwire . "My basic message is don't give up yet. There is just too much we don't know."

Dr. Philip Barter

And EAS president Dr John Chapman (Hôpital de la Pitie-Salpetrière, Paris, France) had a similar opinion. "There is no question that it's too soon to give up on HDL," he told heartwire . "There is no doubt that low HDL increases the risk of cardiovascular disease by about 40%. The worldwide epidemiological data on this are vast. It explodes the risk, but we just don't understand why."

The next frontier or not?

Dr. John Chapman

After the great success of lowering low-density lipoprotein (LDL), the idea of raising the "good" HDL cholesterol was seen as the natural next step in the battle against heart disease. Driven by epidemiological studies and discovery of the apolipoprotein (apo) A1 Milano variant of the HDL complex--which was found to be associated with a low risk of cardiovascular disease and regression of atherosclerosis in intravascular ultrasound [IVUS] studies, gaining it the label of "liquid Drano for the coronary arteries"--raising HDL became the next holy grail. The approach was described as the "next frontier" and "second magic bullet."

But things have not gone quite as planned. While the negative results of the first major trial of an HDL-raising drug, torcetrapib, were attributed to its off-target side effect of raising blood pressure, there have been three more recently reported trials, all of which cast doubt on the strategy of raising HDL. These were the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL Cholesterol/High Triglyceride and Impact on Global Health Outcomes (AIM-HIGH) study with niacin, dal-OUTCOMES with dalcetrapib (Roche), and a genetic study published a couple of weeks ago in the Lancet, which showed that individuals with gene variants that increase HDL levels did not have a reduced risk of heart disease [1]. This resulted in a front-page story in the New York Times casting doubt over the whole HDL hypothesis

I think we all got a little too optimistic that any increase in HDL will be good. Tall commented: "The New York Times article suggested that we have been pulling the wool over the eyes of the public about HDL. It made me feel a bit defensive, but there is some truth to it. Although AIM-HIGH and dal-OUTCOMES were both underpowered, if you put it all together with the recent genetic study, it isn't looking good. We are at a watershed. I think we all got a little too optimistic that any increase in HDL will be good. It does now appear that it is not as simple as just raising HDL per se. But perhaps we need to focus on which type of HDL we are raising."

Tall emphasized to heartwire that there is still reason for hope. "There is strong evidence from epidemiological studies, and we have shown efficacy of HDL in promoting cholesterol efflux from macrophages. There are a whole battery of studies in both animals and humans on this. Synthetic HDL particles have been shown to be good at sucking cholesterol out of the artery. But that is very different from a small increase in circulating HDL. We want to make sure that the HDL formed is empty and so has the capacity to take up cholesterol. The large trials of HDL-raising therapies so far may have just raised already overladen HDL. That is one possibility."

He suggested that a modified HDL hypothesis could be that HDL function, such as macrophage cholesterol efflux, may relate to coronary heart disease more than simply HDL levels. "So there is still hope for the field."

Barter: Interpretation of genetic study "flawed"

Barter offered the theory that studies conducted so far were not an adequate test of the HDL hypothesis. Addressing the genetic study recently published in the Lancet, Barter said its interpretation had been seriously flawed.

"One gene that is associated with an increase in HDL and a reduction in [cholesteryl ester-transfer protein] CETP--a variant of a CETP gene--was shown to be associated with a significant reduction in cardiovascular disease, but because this gene is also associated with a reduction in LDL, the benefit couldn't be attributed to HDL," he told heartwire . "But this is the third study to show that a gene variant of CETP is associated with a reduction in cardiovascular risk. The conclusion is that, when you have a reduction in CETP activity with higher HDL and lower LDL levels, there is less cardiovascular disease."

He noted that the HDL increase associated with most of the genes evaluated in the Lancet study was small, apart from the endothelial lipase gene, which showed a large increase in HDL, but this did not reduce coronary heart disease. 'All that means is that the HDL that is increased with that gene variant doesn't have enhanced function or has reduced function.'

"We need to know how genetics affect HDL function, but this is much more difficult to measure. HDL is very complicated; it is no good just measuring the amount of something that is there. We need to know what it is doing."

The many functions of HDL

Barter explained that HDL has many functions: in addition to removing cholesterol from macrophages, it also inhibits LDL oxidation, promotes endothelial repair, and has antidiabetic, anti-inflammatory, and antithrombotic properties. "We don't know which of these properties are clinically important. We don't know which function to measure.

"To measure all these things in one sample might cost $1000. It is infeasible to do that in a large-scale study. We need a lot more basic research into HDL, we need to find out whether all its functions correlate with each other, and we need to look at which functions of HDL are compromised in diabetic and obese patients."

He also pointed out that HDL is very heterogeneous. "There are many different subpopulations, and we don't know which subpopulations are the most functional. And for a treatment that increases HDL, we have to analyze which subpopulations and which functions of HDL it is increasing."

Barter suggested that different functions of HDL may be more important at different times. "While the story started with cholesterol efflux--and this is one highly likely protective mechanism--it is almost certainly not the only one. The anti-inflammatory or antithrombotic properties may be more important after an event."

He also noted that the biggest predictor of HDL concentration is environmental factors--obesity, insulin resistance, diabetes--which will not have been accounted for in genetic studies. "The actual HDL concentration is influenced enormously by lifestyle factors. You can't control for this in a gene-association study."

Barter also questioned whether low levels of HDL signify a real increased risk of heart disease or whether they are just a marker of something else that is protective. "In epidemiology, the level of HDL is predictive of risk. So in this regard, the level of HDL does appear to correlate with protective functions. But does that mean this relationship is causal? If other factors are adjusted for, the relationship is still there. This still doesn't make it causal--it may reflect something else we don't know about."

Barter thinks that's unlikely to be the case. HDL, he notes, has many actions that should be protective; in animal studies, for example, raising HDL reduces atherosclerosis. "Maybe humans are unique, but I think it is inconceivable that HDL it is not protective in humans--but this has not been proven yet."

More large outcome trials under way

After the torcetrapib failure, many have been of the opinion that CETP inhibitors are making dysfunctional HDL. But Barter argues that this is not established. He says the off-target toxicity of torcetrapib is a "highly plausible explanation" for its lack of benefit. "And in dal-OUTCOMES, HDL was increased by 30%, but there was no effect on LDL, and it may be that we need both an increase in HDL and a reduction in LDL to show benefit. This is consistent with the genetics."

He says there are two main conclusions that can be reached from all the HDL controversy in the past few weeks: one, that the HDL hypothesis has not yet been tested properly, so it must not yet be buried; and two, the CETP hypothesis should not be abandoned until a much more potent inhibitor has been tested.

In fact, a more potent CETP inhibitor is indeed now being tested in the Randomized Evaluation of the Effects of Anacetrapib Through Lipid-Modification (REVEAL) trial with anacetrapib (Merck), which increases HDL by up to 140% and reduces LDL by 35% to 45%. Another CETP inhibitor, evacetrapib (Lilly), which has a similar profile, is about to start a large-scale trial. "If these trials do not show benefit, then I think we can say CETP inhibition is not the way to go, but it is too premature to reach this conclusion now," Barter commented.

Another large trial should settle the debate over niacin. The Heart Protection Study--Treatment of HDL to Reduce the Incidence of Vascular Events (HPS THRIVE) trial in 25 000 patients (the results of which are expected early next year) should answer the questions that AIM-HIGH didn't. But none of these trials will prove the HDL hypothesis, as all the agents have other actions in addition to raising HDL.

Other approaches

In another talk at the EAS meeting, Dr Kausik Ray (St George's, University of London, UK) outlined some of the many new approaches to boosting HDL in development. These include:

Infusing artificial and recombinant formulations of apoA1 (which forms HDL in the body); several products are in phase 2 trials in acute settings.

Delipidation of HDL, which involves taking a large quantity of blood, removing the cholesterol from the HDL, and then reinfusing the blood.

RVX-208: A drug that increases the endogenous production of apoA1, which is now being tested in IVUS studies in humans. Agents that increase ABCA1, the protein that mediates the transport of cholesterol out of the cell so that it can be cleared from the body.

Ray said that these therapies would give a better insight into the HDL hypothesis. New basic research suggests that it is the small HDL particles (prebeta HDL) that need to be increased, but CETP inhibitors lead to a rise in large-particle HDL, which is not as effective in promoting reverse cholesterol transport, he explained.

Because the apoA1 products in development appear to raise small HDL particles, Ray said he thought that these were a more hopeful approach.

It's not what you do, it's the way that you do it.

"If ongoing trials with the apoA1 products in the acute coronary syndrome setting are positive, this will undoubtedly result in a paradigm shift," he commented. "But until we get a positive outcome from a trial with an HDL-based strategy, we haven't got a handle on how to go forward. If we get a positive trial, we would then need to work out what proportion of benefit was related to the HDL level and/or function."

But Ray was also adamant that HDL's day is not yet over. "We now know that HDL is a lot more complex than we initially thought, but it is still irrefutable that low HDL is a marker of risk."

Chapman concluded: "We need to neutralize the risk associated with low HDL, but we still don't have enough biological knowledge on how to do this. I believe it's a case of 'it's not what you do, it's the way that you do it.' We've just got to work out what the best way is."

References

Voight BF, Peloso GM, Orho-Melander M, et al. Plasma HDL cholesterol and risk of myocardial infarction: A Mendelian randomization study. Lancet 2012; DOI:10.1016/S0140-6736(12)60312-2. 22607825

Kolata G. Doubt cast on the 'good' in 'good cholesterol.' New York Times, May 16, 2012.

June 6, 2012 - Boehringer Ingelheim today announced an update to the prescribing information for dabigatran (Pradaxa), to include language confirming that the 150-mg twice-daily dose was superior to warfarin in reducing ischemic and hemorrhagic strokes in patients with non-valvular atrial fibrillation (NVAF).

The "Clinical Studies" section of the label will now read, "Pradaxa 150 mg twice daily was superior in reducing ischemic and hemorrhagic strokes relative to warfarin." The update reflects previously released results of the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial, a non-inferiority comparison of dabigatran vs warfarin in more than 18,000 patients with NVAF.

In RE-LY, dabigatran at the higher dose of 150 mg twice daily was superior to adjusted-dose warfarin in reducing ischemic and hemorrhagic stroke.

The risk for major bleeding was similar across subgroups except for aged, where there was a higher incidence of major bleeding with dabigatran for those aged 75 and older. There were also higher rates of gastrointestinal and total gastrointestinal bleeding, but a 59% reduction in intracranial bleeding, with dabigatran vs warfarin.

Dabigatran, a direct thrombin inhibitor, was the first warfarin alternative approved (in October 2010) by the US Food and Drug Administration (FDA) for the reduction of stroke and systemic embolism in patients with NVAF.

Rivaroxaban (Xarelto, Bayer/Johnson & Johnson), a factor Xa inhibitor, was approved by the FDA in November 2011 for the same indication.

On the strength of 2 positive trials, AVERROES and ARISTOTLE, a third still-investigational agent, apixaban (Eliquis, Pfizer/Bristol-Myers Squibb), also a factor Xa inhibitor, may not be far behind - the FDA is expected to make a decision on the drug in this setting on or before June 28.

Concerns in the meantime have been raised about bleeding events and a possible increase in myocardial infarction with dabigatran. Most recently, results of a review of bleeding events with dabigatran since its approval by the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) concluded that the risk is actually significantly lower than seen in clinical trials, but nevertheless CHMP recommended that the risks continue to be kept under close review.

In January 2012, in response to the reports of bleeding, the FDA revised the label for dabigatran, updating the Dosage and Administration section to include more information about monitoring renal function and adjusting the dabigatran dose if necessary, because its half-life and anticoagulant activity are increased in patients with renal impairment.

Boehringer reports that more than 3.2 million prescriptions for dabigatran 150 mg and 75 mg have been written for more than 600,000 patients with NVAF in the United States since it was approved.

"PRADAXA is an important treatment option for many patients with NVAF as it is the only treatment compared to warfarin that provides a superior reduction in ischemic and hemorrhagic stroke, which is the main goal of anticoagulation treatment," John Smith, MD, PhD, senior vice president for clinical development and medical affairs, Boehringer Ingelheim Pharmaceuticals Inc, said in the company statement. "The inclusion of specific wording about the superiority of PRADAXA over warfarin in the prescribing information is important in defining the benefit it provides when physicians are considering treatment options for this patient population."

More information will be available from RELY-ABLE, a long-term safety study, results of which will be presented later this year, the company statement notes, and from GLORIA-AF, a patient registry, the second phase of which was recently launched.

XLIX European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Congress: Abstract FO064. Presented May 25, 2012.

June 1, 2012 (Paris, France) - Vitamin D supplementation is safe and economic for patients with chronic kidney disease (CKD); it can also decrease the need for erythropoietin-stimulating agents and ward off anemia by decreasing hepcidin levels and increasing ferroportin levels.

A new study has confirmed the positive effects of vitamin D on hepcidin and ferroportin levels in the serum of patients with CKD and in healthy volunteers. Justine Bacchetta, MD, PhD, from the Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rheumatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron Cedex, France, presented the research here at the XLIX European Renal Association-European Dialysis and Transplant Association Congress.

The study by Dr. Bacchetta and colleagues was based on reports of improved hemoglobin levels and decreased erythropoietin-stimulating agents requirements after vitamin D repletion in patients with CKD. "The iron homeostasis factor hepcidin is emerging as a likely cause of resistance to erythropoietic-stimulating factor," she noted. Higher hepcidin levels are also seen in CKD patients with anemia.

The importance of identifying markers for a worsening condition was underscored by Peter Stenvinkel, MD, PhD, professor of renal medicine in the Department of Renal Medicine at the Karolinska University Hospital at Huddinge Karolinska Institute in Stockholm, Sweden.

"The risk-factor profile is different from the general population for patients on dialysis and with advanced renal disease. We do not know the reason...that risk factors for cardiovascular and other diseases in the general population are the opposite in patients with advanced stages of renal disease," but is called the reverse epidemiology phenomenon, she explained.

Using reverse-transcriptase polymerase chain reaction (rtPCR) to assess hepcidin messenger (m)RNA, the researchers evaluated the effect of vitamin D on the expression and production of hepcidin, a peptide hormone that sequesters iron and is elevated in the serum of CKD patients.

They also investigated the effect of vitamin D on the expression of ferroportin, which exports iron out of cells, to clarify the possible downstream effect on the development of anemia. Ferroportin levels were determined with immunohistochemistry.

In the trial, a single oral dose of ergocalciferol 100,000 IU was given to 7 healthy subjects (4 men and 3 women); mean age was 42 years (range, 27 to 63 years). Measurements of serum hepcidin were taken at baseline and at 24 and 72 hours.

In vitro studies were done using monocytes isolated from the dialysate of patients undergoing peritoneal dialysis and using peripheral blood mononuclear cells (PBMC) that were taken from the donors.

There was a 50% decrease in the serum hepcidin of all the healthy donors 24 hours after a single oral dose of vitamin D 100,000 IU; this suppression persisted for 72 hours (P = .001).

Levels of the active metabolites of 25-hydroxy vitamin D and 1,25 dihydroxy vitamin D were also detected in the serum.

A decrease of hepcidin and ferritin mRNA in PBMCs after vitamin D administration was seen on rtPCR. Increased levels of ferroportin were detected in the PMBCs using immunohistochemistry staining.

Similar results were observed in the monocytes of CKD patients. After vitamin D administration, a 0.42-fold decrease in hepcidin transcription was seen in PBMCs and a 0.57-fold decrease was seen in monocytes taken from patients with CKD (P < .05 for both).

Furthermore, decreased recruitment of RNA polymerase II to the hepcidin gene promoter after the same treatment was demonstrated with chromatin immunoprecipitation.

"This points to a direct effect of 1,25 dihydroxy vitamin D on hepcidin transcription," said Dr. Bacchetta.

Ferroportin was expressed, and membrane enhancement in HepG2 cells, the adherent population of the PBMCs, was seen on immunohistochemistry after treatment.

"For the first time, we have shown results, both in vitro and in vivo, indicating that vitamin D is a potent suppressor of hepcidin in humans. We propose that these findings provide a clinically relevant mechanism showing how vitamin D supplementation can improve anemia management in CKD patients," Dr. Bacchetta explained.

"Vitamin D therapy absolutely has a role in the treatment of patients with CKD," said Dr. Stenvinkel.

"The majority of dialysis patients have vitamin D deficiency, even in countries like Portugal and Brazil with a lot of sunlight. We need to replenish those stores in patients. It is an important cornerstone of treatment."

"Even if we do not have data from intervention trials regarding its effect on mortality, we know from registry and observational studies that those who have vitamin D treatment do better. If administered at the right levels, vitamin D is a nonrisky treatment," Dr. Stenvinkel asserted.

Funding for this study came from Académie Française Jean Walter Zellidja, Réunion Pédiatrique de la Région Rhône Alpes, Société Française de Pédiatrie/Evian, Fondation pour la Recherche Médicale, the Philippe Foundation. Dr. Bacchetta has disclosed no relevant financial relationships. Dr. Stenvinkel reports being on the advisory board of Abbott and receiving grants from Bayer and Gambro.

Half of UK workers (51 per cent) have experienced back pain during the last year, with one in five taking time off work because of their condition, a study has found.

Nuffield Health surveyed 1,600 people, aged 16 to 65, to determine their experiences of back pain.

Researchers found that 58 per cent of 55 to 65-year-olds had suffered from pain in the last 12 months, making this the most susceptible age group.

A third of respondents said they had been living with back pain for more than a year, with one in seven claiming to have been affected for more than five years.

Dr. Andy Jones, group medical director for Nuffield Health, said: 'Back pain affects a huge number of people on a daily basis.

'If these figures reflect the wider working population you have a situation where many thousands of people are suffering permanent, debilitating back pain.'

Experts recommend a number of self-help measures to treat and prevent back pain, including exercise, relaxation techniques and changing your sleeping pattern.

Efforts should be made to improve the advice patients receive on fertility following a diagnosis of cancer, research suggests.

Scientists at the University of Aberdeen and NHS Grampian questioned 16 men and 18 women, aged 17 to 49, who had been diagnosed with cancer, along with 15 health professionals.

They found that many women had a poor understanding of the effect their cancer treatment might have on their future fertility.

Men were typically encouraged to consider storing sperm, even if they already had children, and most discussed the possibility of sperm banking with health care staff.

In contrast, few women remembered having any discussion about fertility preservation. There was also no local protocol in place for immediate referral.

When asked why they had not discussed fertility preservation with female patients, most staff said they thought treatment was more urgent.

Valerie Peddie, a fertility nurse specialist and research midwife at the University of Aberdeen, said: 'It has been widely argued that at the time of diagnosis, patients should be provided with accurate information about the potential risk of impaired fertility after treatment for cancer.

'However, in reality the immediate emphasis is often on treatment, with little time available to discuss future fertility or options for fertility preservation.'

The findings are published in the journal BJOG, whose deputy editor-in-chief Pierre Martin-Hirsch said that more research is needed.

Last year (November 2011), a survey of more than 300 health care practitioners - conducted by researchers at the Royal Free Hampstead NHS Trust - found that fewer than 40 per cent took breast cancer patients' personal circumstances into account when considering whether to discuss fertility preservation.

Ann Intern Med. Published online May 28, 2012. .

May 29, 2012 - Exercise or physical therapy, along with vitamin D supplementation, are the best medicine for fall prevention among older adults, according to a report by the US Preventive Services Task Force (USPSTF). The new clinical guideline was published online May 28 in the Annals of Internal Medicine.

Virginia A. Moyer, MD, MPH, on behalf of the USPSTF, reported new recommendations for fall prevention among community-dwelling adults aged 65 years and older after reviewing evidence on both the efficacy and possible harm from interventions. Dr. Moyer and colleagues reviewed data on multi-factorial clinical assessment, clinical management, clinical education or behavioral counseling, home hazard modification, and exercise or physical therapy.

Falls are the leading cause of injury in adults aged 65 years and older, with 30% to 40% of community-dwelling adults older than 65 years falling at least once each year. Among these patients, 5% to 10% incur a fracture, laceration, or head injury from a fall.

The task force called its recommendation for exercise or physical therapy a grade B recommendation, meaning the service is recommended with a high certainty of moderate benefit.

On the basis of a review of 18 studies that tested exercise or physical therapy, the USPSTF estimated the risk for falls would be reduced 13% (pooled relative risk [RR], 0.87; 95% confidence interval [CI], 0.81 - 0.94).

To prevent 1 person from falling, 16 people needed to undergo physical therapy or undertake exercise for 12 weeks. High-risk populations benefited most (pooled RR, 0.84; 95% CI, 0.78 - 0.91).

Similarly, vitamin D supplementation was also a grade B recommendation, with the USPSTF concluding it has moderate certainty of moderate net benefit among older adults. In a review of 9 trials involving vitamin D supplementation, the authors estimated there was a 17% reduction in the risk of falling over the course of 6 to 36 months of follow-up, with a number needed to treat of 10.

When studies targeted those who were vitamin D deficient, the effect was greater yet.

In contrast, the task force did not recommended multi-factorial risk assessment with comprehensive management of identified risk for the general population of older adults. The authors stressed that the service would likely be beneficial only to selected patients, depending on individual symptoms.

Specifically, a combined analysis of 6 studies on multifactorial clinical assessment with comprehensive management resulted in a non–statistically significant reduction of risk after 12 months, with a pooled RR of 0.89 (95% CI, 0.76 - 1.0). The largest of these studies involved 1559 adults with a mean age of 72.5 years reporting a 25% reduction in the risk of falling in the intervention group compared with control patients (RR, 0.75; 95% CI, 0.64 - 0.88). Multifactorial clinical assessment with less-than-comprehensive follow-up was ineffective in reducing the risk for falls (pooled RR, 0.994; 95% CI, 0.917 - 1.076).

In addition, 4 studies that looked at vision correction failed to report a reduced risk of falling, and evidence for wearing hip protection was mixed. Although 1 study of 4169 women with an average age of 78 years reported a reduced risk of falling after 12 months, a smaller study found no benefit. Evidence of the benefits of protein supplementation was limited, as was evidence for clinical education or behavioral counseling. Three studies examining home hazard modification produced results that fell short of statistical significance.

The author has disclosed no relevant financial relationships.

Cochrane Database Syst Rev. 2012 May 16;5:CD007834. (Review)

BACKGROUND: Restless legs syndrome (RLS) is a common neurologic syndrome and is associated with iron deficiency in many patients. It is unclear whether iron therapy is effective treatment for RLS.

OBJECTIVES: The objective of this review was to assess the effects of iron supplementation (oral or intravenous) for patients with RLS.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Jan 1995 to April 2011); EMBASE (Jan 1995 to April 2011); PsycINFO (Jan 1995 to April 2011); and CINAHL (Jan 1995 to April 2011). Corresponding authors of included trials and additional members of the International Restless Legs Syndrome Study Group were contacted to locate additional published or unpublished trials.

SELECTION CRITERIA: Controlled trials comparing any formulation of iron with placebo, other medications, or no treatment in adults diagnosed with RLS according to expert clinical interview or explicit diagnostic criteria.

DATA COLLECTION AND ANALYSIS: Two review authors extracted data and at least two authors assessed trial quality. We contacted trial authors for missing data.

MAIN RESULTS: Six studies (192 total subjects) were identified and included in this analysis. The quality of trials was variable. Our primary outcome was restlessness or uncomfortable leg sensations, which was quantified using the IRLS severity scale in four trials and another RLS symptom scale in a fifth trial.

Combining data from the four trials using the IRLS severity scale, there was no clear benefit from iron therapy (mean difference in IRLS severity scores of -3.79, 95% CI: -7.68 to 0.10, p = 0.06).

However, the fifth trial did find iron therapy to be beneficial (median decrease of 3 points in the iron group and no change in the placebo group on a 10 point scale of RLS symptoms, p = 0.01).

Quality of life was improved in the iron group relative to placebo in some studies but not others.

Changes in periodic limb movements were not different between groups (measured in two studies).

Objective sleep quality, subjective sleep quality and daytime functioning were not different between treatment groups in the studies that assessed them.

The single study of subjects with end stage renal disease did show a benefit of therapy.

Most trials did not require subjects to have co-morbid iron deficiency and several excluded patients with severe anemia.

The single study that was limited to iron deficient subjects did not show clear benefit of iron supplementation on RLS symptoms.

There was no clear superiority of oral or intravenous delivery of iron.

Iron therapy did not result in significantly more side effects than placebo (RR 1.39, 95% CI 0.85 to 2.27).

AUTHORS' CONCLUSIONS: There is insufficient evidence to determine whether iron therapy is beneficial for the treatment of RLS.

Further research to determine whether some or all type of RLS patients may benefit from iron therapy, as well as the best route of iron administration, is needed.

Smokers are being urged to take the opportunity provided by World No Tobacco Day (May 31st) to give up smoking.

Dr. Mike Knapton, associate medical director at the British Heart Foundation, suggested that the event could provide the incentive people need to quit smoking for good.

Doing so is 'the single best thing you can do for your heart', the expert revealed, as just a year smoke-free will halve a person's chances of having a heart attack.

And after 15 years, an ex-smoker's risk falls to levels found in people who have never smoked.

'What's great about days like today is that if you smoke, you can take heart from knowing thousands of other people just like you are all trying to quit together,' Dr. Knapton wrote on the charity's blog.

'And the benefits start within minutes. Just 20 minutes after your last cigarette, your blood pressure and pulse return to normal, while after 24 hours the carbon monoxide is eliminated from your body.'

This year's World No Tobacco Day is focusing on the tobacco industry's attempts to undermine global tobacco control initiatives.

People who use the diabetes drug pioglitazone may face a heightened risk of bladder cancer, new research suggests.

Scientists at Jewish General Hospital in Montreal, Canada, studied data on 115,727 patients, all of whom started taking drugs for type-2 diabetes between 1988 and 2009.

A total of 470 patients were diagnosed with bladder cancer during the follow-up period - which was typically around 4.6 years for each person.

The researchers found that patients who had taken pioglitazone at some point faced an 83 per cent increase in their risk of bladder cancer, and the chances of developing the disease increased if patients had taken the drug for more than two years or at particularly high doses.

There was no such increase for patients taking a different diabetes drug, called rosiglitazone.

Writing in the British Medical Journal, the researchers said their findings 'provide evidence that pioglitazone is associated with an increased risk of bladder cancer, whereas no increased risk was observed with the thiazolidinedione rosiglitazone'.

They added that previous studies may have underestimated pioglitazone's risk.

Last year (2011), the European Medicines Agency conducted a safety review of pioglitazone and concluded that while there was a 'small' increased risk of bladder cancer, the drug should remain on the market.

