Tuesday, December 25, 2012

Discovery Of A New Type Of Nerve Cell In The Brain

Scientists at Karolinska Institutet in Sweden, in collaboration with colleagues in Germany and the Netherlands, have identified a previously unknown group of nerve cells in the brain. The nerve cells regulate cardiovascular functions such as heart rhythm and blood pressure. It is hoped that the discovery, which is published in the Journal of Clinical Investigation, will be significant in the long term in the treatment of cardiovascular diseases in humans.

The scientists have managed to identify in mice a previously totally unknown group of nerve cells in the brain. These nerve cells, also known as 'neurons', develop in the brain with the aid of thyroid hormone, which is produced in the thyroid gland. Patients in whom the function of the thyroid gland is disturbed and who therefore produce too much or too little thyroid hormone, thus risk developing problems with these nerve cells. This in turn has an effect on the function of the heart, leading to cardiovascular disease.

It is well-known that patients with untreated hyperthyroidism (too high a production of thyroid hormone) or hypothyroidism (too low a production of thyroid hormone) often develop heart problems. It has previously been believed that this was solely a result of the hormone affecting the heart directly. The new study, however, shows that thyroid hormone also affects the heart indirectly, through the newly discovered neurons.

"This discovery opens the possibility of a completely new way of combating cardiovascular disease", says Jens Mittag, group leader at the Department of Cell and Molecular Biology at Karolinska Institutet. "If we learn how to control these neurons, we will be able to treat certain cardiovascular problems like hypertension through the brain. This is, however, still far in the future. A more immediate conclusion is that it is of utmost importance to identify and treat pregnant women with hypothyroidism, since their low level of thyroid hormone may harm the production of these neurons in the foetus, and this may in the long run cause cardiovascular disorders in the offspring."
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Temple Researcher Shows Diabetes, Blood Pressure Link To Colon Cancer Recurrence, Survival

By all accounts, a combination of colon cancer, diabetes and high blood pressure can be a recipe for medical disaster. Now, a new study led by a surgical oncologist and researcher at Temple University School of Medicine and Fox Chase Cancer Center has shown just how deadly this mix can be. In a retrospective analysis of more than 36,000 patients with colon cancer, investigators showed that those with early stage disease and diabetes or high blood pressure - two components of metabolic syndrome - have a greater risk for the cancer returning after treatment and of dying compared to patients with colon cancer who do not have either condition.

"Although metabolic syndrome has been linked to colon cancer, the third leading cause of cancer death in the U.S., previous work looking at its effect on mortality has not adequately accounted for cancer stage or treatment," said senior author Nestor Esnaola, MD, MPH, MBA, Chief of the Division of Surgical Oncology, Professor of Vice-Chair of Clinical and Academic Affairs in the Department of Surgery at Temple University School of Medicine. "Our results suggest that patients with early stage colon cancer who also have diabetes or hypertension may need to be followed more closely for recurrence and could potentially benefit from broader use of adjuvant chemotherapy." Dr. Esnaola and his team reported their findings December 20, 2012 in an early online publication in the journal CANCER.

Metabolic syndrome is a cluster of conditions that affects one in five American adults and which can include diabetes, obesity, high blood pressure, low levels of good cholesterol and high amounts of lipids in the blood.

To better understand the effect of metabolic syndrome on colon cancer outcomes, Dr. Esnaola and his team linked data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, a large population-based database, to Medicare data from 1998 to 2006 on 36,079 patients with colon cancer, including 7,024 patients (19.5 percent) who were identified as having metabolic syndrome. They analyzed the effect of metabolic syndrome and its components on colon cancer recurrence and overall survival, controlling for various sociodemographic factors, tumor factors, other medical conditions and cancer treatment received.

"Metabolic syndrome as a whole had no apparent effect on colon cancer recurrence or survival," said Dr. Esnaola, who is also an attending surgeon at Fox Chase Cancer Center. "When we teased out and analyzed the effect of each of its components, however, the data told a different story."

The researchers found that among patients with early stage disease, patients with diabetes or high blood pressure had a significantly greater risk of cancer recurrence rate and death after treatment. For example, 47.7 percent of patients who did not have diabetes were still alive five years after diagnosis compared to only 41.3 percent of patients with diabetes. When the researchers looked more closely, they also found that cancer recurrence rates at five years were approximately 8 percent higher in patients with diabetes or hypertension.

In contrast, the analysis showed that patients with abnormally high levels of lipids in the blood had a lower risk of recurrence and death from colon cancer. Overall, 39 percent of patients with normal lipid levels were still alive after five years, compared to 52.7 percent of patients with abnormal levels. Cancer recurrence rates were approximately 11 percentage points lower in patients with abnormal lipid levels.

"Although we did not have data on medication for these patients, we suspect that the higher survival and lower recurrence rates observed in patients with high lipid levels in our study group were likely due to the protective effects of statins," Dr. Esnaola said. Statins are drugs that are widely used to lower cholesterol and lipid levels and have been shown to lower the risk of developing colon cancer in people.

"To our knowledge, this is the largest study to date controlling for cancer stage and treatment that has analyzed the effect of metabolic syndrome and its components on colon cancer recurrence and survival," said Dr. Esnaola. "The adverse effects of diabetes and hypertension in early stage patients and apparent protective effect of high blood lipids observed in our cohort suggest that when it comes to metabolic syndrome and cancer outcomes, the devil is in the details."

Dr. Esnaola currently is investigating the effect of metabolic syndrome and its components on other cancer types, and plans to confirm these results in a larger set of data that contains information on cancer stage, treatment and medication. "In the interim, our results underscore the need for clinical trials to define the true benefits of (the diabetes drug) metformin and statins in patients with early stage colon cancer," he said.
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Over-Indulging Can Cut Hours Off Your Life

Although the holiday season is all about eating, drinking, and celebrating with loved ones, each day of over-indulging can cut many hours off a person's life.

The finding came from a study conducted by Professor David Spiegelhalter, statistician at the University of Cambridge, and was published in the British Medical Journal.

Since the holidays are the time when people tend to over-indulge, they need to keep in mind that thirty minutes or more can be cut off their life expectancy for each day that they smoke, have a few drinks, eat red meat, and even watch television.

On the other hand, two hours can be added to their life for each day that they eat plenty of fruits and veggies, exercise, and have just one alcoholic