The National Institute for Health and Clinical Excellence (NICE) has published new guidance on the use of opioids to relieve pain in patients receiving palliative care for a chronic or incurable illness.

Strong opioids are often the only effective form of pain relief for people with incurable cancer, chronic kidney or respiratory diseases, or neurodegenerative conditions.

But many patients are reluctant to take them due to concerns about their side-effects or misunderstandings about the risk of addiction.

NICE's new guideline aims to standardise opioid use in palliative care and address these concerns.

Professor Mark Baker, director of NICE's Centre for Clinical Practice, said: 'We understand that patients can be anxious about using these medicines for a number of reasons. Likewise, healthcare professionals may not always be sure about when to prescribe certain types of opioids.

'The new guideline aims to address all those fears and provide clear advice to the NHS to ensure a consistent approach to treatment and ultimately help to drive up standards of care.'

The guidance makes recommendations for areas such as communication of risks to patients, how to commence treatment with strong opioids and when to review a patient's pain relief.

It also provides advice on the co-prescribing of laxatives to ease the common problem of constipation and how to inform patients about the risk of other side-effects.

Dr. Damien Longson, who chaired the guideline development group, said it places a 'strong emphasis' on good communication between doctors and patients.

'This will help the patient to feel content in following what has been prescribed and therefore potentially improving their pain control and reducing any associated side effects,' he explained.

Patients with a common heart condition called atrial fibrillation could now benefit from a new clot-busting drug called rivaroxaban (Xarelto).

The National Institute for Health and Clinical Excellence (NICE) has published final guidance recommending the oral drug, which helps to prevent the blood from clotting.

It works by preventing a substance called Factor Xa from enabling the formation of thrombin and fibrin, key components in the formation of blood clots.

This is particularly important for people with atrial fibrillation, who have an irregular heart beat and are more susceptible to blood clots and stroke.

Professor Carole Longson, director of NICE's Health Technology Evaluation Centre, said: 'Rivaroxaban, like dabigatran etexilate, which NICE recently approved as an option for this indication, can benefit people with atrial fibrillation.

'We are therefore pleased to recommend rivaroxaban as another cost-effective option for the prevention of stroke and systemic embolism in people with atrial fibrillation.'

The drug's approval was welcomed by the British Heart Foundation, which said it would benefit some atrial fibrillation patients.

Dee Maddock, the charity's senior cardiac nurse, observed that rivaroxaban does not require close monitoring like warfarin and is just as effective for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation.

The number of people diagnosed with hospital infections has fallen in England, new figures show.

The Health Protection Agency (HPA) said the prevalence of healthcare-associated infections (HCAI) fell from 8.2 per cent to 6.4 per cent of hospital patients between 2006 and 2011.

A total of 3,360 patients out of 52,443 surveyed in England were diagnosed with an infection between September and November 2011, with 135 of these patients having more than one hospital infection.

According to the figures, the most common types of HCAI were respiratory, urinary tract and surgical site infections.

The report also shows that the prevalence of HCAIs varies between NHS hospitals (6.5 per cent) and the independent sector (2.2 per cent).

The HPA also noted that MRSA bloodstream infections and C. difficile infections have significantly reduced since 2006.

Lead report author Dr Susan Hopkins, healthcare epidemiologist at the HPA, said: 'Measures that were put in place to tackle MRSA and C. difficile infections have ensured that over the last few years rates have consistently gone down.'

However, bacterial infections such as E. coli are on the increase and Professor Anthony Kessel, medical director of the HPA, said there are now 'new challenges to meet'.

Children who are born via caesarean section may face an increased risk of obesity, research suggests.

Scientists at Harvard Medical School looked at 1,255 mothers - all of whom joined the study before 22 weeks' gestation - and their babies, who were measured and weighed at birth, six months and three years.

Around a quarter of births (25%) were by caesarean section.

The researchers found that, irrespective of birth weight and maternal weight, babies who were born via caesarean section were twice as likely to be obese by the age of three as those born vaginally.

Almost 16 per cent of c-section babies were obese at this age, compared with just 7.5 per cent of those born naturally.

Publishing their findings in the Archives of Disease in Childhood, the study authors pointed out that the two delivery methods result in differences in the composition of gut bacteria, and that this may explain the apparent link between caesarean section and childhood obesity.

'An association between caesarean birth and increased risk of childhood obesity would provide an important rationale to avoid non-medically indicated caesarean section,' they concluded.

Responding to the research, Sue Macdonald from the Royal College of Midwives claimed that unnecessary caesarean sections may have 'detrimental effects' for both women and children.

'This highlights the need to avoid caesarean sections that are not medically needed,' she added.

American Association of Clinical Endocrinologists (AACE) 21st Annual Meeting and Clinical Congress: Abstract 253. Presented May 24, 2012.

May 24, 2012 (Philadelphia, Pennsylvania) - Telemedicine is an acceptable way to deliver care to endocrinology patients in rural areas, according to a study reported here at the American Association of Clinical Endocrinologists 21st Annual Meeting and Clinical Congress.

"There is an increased prevalence of diabetes in rural compared with urban areas, which is compounded by the problem of a lack of endocrinologists," said Rabia A. Rehman, MD, an endocrinology fellow at the University of Tennessee Health Science Center in Memphis.

"Patients have to travel hundreds of miles to meet a specialist and wait up to 6 months for an appointment. We think this gap can be bridged with telemedicine," she said in a press conference.

The study involved 66 patients (mean age, 53.8 years) from 5 rural areas in Tennessee who were referred by their primary care providers to the telemedicine unit of the University of Tennessee over a period of 2.5 years.

Almost three quarters of the cohort (73%) was female, 35 (53%) had type 2 diabetes, 27 (41%) had hypertension, 30 (45%) had dyslipidemia, 20 (30%) had thyroid disease, and 8 (12%) had osteoporosis or hypercalcemia.

For some patients who had more than 1 endocrine disorder, other consultations included hyponatremia and polycystic ovarian syndrome.

Patients were interviewed and examined using video conferencing in the telemedicine studio, explained Dr. Rehman.

"There is a nurse present with the patient at the remote site who can not only take vital signs, but who can help the physician with some basic physical exam maneuvers, like swelling in the legs or thyroid exams."

Laboratory tests and management strategies were sent to the patients' primary care physicians, who then continued the follow-up.

In 85% of 20 diabetic patients, there was significant improvement at 6 months, compared with baseline, with glycated hemoglobin (HbA1c) decreasing from 9.1% to 7.5 % (P < .002), said Dr. Rehman.

Four patients with thyroid disease became euthyroid over the follow-up period, and 70% of subjects with dyslipidemia showed improved lipid profiles.

Nearly all patients (97%) were comfortable receiving care through video conferencing, she said.

"We think it may be a little costly to set up the equipment up front. However, in the long-run, this will be cost effective, not only for the patients but for overall healthcare," she said. "This will save patients from traveling long distances, resulting in timely consultation and leading to better control. Improvement of HbA1c will also result in prevention of the multiple morbidities and complications that result from uncontrolled diabetes."

Dr. Rehman has disclosed no relevant financial relationships.

May 24, 2012 (Belgrade, Serbia) - Renin-angiotensin-system (RAS)-blocking agents were seen to significantly improve survival in patients with heart failure with preserved ejection fraction (HF-PEF) in an observational study of patients representing most of Sweden.

The finding is at odds with at least three major randomized trials that had all but dashed previously high expectations for this use of the drugs. But the cohort study's investigators allege that there are important limitations to those trials, which tested ACE inhibitors and angiotensin receptor blockers (ARBs), and that they showed signals of possible benefit that ought to keep the RAS-inhibitor door open for HF-PEF.

The investigators aren't arguing that their study, which included a propensity-matched cohort analysis, carries more weight than controlled trials. Still, it suggests that "one should consider RAS antagonists for a likely but not proven benefit" in HF-PEF until the question is settled by an "adequately powered randomized controlled trial," said Dr Lars H Lund (Karolinska Institute, Stockholm, Sweden) here at the Heart Failure Congress 2012 sessions of the European Society of Cardiology Heart Failure Association.

"Representative of Sweden for Sure"

His group's analysis of >3000 propensity-matched pairs of patients with HF-PEF in the Swedish Heart Failure Registry saw a 9% (p=0.008) decline in all-cause mortality associated with treatment with either ACE inhibitors or ARBs.

The matched pairs were taken from >16 000 patients with LVEF >40% who were part of an overall cohort of >64 000 heart-failure patients in the registry. They included 12 543 who were on RAS inhibitors and 3673 not taking them.

"I think our population is representative of clinical practice. It covers almost all hospitals in the country. It's representative of Sweden for sure," Lund told heartwire. The unadjusted HR for the effect of RAS inhibition on all-cause mortality at one year in the overall cohort was 0.48 (p<0.001.)

The 3329 matched pairs were based on a propensity-scoring system that included 42 "relevant covariates" that were not only clinical and hemodynamic in nature but also socioeconomic, Lund said in his presentation. Adjusted that way, the HR for the same end point remained significant at 0.91 (p=0.008).

• 0.86 (p=0.051) for the effect of the ARB candesartan on cardiovascular death or HF hospitalization in the CHARM-Preserved trial.
• 0.92 (p=0.545) for the ACE inhibitor perindopril's effect on death or HF hospitalization in PEP-CHF.
• 0.95 (p=0.60) with another ARB, irbesartan, for death or CV hospitalization in I-PRESERVE.
• As the formal discussant following Lund's presentation, I-PRESERVE co–principal investigator Dr Barry M Massie (University of California and San Francisco VA Medical Center) critiqued the Swedish cohort analysis and defended the three randomized trials.

"I think probably the fact that most concerns me about this study is the definition of HF-PEF," he said. "I think very few people would say that an ejection fraction of 40% is normal in a chronic heart-failure population. Generally the trials that have been conducted have had cut points of 45% or 50%, and those are what I personally consider relatively preserved."

"There Were Trends"

Interviewed, Lund acknowledged their analysis is limited in being solely observational but said there were aspects of the three trials that were worth further exploration. 'There were trends,' he said. 'Call it signals, interactions, whatever, but heart-failure hospitalizations were reduced.' Also, patients in those trials had N-terminal pro–brain natriuretic peptide [NT-proBNP] levels 'in the 300 to 400 [ng/L] range," he said. "That's barely heart failure."

Whether it was "stated or unstated," according to Lund, the designers of the three trials "didn't want a lot of comorbidity, so they had younger patients with normal renal function and relatively good functional status." He added, "It's a classic example of where the real-life populations get excluded from randomized trials."

In the matched cohort, he emphasized, the mean age was 79, while in the trials it was in the upper 60s to lower 70s. Also, renal function was more compromised, and the mean NT-proBNP levels were 4577 ng/L and 5192 ng/L for the two groups respectively. "We believe our registry [represents] older patients, sicker patients and--we propose--is more real life."

Massie acknowledged that PEP-CHF was underpowered in part because of a low overall rate of primary events and a substantial number of patients dropping out of the trial. But he was adamant that wasn't the case with I-PRESERVE.

"I know [Lund] thought it was underpowered, but [I-PRESERVE had] 1500 events for the primary end point. I don't believe it really was an underpowered trial. I think what we saw is what we got, and I think it's probably the right answer. I would not want to conclude from I-PRESERVE that there is an effect of RAS blockers."

As an aside, Massie pointed out that in the DIG trial HF-PEF arm, in which the LVEF cutoff was 45%, digoxin was associated with an HR for cardiovascular mortality or HF hospitalization of 0.88 (p=0.209) for the entire follow-up period but 0.75 (p=0.044) at two years. "Digoxin thus far has proved to be perhaps the most effective intervention in heart failure with preserved ejection fraction."

As for the near future, he said, the long-awaited Treatment of Preserved-Cardiac-Function Heart Failure (TOPCAT) trial, "which is over but not yet fully analyzed," entered 3200 patients with heart failure, an LVEF >45%, and at least one of the following indicators of increased risk: HF hospitalization within the past 12 months, brain-type natriuretic peptide (BNP) >100 pg/mL, or an NT-pro-BNP >360 pg/mL.

TOPCAT, funded by the National Heart, Lung, and Blood Institute, randomized the patients to placebo or the aldosterone antagonist spironolactone and followed them for an average of 3.25 years for the primary end point of cardiovascular death, aborted cardiac arrest, or HF hospitalization.

"All patients have completed their follow-up, and we expect to get a result toward the end of this year," Massie said. "And hopefully we will get a treatment, and it may well be a RAS blocker that's effective."

Lund discloses consulting for and receiving research funding and speaker's fees from AstraZeneca.

Lund LH. RAS antagonists in HFPEF--Renin-angiotensin system antagonists are associated with reduced mortality in heart failure with preserved ejection fraction. A prospective propensity score-matched cohort study. Heart Failure Congress 2012; May 21, 2012 Belgrade, Serbia.

People who take calcium supplements may increase their chances of having a heart attack, new research suggests.

Previous studies have indicated that a high intake of calcium may help to lower blood pressure and reduce the risk of obesity and type-2 diabetes.

But the latest study in the journal Heart raises fears that calcium supplements may actually increase the risk of heart attacks.

Researchers looked at data on almost 24,000 people who took part in the German arm of the European Prospective Investigation into Cancer and Nutrition (EPIC).

Participants were aged between 35 and 64 when they enrolled in the study in 1994-98 and provided information on their dietary habits and use of supplements, before being tracked for an average of 11 years.

During that time, there were 354 heart attacks and 260 strokes and the researchers found that individuals with a moderate intake of calcium - from either food or supplements - had a 31% lower risk of having a heart attack than those with the lowest intake.

However, further analysis revealed that those who regularly took calcium supplements were 86%more likely to have a heart attack than those who did not.

The study authors concluded that increasing calcium intake from dietary sources 'might not confer significant cardiovascular benefits, while calcium supplements, which might raise risk, should be taken with caution'.

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said that calcium supplements do NOT necessarily cause heart attacks.

'Further research is needed to shed light on the relationship between calcium supplements and heart health. We need to determine whether potential risks of the supplements outweigh the benefits calcium can give sufferers of conditions such as osteoporosis,' she added.

A research team at Arizona State University is working on a new technique for the detection of the bone-thinning disease osteoporosis.

The researchers, who are funded by Nasa, have discovered that isotope analysis is better than x-rays at detecting bone loss and could help doctors to diagnose osteoporosis at a much earlier stage.

Isotopes are atoms of a particular element that differ in their masses and the new technique measures the isotopes of calcium that are present in a person's urine to shed light on their bone health.

Dr. Joseph Skulan, one of the study's authors, revealed: 'Bone is continuously being formed and destroyed.

'In healthy, active humans, these processes are in balance. But if a disease throws the balance off then you ought to see a shift in the calcium isotope ratios.'

Dr. Ariel Anbar, a professor in Arizona State University's department of chemistry and biochemistry, explained that by the time bone loss can be detected by x-rays, significant damage has already occurred.

'We think there might be a better way,' he added.

The findings are published in the Proceedings of the National Academy of Sciences and were welcomed by Dr. Nicola Peel, a spokeswoman for the UK's National Osteoporosis Society.

She told the BBC: 'This approach of using calcium isotopes is very interesting and appears to have potential to detect very early changes of bone loss.'

There has been an increase in the number of women having more than one abortion, new figures show.

Statistics published by the Department of Health reveal that 36 per cent of women who had an abortion in 2011, had already had one or more previous abortions.

This is significantly higher than the 31 per cent of women undergoing abortions in 2001 who had previously had an abortion.

The figures also show that 26 per cent of abortions performed on women under the age of 25 in 2011 were repeat abortions.

Overall, the number of abortions in England and Wales increased by 0.2 per cent between 2010 and 2011, from 189,574 to 189,931.

Tracey McNeill, UK and Europe director at Marie Stopes International, said she was 'concerned' by the increase in the number of women seeking abortions.

'We believe this increase shows that all parties involved in sexual health need to take rapid action if we want to see numbers go down over the coming years,' she commented.

Ms McNeill added that the way contraception is provided to women after an abortion needs to change 'radically ... if we're going to reduce the number of abortions by any great number.

Taking common painkillers such as aspirin could provide protection against skin cancer, new research suggests.

Scientists at Denmark's Aarhus University Hospital looked at medical records from northern Denmark between 1991 and 2009.

During that time, they found 1,974 instances of squamous cell carcinoma, 13,316 cases of basal cell carcinoma and 3,242 diagnoses of malignant melanoma.

When information on painkiller use was taken into account and compared with that of 178,655 individuals without skin cancer, the researchers observed some clear trends.

They found that people with more than two prescriptions for non-steroidal anti-inflammatory drugs (NSAIDs) were 15 per cent less likely to be diagnosed with squamous cell carcinoma and 13 per cent less likely to develop malignant melanoma than those with fewer prescriptions for these drugs.

NSAID use did not appear to reduce the overall risk of basal cell carcinoma, but it did seem to reduce the risk of this type of skin cancer on body areas other than the head and neck when taken long-term or in high doses.

Sigrun Alba Johannesdottir, whose findings are published in Cancer journal, said: 'We hope that the potential cancer-protective effect of NSAIDs will inspire more research on skin cancer prevention.'

Figures from Cancer Research UK show there were 11,877 new cases of malignant melanoma and more than 91,100 diagnoses of non-melanoma skin cancer in the UK in 2009.

Women who regularly eat unhealthy fats may be more likely to develop memory problems, a study has found.

Scientists at Brigham and Women's Hospital in the US looked at data on 6,000 women over the age of 65, all of whom had participated in a long-term health study.

The women had three cognitive function tests over a four-year period and completed diet surveys.

Publishing their findings in the Annals of Neurology, the team found that the total amount of fat consumed did not seem to influence cognitive function….. However, the type of fat did appear to influence the women's memory performance and overall cognitive function.

Saturated fat in particular was found to be associated with worse cognitive function and memory over time, whereas monounsaturated fat - which is found in olive oil - was linked to better cognition and memory.

Dr. Olivia Okereke, from the hospital's psychiatry department, commented: 'Our findings have significant public health implications.

'Substituting in the good fat in place of the bad fat is a fairly simple dietary modification that could help prevent decline in memory'.

In 2011, scientists at the University of Pittsburgh found that eating baked or grilled fish could help to protect against Alzheimer's disease.

Nearly two-thirds of people are worried about dementia, according to research published at the start of Dementia Awareness Week (May 20th to 26th).

A YouGov poll commissioned by the Alzheimer's Society and Saga Homecare found that 61 per cent of people are worried about their risk of developing dementia, or about someone they know developing the condition.

However, just 16 per cent of respondents said they wanted to know more about dementia, with the majority apparently preferring to stick their heads in the sand.

Jeremy Hughes, chief executive of the Alzheimer's Society, said: 'Dementia is the biggest challenge facing the UK today so it's not surprising that people are so worried.

'Only through knowing more will we ensure the people with the condition are treated with the dignity and respect they deserve.'

The Alzheimer's Society has just announced actress Carey Mulligan as its newest ambassador.

The Bafta-winning star has agreed to support the charity's work as her own grandmother has been living with Alzheimer's disease since 2004.

People who do not have a history of vascular disease may still benefit from taking cholesterol-lowering statins, a study has found.

Researchers at Oxford University analysed data from 27 previous clinical trials involving around 175,000 people to investigate the effects of lowering levels of low-density lipoprotein (LDL or 'bad cholesterol') with statin therapy.

They found that statins were associated with a 21 per cent reduction in serious vascular events per 1mmol/L reduction in LDL, including among those patients with the lowest risk of vascular disease.

In fact, the reduction in major vascular events among those with the lowest risk of vascular disease was at least as big as in those with the highest risk.

The researchers, whose findings are published in the Lancet medical journal, also noted that the reduction in patients' risk of major vascular events 'exceeds any known hazards of statin therapy'.

A spokeswoman for the British Heart Foundation, which part-funded the study, said that the findings 'will help to inform policy and treatment guidelines in the future'.

May 22, 2012 (San Diego, California) - Supplements used for body-building and weight loss were the most frequent cause of liver injury related to herbal or dietary supplements in a review of the 8-center US Drug-Induced Liver Injury Network (DILIN).

The findings were reported here at Digestive Disease Week (DDW) 2012 by Victor J. Navarro, MD, professor of medicine, pharmacology and experimental therapeutics at Thomas Jefferson University in Philadelphia, Pennsylvania.

"Body-building and weight-loss supplements were implicated in 31% and 18% of cases, respectively," Dr. Navarro said. "Hepatotoxicity due to herbal/dietary supplements can be severe, resulting in transplantation in 7% of cases."

Dietary supplements include herbal remedies, body-building supplements, health food supplements, and any such substance bought over the counter or online that is not prescribed by a physician.

Hepatotoxicity from medication is the primary reason for drug withdrawal. Although up to 40% of Americans are believed to take at least 1 herbal or dietary supplement, the potential toxicity of these products is not well defined, Dr. Navarro said.

Dr. Navarro and colleagues, therefore, examined DILIN's experience with consecutive cases of hepatotoxicity attributable to herbal/dietary supplements between 2003 and 2011. They detailed the different types of products that were implicated and described the clinical characteristics, severity, and causality associated with cases of non–acetaminophen-related liver injury, as defined by strict criteria for liver enzyme elevation.

Clinical and laboratory data were collected for all patients, who were assigned DILIN severity scores by expert opinion. Patients were followed until their injury resolved.

The investigators identified 1048 total cases over the 8 years, of which 18.4% were deemed potentially attributable to herbal/dietary supplement use, Dr. Navarro reported.

He presented an analysis of 93 cases that had been fully "vetted" for cause of liver injury related to body-building supplements to provide more details of problem.

The analysis showed that 31% of cases appeared to be solely due to body-building supplements and 18% were solely due to weight-loss products. Less commonly (<10% each), immune support products, cough and cold formulations, and products marketed for mental health were implicated. Rarely, there were associations between liver injury and multiple vitamins; Chinese herbs; anti-inflammatory/analgesic compounds; energy boosters; sleep aids; and supplements for sexual performance, joint support, and gastrointestinal health.

Clinical Features of Injury Differed

Users of these products were all male, had a mean age of 35 years, were largely white (83%), and were often overweight (mean body mass index [BMI], 28.6 kg/m²). They experienced a longer latency between taking the product and falling ill, and they had a "striking" degree of hyperbilirubinemia. Their cases were also much more likely to be scored as "definitely" attributable to the supplement.

"The duration of their injury was much longer, as compared with the other populations," Dr. Navarro noted. "They had itching, anorexia, and weight loss. In other words, their lives were derailed for a longer period."

For liver injury due to weight-loss products, the typical user was female (65%), had a mean age of 37 years, was white (65%), and was overweight (BMI, 28.4 kg/m²). These patients were particularly notable for their hepatocellular injury (vs cholestatic or mixed injury), meaning their livers were "more inflamed," he explained.

Ingestion of a body-building supplement resulted in hospitalization in 52% of these cases and in liver or other organ failure for 7%, but none required transplants. Patients who fell ill because of weight-loss products were hospitalized 47% of the time, 12% experienced organ failure, and 12% required transplantation.

In the group of patients whose injury was related to an herbal or dietary product other than body-building or weight-loss supplements, the rate of hospitalization was 32%, organ failure occurred in 15%, and 11% underwent transplantation.

Dr. Navarro said he does not know "the denominator," ie, how many Americans currently use supplements; therefore, the ratio of use to injury cannot be determined. "I wish we did know," he said, "but we do know that in dollars, it's about $19 billion a year."

Making these products safer will be a challenge, he added. "The regulatory environment is a confounding factor in our research," he noted, explaining that ingredients can change from batch to batch. "The environment is permissive enough that we will be challenged to determine what within a certain product is actually causing the injury."

William Lee, MD, from the University of Texas Southwestern in Dallas, has treated patients who were part of the DILIN database. He commented, "It is very clear that the body-building drugs - typically anabolic steroids they get from the gym - have this effect on young men. They turn bright yellow and stay yellow for about 3 months at a time, though they virtually all recover. It just takes a long time. Weight-loss drugs cause more liver damage and not as much jaundice," he said.

Dr. Lee said that he would discourage anyone from using an herbal/dietary supplement. "The public wants to use these products all the time, but there is toxicity, and the body-building and weight-loss supplements are the main concerns." Dr. Navarro disclosed he is a consultant for Merck & Co. Dr. Lee has disclosed no relevant financial relationships. Digestive Disease Week (DDW) 2012. Abstract #167. Presented May 19, 2012.

Two patients with an irreversible form of blindness have undergone a revolutionary stem cell treatment in a bid to restore their eyesight.

Corneal blindness occurs when the cornea - the transparent front part of the eye - becomes clouded so that the person cannot see.

At present, the only treatment is to transplant tissue from the cornea of a deceased organ donor.

But Scottish experts hope their new technique will change that by enabling stem cells to be taken from an organ donor, grown under laboratory conditions and transplanted into the patient's cornea.

The first patient to undergo the experimental therapy was Sylvia Paton, who was treated at the Princess Alexandra Eye Pavilion in Edinburgh 12 weeks ago.

The extent to which the procedure has worked will not be known for several months.

Ms Paton met with Scottish health secretary Nicola Sturgeon, who said this type of research was 'vital'.

'If it proves to be successful, we could see many more people benefit as a result,' Ms Sturgeon said.

She added: 'Corneal epithelial stem cell transplantation represents one of the first of a new generation of regenerative therapies which we hope will transform medicine over the coming decades.'

More than a third of people with high cholesterol put their heart health at risk by failing to take their medication as prescribed, new research shows.

A survey of adults, conducted by the British Heart Foundation, revealed that 36 per cent of people with high cholesterol do not take their medication, which means they could be at greater risk of a heart attack.

Research conducted on behalf of the charity also found that 28 per cent of people stop taking their medication when their symptoms disappear, while a further 23 per cent do not like the side-effects.

Dr. Mike Knapton, the charity's associate medical director, commented: 'Having high cholesterol or high blood pressure are major risk factors for developing heart and circulatory disease, which is still the UK's biggest killer, yet we found people with these conditions were often oblivious to the link.

'We want to remind people how vital heart medicines are - even if they feel well and don't have obvious symptoms.'

The poll came as research published in the Lancet medical journal revealed that even people with no history of vascular problems could benefit from statin therapy.

People with a family history of persistent high blood pressure or 'hypertension' may be able to reduce their own risk by maintaining a good level of physical fitness, research suggests.

Scientists at the University of South Carolina in Columbia followed 6,278 adults, aged 20 to 80 years, for approximately 4.7 years to investigate the links between fitness and hypertension risk.

They found that people who had a parent with high blood pressure had a 34 per cent lower risk of developing the condition if they were highly fit than if they had a poor level of fitness.

Dr. Robin Shook, a doctoral student at the university's Arnold School of Public Health, said the findings were 'impossible to ignore'.

He commented: 'This awareness can serve the clinician and the patient as they work together to find effective and reasonable ways to avoid the diseases that have affected their family members - in some cases for generations.'

The findings, which are published in Hypertension journal, were welcomed by Maureen Talbot, senior cardiac nurse at the British Heart Foundation.

She observed that while we cannot change our family's health history, we 'do have some control over our own health'.

A 20% or higher tax on unhealthy food and drinks could have a significant effect on levels of obesity and heart disease, new research suggests.

Dr. Oliver Mytton and Dr Mike Rayner at the University of Oxford examined the available evidence on the effects of introducing food taxes.

They found that taxing a wide range of unhealthy products tends to provide greater health benefits than only introducing taxes on a particular group of foods or beverages.

However, placing taxes on sugary drinks appears to be particularly effective, with modelling studies conducted in the US suggesting that a 20% tax on such beverages could reduce obesity levels by 3.5% on its own.

Meanwhile, separate research indicates that by imposing 17.5% VAT on unhealthy foods in the UK, the number of deaths from heart disease could be cut by up to 2,700.

Writing in the British Medical Journal, the Oxford researchers say that health-related food taxes of at least 20% should be combined with subsidies on healthy foods to have the greatest effect on diet-related conditions.

Dr. Rayner pointed out that prime minister David Cameron has previously signalled his desire to look into 'fat taxes'.

'He should now commission an independent review of the existing evidence that looks at the options for taxing unhealthy foods,' he claimed.

The expert added: 'A tax on sugary drinks is one measure that is a sure, safe bet that would change how many calories people consume across the nation and have a significant effect on obesity levels.'

May 22, 2012 - Observational studies have linked vitamin D to a number of musculoskeletal, neoplastic, metabolic, and cardiovascular disorders, but these findings have not been confirmed to a sufficient degree by large-scale and long-term randomized controlled trials, according to the findings of a recent review.

Clifford J. Rosen, MD, from the Tufts University School of Medicine in Boston, Massachusetts, and colleagues published their findings online May 17 and in the June print issue of Endocrine Reviews.

The authors noted that the therapeutic role of vitamin D remains a popular research topic. "In a 2-month span during the summer of 2011, there were more than 500 publications centered on vitamin D, most of which were related to its relationship to nonskeletal tissues," the authors write. "However, the results from those studies, as well as others, are confounded and difficult to interpret."

Preclinical Efficacy of Vitamin D Supplementation

The authors note that several beneficial effects of vitamin D have been reported in the literature. For example, they note, humans and mice lacking the vitamin D receptor develop alopecia, and that mice lacking the receptor, but not those lacking CYP27B1 (the enzyme that 1α-hydroxylates vitamin D metabolites), exhibit increased susceptibility to chemically or ultraviolet-induced tumors.

The authors also cite several studies suggesting an inverse relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and colorectal cancer incidence. For example, a 2008 meta-analysis performed by the International Agency for Research on Cancer that revealed a significant inverse association between serum 25(OH)D and cancer risk, although significant between-study heterogeneity was observed.

The authors also report that several observational studies revealed an increased risk for cardiovascular disease among patients with low vitamin D levels. In the Framingham Offspring Study, participants with 25(OH)D levels of less than 15 ng/mL had a greater risk for incident cardiovascular events than the other participants (hazard ratio, 1.62; 95% confidence interval, 1.11 - 2.36; P = .01).

Lack of Clinical Data
Despite the body of research on the nonskeletal effects of vitamin D, there is a paucity of clinical data supporting its efficacy. The authors report that no large-scale, randomized, placebo-controlled clinical trials have demonstrated the superior efficacy of vitamin D metabolites over other treatments for proliferative skin disorders or skin cancer.The authors report that no large-scale, randomized, placebo-controlled clinical trials have demonstrated the superior efficacy of vitamin D metabolites over other treatments for proliferative skin disorders or skin cancer.

Similarly, the authors state that no currently available clinical evidence demonstrates the efficacy of vitamin D supplementation in reducing the risk for type 2 diabetes or metabolic syndrome. Although the authors suggest that vitamin D supplementation reduces the risks for falls, the threshold 25(OH)D level needed for this effect remains uncertain.

Despite the strong experimental evidence of the efficacy of vitamin D in reducing colorectal cancer risk, the limited clinical trial data did not support this finding. Moreover, to date, no benefit of vitamin D has been clinically demonstrated for other types of cancer such as breast and prostate cancers.

The authors additionally indicate that there is insufficient clinical evidence supporting the use of vitamin D to reduce the risk for cardiovascular disease.

19th European Congress on Obesity (ECO). Abstract #152. Presented May 11, 2012.

May 22, 2012 (Lyon, France) - Obese individuals taking 3 mg of liraglutide daily who completed a 1-year study lost a mean 35.6% of excess body weight.

The number needed to treat (NNT) to achieve a loss of 10% of total body weight was only 3, Nick Finer, MBBS, consultant endocrinologist and bariatric physician at University College London Hospitals (UCLH) and UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery at University College London, United Kingdom, reported here at the 19th European Congress on Obesity (ECO).

Liraglutide, an injectable long-acting glucagon-like peptide (GLP)-1 analogue, is approved for the treatment of type 2 diabetes as an adjunct to diet and exercise.

Dr. Finer described a 20-week trial extended to 52 weeks in which participants with a body mass index (BMI) of 30 to 40 kg/m2, aged 18-65 years, and with a fasting plasma glucose level less than 7.0 mmol/L (126 mg/dL) underwent a placebo run-in for 2 weeks and were then randomly assigned to 1 of 6 treatment groups: subcutaneous liraglutide at 1.2 mg/day, 1.8 mg/day, 2.4 mg/day, or 3.0 mg/day; subcutaneous placebo injection; or oral orlistat, 120 mg 3 times per day.

From weeks 20 to 52, the investigators and participants were blinded to liraglutide or placebo treatment. Throughout the trial, participants were on a diet providing a 500-kcal/day deficit and had increased physical activity.

In a post hoc analysis, the investigators explored the percentage of weight loss at 52 weeks in responders who achieved a 5% or greater weight loss at 12 weeks, as well as the percentage of excess body weight loss (EBWL) at 52 weeks with liraglutide.

All the groups (n = 90-98 per group) were well matched for baseline characteristics and differed little at baseline for individuals who completed 52 weeks. They were about 1 quarter male, aged 45 to 47 years, with body weight of 96.0 to 98.4 kg, BMI of 34.1 to 35.0 kg/m², and excess body weight of 34.8 to 38.4 kg. Excess body weight is that amount in excess of having a calculated BMI of 25 kg/m².

Across all the groups, a total of 356 participants completed 52 weeks.

Weight loss at 20 weeks continued out to 52 weeks in a dose-dependent manner for liraglutide. "You can see that orlistat patients did lose weight but were about equivalent to the lowest dose, the 1.2 mg of liraglutide, and about half that seen for the higher doses of liraglutide," Dr. Finer reported.

Patients who achieved at least a 5% weight loss at 12 weeks were considered responders, and that included 75% of people receiving 3.0 mg of liraglutide per day and 32% of those receiving placebo. The placebo responder group lost 7.1 kg by 52 weeks.

The highest-dose liraglutide non-responders had lost only 3.4 kg at 12 weeks "but in fact continued to lose weight out to 1 year - 6 kilos - so one might argue these were not truly non-responders," Dr. Finer said.

Liraglutide responders had lost 7.9 kg at 12 weeks and by 52 weeks had lost 11.1 kg, which was a total body weight loss of nearly 12%.

Only 38% of the orlistat group were responders. "In terms of the ultimate weight loss in the responders' group, there was not a large difference between orlistat and liraglutide," D. Finer said. "If you did respond to orlistat, you did well. It was just you were much less likely to respond."

Increasing liraglutide doses were associated with increasing amounts of EBWL; a 35.6% EBWL was seen with the 3.0-mg dose, which is the dose being carried forward in further weight loss trials.

No one who completed 52 weeks of treatment with liraglutide, 3.0 mg, gained weight, but 27% of those receiving placebo and 13% of those taking orlistat did.

"I would like to emphasize that liraglutide is not licensed as a weight loss agent at this stage and has not completed its safety trials let alone its long-term efficacy trials in phase 3 trials," Dr. Finer cautioned the audience.

In an intention-to-treat analysis, the NNT to achieve a 5% weight loss at 1 year was 2 for liraglutide, 3.0 mg; 3 for orlistat; and 4 for placebo. To achieve a 10% weight loss, the NNTs were 3, 7, and 10, respectively. "I think that we should be encouraged by these data," Dr. Finer said. "I think there's often a lot of negativity, but an NNT of 3 [for liraglutide] for a 5% weight loss is really quite impressive."

Dr. Finer said the 35% EBWL with liraglutide stacks up favorably against the findings seen with bariatric surgery. "The use of excess body weight loss and also, I should say, numbers needed to treat, I think give clearly defined weight loss targets and perhaps a more optimistic interpretation of these data," he concluded.

Luca Busetto, MD, from the Department of Medical and Surgical Sciences and a member of the Obesity Center at the University of Padova in Padova, Italy, commented to Medscape Medical News that newer, effective antiobesity drugs may in the future be the most appropriate treatment for people with class 1 obesity.

"Probably the potency of these new drugs will be sufficient enough in order to solve the problem," he said. "So I think that we will not need surgery any more in patients with BMI between 30 to 35 [kg/m2], and probably also in the BMI class 35 to 40 [kg/m2] we may have some competition between drugs and surgery, at least less invasive surgery." For larger patients, Dr. Busetto thinks that surgery will remain the most efficacious therapy for at least the next 5 to 10 years.

For patients who can be managed with drugs, he thinks therapy will probably have to be life-long, although long-term data are lacking. "Obesity is a chronic disease, and probably we need to think of treating obesity as we treat hypertension, as we treat type 2 diabetes," Dr. Busetto said.

But as with other chronic medications, adherence may be a problem, especially with an injectable drug such as liraglutide, although development of longer-acting GLP-1 analogues that require less frequent injections may help.

Dr. Busetto predicted that liraglutide for weight loss may face some regulatory hurdles both in the United States and in Europe because licensing agencies may require not only demonstration of efficacy for weight loss but also demonstration of cardiovascular safety, "probably as a consequence of the problem with sibutramine in the past."

Dr. Finer has been an advisory board member and done paid lecturing and commercially sponsored research for Novo Nordisk A/S. He has also received lecture and consultancy fees from Roche in the past. The study was funded by Novo Nordisk A/S. Dr. Busetto has disclosed no relevant financial relationships.

A cancer diagnosis can be financially - as well as emotionally - devastating, according to a new campaign from Macmillan Cancer Support in Wales.

The charity's latest report highlights the fact that money is one of the biggest worries faced by people who are diagnosed with the disease.

It suggests that more than half of patients worry about their finances, with 41 per cent feeling more stressed as a result.

Writing in the report's foreword, the charity's general manager for Wales, Susan Morris, explained: 'A cancer diagnosis can mean taking a long time off work and this means a big drop in income.

'At the same time, there are a lot of costs associated with cancer - dozens of trips to and from hospital and increased heating bills to deal with the cold chemotherapy brings.'

Ms Morris added that at a time when patients should be focusing on getting better, many 'spend their time worrying about money'.

A Welsh government spokesman told the BBC that patients' needs are assessed following a cancer diagnosis and information is provided on access to financial help and support.

He added that cancer patients in Wales are entitled to free prescriptions and free parking at NHS hospitals.

Patients with chronic migraine may soon be able to get injections of botox on the NHS. The National Institute for Health and Clinical Excellence (NICE) has published new final draft guidance which recommends the therapy. After reviewing the latest evidence provided by manufacturer Allergan, NICE's appraisal committee has concluded that botox is likely to represent a cost-effective use of NHS resources.

Better known for its role as a non-surgical cosmetic treatment, botox (botulinum toxin type A) has also shown promise as a preventative treatment for migraine.

NICE final draft guidance, therefore, recommends botox as a treatment option for chronic migraine in adults who have already tried at least three other preventative medications.

However, injections should be stopped after two treatment cycles if the patient's headaches have not improved, or if they are diagnosed with a type of migraine called episodic migraine, for which botox is not licensed.

Professor Carole Longson, director of NICE's Health Technology Evaluation Centre, said: 'Chronic migraines are extremely debilitating and can significantly affect a person's quality of life.

'We are pleased that the committee has been able to recommend botox as a preventative therapy for those adults whose headaches have not improved despite trying at least three other medications and whose headaches are not caused by medication overuse.'

The decision was welcomed by Joanna Hamilton-Colclough, director of the charity Migraine Action.

She said: 'We hope for the majority of sufferers - many of whom are unable to work due to their condition - local providers of botox in the NHS will become established.'

The vast majority of people do not eat the recommended amount of fruit and vegetables, new research shows.

Health experts advise people to eat at least five different portions of fruit and vegetables each day in order to ensure a sufficient intake of key nutrients.

But a survey of 2,128 adults, conducted by research firm YouGov on behalf of the World Cancer Research Fund (WCRF), has found that just 22 per cent of people meet this target.

This figure falls to 17 per cent among lower-income households, along with 18 per cent of those living in the north of England.

Even in the area with the highest levels of consumption - the south of England - the proportion of adults eating five or more portions each day is just 26 per cent.

Kate Mendoza, head of education at the WCRF, commented: 'These figures show that many people are still finding it difficult to follow the healthy eating message.

'Getting at least five portions of fruit and vegetables a day is the building block of a healthy diet.'

Fruit and vegetables are full of fibre, which was recently shown to have a protective effect against bowel cancer.

According to the report, published by the WCRF and the American Institute for Cancer Research, there is now 'convincing' evidence that fibre-rich foods protect against the disease.

Eating eggs for breakfast could help people to eat fewer calories at their next meal, research suggests.

Scientists at the Pennington Biomedical Research Centre in the US studied 20 people, half of whom were given eggs for breakfast while the others ate cereal.

After three hours had passed, participants were given lunch to see how much they ate.

The researchers found that those who had eaten eggs for breakfast benefited from reduced hunger and an increased sense of fullness or 'satiety'.

Eating eggs also boosted levels of hormones associated with satiety.

Dietician Dr Carrie Ruxton said: 'This study adds to a growing evidence base which suggests that eggs may indeed be nature's appetite suppressant.

'The new research provides information on hormone levels for the first time, showing that consumption of eggs boosts PYY, a potent satiety hormone, while reducing levels of the hunger hormone ghrelin.'

Tracy Parker, heart health dietician at the British Heart Foundation, said that people who are trying to lose weight or want to stop snacking could benefit from the findings.

May 14, 2012 - The number and rate of battery-related emergency department (ED) visits for children younger than 18 years nearly doubled between 1990 and 2009.

The risks were highest for children younger than 5 years and often involved the small, coin-like batteries that power toys, games, and watches and for younger children, according to a study published online May 14 and in the June print issue of Pediatrics.

The study authors call for much greater preventive efforts by caregivers and better childproof designs for battery compartments by manufacturers.

Samantha J. Sharpe, BS; Lynne M. Rochette, PhD; and Gary A. Smith, MD, DrPH, all from the Center for Injury Research and Policy, the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, conducted an analysis of data from the National Electronic Injury Surveillance System for the 20-year period.

They estimate that 65,788 children (95% confidence interval, 54,498 - 77,078 children) younger than 18 years visited EDs for battery-related incidents during the study period. That averages to 3289 visits per year, or 1 visit approximately every 3 hours. Almost 80% of the patients were 5 years old or younger. One-year-old children accounted for 20.9% of all visits, which was the largest proportion for any single age.

Overall, the rate of visits increased from 4 per 100,000 children in 1990 to 7.4 per 100,000 in 2009 (m, 0.178; P = .002). For children aged 5 years and younger, however, the rate was almost twice as high and increased from 10 per 100,000 in 1990 to 19.1 per 100,000 in 2009 (m, 0.418; P = .007).

Among the visits for which the type of battery was included in the records, the number of visits associated with coin-like "button" batteries more than doubled from 1301 in 1990 to 2785 in 2009. "[Button batteries were implicated in >80% of all ED visits for which battery type was specified," the researchers write. Although this trend was not statistically significant during the 20-year period, it did reach statistical significance during the last 8 years of the study for children aged 5 years and younger. Cylindrical batteries were involved in 16.2% of the visits.

Almost 92% of the children were treated and released from the EDs; the others were admitted, transferred to another hospital, or had other dispositions.

Most Batteries Pass Harmlessly Through the Gastrointestinal Tract

"This study demonstrated a significant increase in the frequency and rate of ED visits due to battery ingestions among children," the researchers write. "Most batteries will pass through the gastrointestinal tract spontaneously without adverse consequences. However, severe morbidity and fatality can occur if the battery lodges in the esophagus."

One of the study's weaknesses, the authors note, is that surveillance data only capture records of ED visits, and not incidents treated at other healthcare facilities. "Therefore, this study underestimates the true number of pediatric battery-related exposures."

The National Electronic Injury Surveillance System also does not contain adequate data on mortality or diagnostics, treatment, or outcomes after patients leave EDs, the researchers write. They used US Census data for calculating population-based ED visit rates.

The study also did not yield data on whether increases in visits were a result of increases in exposure or increases in severity of exposure, or whether caregivers were more knowledgeable about battery exposures and sought more care.

The researchers conclude, "Batteries pose an important hazard to children, especially those aged ≤5 years. Primary prevention of battery exposures is critical because of the limited effectiveness of medical interventions once tissue damage has occurred. The increasing number and rate of battery-related ED visits among children underscore the need for increased prevention efforts."

The study was partially supported by the National Center for Injury Prevention and Control at the US Centers for Disease Control and Prevention. The authors have disclosed no relevant financial relationships.

May 11, 2012 (Atlanta, Georgia) - The strategy of taking MI patients to a PCI-capable hospital directly rather than to a nearer non-PCI hospital reduces time to reperfusion and can reduce mortality, a new study has shown [1].

Lead author Dr. Emil Fosbol (Duke Clinical Research Center, Durham, NC) said: "We found that patients taken directly to a PCI hospital were reperfused an average of 31 minutes faster than patients first taken to a hospital without PCI capability. Thirty-one minutes in the STEMI world is a lot and could translate into a reduction in mortality."

Indeed, the study did suggest a mortality reduction. Crude in-hospital mortality was lower in patients taken directly to a PCI hospital than in those taken to a local non-PCI hospital (6.3% vs 9.4%, p=0.046). But this was not significant after adjustment for other factors.

Fosbol commented to heartwire that he didn't expect to see a mortality difference in this one study with relatively small numbers. "The time difference to PCI would suggest that a mortality difference may be possible, but I would think it would need more patients and longer-term follow-up to show up. The mortality results we saw are very encouraging."

The study was presented by Fosbol at the American Heart Assocation's (AHA's) Quality of Care and Outcomes Research 2012 Scientific Sessions held this week.

"Until now, no well-designed study has examined the recommendation to take STEMI patients directly to a PCI hospital. The only rationale we had was the sooner you get there, the better," Fosbol said.

He and his colleagues linked emergency-services records in North Carolina between 2008 and 2010 with a clinical registry of STEMI patients.

Of the 1224 patients involved, 63% went directly to a PCI-capable hospital and 37% were first taken to a nearer non-PCI hospital.

Thirty-one minutes in the STEMI world is a lot.

Results showed that the time from first medical contact to reperfusion treatment with either PCI or lysis averaged 93 minutes for those taken directly to a PCI hospital compared with 124 minutes for those taken to the local non-PCI hospital. For patients who received only PCI, these times were 93 minutes and 161 minutes, respectively. Patients in the group taken directly to PCI hospitals were almost three times more likely to get treatment within guideline recommendations.

Predictors of being taken directly to a PCI hospital were white race (OR 1.37), chief complaint of c hest pain (OR 2.08), having received a prehospital ECG (OR 2.14), cardiogenic shock (OR 1.82), and a prior history of PCI (OR 1.66).

Room for improvement

"Our results suggest that there is still significant room for improvement regarding time and clinical outcomes for the one-third of patients taken to local hospitals," Fosbol commented, adding that to achieve this, more regional systems of care need to be introduced.

"The emergency services need to be given clear instructions on where to go," he said. Fosbol reported that since 2008 in North Carolina there have been more specific protocols on this introduced. But it all depends on how well hospitals and emergency services work together, and it can be very political. "We have 150 emergency medical services agencies just in this one state, and there can be agreements whereby some agencies take patients to certain non-PCI hospitals. The way the system is set up and people get paid is not the best way of ensuring patients always get to the best place."

Duke/AHA launch new regional project

The aim of facilitating better coordinated regional programs for STEMI patients is taking another step forward with the "Regional Systems of Care Demonstration Project," announced today [2].

The project, which has been developed by Duke University Medical Center and the AHA, will target 20 regions, including New York City, Philadelphia, Detroit, San Antonio, and Phoenix.

The new program builds on the Mission: Lifeline program and Duke's Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments (RACE) project. "By building consensus among all primary-PCI hospitals in the state, we were able to convince the majority of emergency departments and emergency medical systems to adopt uniform and coordinated processes for rapid diagnosis and treatment," said Duke cardiologist Dr. James Jollis, referring to the RACE program.

During the next two years, the demonstration project team will work closely with cardiologists, emergency-medicine physicians, nurses, and paramedics from each region to help them implement similar, coordinated programs. Data will be collected so each region can measure their success.

The project is being funded by educational grants from the Medicines Company and Abiomed.

References:

• Fosbol DL, Granger C, Jollis J, et al. The impact of an emergency medical services hospital bypass protocol on reperfusion time for patients with ST-elevation myocardial infarction (STEMI). Quality of Care and Outcomes Research 2012 Scientific Sessions; May 10, 2012; Atlanta, GA. Presentation.
• Duke University Medical Center. Program to coordinate regional systems to speed heart attack care [press release]. May 11, 2012. Available here.Heartwire © 2012 Medscape, LLC

Global efforts to tackle malaria are being hampered by the large quantity of fake anti-malarial drugs on the market, new research has found.

Scientists at the US National Institutes of Health (NIH) analysed data from previous studies that had looked at the chemical composition and packaging of anti-malarial drugs in sub-Saharan Africa and south-east Asia.

They found that approximately 36 per cent of drugs in south-east Asia were fake, while one in three samples from sub-Saharan Africa contained too much or too little of the active ingredient.

Review author Gaurvika Nayyar, from the NIH's Fogarty International Centre, said: '3.3 billion people are at risk of malaria, which is endemic in 106 countries.

'Much of this morbidity and mortality could be avoided if drugs available to patients were efficacious, high quality and used correctly.'

The findings are published in the Lancet Infectious Diseases and follow recent figures from the UK's Health Protection Agency showing a 22 per cent increase in malaria cases among travellers returning from the Indian sub-continent.

Migrants from countries with a high incidence of tuberculosis (TB) will soon need to be screened for the disease before being granted a UK visa, the government has announced.

Immigration minister Damian Green confirmed the new measures yesterday (May 21st) and claimed they will save the country more than $40 million over the next ten years.

Under the new rules, people from 67 countries with high TB rates who wish to enter the UK for more than six months will be required to undergo pre-entry screening, followed by treatment if required.

Mr. Green noted that the costs of screening and subsequent treatment will be met by visa applicants.

'Tuberculosis is currently at its highest level in the UK for 30 years and it's essential that we take action to tackle its continued rise,' he said.

'Pre-entry screening, followed by treatment where necessary, will help to prevent the risk of TB in the UK and will also save lives.'

There were nearly nine million new cases of TB - and 1.4 million deaths - around the world in 2010.

Figures from the UK's Health Protection Agency show there are approximately 9,000 cases of the disease reported each year in the UK, with the majority occurring in major cities.

A drug currently used to treat arthritis could also help to tackle the parasite that causes dysentery.

Researchers at the University of California in San Francisco (UCSF) and San Diego (UCSD) have found that auranofin prevents the growth of the parasite Entamoeba histolytica, which can cause an intestinal infection called amoebic dysentery.

The drug was found to be effective in lab and animal studies, prompting the team to apply to conduct clinical trials in humans.

Their findings will soon be published in the journal Nature Medicine and indicate that auranofin may provide a low-cost treatment for amoebic infections.

Co-senior author Dr. James McKerrow, professor of pathology in the UCSF Sandler Centre for Drug Discovery, said: 'When we're looking for new treatments for the developing world, we start with drugs that have already been approved.

'If we can find an approved drug that happens to kill these organisms, we've leapfrogged the development process that goes into assessing whether they are safe, which also makes them Affordable throughout the world.'

Dr. Sharon Reed, from UCSD, added that the discovery could save years of expensive development and provide a new therapy for a 'major' health threat.

Infertility treatment may soon be routinely available on the NHS for women in their early 40s, following new recommendations from the National Institute for Health and Clinical Excellence (NICE).

The institute's updated draft guideline suggests that the upper limit should be raised from 39 to 42 for some women who have no other chance of conceiving.

It also recommends that women aged 39 and under who have not conceived after two years of trying for a baby, or after 12 cycles of artificial insemination, should be offered three full cycles of IVF treatment.

Oral ovarian stimulation agents are no longer recommended for women with unexplained infertility.

And couples with mild male fertility problems, unexplained fertility problems or minimal-to-mild endometriosis may no longer be offered intrauterine insemination, after research found they are more likely to conceive during the next two years without medical intervention.

NICE deputy chief executive Dr. Gill Leng said that the distress caused by infertility can lead to depression and the breakdown of relationships.

'However, in many cases infertility can be treated effectively - there are thousands of babies and happy parents thanks to NHS fertility treatment - which is why the NHS provides services and why NICE produces guidance on the topic,' she observed.

Dr. Leng added that the new guidance uses the latest evidence 'to make sure that treatment for infertility is offered at a time and in a way which is most likely to result in pregnancy'.

The guideline review was welcomed by the British Fertility Society, which urged primary care trusts to comply with the guidance and provide eligible couples with treatment.

A drug called Avastin is just as effective at treating a common eye condition as a more expensive medicine called Lucentis, new research shows.

Lucentis is currently used in the NHS to treat neovascular or 'wet' age-related macular degeneration (AMD), the most common cause of blindness in developed countries.

But research due to be published in the journal Ophthalmology suggests that the NHS could save $84.5 million a year by switching to the cheaper therapy.

One-year results from a study conducted by 23 hospitals and universities in the UK show that Avastin is just as effective as Lucentis

The trial - which involved 610 patients - also found that the injections can be given as needed, rather than on a monthly basis, without reducing the treatment's effectiveness.

Lead researcher Professor Usha Chakravarthy, from Queen's University Belfast's Centre for Vision and Vascular Science, revealed: 'Regardless of the drug received, or treating monthly or as needed, sight in the affected eye improved by between one and two lines on a standard eye test.'

Some NHS trusts recently decided to start using the cheaper drug Avastin, despite National Institute for Health and Clinical Excellence guidance recommending the use of Lucentis for wet AMD.

WASHINGTON (Reuters) May 08 - U.S. drug reviewers on Tuesday said Arena Pharmaceuticals Inc's obesity pill appeared to help people lose weight and was unlikely to cause tumors in humans, but questioned if the company had provided enough data to rule out heart problems.

Lorcaserin is one of three new potential obesity treatments vying to gain U.S. approval and be the first new weight-loss treatment on the market in over a decade, after initial rejections over safety issues.

Obesity, a leading cause of diabetes, heart disease and other health problems, has reached epidemic proportions in the United States with nearly a third of the population falling into the category.

But the FDA has set a very high approval bar for weight loss drugs because such a large portion of the general population is likely to want to take them.

The FDA first rejected lorcaserin, which is being developed in partnership with Japanese drugmaker Eisai Co Ltd, in October 2010, citing potential cancer risks.

Arena resubmitted its application with more data to show that the previous findings of tumors in rats did not apply to people, which seemed to assuage some of the FDA's concerns.

Shares of Arena shot up nearly 18% to $3.20 in morning trading on Nasdaq after the FDA posted its review online.

The FDA documents come ahead of an advisory panel of outside experts, which will review the pill on Thursday. The FDA will make its final decision by June 27, taking into account the panel's recommendations.

The FDA's main concern seemed to be risks to heart valves seen with lorcaserin, which could be a sign of broader heart damage. Heart problems have dogged the obesity field for decades, making the FDA especially cautious about any potential risks.

The infamous diet drug "fen-phen" was pulled from the market in 1997 after reports of sometimes fatal heart-valve problems, and another diet pill, Meridia, was withdrawn in 2010 after being linked to heart problems.

The same FDA advisory panel that is due to review lorcaserin recommended in March that all new obesity drugs need heart safety studies, even if clinical trials do not initially show evidence of increased heart risk.

Analysts have said Arena's pill may have the lowest chance of approval, with a smaller weight loss compared to drugs from Vivus Inc and Orexigen Therapeutics Inc, meaning the FDA may be willing to accept fewer risks.

Reuters Health Information © 2012

A more coordinated approach to improving care after falls could help to reduce fall-related deaths in over-75s by up to 30 per cent, a report suggests.

The NHS Confederation has called for a national drive to tackle the problem, which costs the health service millions of pounds every year.

Figures show that one in three over-65s suffer a fall each year, while falls are one of the main causes of injury-related death in over-75s.

In recent years, steps have been taken to prevent falls, but there are still problems as a result of the disjointed care that people receive after experiencing a fall.

The NHS Confederation's Ambulance Service Network and its Community Services Forum want this aspect of falls to be addressed to prevent people from falling again in the future.

Jo Webber, director of the Ambulance Service Network, said: 'We have to take the opportunity of the NHS reforms to get organisations across health, social care and local authorities working together.

'There are mechanisms available in the NHS reforms to make joint working possible but they will require leadership from the national to local level to really work.'

Age UK spokeswoman Michelle Mitchell welcomed the report, telling the BBC that effective falls prevention services should be available in all areas 'to support people who have fallen and prevent it from happening again'.

The number of people with osteoarthritis is likely to double to more than 17 million by 2030, an expert has claimed.

Philip Conaghan, professor of musculoskeletal medicine at the University of Leeds, believes millions more people will develop the degenerative joint condition as a result of increased life expectancy and rising obesity rates.

Age and excess weight are two of the main risk factors for osteoarthritis, which tends to affect the hips, knees and hands.

Professor Conaghan said: 'Britain is facing a tsunami of pain due to osteoarthritis as the number of people over 50 increases dramatically and obesity levels continue to rise.

'Action is needed immediately; we have to bust this myth that painful joints are an inevitable part of getting older that we have to put up with.'

His comments came as a new survey from the charity Arthritis Care found that 71 per cent of people with osteoarthritis experience constant pain.

The research also revealed that the average person is 57 years old when they are diagnosed with osteoarthritis, but that up to one-fifth of patients are diagnosed with the condition under the age of 45.

Judith Brodie, the charity's chief executive officer, said that the future is 'bleak' given the nation's ageing and increasingly obese population.

'We need policymakers and professionals to take the condition seriously; to implement robust and meaningful strategies to address how osteoarthritis is treated and managed across the UK and to improve health services,' she added.

Children with a strong group of friends tend to be more physically active than those with fewer people to spend time with, a study has found.

Research funded by the World Cancer Research Fund (WCRF) and the National Prevention Research Initiative found that each additional friend a child had was associated with an extra ten minutes of physical activity at the weekend.

Each extra friend was also associated with just under four more minutes of moderate to vigorous exercise after school.

However, the researchers noted that the trend only appears to hold true for girls and not for boys.

Dr. Russell Jago, from the University of Bristol's Centre for Exercise, Nutrition and Health Sciences, said: 'We want to encourage young people to be active with their friends and support each other.

'This information can be used to design strategies to improve activity levels among children at a crucial stage in their development.'

England's chief medical officer advises that children and young people should do at least 60 minutes of moderate-intensity exercise each day.

A plant compound naturally found in many fruits, vegetables and teas could help prevent blood clots, a new study has found.

US researchers have discovered that the chemical rutin, which is found in apples, oranges, onions and green and black teas, could block an enzyme involved in the formation of blood clots.

Scientists from the Harvard Medical School tested the effect more than 5,000 compounds had on clot-prone mice and discovered that rutin was the most effective chemical at preventing clots in arteries and veins.

Professor Robert Flaumenhaft, from the Harvard Medical School said: 'Clots occur in both arteries and in veins. Clots in arteries are platelet-rich, while those in veins are fibrin-rich.

'This discovery suggests that a single agent can treat and prevent both types of clots.'

Professor Flaumenhaft added that a safe and inexpensive drug that could reduce recurrent clots could help save 'thousands of lives'.

The findings are published in the Journal of Clinical Investigation.

One in six cancers are caused by largely treatable or preventable infections, according to latest estimates.

The Lancet Oncology review found that infections cause around two million cancer cases a year, with 80 per cent of these in the developing world.

Four infections - human papilloma viruses (HPV), Helicobacter pylori and hepatitis B and C viruses - account for 1.9 million cases of cervical, gut and liver cancers.

The study, which looked at incidence rates for 27 cancers in 184 countries, also found that 1.5 million of the 7.5 million cancer deaths worldwide in 2008 were down to treatable or preventable infections.

Nearly a third of cancer cases occur in people under 50.

Catherine de Martel and Martyn Plummer from the International Agency for Research on Cancer in France said: 'Application of existing public-health methods for infection prevention, such as vaccination, safer injection practice, or antimicrobial treatments, could have a substantial effect on future burden of cancer worldwide.'

Heart attack survivors who live near a major road are at an increased risk of death compared to those who reside in more suburban areas, according to new research.

US scientists have found that heart attack survivors living less than 100 metres from a roadway had a 27 per cent higher risk of death within ten years than those living at least 1,000 metres away.

Researchers at the Beth Israel Deaconess Medical Center in Boston also found that the risk drops to 13 per cent for those living between 200 and 1,000 metres from areas of high traffic.

Lead author Dr Murray Mittleman said: 'Living close to a highway is associated with adverse cardiovascular outcomes in those with underlying cardiac disease. 'Besides air pollution, exposure to noise could be a possible mechanism underlying this association.'

A total of 3,547 heart attack survivors took part in the ten-year study, with 1,071 participants dying during the research period.  Nearly two thirds (63 per cent) of these patients died of cardiovascular disease, 12 per cent died of cancer and four per cent expired from respiratory disease.

The findings were published in the May 7th edition of the Circulation journal.

Intrauterine devices (IUDs), or 'the coil', are the most effective form of emergency contraception and should be offered routinely to women who wish to avoid unwanted pregnancy, experts say.

An IUD is a small device made from plastic and copper that fits inside the womb and prevents sperm from reaching the egg by altering the composition of fluids in the womb and fallopian tubes.

Researchers at Princeton University in the US looked at data from 42 previous studies that were carried out between 1979 and 2011 in order to assess the effectiveness of IUDs.

Overall, IUDs were found to fail in less than one per 1,000 cases, making them more effective than the morning after pill.

Furthermore, IUDs can be left in place for five to ten years after insertion, providing ongoing protection against unwanted pregnancy.

Kelly Cleland, whose findings are published in the journal Human Reproduction, revealed that at least 36 per cent of pregnancies around the world are unplanned.

'This study is the most comprehensive review to date of the efficacy of IUDs used for emergency contraception, and our results provide clear evidence that they are a highly effective method of emergency contraception,' she confirmed.

Ms. Cleland added that failure rates for emergency contraceptive pills are at least ten to 20 times higher.'

Scientists have identified a cellular mechanism that appears to be behind the onset of tinnitus.

Tinnitus involves ringing or buzzing in the ear and can have a range of causes, such as a cold or prolonged exposure to loud noise.

One in 200 people are severely affected by the problem, but about one in ten have mild symptoms.

Now, researchers at the University of Leicester have shown that following exposure to loud noises, nerve cells or 'neurons' in part of the brain called the dorsal cochlear nucleus fire erratically, eventually leading to tinnitus.

Furthermore, they discovered that these neurons are unable to return to their usual state because of malfunctions in the potassium channels that regulate the cells' electrical activity.

Lead researcher Dr. Martine Hamann, from the university's department of cell physiology and pharmacology, explained: 'After exposure to loud sound, the channel is functioning less and therefore the cell is constantly active, being unable to reach its resting state and displaying those irregular bursts.'

The discovery, which is published in the journal Hearing Research, could one day lead to the first drug therapies to prevent the development of tinnitus.

Part of the research was funded by Deafness Research UK, whose chief executive Vivienne Michael welcomed the progress.

She added: 'The charity continues to fund research into better treatments for tinnitus, with the ultimate aim of a cure.'

The NHS will have to significantly increase the amount it spends on diabetes over the coming years, a report has claimed.

According to the Impact Diabetes report, published in the journal Diabetic Medicine, annual spending on diabetes will increase from its current level of $9.8 billion to $16.9 billion by 2035.

This means the NHS will soon be spending 17 per cent of its budget on diabetes and related complications.

Much of this money will be spent on treating complications of diabetes, rather than the condition itself, the report suggests.

At present, $7.7 billion is spent on treating diabetes-related complications, but this is likely to rise to $13.5 billion by 2035-36.

Diabetes UK, one of the organisations behind the report, warned that the amount spent on treating the disease will rise to 'unsustainable levels' without urgent action.

Chief executive Barbara Young said: 'The most shocking part of this report is the finding that almost four-fifths of NHS diabetes spending goes on treating complications that in many cases could have been prevented.

'The failure to do more to prevent these complications is both a tragedy for the people involved and a damning indictment of the failure to implement the clear and recommended solutions.'

A spokeswoman for the Department of Health told the BBC that the government is tackling the disease by encouraging healthier lifestyles, helping people to manage their condition through annual primary care health checks, and improving management of the condition in hospital.

May 2, 2012 - Imagine a patient walking into a pharmacy, self-diagnosing a cough at a kiosk with medical software, and then getting a drug from a pharmacist in the back of the store, all without a physician's prescription.

The US Food and Drug Administration (FDA) is imagining this scenario, much to the alarm of the American Medical Association (AMA) and other medical societies, which see the beginnings of an end-run around physician authority.

Since February, the FDA has been soliciting opinions on creating a new paradigm for drug approval.

Right now there are 2 types of drugs - those that require a clinician's prescription, and those that can be sold over the counter (OTC) without a script, because patients are considered able to safely treat themselves with the product.

Under the new paradigm, the agency would approve drugs in a third class - those that ordinarily would require a prescription, but which would be sold OTC under conditions of "safe use." Such conditions of safe use, specific for each drug, could include reliance on FDA-approved technology, such as medical software for self-diagnosis and blood tests administered by a patient or pharmacist, according to an FDA notice of a public hearing on the issue on March 22. The FDA document, published in February, also solicited written comments.

Safe use also could mean a pharmacist assessing whether a patient has any condition or risk factor that would contraindicate the use of a particular drug, or helping a patient choose between different drugs. With some medications, the FDA would require an initial visit to a clinician for a prescription but allow more automatic refills than usual before a follow-up visit.

Safe-use medications, the agency states, could benefit many Americans who go untreated or undertreated for their conditions because they are deterred from visiting a clinician by the "cost and time required." The deterrence factor of making one or more visits to get a prescription "may contribute to the undertreatment of certain common medical conditions including hyperlipidemia, hypertension, migraine headaches, and asthma."

"There Is No Substitute for a Clinician"

At the FDA hearing on March 22, 2 medical societies went on record objecting to the proposal for OTC safe-use drugs.

Sandra Fryhofer, MD, chair-elect of the AMA Council on Science and Public Health, said her group continues to "strongly support" the status quo of 2 drug classes - prescription and traditional OTC. In exploring how new technologies and new roles for pharmacists might expand the portfolio of OTC drugs, the FDA should not "undermine the relationship that a patient has with his or her physician".

"In our view, lack of oversight from a practitioner could be a serious concern," said Dr. Fryhofer.

The FDA has not provided any evidence showing that patients with hypertension, hyperlipidemia, or asthma can diagnose and manage these conditions by themselves, she noted. "The balance of medical evidence strongly suggests otherwise."She also estimated that patients would pay more out-of-pocket for drugs that insurers would shift into the OTC safe-use category.

Bobby Lanier, MD, speaking for the American College of Allergy, Asthma and Immunology (ACAAI), raised similar concerns, but more pointedly.

"The new proposals here being discussed are chilling and scary," said Dr. Lanier. "You are facilitating bad behavior by not having (patients) talk to a clinician. In our mind, there is no substitute for a clinician."

The FDA heard more objections like these from organized medicine in written responses to its notice. "Allowing the pharmacist authority to dispense medication without consulting the patient's physician first could seriously compromise the physician's ability to coordinate the care of multiple problems of many patients," said Roland Goertz, MD, president of the American Academy of Family Physicians.

The Endocrine Society told the FDA that whatever it does, it should exclude diabetes drugs from a new safe-use category. "Diabetes is an extraordinarily complex disease, "said Endocrine Society President Janet Hall, MD. The ability to prescribe drugs for this condition "should rest with the primary care physician or endocrinologist."

Pharmacists Tout Easy Accessibility Compared to Physicians

The notion of OTC safe-use drugs has its supporters, particularly among pharmacists. They say this hybrid of prescription and OTC drugs will increase consumer access to healthcare. Pharmacist groups lined up behind the proposal include the American Pharmacists Association (APA), the National Community Pharmacists Association, the Academy of Managed Care Pharmacy, and the National Association of Boards of Pharmacy.

These organizations tout the ability of pharmacists to make the new safe-use model a success. Pharmacists are "the medication experts," and for many Americans, more accessible than physicians, they claim. Through their frequent conversations with patients, pharmacists are in a good position to help them stick to their medication regimens - improving health outcomes and reducing costs. At the same time, the pharmacist groups recognize the need for their members to collaborate with physicians, and refer patients who need more in-depth treatment.

And it is not as if pharmacists would be filling a brand new role. The APA says that pharmacists are authorized to independently administer influenza immunizations in all 50 states.

In a letter to the FDA, the Arkansas Pharmacists Association noted that members of their profession in the United Kingdom and Australia dispense "pharmacist-only" medications without a clinician's prescription. The group also said this model has worked in Arkansas with the nasal decongestant pseudoephedrine. Instead of making the drug prescription-only - and requiring a physician's appointment - to keep it out of the hands of methamphetamine makers, the state legislature recently made pseudoephedrine pharmacist-only. Patients now can buy it if a pharmacist determines that they have a legitimate medical need.

The ability of pharmacists to dispense safe-use drugs will become even more important in 2014 when the Affordable Care Act brings a host of newly insured Americans into the healthcare system, writes Mark Riley, PharmD, the executive vice president of the Arkansas association. The new paradigm is needed, Dr. Riley said, "for healthcare to remain Affordable and accessible."

The FDA has yet to propose specific regulations that would create the OTC safe use drug class. The deadline for submitting comments on what the agency set forth in its February 2012 notice is May 7. The notice explains several ways to submit comments.

People who eat plenty of fish, chicken and nuts may benefit from a reduced risk of dementia, scientists say.

Researchers at Columbia University Medical Centre in the US asked 1,219 people, aged 65 and over, to provide information on their diet for approximately 1.2 years.

Participants then had blood tests to measure their levels of beta-amyloid - a protein associated with Alzheimer's disease and memory problems.

The researchers found that people who ate higher levels of omega-3 fatty acids - which are found in oily fish, chicken and nuts - tended to have lower levels of the protein in their blood.

Study author Dr Nikolaos Scarmeas, whose findings are published in the journal Neurology, said that blood levels of beta-amyloid are 'to a certain degree' related to levels of the protein in the brain.

'Determining through further research whether omega-3 fatty acids or other nutrients relate to spinal fluid or brain beta-amyloid levels or levels of other Alzheimer's disease-related proteins can strengthen our confidence in beneficial effects of parts of our diet in preventing dementia,' he added.

Dr. Anne Corbett, research manager at the Alzheimer's Society, said that good fats such as omega-3 have previously been suggested to reduce the risk of dementia.

'Although this study didn't go as far as looking specifically at the condition, it adds weight to a growing body of evidence,' she commented.

The UK's low diagnosis rate for dementia is partly down to the fact that many people with memory loss do not visit their doctor, a survey of GPs suggests.

The Alzheimer's Society surveyed 382 GPs and found that two-thirds believe many patients are not diagnosed because they do not make an appointment to discuss their concerns.

Just 43 per cent of people with dementia in the UK are thought to have received a diagnosis and there is widespread variation in diagnosis rates across the country, ranging from 70 per cent in Belfast to just 27 per cent in Dorset.

Jeremy Hughes, chief executive of the Alzheimer's Society, said that the charity's survey provides 'vital clues' as to why this might be.

'We all forget things now and again but if memory loss is starting to interfere with your daily life, it's really important not to just ignore it,' he advised.

'If someone does have dementia, then it is best to know as soon as possible. They can then access potential treatments, support and plan for the future, along with their family.'

Prime minister David Cameron recently announced extra funding for research into dementia, describing the condition as a 'national crisis'.

A national campaign launched in January 2005 that encouraged healthcare workers to observe hand-hygiene measures was effective at improving cleanliness and reducing infection, a study has found.

The 'cleanyourhands' campaign was used in all NHS trusts in England and Wales, including posters encouraging workers to clean their hands and provide bedside alcohol handrub.

Researchers at University College London (UCL) and the Health Protection Agency (HPA) have now evaluated the campaign's effectiveness and found a clear link between hospitals' procurement of alcohol handrub and soap and their infection rates.

Over a four-year period, the procurement of alcohol handrub and soap almost tripled, while rates of meticillin resistant Staphylococcus aureus (MRSA) - a potentially serious healthcare associated infection - fell from 1.88 to 0.91 cases per 10,000 bed-days.

At the same time, levels of Clostridium difficile infection fell from 16.75 to 9.49 cases per 10,000 bed-days, according to a report published in the British Medical Journal.

Dr. Sheldon Stone, principal investigator at the UCL Medical School, said: 'Until now we haven't been able to say whether national campaigns of this kind deliver tangible benefits for patients.

'The cleanyourhands campaign has been a real British success story. It has really changed the culture amongst NHS staff.'

Professor Barry Cookson, director of the HPA's Laboratory of Healthcare Associated Infection, added that hand-washing and the use of alcohol handrub can be 'exceptionally effective' at combating the spread of healthcare associated infections.

An advertising campaign has been launched to raise awareness of the dangers of listening to loud music for too long.

Action on Hearing Loss is concerned that many people do not realise the potential damage they can cause by listening to loud music, either in clubs or through headphones.

Its new campaign features images of people's ears being attacked by a drill or hammer to highlight the risks.

Jackie Ballard, the charity's chief executive, said: 'For years we have tried to educate people about the dangers of loud music and this campaign is a new way for us to try to reach different audiences with this vital message.

'The Loud Music message is simple: take action now to protect your hearing.'

The campaign is supported by a number of well-known names in the music industry, including Coldplay star Chris Martin, who has admitted to suffering from tinnitus - a persistent ringing in the ears - for about ten years.

'Looking after your ears is unfortunately something you don't think about until there's a problem,' he said.

'Now we always use moulded filter plugs, or in-ear monitors, to try and protect our ears.'

People who jog on a regular basis may enjoy a longer lifespan, new research suggests.

Scientists at Bispebjerg University Hospital in Copenhagen presented the latest findings from the Copenhagen City Heart study - an ongoing cardiovascular study - at the EuroPrevent2012 meeting in Dublin this week (May 3rd to 5th).

The research began in 1976 and looked at about 20,000 men and women, aged 20 to 93 years, to investigate preventative factors in heart disease and stroke.

According to the latest findings, regular jogging increases the life expectancy of men by an average of 6.2 years and that of women by 5.6 years.

Peter Schnohr, the study's chief cardiologist, revealed that between one and 2.5 hours of slow to average-speed jogging per week appears to be best for longevity.

'We can say with certainty that regular jogging increases longevity,' he confirmed. 'The good news is that you don't actually need to do that much to reap the benefits.'

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said the findings were unsurprising, as physical activity has long been known to improve health.

'Staying active can help prevent and manage a wide variety of health conditions and keep your heart in great shape,' she observed.

A new study has been launched to determine the potential of a compound found in the curry spice turmeric to fight bowel cancer.

Patients with advanced bowel cancer will be given tablets containing the ingredient, curcumin, alongside their standard anti-cancer treatment.

It is hoped that the compound - which has previously been shown to enhance chemotherapy drugs' ability to destroy bowel cancer cells in the lab - may help to make cancer treatment more effective.

At present, between 40 and 60 per cent of patients do not respond well to standard advanced bowel cancer therapy.

Chief investigator Professor William Steward said that the research is at a very early stage, but that the work is 'intriguing'.

'The prospect that curcumin might increase the sensitivity of cancer cells to chemotherapy is exciting because it could mean giving lower doses, so patients have fewer side-effects and can keep having treatment for longer,' he explained.

Dr. Joanna Reynolds, director of centres at Cancer Research UK, added that by carrying out this kind of clinical trial, the charity hopes to find out more about the potential benefits of curcumin, as well as any side-effects it might cause.

Aspirin appears to be just as effective as warfarin at preventing stroke and dying in patients with heart failure, a study has found.

Researchers followed more than 2,300 patients in 11 countries over a ten-year period to compare aspirin - which prevents clotting - and warfarin, which thins the blood.

Overall, they found that the combined risk of death, stroke and cerebral haemorrhage was 7.47 per cent per year for those on warfarin, and 7.93 per cent per year for those taking aspirin.

Warfarin users were almost half as likely to have a stroke as aspirin users, but more than twice as likely to suffer major bleeding - meaning the two results cancelled each other out.

The findings suggest that in heart failure patients with a normal heart rhythm, aspirin may be just as effective as warfarin, while removing the need for a prescription and regular blood tests.

Principal investigator Dr Shunichi Homma, from Columbia University Medical Centre, said: 'Since the overall risks and benefits are similar for aspirin and warfarin, the patient and his or her doctor are free to choose the treatment that best meets their particular medical needs.

'However, given the convenience and low cost of aspirin, many may go this route.'

The findings, which are published in the New England Journal of Medicine, could have important implications, as British Heart Foundation statistics suggest there are more than 27,000 new cases of heart failure in the UK every year.

Men with low levels of testosterone may face a heightened risk of developing type-2 diabetes, new research suggests.

Scientists at the University of Edinburgh carried out tests on mice to see whether lowering the levels of testosterone in the animals' fat tissue had any effect on their resistance to insulin - the hormone that controls levels of sugar in the blood.

They found that when they blocked the function of testosterone, the mice developed insulin resistance - increasing their chances of developing diabetes.

This was true regardless of the animals' weight.

The study, which was funded by Diabetes UK, may help to explain why older men - who have lower levels of testosterone than younger men - are more likely to develop diabetes as they age.

Dr. Kerry McInnes, from the University of Edinburgh's Endocrinology Unit, said: 'This study shows that low testosterone is a risk factor for diabetes no matter how much a person weighs.'

Dr. Iain Frame, director of research at Diabetes UK, revealed that the link between low testosterone and type-2 diabetes was even more pronounced in mice that were fed on a high-fat diet.

'This reinforces Diabetes UK advice that a healthy balanced diet is important for everyone and particularly for those already at high risk of developing type-2 diabetes,' he added.

Teenagers with high levels of vitamin D do not appear to benefit from enhanced academic performance, new research suggests.

Scientists at the University of Bristol studied data on more than 3,000 children whose levels of vitamin D2 (sourced mainly from plants) and vitamin D3 (sourced mainly from sunlight) were measured at age nine.

The youngsters' abilities in English, math and science were then assessed at ages 13-14 and 15-16 to see whether there was any association between vitamin D levels and cognitive function.

Publishing their findings in the Journal of Epidemiology and Community Health, the study authors revealed that levels of vitamin D3 were not associated with better academic achievement.

And children with higher levels of vitamin D2 actually tended to have poorer performance in English at age 13-14 and achieved fewer A-star to C grades in their GCSEs.

'Our results suggest that protection of children from UVB exposure, which has been associated with low levels of vitamin D but which protects against skin damage and skin cancer, is unlikely to have any detrimental effect on academic achievement,' the researchers concluded.

Current NHS guidance suggests that people should be able to get enough vitamin D by exposing their skin to a little sun during the summer months and eating a healthy balanced diet including foods such as oily fish and eggs.

People with diabetes often face difficulties when it comes to self-managing their disease, a new study has found. The condition requires patients to monitor their blood sugar levels, organise their medication and follow a restrictive diet.

Researchers at Queen Mary, University of London found that many Britons manage their diabetes effectively after completing a short educational course on self-management. But others struggle because the course ignores many external factors, such as food labelling in restaurants and the behaviour of family members and colleagues.

The researchers, who shadowed 30 people with diabetes on several occasions to see the challenges they faced, concluded that some patients do not self-manage their condition well because of family responsibilities. Others were struggling financially or had other medical conditions that limited their ability to manage their diabetes.

Professor Trisha Greenhalgh, whose findings are published in the journal BMC Health Services Research, said: 'Until now there has been very little research on what people with diabetes do and how they cope when health professionals aren't around.

'We have shown that self-management of diabetes is hard work, both practically and emotionally, and that many but not all people with diabetes are skilful at undertaking and co-ordinating all the different tasks involved.'

NHS figures show that approximately 2.8 million people in the UK are affected by diabetes, while more than one million Britons are thought to have undiagnosed type-2 diabetes.

People who survive a stroke are unable to make the best possible recovery because of poor post-hospital care and a lack of coordination between health and social services, a report claims.

The Stroke Association commissioned a survey of more than 2,200 people affected by stroke to support its report.

It found that 38 per cent of stroke survivors had not received an assessment of their health and social care needs, while fewer than two-fifths of those who were assessed were subsequently given a care plan.

This is despite the fact that the National Stroke Strategy states people should be assessed six weeks after leaving hospital, again after six months and then once a year.

Almost half of those receiving health and social care services said the two were not well coordinated, while one in five said services had been withdrawn despite their needs staying the same.

Jon Barrick, the Stroke Association's chief executive, said: 'More people than ever are surviving a stroke and that's a welcome improvement.

'But many stroke survivors tell us that after all the effort to save their lives they then feel abandoned when they return home.'

A spokesman for the Department of Health said the government was determined to drive up standards for stroke patients 'by ensuring, among other things, that patients have a joint care plan prepared for them before they leave hospital'.

A team of British scientists have identified a new process that appears to play an important role in the regulation of blood pressure.

Researchers at the University of Southampton discovered a process that controls the ability of arteries to constrict, which in turn influences the flow of blood and the risk of high blood pressure.

According to the research team, polyunsaturated fats are made by muscle cells in the arteries, rather than being taken up from the blood.

They found that it was possible to reduce constriction within the arteries by blocking the action of two enzymes that create these fats, thereby allowing blood to flow more freely through the vessels.

Lead researcher Dr Graham Burdge, whose findings are published in the journal PLoS One, believes the discovery could ultimately pave the way for new treatments.

He said: 'Discovering a new process which controls how arteries work, and finding that it can be modified in the laboratory, raises a strong possibility for developing new medicines that may lead to better ways of treating cardiovascular disease.'

The study was funded by the British Heart Foundation whose associate medical director, Professor Jeremy Pearson, welcomed the findings.

He pointed out that one in three adults are affected by high blood pressure and that this increases their risk of suffering a heart attack or stroke.

The majority of women feel conscious of their body while exercising in public and are concerned about what other women will think, a survey suggests.

A poll of 1,450 women, conducted by mental health charity Mind for the 'Feel better outside - feel better inside' campaign, found that two-thirds of women are conscious of their body shape when taking part in outdoor activities.

The same proportion of women do not think they could keep up in an exercise group and almost half do not take part because they worry about looking uncoordinated and silly.

Many females are so concerned that they take extreme measures just in order to keep fit.

These include exercising very early in the morning or late at night (over 50 per cent); exercising in places where they are unlikely to see anyone they know (almost two-thirds); and wearing baggy clothing to hide their figure (67 per cent).

Beth Murphy, Mind's head of information, pointed out that activities such as walking, cycling and gardening are good for people's mental health.

'However for many of us exercising in the great outdoors can be incredibly daunting, especially if already feeling low and self-confidence is at rock bottom," she said.

'At these times you can feel like the only person in the world experiencing this, but Mind's research highlights that far from being alone, 90 per cent of women are in exactly the same boat.'

NHS Blood and Transplant (NHSBT) and Facebook have announced a new collaboration to encourage people to sign up to the organ donor register.

At present, people with Facebook's new 'timeline' feature can add various life events to their profile for others to see.

Now, users can click a new health and wellbeing button that includes their intention to become an organ donor.

It is hoped that by witnessing people's plans to donate their organs after their death, others will be encouraged to do likewise, as more than 30 million people in the UK alone use Facebook.

They can do this by visiting NHSBT's Facebook page to sign up to the organ donor register and officially register their wishes.

Sally Johnson, director of organ donation and transplantation at NHSBT, said: 'We need more people to sign up to the register and share their wishes with their friends and family, our job is to make that as quick and easy as possible.

'This is an exciting new way to use the power of social media to reach a huge audience and encourage people to think about it, act and share that information.'

Figures from NHSBT show that since the start of last month (April 1st 2012), 104 people have donated organs and 274 patients have received transplants.

However, more than 7,500 people are still waiting for life-changing transplants.

A new class of drugs could help to treat aggressive forms of pancreatic cancer, a disease that has a particularly low rate of survival.

Researchers at Cancer Research UK's Cambridge Research Institute have discovered that a gene called USP9x is switched off through chemical tags on the surface of the DNA.

The research, which was carried out on mice and human cancer cells in the laboratory, suggests that this gene may be faulty in up to 15 per cent of pancreatic cancers.

Existing drugs that strip away the chemical tags on the DNA's surface and are already being used to treat lung cancer could therefore be used to treat pancreatic disease, the scientists say.

Professor David Tuveson, one of the lead authors of the study, which is published in Nature journal, said: 'The genetics of pancreatic cancer has already been studied in some detail, so we were surprised to find that this gene hadn't been picked up before.

'We suspected that the fault wasn't in the genetic code at all, but in the chemical tags on the surface of the DNA that switch genes on and off, and by running more lab tests we were able to confirm this.'

Pancreatic cancer is the 11th most common form of cancer in the UK, according to the charity Pancreatic Cancer UK.

The disease affects more than 7,600 people a year and tends to be diagnosed in people over the age of 60.

Nearly one in four women risk developing skin cancer by failing to apply sun lotion during overseas holidays, a survey suggests.

Researchers at Macmillan Cancer Support questioned 1,500 adult women about their behaviour in the sun.

They found that 22 per cent of women do not wear sunscreen when they visit hot countries, even on sunny days.

Of those who never wear sunscreen, 24 per cent said they do not burn; 14 per cent argued that products are too expensive; and 12 per cent claimed they do not work.

The survey also revealed that 79 per cent of women have been badly sunburnt in the past.

Carol Goodman, an information nurse specialist at Macmillan, said: 'As people are preparing to go abroad for their annual holiday, it is very concerning that nearly a quarter of British women are putting themselves at risk of skin cancer by not wearing any suntan lotion abroad.'

Ms Goodman added that more than 2,500 people die of skin cancer each year in the UK.

The survey was carried out for Sun Awareness Week (April 30th to May 6th), which aims to increase people's understanding of the need to protect the skin from the sun's rays.

Women who go through the menopause early may be more likely to develop the bone-thinning disease osteoporosis, scientists say.

Researchers at the Skane University Hospital in Malmo, Sweden, studied data on 390 white north European women, all of whom were 48 years old when they enrolled in the Malmo Perimenopausal Study in 1977.

They were then followed up until the age of 77, at which point 198 women were still involved in the research.

The study authors found that 56 per cent of women who started the menopause early (before age 47) had osteoporosis at age 77, compared with just 30 per cent of those who started the menopause later.

Women who started the menopause early were also found to have a higher risk of fracture and premature death.

The findings are published in BJOG: An International Journal of Obstetrics and Gynaecology and suggest that women who go through early menopause may be candidates for bone-strengthening therapy.

Study author and orthopaedic surgeon Ola Svejme said: 'The results of this study suggest that early menopause is a significant risk factor for osteoporosis, fragility fracture and mortality in a long-term perspective.

'To our knowledge, this is the first prospective study with a follow-up period of more than three decades.'

Approximately 300,000 fragility fractures occur each year in the UK, according to the National Osteoporosis Society.

The vast majority of people do not realize that a persistent cough could be a sign of lung cancer, research suggests.

A survey of almost 1,500 people, conducted by Cancer Research UK, revealed that just five per cent of respondents knew this was a possible symptom of the disease.

Furthermore, just two people realized that a painful cough could be a warning sign, while less than 15 per cent cited persistent chest pain.

Other possible symptoms of lung cancer that most people failed to recognize include a change in an existing cough; a persistent chest infection; unexplained weight loss or fatigue; coughing up blood; and shortness of breath.

Sara Hiom, director of information at Cancer Research UK and an author of the study in the journal Thorax, said: 'It's very worrying to see from our survey results that when asked to think of lung cancer symptoms many common ones simply don't come to mind for most people.'

Ms Hiom emphasised the importance of recognising symptoms and catching the disease in its earliest stages, as this can improve a person's chances of survival.

Lung cancer is the second most common form of cancer in the UK and approximately nine out of every ten cases is caused by smoking.

Men are more likely than women to die suddenly from a heart attack caused by an irregular heart rhythm, new figures suggest.

Since July 2008, nearly two-thirds (62 per cent) of deaths involving sudden arrhythmic death syndrome (SADS) have been in men.

The figures are contained in a new report from the National Audit of SADS, which also revealed that people in their 30s are most at risk of sudden heart death, with the average age at death found to be 33.

In addition, the research showed that 33 per cent of people died while resting; 19 per cent while in bed; and 17 per cent while exerting themselves.

The researchers looked at 317 cases of SADS from 17 hospitals and hope more facilities will participate in the audit in the future.

Perry Elliott, clinical lead for inherited cardiovascular disease services at University College London's Heart Hospital and co-chairman of the audit, said: 'While SADS kills a relatively small number of people in England and Wales, recent events in the sporting world highlight the devastating impact that the condition continues to have on people.

'As this report shows, much progress has been made, but we still need NHS trusts to provide more data to build on this basic analysis and to improve the outlook for families affected by this fatal condition.'

Professor Peter Weissberg, the British Heart Foundation's medical director, welcomed the audit and agreed that greater hospital participation is needed to provide a true picture of the scale of the problem.

He observed: 'The real tragedy is that, even when a case of SADS is identified, coroners and their pathologists all too often fail to alert family members to the possibility that they might be at risk.

'This is a simple measure that could save another young life.'

Inducing labour in pregnant women without good medical reason could increase the risk of complications, Australian scientists have warned.

A research team at the University of Adelaide looked at data on more than 28,000 births that took place between 2006 and 2007.

The scientists found that induction for non-recognised reasons was associated with a 67 per cent increase in the risk of needing a caesarean section, compared with women who waited for labour to begin naturally.

Furthermore, unnecessary induction was linked to a greater risk of newborns requiring specialist care.

Dr. Rosalie Grivell, whose findings are published in the journal Acta Obstetricia et Gynecologica Scandinavica, said: 'We hope our findings will increase awareness of the potential harmful effects that elective induction can have on both women and their infants.

'In the absence of serious maternal or foetal problems or a medical recommendation, induction of labour is best avoided.'

A study published in BJOG: An International Journal of Obstetrics and Gynaecology last year (2011) found that maternal obesity was associated with an increased likelihood of induction of labour.

Women who are tall and have a high body mass index (BMI) may face an elevated risk of developing ovarian cancer, scientists have said.

Researchers at the University of Oxford and their international colleagues studied data obtained during 47 studies in 14 countries.

They looked at information on more than 25,000 women with ovarian cancer and more than 81,000 women who were cancer-free.

Analysis revealed that for every 5cm increase in a woman's height, there was a seven per cent increase in her risk of developing ovarian cancer.

Furthermore, among women who had never taken menopausal hormone therapy, a high BMI was also found to be a risk factor for the disease.

The findings are published in the journal PLoS Medicine and suggest that if all other risk factors had remained constant, recent increases in women's average height and BMI would have resulted in a three per cent increase in ovarian cancer incidence every ten years.

'The increase in ovarian cancer risk with increasing height and with increasing body mass index did not vary materially by women's age, year of birth, ethnicity, education, age at menarche, parity, family history of ovarian or breast cancer, use of oral contraceptives, menopausal status, hysterectomy, or consumption of alcohol and tobacco,' the study authors revealed.

Dr. Gillian Reeves, from Oxford's Cancer Epidemiology Unit, told the university's news service that there are a number of possible explanations for why height is related to ovarian cancer risk and that future studies should clarify the reasons.

More than 11 million UK adults boost their intake of sugar and calories by consuming sports drinks at their desks, a study has found.

A survey of more than 2,000 adults, commissioned by the Natural Hydration Council, revealed that one in three people use sports drinks for energy, even though they rarely break a sweat during exercise.

Furthermore, 19 per cent of people use sports drinks when they feel tired, while 18 per cent drink them when they are hungover.

The survey suggests that many people are using these drinks inappropriately, while almost 80 per cent do not drink water before exercising.

Professor Paul Gately, from Leeds Metropolitan University, said that levels of consumption of sports drinks were 'worrying'

He explained: 'These products are designed for highly active sportspeople and ultimately may be beneficial only for those undertaking regular high-intensity training and performance exercise lasting for more than 45 minutes.'

The expert also noted that some people treat sports drinks as their 'preferred option' for general hydration when they are not exercising, when they should simply be consuming water.

According to the Natural Hydration Council, people should sip water every 20 minutes when exercising, while those who perform high-intensity exercise for more than 45 minutes at a time may benefit from a sports drink or a diluted fruit juice.

Patients with metal-on-metal hip replacements are no more at risk of developing cancer in the years following surgery than the general population, a study has found.

Researchers at the universities of Bristol and Exeter looked at data contained in the National Joint Registry of England and Wales, which holds the records of more than one million procedures.

They compared cancer rates in patients with metal-on-metal hip implants with those in patients with other types of implant and the general population.

Analysis revealed that the average 60-year-old man with moderate health and a metal-on-metal stemmed hip replacement has a 6.2 per cent chance of being diagnosed with cancer in the five years following surgery. For other types of hip implant, there is a 6.7 per cent chance.

The comparable figures for women were 4.0 per cent for metal-on-metal stemmed hip replacements and 4.4 per cent for other types of implant.

Overall, the incidence of cancer diagnosis was lower after hip replacement than in the general population.

Publishing their findings in the British Medical Journal, the study authors concluded that the risk of cancer among hip replacement patients is 'relatively low'.

However, Ashley Blom, professor of orthopaedic surgery at the University of Bristol, commented: 'Although this is very reassuring, we do not know what are the long-term risks and thus further studies will be necessary in the future.'

One in five supermarket chickens have tested positive for campylobacter, a bacterium that can cause food poisoning.

Consumer watchdog Which? carried out tests on 192 whole chickens and chicken portions from nine UK supermarkets.

Researchers found that 18 per cent were contaminated with campylobacter; 17 per cent with listeria - which can also cause food poisoning - and 1.5 per cent with salmonella.

All of the major retailers involved in the research - Aldi, Asda, The Co-operative, Lidl, Marks & Spencer, Morrisons, Sainsbury's, Tesco and Waitrose - provided samples in which bacterial contamination was found.

Richard Lloyd, the campaign group's executive director, described the situation as 'unacceptable'.

He observed: 'We want to see the risk of contamination minimised at every stage of production, because for far too long consumers have been expected to clean up mistakes made earlier in the food chain.'

However, he acknowledged that levels of contamination have improved since 2009, when research by the Food Standards Agency (FSA) uncovered campylobacter in 65 per cent of fresh chickens.

The FSA is currently looking for researchers to conduct a systematic review on the survival of norovirus in foods, as the virus is a major cause of intestinal disease.

People with depression may benefit from regular walking, new research suggests.

Vigorous exercise has already been shown to have benefits for people with depression, but scientists at the universities of Stirling and Edinburgh wanted to find out whether less intensive activity could also be helpful.

The researchers reviewed the findings of eight trials, all of which had looked at walking as a treatment for depression.

They found that, overall, walking appeared to have a significant effect on symptoms of depression.

Publishing their findings in the journal Mental Health and Physical Activity, the study authors admitted that existing evidence on the subject is 'limited'.

'Thus, while walking is a promising treatment for depression or depressive symptoms with few, if any, contraindications, further investigations to establish the frequency, intensity, duration and type(s) of effective walking interventions particularly in primary care populations would be beneficial,' they concluded.

About one in ten people experience depression at some point during their lifetime and figures suggest that about four per cent of UK children, aged five to 16, are affected.

Health professionals from a range of disciplines are teaming up to help reduce the nation's high levels of obesity.

NHS figures show that 26 per cent of men and women were obese in 2010, while around three in ten children, aged two to 15, were either overweight or obese.

Now, the Academy of Royal Medical Colleges (AoRMC) - which involves all 21 royal medical colleges and faculties - has come together to launch a campaign aimed at finding the best ways to tackle the problem.

Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health and the academy's vice-chair, said: 'Our starting point is the collective desire to ensure the healthcare profession is doing all it can to detect, treat, manage - and ultimately prevent - obesity.'

The professor noted that the colleges' and faculties' collaboration is 'unprecedented', but that obesity represents a 'huge crisis waiting to happen'.

Professor Sir Neil Douglas, chair of the AoRMC, added that medical professionals are 'determined' to push through whatever changes are needed to tackle obesity.

The biggest ever research study into the causes of Parkinson's disease has been launched by the charity Parkinson's UK.

Led by Dr. Donald Grosset at the University of Glasgow, the $1.6 million study will follow 3,000 volunteers who were recently diagnosed with the disease or were aged under 50 at diagnosis.

'The cure for Parkinson's is a global challenge and all the samples gathered from our thousands of volunteers will be available for analysis by researchers the world over,' Dr. Grosset revealed.

He added that this should speed up the development of a cure for the disease.

Dr. Kieran Breen, director of research and innovation at Parkinson's UK, agreed that the study could make a 'huge difference'

'Finding a cure for Parkinson's is like building a gigantic jigsaw, but we still have a number of the pieces missing,' he said. 'This vital new study will help us fill in some of the gaps in our knowledge.'

The launch of the study coincides with Parkinson's Awareness Week (April 16th to 22nd), which helps to raise money for research into Parkinson's, as well as improving the public's knowledge of the disease.

Shift workers and other people with disrupted sleep patterns may face an increased risk of diabetes and obesity, scientists say.

Researchers at Brigham and Women's Hospital and Harvard Medical School studied a group of healthy adults who spent more than five weeks under controlled laboratory conditions.

Participants had an initial period of recommended sleep, followed by three weeks of restricted sleep and unusual sleep patterns.

This period consisted of 5.6 hours of sleep every 24 hours, combined with recurring 28-hour 'days'.

After this three-week period, the participants were allowed nine days of recovery sleep and returned to their usual circadian rhythm.

The researchers found that prolonged restricted sleep with disrupted hours was associated with a slower metabolic rate and increased levels of blood glucose following meals.

These reverted to normal during the nine days of recovery sleep and return to stable day-night patterns.

Publishing their findings in the journal Science Translational Medicine, the study authors concluded: 'In humans, prolonged sleep restriction with concurrent circadian disruption alters metabolism and could increase the risk of obesity and diabetes.'

Dr. Matthew Hobbs, head of research at Diabetes UK, said the study was 'interesting' but had not replicated the conditions experienced when working night shifts.

He told the BBC: 'The study also involved only 21 people. For these reasons, it is not possible to conclude that the findings would translate to real conditions in the wider public.'

Deaf people are twice as likely to have mental health problems as the general population, new research shows.

Dr. Johannes Fellinger, from the Hospital of St John of God and the Medical University in Vienna, Austria, carried out a review of existing research to shed light on the links between deafness and mental health problems.

He and his colleagues found that deaf children who cannot make themselves understood within their own family are four times more likely to have mental health problems than those from families with a successful communication strategy.

The study authors also highlighted the need to improve access to mental health services for deaf people.

Writing in the Lancet medical journal, they concluded: 'Improved access to health and mental health care can be achieved by provision of specialist services with professionals trained to directly communicate with deaf people and with sign-language interpreters.'

Roger Wicks, director of research, policy and government relations at Action on Hearing Loss, said the review confirmed the charity's own findings in 2010.

He revealed: 'In conjunction with Glasgow Caledonian University, we found deaf people faced numerous barriers when accessing mental health services, such as a general lack of deaf awareness, lack of communication support (for example, BSL interpreters) and a lack of technical support (for example, hearing aid induction loop systems).'

March 16, 2012 - Estradiol valerate and estradiol valerate/dienogest (Natazia, Bayer HealthCare Pharmaceuticals Inc) oral contraceptive tablets were approved March 14 for the treatment of heavy menstrual bleeding (HMB).

According to a company press release, this agent is the first and only oral contraceptive indicated for the treatment of HMB.

The drug was approved in May 2010 for the prevention of pregnancy. The current approval was based on results from 2 multicenter, randomized, double-blind, placebo-controlled clinical trials including 421 women.

Women in the study were at least 18 years of age and were diagnosed with dysfunctional uterine bleeding, described as heavy, prolonged and/or frequent, and without organic pathology. HMB was defined as "menstrual blood loss of 80 mL or more in at least 2 bleeding episodes during a 90-day run in phase."

Patients were randomly assigned to receive either treatment or placebo for 7 menstrual cycles. Complete symptom relief during a 90-day efficacy assessment phase was reported in 29.2% and 29.5% of the treatment groups in each study compared with 2.9% and 1.2% of the placebo groups, respectively.

Overall, there was a significant reduction in blood loss for those with HMB in the treatment groups compared with those in the placebo groups (P < .0001 for both studies).

The most common adverse effects associated with treatment, present in at least 2% of treated patients, were headache/migraine, breast pain/discomfort/tenderness, menstrual disorders, nausea or vomiting, acne, mood changes, and weight gain.

Although the drug was approved for pregnancy prevention in May 2010, the contraceptive efficacy of Natazia has not been determined in women with a body mass index (BMI) greater than 30 kg/m²

"Heavy menstrual bleeding is a common disorder reported by around three million women of reproductive age each year in the United States," Pamela A. Cyrus, MD, vice president and head of US Medical Affairs, Bayer HealthCare Pharmaceuticals, noted in a news release. "As the first oral contraceptive treatment approved for heavy menstrual bleeding in women without organic pathology who choose an OC for contraception, Natazia represents a new treatment approach for appropriate women with this medical condition."

Scottish scientists have shed light on the way in which controversial electroconvulsive therapy (ECT) affects the brain and eases severe depression.

Researchers at the University of Aberdeen say the therapy works by 'turning down' an overactive connection between parts of the brain that control mood and other parts involved in thinking and concentration.

This can help people with severe depression to increase their enjoyment of life and get on with day-to-day activities.

The finding, which is published in the Proceedings of the National Academy of Sciences, helps to explain the underlying mechanisms of ECT, during which the patient is anaesthetised and a seizure induced.

Professor Ian Reid, professor of psychiatry at the University of Aberdeen and consultant psychiatrist at the city's Royal Cornhill Hospital, said: 'We believe we've solved a 70-year-old therapeutic riddle because our study reveals that ECT affects the way different parts of the brain involved in depression connect with one another.'

The professor added that ECT is one of the most effective therapies for severe mood disorders, with between 75 and 85 per cent of patients recovering from their symptoms after treatment.

Other approaches to treating depression include medication, talking therapies and lithium treatment.

Nine out of ten people who have gone overseas for surgery would do the same again and would recommend medical tourism to their family members and friends, a survey has found.

More than 1,000 patients were polled on behalf of the health tourism website Treatment Abroad.

Researchers found that 84% of respondents would return to the same doctor, dentist or clinic, with 85% claiming to be 'very' or 'quite' satisfied with their experience of medical tourism.

When asked why they had travelled overseas for treatment, 83% of survey participants cited cost.

Many had saved more than $2,000 by going abroad and 12.7% had saved more than $10,000.

The survey also revealed that Belgium was the most popular choice among Britons seeking treatment abroad, followed by Hungary, Poland, Czech Republic and Turkey.

Keith Pollard, managing director of www.treatmentabroad.com, commented: 'So often overseas treatment is portrayed as being a poor alternative to what is available in the UK and yet it's clear from this survey that that is simply not true.'

Mr. Pollard added that the vast majority of people who seek treatment abroad are 'delighted' with the levels of care and the results of their surgery.

Scientists in the US say that a naturally occurring acid called conjugated linoleic acid (CLA) may be an effective treatment for Crohn's disease.

Crohn's disease is a long-term condition characterised by inflammation of the lining of the digestive system, causing diarrhoea, abdominal pain, fatigue and weight loss.

New research suggests that CLA - which is found in meat and dairy products - may help to treat the disease, which affects about 90,000 people in the UK.

US scientists found that patients with mild to moderate Crohn's disease who took CLA supplements showed noticeable improvements in disease activity and quality of life.

Professor Kim Isaacs, professor of gastroenterology at the University of North Carolina at Chapel Hill, revealed: 'CLA was well tolerated by all of the study subjects. These findings are very encouraging and will need to be verified in a randomised controlled trial.'

The research suggests that patients may benefit from taking CLA in capsule form, or from ingesting probiotic bacteria, some of which have been shown to produce CLA.

Principal investigator Dr Josep Bassaganya-Riera added that the findings, which are published in the journal Clinical Nutrition, validate the anti-inflammatory properties of CLA in the gut and suggest it may have 'tremendous' therapeutic potential.

Patients with high blood pressure who have different readings in each arm appear to have a reduced chance of living for the next ten years, scientists have found.

Researchers at the Peninsula College of Medicine and Dentistry studied 230 patients in Devon between 1999 and 2002, all of whom had high blood pressure.

They found that patients had a nine per cent increase in their risk of death for every one mmHg difference in blood pressure between their left and right arms.

Publishing their findings in the British Medical Journal, the study authors said that blood pressure in both arms should be measured for those receiving treatment for high blood pressure.

At present, this often does not happen, despite national guidelines advising doctors to measure blood pressure in both arms.

Maureen Talbot, senior cardiac nurse at the British Heart Foundation, said that the study supports the national guidelines.

She revealed: 'It is normal to have a small difference in your blood pressure readings between arms.

'However, a big difference between your readings may carry risks, so more tests could be needed to check your heart health.'

Curcumin, a compound found in the spice turmeric, may be beneficial for people with Parkinson's disease, US scientists say.

About 120,000 people in the UK are affected by Parkinson's disease - a chronic neurological condition that affects the way the brain coordinates body movements.

Scientists at Michigan State University (MSU) believe curcumin may help to prevent alpha-synuclein proteins from clumping together in the brains of people with early-stage Parkinson's.

Co-author Lisa Lapidus, associate professor of physics and astronomy at MSU, revealed: 'More specifically, curcumin binds strongly to alpha-synuclein and prevents aggregation at body temperatures.'

Dr. Lapidus cautioned that curcumin may have limited usefulness as a drug, as it is unable to enter the brain.

But she added that the findings, which are published in the Journal of Biological Chemistry, may open the door for the development of new drug treatments.

Earlier this month (March), scientists at Harvard University School of Public Health reported that people who take cholesterol-lowering statins may be less likely to develop Parkinson's.

Evidence in support of taking a daily dose of aspirin to reduce the risk of cancer has grown, thanks to three new papers published in the Lancet and the Lancet Oncology medical journals.

The papers were all written by Professor Peter Rothwell, from the University of Oxford and the John Radcliffe Hospital, and colleagues.

In the first Lancet paper, the researchers studied data from 51 clinical trials looking at aspirin's effect on vascular risk.

They found that daily aspirin reduced the risk of dying from cancer by 15 per cent, rising to 37 per cent among those on aspirin from five years an onwards.

The researchers concluded that 'the short-term reductions in cancer incidence and mortality and the decrease in risk of major extra-cranial bleeds with extended use, and their low case-fatality, add to the case for daily aspirin in prevention of cancer'

In the second Lancet paper, the researchers found evidence that aspirin use reduced the risk of cancer metastasis (spread).

And the third paper, published in the Lancet Oncology, involved a systematic review of observational and randomised trials.

This identified a 38 per cent reduced risk of bowel cancer in the observational trials and a 42 per cent reduction in the randomised trials, as well as uncovering similar reductions in the risk of other cancers.

'Observational studies show that regular use of aspirin reduces the long-term risk of several cancers and the risk of distant metastasis,' the study authors concluded.

The 'exciting' findings were welcomed by Professor Peter Johnson, chief clinician at Cancer Research UK.

He said: 'This latest research adds to the evidence that taking a daily dose of aspirin for several years is one of the things that can help to lower the risk of oesophageal, bowel, stomach and lung cancers.'

US scientists claim to have found a link between breast cancer and arthritis.

A research team at the University of North Carolina carried out tests on mice after previous epidemiological studies indicated that women with both diseases were more likely to have aggressive cancer.

Their studies revealed that arthritic mice tended to have more mast cells - immune system cells that cause inflammation - than non-arthritic mice.

Furthermore, the cKit receptor on mast cells appears to be linked to the transmembrane stem cell factor (SCF) ligand found on metastatic breast cancer cells.

Pinku Mukherjee, who was involved in the research, said: 'We confirmed the relationship we suspected between autoimmune disease and metastastic breast cancer cells.

'This is an exciting result for us because it confirms an interesting interdependence between cancer metastasis and a specific component of the immune system.'

The findings were presented at the American Association for Cancer Research annual meeting on April 1st.

A recent study found that just one alcoholic drink per day could raise women's chances of developing breast cancer.

Sixteen per cent of people with irritable bowel syndrome (IBS) lose between two and three hours a day to tummy troubles, new research suggests.

A survey of 3,000 adults, conducted on behalf of Lepicol, found that 45 per cent of people have experienced ongoing digestive health issues such as IBS.

Sixteen per cent said their problem was so severe that it disrupted between two and three hours of their daily activity, amounting to more than two months out of every year.

A further 30 per cent said their daily activity was disrupted for between two and three hours a week.

When asked about the main causes of their digestive complaints, 65 per cent of people blamed stress, with 56 per cent also citing diet and 15 per cent attributing their problems to alcohol consumption.

Dr. Nick Read, chair of the IBS Network, said: 'This research suggests that among a random sample of people, IBS may be much more prevalent than previously thought.

'According to these findings, most people acknowledge that stress is the most common cause, with diet coming a close second.'

Peter Cartwright, a microbiologist and expert on digestive disorders, said that sufferers may want to try taking a natural probiotic, as this could help to improve the environment in their digestive tract and aid their overall health and wellbeing.

NHS figures suggest that between ten and 20 per cent of people experience IBS at some point, with women being more commonly affected than men.

Babies who are fed on demand may perform better at school than those fed to a schedule, new research suggests.

Scientists at the Universities of Essex and Oxford carried out a large-scale study to investigate the effects of scheduled feeding compared with feeding on demand.

Their research used data on more than 10,000 children who were born in and around Bristol in the early 1990s and took part in the Avon Longitudinal Study of Parents and Children.

Analysis revealed that demand-fed babies tended to have higher IQ scores between the ages of five and 14 years than children who had been fed to a schedule during infancy.

Lead researcher Dr Maria Iacovou, from the University of Essex's Institute for Social and Economic Research, urged caution over the findings, which are published in the European Journal of Public Health.

She noted: 'We cannot definitively say why these differences occur, although we do have a range of hypotheses.

'This is the first study to explore this area and more research is needed to understand the processes involved.'

Dr. Iacovou also noted that difference between schedule-fed and demand-fed children did not seem to be affected by the decision to breastfeed or bottle-feed.

In the UK, mothers are advised to breastfeed babies exclusively for the first six months of life, after which other foods may be introduced alongside breastfeeding.

People with rheumatoid arthritis are more likely to have an irregular heart rhythm and suffer a stroke than the general population, a study has found.

Scientists at Copenhagen University Hospital Gentofte analysed data on more than four million people, 18,247 of whom had rheumatoid arthritis.

Over a five-year period, people with rheumatoid arthritis had a 40 per cent increased risk of atrial fibrillation - the most common type of irregular heart rhythm - and a 30 per cent increased risk of stroke.

Publishing their findings in the British Medical Journal, the study authors suggested that patients with rheumatoid arthritis should be screened each year for atrial fibrillation, which increases a person's chances of having a stroke.

They also noted that inflammation is involved in the development of atrial fibrillation and stroke, and that effective control of inflammation is therefore crucial for people with rheumatoid arthritis.

Professor Michael Ehrenstein, a spokesman for Arthritis Research UK, told the Daily Mail: 'Inflammation plays a central role in rheumatoid arthritis and in the disease process of many other related conditions, so it's not surprising that it may also play a role in the development of atrial fibrillation.'

People over the age of 45 are three times more likely to drink on most days than their younger counterparts, figures show. The latest data from the Office for National Statistics (ONS) reveal that 13 per cent of over-45s drink almost every day.

This compares with just four per cent of under-45s.

Among the over-65s, 22 per cent of men and 12 per cent of women consume alcohol almost every day. In contrast, just three per cent of 16 to 24-year-old men and one per cent of women in this age group drink practically every day throughout the year.

However, young people show a tendency towards binge-drinking, with 24 per cent of 16 to 24-year-old men and 25 per cent of 25 to 44-year-old men drinking more than eight units of alcohol in a single day.

Eric Appleby, chief executive of Alcohol Concern, said that middle-aged people 'are taking unnoticed risks with their health, increasing their likelihood of suffering illnesses such as liver disease, stroke and cancer'.

Health experts say that men should not regularly drink more than three to four units of alcohol per day, while women should limit themselves to two to three units.

Millions of people do not eat the recommended amount of fruit and vegetables, new research has found.

The Health Food Manufacturers' Association (HFMA) commissioned a survey of more than 10,000 adults to shed light on people's lifestyle habits. Researchers found that more than 30 million adults do not eat the recommended five portions of fruit and vegetables each day.

This represents an eight per cent increase in non-compliance since 2010.

The researchers also discovered that almost two-fifths (37 per cent) of people believe their diets have worsened since the start of the recession. Almost 84 per cent now eat junk food, with almost a third doing so because it often costs less than healthier alternatives.

Graham Keen, executive director of the HFMA, said: 'It is vital that as a nation we are responsible for our actions and managing diet is one of the keys for people to take ownership of their health.

'Everyone should know that the best solution for most people to consume key nutrients, such as vitamins and minerals, is to eat as healthy a diet as possible.'

Government health experts say that people should aim to eat a minimum of five portions of different fruit and vegetables each day, which can include fresh, frozen, tinned, dried and juiced varieties.

March 13, 2012 - Regular use of cholesterol-lowering statins may help reduce the risk for Parkinson's disease (PD), particularly in adults younger than age 60 years, according to new data from the ongoing Harvard School of Public Health Health Professionals Follow-Up Study and the Nurses' Health Study.

The data suggest that long-term use of statins "could provide a benefit against risk of developing PD,"Xiang Gao, MD, PhD, from Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, who led the study, told Medscape Medical News. "However, our findings are preliminary and need to be interpreted with caution." Dr. Xiang Gao

For example, only about 70% of those receiving cholesterol-lowering drugs in this study were actual statin users, the researchers note. The analysis yielded only marginally significant results in favor of statins' neuroprotective effects and "could be due to chance," the investigators say.

The study is published in the March issue of Archives of Neurology.

26% Risk Reduction Overall

The analysis included 38,192 men from Health Professionals Follow-Up Study and 90,874 women from the Nurses' Health Study. Information on regular cholesterol-lowering drug use, a surrogate marker of statin use, was collected via questionnaire in 1994. During 12 years of follow-up (1994 to 2006), the researchers documented 644 incident cases of PD: 338 in women and 306 in men.

The researchers report that the incidence of PD was lower among statin users relative to nonusers. The pooled relative risk (RR) of PD was 0.74 (95% confidence interval [CI] 0.54 - 1.00; P = .049) comparing current statin users with nonusers, after adjusting for several potentially confounding factors including age, smoking, caffeine intake, and the use of ibuprofen, which has been consistently found to be inversely associated with PD risk (pooled RR, 0.62), the researchers note.

There was a significant interaction between statin use and age in relation to PD risk (P for interaction = .03). A significant protective effect was apparent in subjects younger than 60 years at the beginning of follow-up but not among those who were older (Table).

Table. Reduction in Risk of Parkinson's Disease with Statin Use By Age Group
Group Adjusted Pooled Relative Risk 95% Confidence Interval P
< 60 years 0.31 0.11 - 0.86 .02
> 60 years 0.83 0.60 - 1.14 .25
Protective Effect Plausible; Results Mixed

Recently, statins have been shown to possess potent anti-inflammatory and immune-modulating effects, which fueled the hypothesis that statins could be neuroprotective agents, Dr. Gao and colleagues note in their report. Yet, prospective and epidemiologic studies to date have generated mixed results regarding statin use and PD risk, and the overall evidence for benefit "remains unconvincing," they say.

The researchers caution that their analysis has several limitations. Chief among them is the fact that they classified use of any cholesterol-lowering drugs before 2000 as statin use; as a result, misclassification was "inevitably introduced," they say. However, based on US retail prescription data, statins accounted for 72% of total cholesterol-lowering drug use in 1994, 80% in 1996, and more than 90% in 2000.

The lack of information on which specific statin drugs were used is another limitation. "We would like to test the effects of each specific statin as their ability to enter the brain varies and so they may have different effects on PD," Dr. Gao commented.

For example, lovastatin and simvastatin have been shown to have more potency to cross the blood-brain barrier relative to atorvastatin calcium. The researchers say it is likely that their results are driven by these 2 statins given that they were the most commonly prescribed in the mid-1990s.

The authors say they cannot exclude residual confounding because of the observational nature of the study.

Clearly more study is warranted, the researchers conclude, not only because statins may have neuroprotective effects, but also because they may have unfavorable effects by lowering the level of plasma coenzyme Q10, which may itself be neuroprotective in PD.

The study was supported by the National Institute of Neurological Disorders and Stroke. Dr. Gao has been a consultant for Teva Pharmaceuticals.

Men who drink a single fizzy drink each day may significantly increase their chances of having a heart attack, new research suggests.

Scientists at the Harvard School of Public Health in the US looked at data on 42,883 men.

They found that those who drank a can of fizzy drink a day had a 20% higher risk of heart disease than those who didn't have any fizzy drinks.

The findings, which are published in Circulation journal, add to a growing body of evidence 'that sugary beverages are detrimental to cardiovascular health', according to lead author and professor of nutrition and epidemiology Dr Frank Hu.

He claimed: 'Certainly, it provides strong justification for reducing sugary beverage consumption among patients and, more importantly, in the general population.'

Less frequent consumption of fizzy drinks - for instance twice a week - did not increase men's risk of heart disease.

Tracy Parker, a British Heart Foundation dietician, said that people should not have fizzy drinks every day.

'Go for healthier alternatives such as water, low fat milk or unsweetened juices, which are kinder to our waistlines as well as our heart,' she advised.

Men who drink a single fizzy drink each day may significantly increase their chances of having a heart attack, new research suggests.

Scientists at the Harvard School of Public Health in the US looked at data on 42,883 men.

They found that those who drank a can of fizzy drink a day had a 20% higher risk of heart disease than those who didn't have any fizzy drinks.

The findings, which are published in Circulation journal, add to a growing body of evidence 'that sugary beverages are detrimental to cardiovascular health', according to lead author and professor of nutrition and epidemiology Dr Frank Hu.

He claimed: 'Certainly, it provides strong justification for reducing sugary beverage consumption among patients and, more importantly, in the general population.'

Less frequent consumption of fizzy drinks - for instance twice a week - did not increase men's risk of heart disease.

Tracy Parker, a British Heart Foundation dietician, said that people should not have fizzy drinks every day.

'Go for healthier alternatives such as water, low fat milk or unsweetened juices, which are kinder to our waistlines as well as our heart,' she advised.

People who regularly eat red meat appear to face an increased risk of death, new research has found.

Scientists at Harvard School of Public Health in the US observed nearly 38,000 men for up to 22 years, as well as more than 83,500 women for up to 28 years.

Participants had no history of heart disease or cancer at the start of the study and provided information on their dietary habits every four years.

The researchers found that a daily serving of red meat was associated with a 13% increased risk of death, while a daily portion of processed meat - such as a sausage or two slices of bacon - was associated with a 20% increased risk.

Eating red or processed meat was also linked to an increased risk of dying from cardiovascular disease or cancer.

Lead author Dr An Pan, whose findings are published in the Archives of Internal Medicine, said: 'Our study adds more evidence to the health risks of eating high amounts of red meat, which has been associated with type-2 diabetes, coronary heart disease, stroke, and certain cancers in other studies.'

Victoria Taylor, senior heart health dietician at the British Heart Foundation, said that the saturated fat content of red meat could be to blame for the link.

'However, the study does not differentiate between leaner and fattier cuts of meat, so it would be useful to know if the association is the same when this is taken into account,' she observed.

Males who are circumcised before their first sexual experience may benefit from a reduced risk of prostate cancer, new research published in Cancer journal suggests.

Scientists at Fred Hutchinson Cancer Research Centre analysed data on 3,399 men, including 1,754 who had been diagnosed with prostate cancer.

Men who were circumcised before having sexual intercourse for the first time were found to be 15% less likely to develop prostate cancer - including both aggressive and less aggressive forms - than uncircumcised men.

Circumcised men were 12% less likely to develop less aggressive prostate cancer than uncircumcised men, and 18 per cent less likely to develop more aggressive disease.

The researchers said circumcision may protect against sexually transmitted infections by toughening the inner foreskin and eliminating the space under the foreskin, in which pathogens may thrive.

It is thought that sexually transmitted infections may contribute to the development of prostate cancer by causing chronic inflammation and providing a suitable environment for the growth of cancer cells.

Lead author Dr Jonathan Wright commented: 'These data are in line with an infectious/inflammatory pathway which may be involved in the risk of prostate cancer in some men.

'Although observational only, these data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer.'

Most primary care trusts (PCTs) in the UK do not fund routine circumcision, although some fund the procedure for religious reasons.

People who regularly eat white rice may face an increased risk of developing type-2 diabetes, scientists say.

Researchers at the Harvard School of Public Health in the US analysed data from four previous studies. They observed a significant link between regular consumption of white rice and type-2 diabetes, with an individual's risk increasing as their white rice intake rose.

On average, the researchers concluded that a person's risk of developing type-2 diabetes increased by 10% for every additional weekly serving of white rice.

It is thought that white rice may contribute to a person's risk of diabetes because of its low content of fibre, magnesium and vitamins - some of which are associated with a lower risk of type-2 diabetes.

In addition, white rice has a high GI value, and high GI diets are linked with an increased risk of developing the disease.

Writing in the British Medical Journal, the study authors claimed that a high intake of white rice 'is associated with a significantly elevated risk of type-2 diabetes'.

The findings suggest that it may be advisable to eat whole grains instead of refined white rice.

Brown rice makes a good alternative and can help to increase the amount of starch in people's diet.

There has been an increase in the number of cases of oral (mouth) cancer in the UK, with the number rising above 6,000 per year for the first time, figures show.

There are now more than 6,200 cases of the disease per year, compared with around 4,400 cases a decade ago.

Cancer Research UK - which published the figures - said the increase is thought to be linked to human papillomavirus (HPV) infections, which affect up to eight in ten people at some point during their life.

Some strains of the virus - including HPV-16 - increase a person's chances of developing oral cancer, and cases of HPV-16-positive cancer are on the rise, according to Richard Shaw, a head and neck cancer expert at the Liverpool Cancer Research UK Centre.

He revealed: 'We have also noticed that patients with HPV-related oral cancers tend to be younger, are less likely to be smokers and have better outcomes from treatment than those whose tumours show no evidence of HPV.

'This raises questions as to exactly how these cancers develop and why they only affect a small proportion of people who are exposed.'

While the increase in oral cancers has been linked to HPV, research suggests that at least three-quarters of cases of the disease could be prevented by giving up smoking and drinking less alcohol.

The majority of people who have their blood pressure tested have readings that are higher than normal, new figures suggest.

Lloyds Pharmacy analysed the results of more than 100,000 blood pressure tests that were carried out in 2010 and 2011.

Researchers found that more than 60 per cent of men and 55 per cent of women had above-normal readings.

Just 18 per cent of tested people had normal readings, while only 12 per cent had 'ideal' numbers.

The pharmacy also noted that the number of people with high blood pressure increased between 2010 and 2011, and that 30 per cent of under-35s tested in 2011 were in the high to very high range.

Consultant heart surgeon Leslie Hamilton said: 'Many people put their heart problems down to genetics, but your blood pressure is one area that you can control with lifestyle changes and medicine.

'We know that the results of a one-off test are not conclusive - that's why I'm urging people to get checked regularly and take the time to understand what their numbers actually mean.'

Experts say that people should aim to keep their blood pressure below 120 over 80 in order to reduce their risk of heart disease and stroke.

February 15, 2012 (Paris, France) - The risk of MI went up significantly with rising concentrations of most of major air pollutants included in a new meta-analysis of studies in which pollution-exposure times were measured for no more than a week [1]. The individual culprits included carbon monoxide and sulfur dioxide but not ozone, which appeared unrelated to MI risk.

Compared with traditional cardiovascular risk factors such as tobacco use, hypertension, or diabetes, the relative risks of myocardial infarction [observed in the meta-analysis] are rather low, "observed lead author Dr. Hazrije Mustafic (University Paris Descartes, France) for heartwire.

"But the difference is in the level of exposure. For example, in France, 20% of the adult population smokes, but the entire population is exposed to air pollution." So with the pollutants, she said, "the risk is low at the individual level, but if you consider the entire population, the impact is not negligible."

Moreover, observed Mustafic, "the majority of studies included in our meta-analysis were conducted in countries where concentrations of air pollutants are less than [World Health Organization] WHO recommendations. Yet even under those conditions, we found significant associations."

The meta-analysis, which is published in the February 15, 2012 Journal of the American Medical Association, examined studies of MI risk with exposure to at least one air pollutant for up to seven days. The number of studies per pollutant ranged from 13 for particulate matter (PM) of <2.5 µm in diameter (PM2.5) to 21 for nitrogen dioxide.

All of the individual air pollutants in the analysis except ozone showed a significant bump in MI relative risk for every increment in concentration. The increments were 10 µg/m³ for all pollutants except carbon monoxide, for which the increment was 1 mg/m³.

Relative Risk (95% CI) for Acute MI Following Up to One Week of Exposure to Pollutants, Per Increment in Concentration*

Pollutant (increment) RR (95% CI) p
Carbon monoxide 1.048 (1.026–1.070) <0.001
Nitrogen dioxide 1.011 (1.006–1.016) <0.001
Sulfur dioxide 1.010 (1.003–1.017) 0.007
PM10 1.006 (1.002–1.009) 0.002
PM2.5 1.025 (1.015–1.036) 0.004
Ozone 1.003 (0.997–1.010) 0.36
*10 µg/m3 for all pollutants except carbon monoxide (1 mg/m3)
PM10=particulate matter <10 µm in diameter
PM2.5=particulate matter <2.5 µm in diameter

Mustafic and her coauthors point to several potential mechanisms that might trigger an MI with short-term exposure to air pollution. They include induction of systemic inflammation, dysregulation of the cardiac autonomic system, increased blood viscosity, vasoconstriction or vasospasm, and promotion of arrhythmias. Experimental evidence suggests a number of mechanisms are probably involved, they write.

Ozone didn't emerge from the meta-analysis as a significant influence on MI risk, at least with short-term exposure, probably because its concentrations in the atmosphere are highly dependent on the brightness of solar radiation as a driver of photochemical reactions, according to the report. "And no study has adjusted for brightness," said Mustafic.

Mustafic had no disclosures. Disclosures for the coauthors are listed in the paper.

References

Mustafic H, Jabre P, Caussin C, et al. Main air pollutants and myocardial infarction: A systematic review and meta-analysis. JAMA 2012; 307:713-721.

February 27, 2012 - Mothers with migraine are more than twice as likely as those without to have an infant with colic, researchers report.

"Infants that inherit migraine genes may be more sensitive to normal stimuli and express that sensitivity as colicky crying," lead investigator Amy Gelfand, MD, a child neurologist at the University of California, San Francisco, told Medscape Medical News.

"This association, if it proves to be robust in future studies, could help mothers prepare for the possibility of having a colicky infant, "she explained, "and give them some comfort and understanding as to why their baby is crying so much. It also may have implications for how we manage colic. For example, perhaps these babies would benefit from decreased stimulation, such as turning down loud music or avoiding bright lights when they are crying."

Dr. Gelfand will present the findings at the American Academy of Neurology (AAN) 64th Annual Meeting, which takes place in New Orleans, Louisiana, in April.

In this cross-sectional study, investigators looked at 154 mothers and their infants. Excessive crying in an otherwise healthy infant was reported by parents based on questions developed by the researchers using standard criteria for colic.

Mothers were surveyed at their infants' 2-month-old well-child visit - the age when infant colic is most likely. The researchers identified colic by parental report using modified Wessel's colic criteria. They obtained migraine history by means of physician diagnosis or a positive screen on the Identity Migraine Questionnaire.

Investigators used a Chi-squared test to compare differences between groups. They found that maternal migraine is associated with a more than 2-fold increased risk for infant colic (Table 1).

Table 1. Mothers and Infants With Colic (n = 154)

Infants Maternal Migraine (%) No Maternal Migraine (%) Prevalence

Ratio P

With colic 28.6 11.1 2.6 .02

The researchers report that mothers with migraine accurately perceived their infants' colic compared with women without headaches.

Data on paternal history of migraine were available for most of the infants, and interestingly, fathers with migraine were also more likely to have an infant with colic (Table 2).

Table 2. Fathers and Infants With Colic (n = 93)

Infants Paternal Migraine (%) No Paternal Migraine (%)

Prevalence Ratio P

With colic 22.2 9.5 2.3 .24

"Since migraine is a highly genetic disorder, our study suggests that infant colic may be an early sign that a child may be predisposed toward migraine headache later in life," Dr. Gelfand said.

"This may be helpful in more accurately identifying children who have childhood periodic syndromes by asking about a history of infant colic," she added. "This study helps to advance our understanding about the different expressions of migraine across a person's lifetime."

Asked by Medscape Medical News to comment on the findings, Joel Saper, MD, a spokesperson for the AAN, said he agrees. "Migraine is a manifestation of something that very likely begins early in life. This is a very interesting piece of science that correlates with something we've suspected for some time - that colic could be part of the migraine spectrum with the body overreacting to normal stimuli." Dr. Saper is the founder of the Michigan Headache and Neurological Institute in Ann Arbor.

Two previous retrospective studies found that children with migraine were more likely to have colic as infants. The authors suggest these studies may have been affected by recall bias because parents were being asked about colic several years after their children were infants.

"This motivated us to try to collect the information about colic when it was actually happening," Dr. Gelfand explained. "This is why we surveyed mothers when they were bringing their infants in for the 2-month well-baby check."

It would also be helpful to have more complete family histories, for example, to have migraine data on both parents for all infants, she said, "and ideally, also information about migraine history in the baby's grandparents. This is hard to do, as usually all 4 grandparents are not present at the 2-month well-baby check."

This was a preliminary study, Dr. Gelfand pointed out, "and we were trying to keep our survey short so that exhausted parents could complete it, so we did not collect data on other epidemiologic variables that may interact in a potential relationship between migraine and colic." She cites parental depression or family stress as examples.

"Critics might note that we did not have an external way of validating that the infants were colicky, as we were going by parental report," Dr. Gelfand said. "However, parental report is a common way for determining colic in research. In addition, physician diagnosis of colic is to a great extent itself dependent on what parents report in the office."

Moving forward, the researchers intend to have parents keep crying diaries so they will have a more objective measure.

"Migraine is a lifelong illness," Dr. Saper said. "And we now have evidence that it starts early in life, much earlier than we knew."

The investigators have disclosed no relevant financial relationships.

American Academy of Neurology (AAN) 64th Annual Meeting. Abstract 113. April 21 - 28, 2012. First results released February 20, 2012.

Heart patients who take statins appear to be significantly less likely to develop depression than those who do not use the cholesterol-lowering drugs, a study has found.

Researchers at the San Francisco VA Medical Centre and the University of California, San Francisco, assessed 965 heart disease patients.

They found that patients who took statins were much less likely to be clinically depressed than those who did not.

Among the 776 patients who were not depressed, 18.5 per cent of those taking statins developed depression over the next six years, compared with 28 per cent of those not taking the drugs.

This means that patients who took statins were 38 per cent less likely to develop depression than patients who did not.

Dr. Mary Whooley, whose findings are published in the Journal of Clinical Psychiatry, said: 'This would suggest that statins may have some kind of long-term protective effect against depression, perhaps by helping to prevent atherosclerosis in the brain, which can contribute to depressive symptoms.'

She added that statins are 'relatively safe and generally well-tolerated'.

A study published in Heart journal in 2010 found that having both depression and coronary heart disease may be more dangerous than having either condition on its own.

February 28, 2012 (Abu Dhabi, United Arab Emirates) - A telemedicine program in Germany facilitates interaction between internists and ophthalmologists and helps to identify patients at increased risk for cardiovascular events using information from the retina, according to a study presented here at the World Ophthalmology Congress 2012.

"The eye mirrors vascular and neurodegenerative diseases," said study presenter Georg Michelson, MD, from the University of Erlangen in Germany. "In particular, retinal microangiopathy correlates with certain systemic diseases such as arterial hypertension, stroke, and diabetes." For instance, retinal vessel-wall thickness, which is increased in stroke, can be seen using a nonmydriatic fundus camera.

Dr. Michelson described previous research done by his team, which showed that stroke risk increased 6.35-fold when cotton-wool spots were observed, and increased 4.71-fold with microaneurysms; stroke risk was 4.25-fold higher with blot hemorrhages.

These proven associations led Dr. Michelson to develop his TalkingEyes program, consisting of a network of 31 internists in private practice. The physicians use a mobile nonmydriatic fundus camera to take digital photographs of the retina in the office. These retinal images are uploaded to a Web-based patient chart, where they are evaluated by an ophthalmologist, who then adds a report to the patient's e-chart.

"If we can connect ophthalmologists to internists with a telemedicine network, this could improve patient care," Dr. Michelson explained.

In this study, 6999 patients had retinal exams performed in the general practitioner's office. Median patient age was 54 years, median body mass index was 27.6 kg/m², 40% reported a history of arterial hypertension, and 11.1% had type 2 diabetes.

During the examination, physicians took 45° photographs of the retina, obtained blood samples, and measured blood pressure. They then calculated cardiovascular risk using the PROCAM index. An ophthalmologist analyzed the fundus images remotely.

Dr. Michelson reported that 9% of the cohort had relevant morphologic changes in retinal vessels, such as arteriovenous crossings, retinal bleeding, microaneurysms, and microinfarcts.

Using the PROCAM index, only 2% of patients were found to be at high risk for a cardiovascular event. However, in 55 patients (0.8%) where no risk was indicated, "we found relevant retinal microangiopathic changes," he reported.

"We have now performed this in about 60,000 patients, and we believe that identifying these unique risk factors is having an impact on therapy," said Dr. Michelson.

He believes changes are occurring in 2 ways. "First, individuals who were screened gained a greater awareness of their risk factors overall, so they are motivated to go to the doctor more often for observation." Second, physicians are responding to evidence of elevated risk.

"In about 20% of cases, we see that therapeutic decisions are being made based on these findings."

Dr. Michelson has disclosed no relevant financial relationships.

World Ophthalmology Congress (WOC) 2012: Abstract IS-TEL-FR 65. Presented February 17, 2012.

A compound responsible for bad breath could help to speed up the transformation of stem cells from dental pulp for use in clinical treatments, scientists say.

The compound in question is hydrogen sulphide (H2S) - the characteristic smell of rotten eggs and a major cause of bad breath or 'halitosis'.

Researchers at Nippon Dental University in Japan have discovered that the compound appears to help stem cells from dental pulp transform into liver cells.

Teeth stem cells that were incubated in a chamber with H2S were converted into liver cells more quickly than those incubated without the gas.

Their finding could prove useful for generating liver cells for transplantation purposes.

Lead study author Dr Ken Yaegaki, whose findings are published in the Journal of Breath Research, said: 'Until now, nobody has produced the protocol to regenerate such a huge number of hepatic (liver) cells for human transplantation.

'Compared to the traditional method of using foetal bovine serum to produce the cells, our method is productive and, most importantly, safe.'

However, an expert at the University of Bristol said much more research is needed.

People exposed to the scent of rosemary (Rosmarinus officinalis) may benefit from improved brain performance, new research suggests.

Scientists at Northumbria University's Brain, Performance and Nutrition Research Centre carried out tests using a chemical called 1,8-cineole, which is one of the main chemicals in rosemary.

They tested the cognitive performance and mood of 20 volunteers, all of whom were exposed to varying levels of rosemary oil aroma.

Participants also provided blood samples so the researchers could measure the amount of 1,8-cineole they had absorbed.

Publishing their findings in the journal Therapeutic Advances in Psychopharmacology, the study authors revealed that blood levels of the chemical were associated with cognitive performance.

The higher a person's levels of 1,8-cineole, the better their cognitive performance, including both speed and accuracy.

Although the study focussed on rosemary, 1,8-cineole is also found in a number of other aromatic plants, including eucalyptus, bay, wormwood and sage.

Rosemary has long been thought to improve the memory, hence its use as a symbol of remembrance in some countries, including Australia and New Zealand.

The annual Act FAST stroke campaign has had a significant impact on the number of people dialling 999 and the number of patients receiving treatment for stroke, new figures show.

The campaign aims to raise awareness of the key symptoms of stroke via the FAST acronym: Facial weakness, Arm weakness, Speech problems ... Time to call 999.

According to the latest figures from the Department of Health, the NHS in England witnessed a 24 per cent increase in stroke-related 999 calls in the two months after the adverts finished running during the 2011 campaign.

There was also a 16 per cent rise in stroke sufferers being seen more quickly.

The figures indicate that the campaign is effective at increasing awareness of the key symptoms of stroke, and of what to do when they occur.

Health secretary Andrew Lansley commented: 'Stroke is the third leading cause of death in England each year and the leading cause of disability.

'The Act FAST campaign has proved it works and we are confident the Act FAST campaign will once again have a very positive impact for people suffering from stroke.'

This year, the campaign will run from February 27th to March 25th.

Jon Barrick, chief executive officer of the Stroke Association, welcomed the figures.

He said: 'We originally funded the research to develop the FAST message and we're delighted with the impact and progress the campaign has made.'

The vast majority of women are not confident of the symptoms of ovarian cancer, new research has found.

Research firm Ipsos Mori polled 1,003 women on behalf of the charity Target Ovarian Cancer.

It found that just three per cent of respondents were very confident at recognising a symptom of the disease.

The UK has one of the worst survival rates in developed countries for ovarian cancer, according to research published last year.

Experts believe one of the main reasons for this is late diagnosis, often because women do not recognise the significance of their symptoms.

Annwen Jones, chief executive of Target Ovarian Cancer, said: 'Women are dying needlessly every day because they didn't know the symptoms of this disease before they were diagnosed with advanced cancer.

'Had it have been caught at an earlier stage their chances of surviving five years would have almost doubled.'

Symptoms of ovarian cancer include persistent pelvic or abdominal pain, increased abdominal size or persistent bloating, difficulty eating and urinary symptoms.

If women experience any of these key symptoms, they should visit their GP to get checked out.

Women who regularly consume a low to moderate amount of alcohol appear to benefit from a reduced risk of stroke, new research suggests.

Scientists at Brigham and Women's Hospital in the US looked at data on more than 83,000 women, none of whom had any history of heart disease, stroke or cancer.

Participants were followed for up to 26 years, during which time there were 2,171 strokes.

The researchers found that women who consumed low to moderate amounts of alcohol - up to 1.5 glasses of wine per day - had a lower risk of stroke than those who never drank.

However, higher levels of alcohol consumption were not associated with a reduced risk of stroke.

Publishing their findings in the journal Stroke, the study authors concluded: 'Light to moderate alcohol consumption was associated with a lower risk of total stroke.'

Figures from the UK's Stroke Association indicate that around 150,000 people have a stroke each year, with the majority of cases occurring in people over the age of 65.

People who live in areas with low levels of sunlight are more likely to develop food allergies and eczema than those in areas with plenty of sunshine, a study has found.

Scientists at the European Centre for Environment & Human Health looked at data on rates of food allergy, eczema and asthma among children throughout Australia.

They found that youngsters in the south of the country - where levels of sunlight are relatively low - were twice as likely to develop eczema as those in the north.

There was also a clear link between latitude and allergies to peanuts and eggs.

The findings, which are published in the Journal of Allergy and Clinical Immunology, suggest that increased exposure to sunlight could help to reduce children's chances of developing food allergies and eczema.

Lead researcher Dr. Nick Osborne commented: 'This investigation has further underlined the association between food allergies, eczema and where you live.

'We're now hoping to study these effects at a much finer scale and examine which factors such as temperature, infectious disease or vitamin D are the main drivers of this relationship.'

One in four people in the UK are affected by allergy at some time in their lives, according to Allergy UK, while NHS figures suggest that about one-fifth of children have eczema.

The number of new cases of a progressive sight-loss condition called age-related macular degeneration (AMD) is likely to rise by a third over the next decade, new research suggests.

AMD accounts for the majority of registered blind and partially sighted people in the UK and affects part of the retina at the back of the eye.

Scientists at St. George's, University of London, set out to calculate the prevalence of AMD in the UK between 2007 and 2009.

They estimated that 2.4 per cent of over-50s had advanced AMD, the risk of AMD rising with age.

According to the researchers, ageing alone will increase the prevalence of AMD by one-third by 2020.

There will also be 71,000 new cases of late AMD each year, they say.

Publishing their findings in the British Journal of Ophthalmology, the study authors concluded: 'Projections over the next decade suggest that the number of prevalent cases of late AMD will increase steadily by a third by 2020 due to population ageing.

'These evidence-based estimates can be used to help plan social and healthcare provision for the present and the future.'

Commenting on the findings, Iara Eaglen from the Royal National Institute of Blind People called for investment in early detection and treatment of AMD.

'This research is a further warning that the right steps must be taken now to avoid unnecessary sight loss and help those who have already lost their sight get the support they need to live full, independent lives,' she added.

Scientists have found a way to use patient's own cardiac stem cells to repair the damage caused by a heart attack.

A research team at Cedars-Sinai Heart Institute in Los Angeles included 25 patients in their study, all of whom had suffered a heart attack.

Eight of the patients were given standard care, while the other 17 were given infusions of cardiosphere-derived stem cells (CDCs) - special cells created using a patient's own heart tissue.

Imaging studies revealed that patients who received infusions of their own stem cells experienced a significant reduction in the amount of scar tissue in the heart - typically from 24 per cent of their heart tissue to just 12 per cent.

In contrast, patients who did not undergo the minimally invasive procedure saw no reduction in scar size.

The researchers, whose findings are published in the Lancet medical journal, claimed: 'This discovery challenges the conventional wisdom that, once established, cardiac scarring is permanent and that, once lost, healthy heart muscle cannot be restored.

'The unprecedented increases we noted in viable heart muscle, which are consistent with therapeutic regeneration, merit further assessment of clinical outcomes.'

Britons should do more than simply brush their teeth to maintain good oral hygiene, experts say.

Dr. Nigel Carter, chief executive of the British Dental Health Foundation, emphasised the importance of products such as dental floss, which just 22 per cent of people use as part of their oral hygiene routine.

He said: 'Using inter-dental brushes, floss or tape at least once a day will help to remove plaque and debris from between the teeth where the toothbrush can't reach.

'Brushing alone will only clean around 60 per cent of the tooth surface, so it is important to remember there are products available to help you establish and develop a good oral health routine.'

The expert also recommended using mouthwash, which the recent Adult Dental Health Survey suggests is used by just 31 per cent of Brits.

He observed that anti-bacterial mouthwashes can help to reduce plaque and prevent gum disease, while some also contain fluoride - described by Dr. Carter as 'the single most important advancement introduced in preventative dentistry for some years'.

The Adult Dental Health Survey, which was published in March 2011, also revealed that 12 per cent of adults experience extreme dental anxiety which prevents them from seeking dental treatment.

Women who experience complications such as high blood pressure or diabetes during pregnancy appear to be more likely to develop cardiovascular disease later in life, a study has found.

Scientists at the University of Bristol studied 3,416 pregnant women, all of whom enrolled in a parent and child study in the early 1990s.

They found that those who experienced complications in pregnancy - including gestational diabetes, pre-eclampsia and premature delivery - were more likely to have cardiovascular risk factors at around 48 years of age.

Gestational diabetes was associated with a 26 per cent increased risk of developing heart disease in middle age, while pre-eclampsia was associated with a 31 per cent increase in risk.

Dr. Abigail Fraser, whose findings are published in Circulation: Journal of the American Heart Association, said: 'Pregnancy may provide an opportunity to identify women at increased risk of heart disease while they are relatively young.

'A woman who experiences complications during pregnancy should be proactive and ask her doctor about future cardiovascular disease risk and steps she should take to modify her risk.'

A recent study found that women with pet dogs are more likely to meet exercise guidelines during pregnancy - something that is likely to be beneficial for their own health and that of their unborn child.

Women with pet dogs are more likely to do the recommended amount of exercise during pregnancy, a study has found.

Scientists at the University of Liverpool looked at data on more than 11,000 pregnant women, all of whom had taken part in the Avon Longitudinal Study of Parents and Children.

They found that those who owned dogs were about 50 per cent more likely to do at least 30 minutes of exercise per day, as recommended by health experts.

The findings, which are published in the journal PLoS One, could have important implications, as excessive weight gain during pregnancy is now known to be associated with health complications.

Dr. Sandra McCune, research programme manager at science centre Waltham, which funded the study, said: 'We are increasingly seeing that exercising with a dog can lead to improved motivation and effectiveness.

'As a low-risk exercise, dog walking can help women, who may otherwise find it hard to meet their exercise targets, keep active and fit during pregnancy.'

There are more than eight million pet dogs in the UK, according to specialist pet insurance provider PetPlan.

The speed at which a middle-aged person walks could give an indication of their risk of developing dementia in later life, new research suggests.

Scientists at Boston Medical Centre performed tests on more than 2,400 men and women, with an average age of 62 years.

Participants had brain scans and completed tests for walking speed, hand grip strength and cognitive function, before being followed for up to 11 years.

During that time, 34 of the participants developed dementia, while a further 70 individuals had a stroke.

The researchers found that people who walked slowly in middle age were 1.5 times more likely to develop dementia than those with a faster walking speed.

They also observed that, among over-65s, a strong hand grip strength was associated with a 42 per cent reduced risk of stroke or transient ischaemic attack (TIA or 'mini-stroke'), compared with those with a weaker grip.

Dr. Erica Camargo, who presented the findings at the annual meeting of the American Academy of Neurology in New Orleans, claimed that these basic tests could be used to assess a person's risk of dementia and stroke.

'While frailty and lower physical performance in elderly people have been associated with an increased risk of dementia, we weren't sure until now how it impacted people of middle age,' Dr. Camargo revealed.

'Further research is needed to understand why this is happening and whether pre-clinical disease could cause slow walking and decreased strength.'

A spokeswoman for the Alzheimer's Society agreed that further research is needed to understand the links and what other factors may be involved.

Breakfast cereals often contain large quantities of sugar and it can be hard for parents to identify healthy varieties due to confusing labelling, a study has revealed.

Consumer watchdog Which? analysed the nutritional content of 50 breakfast cereals, including many varieties that are popular with children.

Its researchers found that 32 of the cereals - including all of the ones aimed at children - were high in sugar.

Amanda Diamond, deputy editor of Which?, revealed: 'Kellogg's Frosties were the worst for sugar, but perhaps more surprisingly, our analysis revealed that other cereals which may be thought of as 'healthy' were also high in sugar.

'We found that Kellogg's Special K and supermarket own-brand rice and wheat flakes - often marketed as low-fat - are high in sugar.'

To make matters worse, just 14 of the 50 cereals had traffic light labelling on their packaging to help people make an informed choice.

Malcolm Clark, coordinator of the Children's Food Campaign, welcomed the report and claimed that the sale and promotion of high-sugar cereals to children was 'hugely counter-productive to public health efforts'.

Britons often feel anxious about the health credentials of the food served up at dinner parties, new research shows.

A survey by Weight Watchers UK revealed that 81 per cent of people worry when invited to a dinner party, with 21 per cent agonising about the food they will be served.

The majority of respondents said they avoid eating high-calorie foods at dinner parties, with more than one in ten faking illness so they do not have to eat.

Researchers also found that one in three dieters give any high-calorie or high-fat foods to their partners or friends, while 16 per cent would even feed them to their host's dog.

Lucy Vickers, a nutritionist at Weight Watchers, insisted that it is still possible to enjoy tasty food with friends and family while losing weight.

'We believe that providing good food without the worry of it affecting weight loss is the way to let your guests enjoy a lovely, guilt-free meal,' she added.

NHS figures indicate that 66 per cent of men and 57 per cent of women in England were overweight or obese in 2009.

People with diabetes face an untimely death because the government has failed to follow through on its promise to improve care, the chief executive of a national charity has claimed.

Diabetes UK's Barbara Young told the BBC that the government should make diabetes a higher priority.

At present, people with type-2 diabetes tend to die around ten years earlier than the rest of the population, while those with type-1 typically die 20 years earlier.

Baroness Young said that this is largely due to poor access to health checks and services that are recommended by the National Institute for Health and Clinical Excellence (NICE).

Speaking ahead of an edition of Radio 4's 'File on 4' programme, she claimed: 'The government often says the right things but the fact is that we are treading water when it comes to delivering quality diabetes healthcare.

'Only dynamic action can bring an end to the scandal of the high levels of early death and preventable complications such as amputation, blindness, kidney failure and stroke.'

Baroness Young also argued that money spent on treating the complications of diabetes should instead be used to prevent those complications from developing in the first place.

The government has launched England's first ever national campaign to raise awareness of the symptoms of bowel cancer.

The disease affects 33,000 people every year in England, but can often be treated effectively when diagnosed at an early stage.

People who develop possible signs of bowel cancer - such as blood in their stools or loose bowel movements for more than three weeks - are advised to discuss their concerns with their GP.

The new 'Be Clear on Cancer' campaign features real-life GPs in a bid to increase awareness of the disease's symptoms and encourage them to visit their family doctor.

Care services minister Paul Burstow said: 'No one likes talking about their poo - it's embarrassing. But bowel cancer is the second biggest cancer killer so we need to get over the embarrassment and talk to someone about it.

'No matter how embarrassing it is, talking to your GP can help save your life.'

Mark Flannagan, chief executive of the charity Beating Bowel Cancer, welcomed the campaign.

He emphasised that the majority of changes in bowel habits are probably not caused by cancer.

'But if they are it is much better to be diagnosed and treated as quickly as possible,' he added.

Britons have been urged to take care in the freezing weather, as blood pressure can rise in the cold.

The Blood Pressure Association warned that people may be at increased risk of heart attack or stroke in cold weather, particularly if they have high blood pressure that they are unaware of.

Figures suggest that about one-third of the 16 million Britons with high blood pressure are unaware of their condition.

This means they are doing nothing to lower their blood pressure and reduce their risk of heart attacks and stroke.

Paul Newman, chief executive of the Blood Pressure Association, said: 'This time of year can be more dangerous for some people due to the cold weather, and we urge anyone who doesn't know their blood pressure numbers to have a test.

'GP practices will test for free and many high street pharmacies offer tests too. When you go, take an elderly friend or relative too; it could be a lifesaver for them.'

The Met Office has issued several severe weather warnings and says there is a 100 per cent chance of severe cold weather, icy conditions and heavy snow between 10:00 GMT on Friday February 3rd and 10:00 GMT on Tuesday February 7th in parts of England.

Efforts should be made to reduce the population's intake of sugar, US scientists say.

Researchers at the University of California, San Francisco, claim that excess sugar consumption contributes to 35 million deaths each year around the world.

This is because a high intake of sugar is associated with non-communication diseases such as diabetes, heart disease, cancer and obesity.

Writing in Nature journal, the experts point out that issues such as alcohol misuse and tobacco have been addresses with societal measures, such as higher taxes on these products and restrictions on their sale via vending machines.

They suggest that similar measures could be considered to help reduce the amount of sugar in people's diets.

Dr. Robert Lustig, professor of paediatrics at the university's Benioff Children's Hospital, said that people need to stop regarding sugar as 'just empty calories'.

'There are good calories and bad calories, just as there are good fats and bad fats, good amino acids and bad amino acids, good carbohydrates and bad carbohydrates,' he revealed.

'But sugar is toxic beyond its calories.'

The majority of people in the UK exceed the recommended intake of sugar, according to NHS experts.

High-sugar foods include cakes, biscuits, sweets and fizzy drinks.

US scientists have discovered that an existing drug for skin cancer could also help to treat Alzheimer's disease - the most common cause of dementia.

A research team at Case Western Reserve University School of Medicine carried out a series of tests using the cancer drug bexarotene.

They found that the drug cleared a protein involved in Alzheimer's disease, called amyloid, from the brains of mice.

Animals subsequently showed signs of improved memory and behaviour, indicating that the therapy may help to reverse symptoms of the disease.

Commenting on the findings, which are published in Science journal, study author Professor Gary Landreth said: 'This is a particularly exciting and rewarding study because of the new science we have discovered and the potential promise of a therapy for Alzheimer's disease.'

The professor added that the research is still at an early stage, but that the therapy worked 'quite well' in mice.

Dr. Anne Corbett, research manager at the Alzheimer's Society, welcomed the findings.

She said: 'This exciting study could be the beginning of a journey towards a potential new way to treat Alzheimer's disease.

'However, this is very early days. People with Alzheimer's should not rush to get this drug, as we need much more research to establish if it has benefits for humans.'

Women who are diagnosed with cancer during pregnancy can safely commence treatment without risking harm to their unborn child, a new study suggests.

Scientists at Leuven Cancer Institute in Belgium looked at 68 pregnancies, during which 236 cycles of chemotherapy were administered.

Women were typically around 18 weeks into their pregnancy at the time of their cancer diagnosis.

The researchers found that the children had normal development, IQ, hearing and heart function.

Those who were born prematurely tended to have lower cognitive development scores, but the researchers pointed out that this was to be expected in premature children and was not linked to chemotherapy use.

Writing in the Lancet Oncology, the study authors concluded: 'We show that children who were prenatally exposed to chemotherapy do as well as other children.

'The decision to administer chemotherapy should follow the same guidelines as in non-pregnant patients.'

Kim Hardwick, senior cancer information nurse at Macmillan Cancer Support, welcomed the research.

She said: 'Cancer during pregnancy is thankfully a rare occurrence. But pregnant women with cancer can be successfully treated with chemotherapy.'

A programme trialled at Cardiff University could significantly reduce the number of antibiotic prescriptions handed out by GPs.

Sixty-eight Welsh GP practices took part in the two-year trial, in which they were given antibiotic prescribing and resistance data derived from their own practices.

GPs were also given access to online learning materials and 'consulting skills' tools, which were designed to help doctors discuss treatment options more effectively with their patients.

The researchers found that participating practices greatly reduced their numbers of antibiotic prescriptions.

They calculate that, if rolled out across the UK, the initiative could cut unnecessary prescriptions by 1.6 million per year, saving the NHS money and helping to tackle antibiotic resistance.

Lead researcher Professor Chris Butler, whose findings are published in the British Medical Journal, said: 'As most antibiotics are prescribed in general practice, safely reducing the number of unnecessary prescriptions is essential.

'The STAR programme helped Welsh GPs gain new skills derived from motivational interviewing so they could achieve evidence-based treatment while taking patient perspectives into account.'

The NHS could be wasting billions of pounds by failing to identify mental health problems among people with long-term conditions, a new report claims.

People with chronic conditions, such as diabetes or heart disease, are two to three times more likely to experience mental health problems than the general population.

But the King's Fund and the Centre for Mental Health say that mental health conditions often go undetected in these patients, resulting in poorer outcomes for patients and a high financial cost to the NHS.

Their report suggests that $1 in every $8 spent on long-term conditions is linked to patients' poor mental health, as co-existing mental health problems can lead to increased hospitalisation rates, increased use of outpatient services and less effective self-management.

According to the report authors, the NHS could therefore make savings, improve patient outcomes and meet efficiency targets by taking a more integrated approach to long-term conditions and mental health.

Lead author Chris Naylor said: 'The prevailing approach towards improving care for people with long-term conditions is at risk of failing unless we look at patients' needs as a whole, including their mental health needs.

'To achieve this, mental health provision cannot simply be tacked on to physical care but needs to be an integral part of it.'

Carers are not receiving the advice and information they need to ensure ill or disabled relatives have a healthy diet, a report has found.

The report, entitled 'Malnutrition and Caring: The hidden cost for families', was prepared by Carers UK, which surveyed more than 2,000 charity members about their experiences of managing their loved one's diet and nutritional requirements.

Researchers found that 25 per cent of respondents were looking after someone who was underweight, while one in six were caring for someone at risk of malnutrition but were receiving no nutritional support.

Three-fifths of carers said they were worried about their loved one's nutrition, with many unsure about where to turn to for help, advice and information.

Helena Herklots, chief executive of Carers UK, said: 'On top of coping with the daily stresses of caring for ill or disabled loved ones, food and nutrition can be a huge source of frustration and worry for families.

'Carers do their best but can often end up feeling guilty and powerless to help if older or disabled loved ones struggle to eat and get the nutrition they need.'

Carers UK and specialist nutrition company Nutricia are calling for all carers to receive information and advice about nutrition, and for GPs to screen for malnutrition during routine consultations.

They also want to see a joint national strategy for malnutrition to ensure a consistent standard of nutritional care across the country.

US scientists have discovered how faults in a particular gene cause Parkinson's disease.

Researchers at the University of Buffalo created human neurons from skin cells in the laboratory to investigate the role played by the 'parkin' gene.

They found that faults or 'mutations' in the gene disrupt the action of the neurotransmitter dopamine and produce more free radicals, which destroy the dopamine neurons and cause Parkinson's.

The team's findings pave the way for the development of potential new therapies for the disease.

Lead author Dr. Jian Feng, professor of physiology and biophysics at the University of Buffalo, said: 'This study provides the first clues about what the parkin gene is doing in healthy controls and what it fails to achieve in Parkinson's patients.'

The findings, which are published in the journal Nature Communications, were welcomed by campaigners.

Dr. Michelle Gardner, research development manager at Parkinson's UK, said that new stem cell technologies are opening doors for research into the disease.

'This study is particularly exciting because it describes for the first time how researchers have successfully generated nerve cells from people with a rare genetic form of Parkinson's, linked to the parkin gene,' she added.

Workers and employers alike can take steps to maintain healthy workplaces, experts have claimed.

According to Ambius, an expert in creating healthy working environments, there are a number of things that can be done to prevent workers from falling ill and taking sick leave.

Trisha Haughey, the company's managing director, observed: 'It is widely accepted that January and February are difficult months in terms of employee motivation and sickness levels.

'Creating a healthy work environment and improving employee wellbeing can go a long way to improve employee engagement and, in turn, productivity at a time when this is so critical for businesses.'

Tips include placing plants in the workplace to remove toxins from the air and encouraging people to eat plenty of fruit and vegetables.

Workers should be provided with a water dispenser, with extra fluids recommended for those returning to work after a spell of sickness.

Hot water and an effective hand-drying method should be provided in washrooms, and shared items - including photocopiers, phones and door handles - should be cleaned regularly with sanitary wipes.

Employers should also advise ill staff to go home, as this will help them to recover more quickly and reduce the likelihood of other workers becoming infected.

Adults of a working age who take two or more prescription drugs are at increased risk of being seriously injured after a fall in the home.

That is according to new research published in the journal Injury Prevention, which sheds a light on the risks facing younger people on multiple medications.

Previous research has already shown that elderly patients taking more than one prescribed drug are more likely to fall, but this is one of the first studies to look outside of this high-risk group.

The team, from the university of Auckland in New Zealand, found that anti-hypertensives and cholesterol-lowering drugs were the most common medications being taken by adults.

Their population-based study of 25 to 60 year-olds included 335 cases of people who died or were admitted to hospital following an unintentional fall at home.

"The findings suggest that, as in the case of older people, younger working aged adults who use multiple prescription medications are at increased risk of falls, an aspect that should be considered in falls prevention programs," they concluded.

There has been a significant increase in the proportion of unsafe abortions carried out around the world, new research has found.

Researchers at the World Health Organisation and New York's Guttmacher Institute analysed data on abortions between 1995 and 2008.

They found that the rate of abortions dropped from 35 per 1,000 women aged 15 to 44 years in 1995 to 29 per 1,000 women in 2003, after which it remained stable for the next five years.

Overall, approximately one in five pregnancies ended in abortion in 2008, although rates tended to be lower in areas with liberal abortion laws.

Researchers observed that the proportion of unsafe abortions rose from 44 per cent in 1995 to 49 per cent in 2008.

Study co-author Dr. Iqbal Shah revealed that the risks are greatest for the poorest women in developing countries.

He explained: 'They have the least access to family planning services and are the most likely to suffer the negative consequences of an unsafe procedure.

'Poor women also have the least access to post-abortion care, when they need treatment for complications.'

Writing in the Lancet medical journal, the researchers concluded: 'Measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are crucial steps.'

Dr. Richard Horton, the journal's editor, described the findings as 'deeply disturbing'.

He remarked: 'Condemning, stigmatising and criminalising abortion are cruel and failed strategies. It's time for a public health approach that emphasised reducing harm - and that means more liberal abortion laws.'

Fried food does not increase a person's risk of heart disease or premature death, according to a new study in the British Medical Journal.

But the researchers emphasised that the study was conducted in the Mediterranean - where the main cooking fats are olive and sunflower oil - and that the results may therefore be different in countries where other fats are using for frying food.

Scientists at the Autonomous University of Madrid based their findings on an 11-year study of 40,757 adults, aged 29 to 69, who provided information on their cooking methods.

They found no link between an individual's levels of fried food consumption and their risk of heart disease.

Writing in an accompanying editorial, Professor Michael Leitzmann from the University of Regensburg in Germany said that the study dispels the myth that fried food is bad for the heart.

However, he insisted that this 'does not mean that frequent meals of fish and chips will have no health consequences'.

Victoria Taylor, the British Heart Foundation's senior heart health dietician, concurred.

She revealed: 'Regardless of the cooking methods used, consuming foods with high fat content means a high calorie intake.

'This can lead to weight gain and obesity, which is a risk factor for heart disease. A well-balanced diet, with plenty of fruit and veg and only a small amount of high-fat foods, is best for a healthy heart.'

Public opinion on whether the legal abortion time limit should be reduced is divided, according to a new poll.

A survey of 1,761 adults by research firm YouGov found that 37 per cent believe legislation should be passed to reduce the legal time limit, while 34 per cent think the current limit of 24 weeks is fine.

People preferring to increase the time limit above 24 weeks are in the minority (five per cent), with a further six per cent believing abortions should be banned altogether.

The survey also revealed a clear gender divide, with 49 per cent of women believing the time limit should be reduced, compared with just 24 per cent of men.

Age also appears to be a factor in determining an individual's views on abortion time limits.

While 43 per cent of 18 to 24-year-olds would reduce the limit, the figure falls to just 35 per cent of over-60s.

Recent research by the World Health Organisation and the Guttmacher Institute in New York revealed that approximately one in five pregnancies around the world ended in abortion in 2008.

A new drug called apixaban (brand name Eliquis) has been approved for use on the NHS in England and Wales to help prevent blood clots after hip and knee surgery.

Patients who undergo hip or knee replacement surgery may now be given apixaban to reduce their risk of venous thromboembolism (VTE).

Figures show that up to 85 per cent of knee surgery patients would develop a blood clot in one of their deep veins (deep vein thrombosis or DVT) without anti-clotting therapy, along with up to 57 per cent of elective hip surgery patients.

Apixaban is designed to prevent blood from clotting by stopping the normal activity of a substance called factor Xa, which is required for the formation of clotting components thrombin and fibrin.

Professor Carole Longson, director of the Health Technology Evaluation Centre at the National Institute for Health and Clinical Excellence (NICE), revealed that blood clots can cause long-term damage to the veins, as well as causing problems if they come loose.

'Apixaban has been shown to be a clinically and cost-effective option for preventing blood clots following elective hip and knee replacement surgery,' she said.

'We are therefore pleased to be able to recommend its use in the NHS in England and Wales alongside other effective treatments already approved by NICE.'

A national charity has urged the government to increase opportunities for scientists to enter the field of dementia.

Alzheimer's Research UK is concerned that the nation's knowledge base could be lost unless scientists are encouraged and supported to carry out vital research.

The charity's 'Defeating Dementia' report, which is being launched at the House of Commons today (January 25th), also urges the government to commit to a national dementia research strategy.

This should encourage ring-fencing of funding for research into dementia and simplify the application process for funding.

Rebecca Wood, chief executive of Alzheimer's Research UK, said: 'The only answer to dementia lies in research that will deliver new treatments and preventions.

'If we can't boost the number of scientists working on dementia, then we will fail the 820,000 living with dementia today, and we will be powerless to avert the looming increases in prevalence.'

The report follows the recent publication of a review by the Health Select Committee into how health and social care systems are coping.

A new test called flexible sigmoidoscopy (FSG) is effective at detecting bowel cancer and benign growths, a US study has shown. Flexible sigmoidoscopy uses a flexible tube with a light and camera at the end to investigate the lower parts of the bowel.

It is currently being introduced by the government as part of England's bowel screening programme.

Researchers at the University of Pittsburgh looked at data on 77,447 people, aged 55 to 74, who enrolled in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial between 1993 and 2001.

Of these, 67,073 had at least one flexible sigmoidoscopy test, while 39,442 had two tests.

The researchers found that 3.8 per cent of people had bowel cancer or advanced adenomas after their first screening test, rising to 4.5 per cent of people after both screening tests.

This means that repeat screening increased the number of detected tumours by 32 per cent.

However, the study authors - whose findings are published in the Journal of the National Cancer Institute - noted: 'Although repeated FSG increases screening yields, it also increases the costs of screening, the need for diagnostic intervention, and the risks of complication.

'Despite our ability to measure the yields from first and repeat FSG, it may not be possible to distinguish specific mortality benefits derived from first as opposed to repeat FSG.'

A recent study in the journal Gut found that the national screening programme in England is on course to cut bowel cancer deaths by a sixth.

Postmenopausal women taking statin medications have an increased risk of incident diabetes mellitus (DM), according to an analysis published online January 9, 2012, in the Archives of Internal Medicine.

Anne L. Culver, B. Pharm, from the Mayo Clinic in Rochester, Minn., and colleagues investigated the correlation between new-onset DM and statin use among postmenopausal women. Data were analyzed for 153,840 women without DM at baseline, aged 50 to 79 years, recruited for the Women's Health Initiative from 1993 to 1998 with ongoing follow-up. Statin use was recorded at enrollment (7.04 percent at baseline) and at year three, and incident DM status was assessed annually.

The investigators found that, during the 1,004,466 person-years of follow-up, there were 10,242 incident cases of self-reported DM. Baseline statin use was associated with an elevated risk of DM (hazard ratio [HR], 1.71). After adjusting for potential confounders, the association remained significant (HR, 1.48) and was seen with all statin medications. These results were confirmed in subset analyses assessing longitudinal measures of statin use in 125,575 women. "Given the wide use of statins in the aging population, further studies among women, men, and diverse ethnicities will clarify DM risk and risk management to optimize therapy," the authors write.

A drug used to treat multiple sclerosis (MS) could also be used to reverse the symptoms of the leading cause of heart attack, new research suggests.

Scientists at the University of Manchester and the University of Illinois in the US discovered that Gilenya produced promising results in mice with ventricular hypertrophy - a fatal disorder that results in an abnormal heart rhythm and cardiac arrest.

The drug enhances the activity of an enzyme molecule called Pak1, which helps to prevent tissue damage following a heart attack.

Researcher Dr. Xin Wang, a lecturer in molecular cardiology at the University of Manchester, revealed that the stimulated enzyme 'prevented and even reversed the symptoms of ventricular hypertrophy'.

Dr. Ming Lei, who is also based in Manchester, added: 'The novel effect of this existing drug means that we have the potential to accelerate the availability of a new therapy for patients with these heart conditions.'

The study is published in Circulation journal and was part-funded by the British Heart Foundation whose associate medical director, Professor Jeremy Pearson, said the drug had shown real promise.

He observed: 'Heart failure currently affects 750,000 people in the UK and this number is increasing. We urgently need new and better ways to help treat and prevent the debilitating condition.'

Cancer patients who take regular exercise may benefit from improved health and wellbeing, research has shown.

A team at the University of Hong Kong analysed the results of 34 trials, all of which had looked at the effects of physical activity among adults with cancer.

They found that women with breast cancer who had taken exercise benefited from improvements in blood sugar control, body mass index (BMI), body weight, fatigue,depression and overall quality of life.

For other forms of cancer, improvements were seen in BMI, body weight, physical function, depression and quality of life.

Younger patients seemed to benefit the most from exercising, although conclusions cannot be drawn from this, as younger people were typically able to exercise for longer than their older counterparts.

Publishing their findings in the British Medical Journal, the study authors concluded that 'quality of life was a clear significant benefit of physical activity and that clinically, there were important positive effects on physical functions and quality of life'.

Many studies have shown exercise to be safe for people with cancer, according to Cancer Research UK.

However, the charity advises patients to check with their doctors before starting any type of exercise.

Differences in blood pressure between a person's left and right arm could help to identify vascular disease, according to a new study published in the Lancet medical journal.

Researchers at the University of Exeter say that measurement of blood pressure in both arms should become part of routine care.

The team reviewed 28 previous papers which had looked at differences in systolic blood pressure between arms.

Overall, they found that a difference of 10mmHg or more between the two arms was associated with an increased risk of peripheral vascular disease.

A difference of 15mmHg or more was also associated with the presence of cerebrovascular disease and an increased risk of death.

Early detection of peripheral vascular disease is important as lifestyle changes and medication can be recommended to reduce an individual's risk of death.

The researchers suggested: 'Findings from our study should be incorporated into future guidelines for hypertension and blood pressure measurement to justify bilateral brachial measurement in the assessment of individuals, and to promote targeted screening for peripheral vascular disease and aggressive risk factor management in subjects with a demonstrable systolic between-arm difference.' Natasha Stewart, the British Heart Foundation's senior cardiac nurse, said more research is needed to confirm the findings.

A new therapeutic approach for Hepatitis C could benefit 170 million people affected by the disease around the world.

Canadian researchers believe they have found a new way to block infection from the virus responsible for the condition in the liver. It is hoped that this will lead to new therapies.

Hepatitis C is caused by chronic HCV infection, which is also one of the leading causes of liver cancer. It is spread through blood-to-blood contact and there is currently no vaccine.

Francois Jean, associate professor in the department of microbiology and immunology at the University of British Columbia, explained that HCV is constantly mutating, making it difficult to target with antiviral therapies.

However, he explained that it needs fat droplets in the liver to form new virus particles, with this accumulation of fat around the liver leading to chronic dysfunction.

Professor Jean and his team therefore developed an inhibitor that decreases the size of these fat droplets, so that HCV is unable to take "residence" in them and infect other cells.

"Our approach would essentially block the lifecycle of the virus so that it cannot spread and cause further damage to the liver," he said.

A symposium in the US will hear the details of several new studies aimed at improving detection and treatment of gastrointestinal (GI) cancers.

The Gastrointestinal Cancers Symposium is taking place in San Francisco, California, from January 19th to 21st 2012.

Among the studies being discussed is a report on new biomarkers that could improve early detection of oesophageal cancer in patients with Barrett's Oesophagus, a condition that significantly increases the risk of cancer.

Using a special microscope, researchers were able to identify three optical biomarkers in cells lining the oesophagus, which allowed them to predict patients' risks of developing cancer.

Other breakthroughs discussed at the symposium included a blood-based biomarker test that is capable of correctly identifying two-thirds of patients with early stage pancreatic cancer, which is very difficult to detect.

Another study suggested that treatment with a multi-targeted drug regorafenib significantly improves survival chances and delays cancer progression in patients with metastatic colorectal cancer that is progressing despite treatment.

A new device being developed in China promises to change the way that people are treated when they suffer from gallstones.

At present, conventional treatment still dictates removal of the gallbladder, a procedure known as a cholecystectomy, when the painful growths occur.

However, scientists from the Second People's Hospital of Panyu District and Central South University in China believe their new device will make removing the entire organ unnecessary.

They developed an endoscope that is designed especially to locate and clear out gallstones and lesions.

Writing in a paper due to be published in the journal Review of Scientific Instruments, the team explained that clinical trials in two hospitals have shown "no significant difference" in safety between the new method and previous types of endoscopes used for cholecystectomies.

A tiny ultrasonic probe is used to locate the gallstones, which can then be removed using a horn-shaped apparatus called an "absorbing box".

January 17, 2012 (Boston, Massachusetts) - The BRIDGE study, showing that the intravenous P2Y12 receptor antagonist cangrelor (the Medicines Company) could represent an effective bridging therapy for patients taking thienopyridine antiplatelet agents such as clopidogrel who are scheduled for surgery, has been published in the January 18, 2012 issue of the Journal of the American Medical Association.

The study was first presented at TCT 2011 last November.

Senior author Dr Eric Topol (Scripps Translational Science Institute, La Jolla, CA) commented to heartwire : "Patients who are taking clopidogrel but are scheduled to have surgery are a big problem. We don't really know what to do with them. As the antiplatelet effect of clopidogrel takes a few days to wear off, it is advised to stop clopidogrel five to seven days before surgery, but we are seeing many patients who have an event during this time when there is no antiplatelet therapy on board." He added that some doctors give a short-acting GP IIb/IIIa blocker over this time, but these haven't been properly tested in this indication, and they don't protect against stent thrombosis as well as thienopyridines.

The researchers believe cangrelor is "ideal" for this bridging role as it has a very short half-life and so a quick "on-off" effect, and because it acts at the same receptor as the thienopyridines it should be just as effective at preventing stent thrombosis.

For the current study, 210 patients taking thienopyridines for ACS or after stent placement who were awaiting CABG had their thienopyridine stopped, and they were then randomized to either cangrelor (0.75 µg/kg per minute) or placebo for at least 48 hours. Study drug was discontinued one to six hours before CABG surgery.

Results showed that more patients had low levels of platelet reactivity--under 240 platelet reactivity units (PRU)--throughout the treatment period compared with placebo

BRIDGE Study: Main Results Outcome
Cangrelor (%)
Placebo (%)
Relative risk (95% CI)
p
PRU <240
98.8
19.0
5.2 (3.3–8.1)
0.001
Excessive CABG-related bleeding
11.8
10.4
1.1 (0.5–2.5)
0.763

There was no significant difference in major bleeding prior to CABG surgery, although minor bleeding episodes were numerically higher with cangrelor. Topol said the bleeding data looked "very encouraging." "There was an increase in minor bleeding, which may have become significant if the trial were larger. It would be good to see results in a larger sample of patients--perhaps undergoing different types of surgeries."

As cangrelor is not yet available commercially, could it be made available for this indication based on these data? Addressing this question, Topol said: "From a regulatory view, this trial is small and only has a surrogate end point (platelet inhibition), so I couldn't say that it will gain approval. But as there is nothing else available for this population and there is a clear need for something, maybe cangrelor could be made available, with further data coming from postmarketing studies."

He added that having patients stop taking clopidogrel because of upcoming surgery is not an infrequent situation. In the paper, the researchers estimate that around 5% of patients will require some type of surgery within the first 12 months after stent implant or an ACS diagnosis. Topol commented: "At present, patients can either tough it out with no antiplatelet therapy or be given an agent unapproved for such use, which doesn't work so well. Under these circumstances perhaps we do have enough data to justify using cangrelor in these patients."

Cangrelor has previously been investigated as an alternative to a clopidogrel loading dose in ACS patients scheduled for PCI in the CHAMPION trial. But it failed to show benefit on the primary end point of death, MI, or ischemic-driven revascularization within 48 hours of the procedure.

References
Angiolillo DJ, Firstenberg MS, Price MJ, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery. A randomized controlled trial. JAMA 2012; 307:265-274.

January 17, 2012 - The US prevalence of obesity continues to be high, with one third of US adults and 1 in 6 US children and adolescents affected, according to 2009 to 2010 data from the National Health and Nutrition Examination Survey (NHANES). The data were presented in 2 papers published online January 17 in JAMA. As alarming as these rates are, the data suggest that they may be topping out, according to the researchers.

"[Obesity prevalence] increased significantly over the 12-year period from 1999 through 2010 for men and for non-Hispanic black and Mexican American women, but did not change between 2003-2009 and 2010 for men or women," write Katherine M. Flegal, PhD, distinguished consultant from the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention, Hyattsville, Maryland, and colleagues in the first article.

In addition, trends in US children and teenagers followed a similar pattern - unchanged, but at 17% - since the last review of 2007-2008, explain Cynthia L. Ogden, PhD, MRP, NCHS epidemiologist, and colleagues in the second article, on children and teenagers. Noting the linear increase in obesity prevalence in children, and predictions that obesity prevalence among children and teenagers may reach 30% by 2030, the authors write that "the data presented herein suggest that the rapid increases in obesity prevalence seen in the 1980s and 1990s have not continued in this decade and may be leveling off."

Among US adults, the age-adjusted obesity prevalence was 35.7% (95% confidence interval [CI], 33.8% - 37.7%). Non-Hispanic black men and women had the highest obesity prevalence rates, at 38.8% (95% CI, 33.9% - 43.9%) for men and 58.5% (95% CI, 52.4% - 64.3%) for women. When age-adjusted prevalence of overweight and obesity were combined (body mass index [BMI] of at least 25 kg/m2), it was 68.8% overall (95% CI, 65.9% - 71.5%), 73.9% for men (95% CI, 70.0% - 77.8%), and 63.7% among women (95% CI, 60.9% - 66.4%. Grade 2 obesity, defined as a BMI of 35 kg/m2 or more, and grade 3 obesity (BMI, 40 kg/m2 or more) again show the highest rates for non-Hispanic blacks, at 20.0% (95% CI, 16.4% - 24.3%) for non-Hispanic black men and 30.7% (95% CI, 26.4% - 35.2%) for non-Hispanic black women.

In the study of children and teenagers, investigators used high weight for recumbent length (BMI 95th percentile or higher of the BMI-for-age growth charts). Between 2009 and 2010, 16.9% of US children and adolescents were obese (95% CI, 15.4% - 18.4%), with 31.8% either overweight or obese (95% CI, 29.8% - 33.7%). Boys were consistently more likely to be obese than girls, at 18.6% vs 15.0%. =Racial differences were also striking, with black children and adolescents having an obesity of prevalence of 24.3% (95 CI, 20.5% - 28.6%) compared with 21.2% (95 CI, 19.5% - 23.0%) for Hispanics and 14.0% (95% CI, 11.7% - 16.7%) for non-Hispanic whites. Older children had higher prevalence rates than each successive younger age group.

NHANES analyses are based on at-home interviews and physical examinations collected continuously since 1999 in children, and since 1960 in adults, and released in 2-year cycles. NHANES is designed as a cross-sectional survey nationally representative of the US noninstitutionalized population. Data from other industrialized countries also suggest that obesity trends may be leveling off worldwide.

Up to 1,200 stillbirths could be prevented each year in the UK, a new report suggests.

Stillbirth and neonatal death charity Sands says that a combination of more research, better care and greater awareness of the risks of stillbirth and newborn baby death could help to prevent many of the 6,500 stillbirth and neonatal deaths that occur every year in the UK.

Its report, which was launched in the House of Commons earlier this week, calls for urgent action to address the problem, which charity chief executive Neal Long described as 'shocking'.

He said: 'Seventeen babies are stillborn or die shortly after birth every day, with stillbirth being the largest contributor to child deaths under the age of five years.

'Our new report, 'Preventing Babies' Deaths: what needs to be done', describes the devastating impact these deaths have on parents and their families, and highlights the areas where we believe progress can be made to save hundreds of babies' lives.'

Dr. Tony Falconer, president of the Royal College of Obstetricians & Gynaecologists, welcomed the report.

He noted that there are many factors associated with stillbirth, including increasing maternal age, obesity, ethnicity and congenital abnormalities.

'It is important that any medical problems need to be identified as soon as possible so that appropriate care can be provided,' the expert observed.

The number of people who spend their final days in their own home has increased in the UK, new research shows.

Figures suggest that around two-thirds of people would prefer to die at home - and a study from King's College London has found that an increasing number are now doing so.

Researchers analysed death registration data from the Office for National Statistics for 2004 to 2010.

They found that 18.3 per cent of deaths in 2004 took place at home, rising to 20.8 per cent in 2010.

This means that a total of 102,416 people died at home in 2010, with the practice being particularly common among cancer patients.

Lead study author Barbara Gomes, whose findings are published in the journal Palliative Medicine, commented: 'What seemed to be an enormous task has happened - the reversal of the British longstanding trend towards an institutionalised dying.

'From 2004 onwards, it became more common for people in England and Wales to die at home.'

According to a 2008 report by the National Audit Office, 24 per cent of people with cancer die at home, with 48 per cent dying in hospital.

Men are twice as likely as women to be diagnosed with diabetes or its precursor, according to new research from VHI Healthcare.

The Irish health insurance provider has screened more than 24,000 people since January 2009, more than 2,500 of whom were diagnosed with diabetes or pre-diabetes.

Of these, approximately 1,600 were men, compared with just 900 women.

This is despite the fact that the majority of people who underwent screening were women; overall, 18.5 per cent of screened men and 8.4 per cent of women were found to have diabetes or its precursor.

Dr Bernadette Carr, medical director of VHI Healthcare, said: 'These figures highlight the importance for both sexes to be aware of the risk factors for diabetes.

'Early detection and lifestyle changes can improve outcomes and, in the case of pre-diabetes, can even delay or prevent progression to diabetes.'

The insurer's study also revealed that 76 per cent of screened men and 54 per cent of women were overweight or obese, while 27 per cent of men and 23 per cent of women had high blood pressure.

NHS experts recommend leading a healthy lifestyle - including maintaining a healthy weight, exercising regularly and keeping blood pressure under control - to reduce the risk of developing type-2 diabetes.

People who consume plenty of vitamin D during childhood appear to be less likely to develop depressive symptoms during adolescence and adulthood, a study has found.

Vitamin D is manufactured inside the body in response to exposure to sunlight and is also found in certain foods, including oily fish such as tuna.

Researchers at the University of Bristol analysed data from the Children of the 90s study in order to assess the vitamin's effect on depression in children.

They found that children with higher levels of vitamin D3 at nine years of age were ten per cent less likely to show signs of depression at 13 years of age.

Lead author Dr. Anna-Maija Tolppanen said: 'Given the importance of depression in childhood and adolescence and the relative ease with which vitamin D levels could be increased with supplements, randomised controlled trials to assess its effectiveness in preventing depressive symptoms would be appropriate.'

The findings are published in the Journal of Child Psychology and Psychiatry.

In the UK, experts recommend that children between the ages of six months and five years take daily vitamin D supplements, along with pregnant and breastfeeding women, over-65s, and anyone who covers up their skin for cultural reasons.

With a new study suggesting that people who become dependent on the internet show the same neurological changes as alcoholics and drug addicts, one expert suggests psychotherapy or drug treatments may be required.

According to Professor Mark Griffiths, it is important to make a clear distinction between being addicted to the internet and having addictions to activities that can take place online.

Writing in the Telegraph, he said: "I believe it is a very different thing to be addicted to certain applications online, such as gambling, gaming, shopping or online sex - these are addictions on the internet, rather than to the internet, and should be treated differently."

He also highlighted how addictions such as these can often be caused by underlying issues such as low self-esteem, and said it is important for treatment to focusing on the cause rather than the symptom.

"There are a wide range of treatments available for addiction, from taking drugs like Prozac to treat the symptoms and cravings, to cognitive behavioural therapy, through to psychotherapy where they talk about underlying problems.

There is little consensus on what counts as addiction, with some using the narrower definition 'dependence' for substance abuse, while using 'addiction' to include compulsive reliance on certain behaviours. ADNFCR-554-ID-801262839-ADNFCR

Real-world lifestyle interventions are an effective way of preventing or delaying the onset of type-II diabetes, it has been claimed.

The chronic condition affects millions of people around the world, but according to research from Emory University in the US, structured lifestyle schemes are the best way to ensure that people with pre-diabetes prevent the condition from developing.

A Diabetes Prevention Programme (DPP) provided participants with the tools to change their lifestyles – exercise equipment, meal replacement shakes, gym membership and personal coaching by nutritionists and physiologists.

Mohammed Ali, assistant professor of global health at Emory's Rollins School of Public Health, highlighted several studies looking at the effectiveness of DPPs, learning that they tend to lead to moderate weight loss of between five and seven per cent.

After a year enrolled in such lifestyle intervention programs, the average participant was found to have lost four per cent of their baseline body weight, an amount that could offer important protection against diabetes.

Cancer Research UK has launched a new outpatients trial of a drug used in the treatment of inherited breast and ovarian cancer.

The Phase II clinical trial will see outpatient volunteers taking the drug in tablet form. It is being led by the Sir Bobby Robson Cancer Trials Research Centre, Newcastle University and the Newcastle Upon Tyne Hospitals NHS Foundation Trust.

Called Rucaparib, the drug will be given to women with advanced breast or ovarian cancer who have faults in the BRCA1 or BRCA2 genes, which are known as a risk factor in the development of tumours.

Rucaparib is from a class of drugs called PARP-inhibitors, which ensures that alternative pathways involved in the reproduction of damaged DNA are blocked off, causing cancer cells to die.

Chief investigator on the trial Professor Ruth Plummer said: "We're seeing encouraging results in women with breast or ovarian cancer treated with PARP inhibitors.

"It's great news that we're able to run a trial of this exciting drug as a tablet which will be a much more convenient and comfortable way to receive the treatment." ADNFCR-554-ID-801261464-ADNFCR.

Two-thirds of smokers in the UK, approximately six million people, will try and quit the habit in January, but half of them will fail within a week, new research suggests.

According to the study, commissioned by Pfizer Limited in support of its Don't Go Cold Turkey disease awareness campaign, one in ten of these attempts will not last beyond 24 hours.

Typically, smokers admit to having unsuccessfully attempted to quit three times before, with 51 per cent confident they can kick the habit in the next six months.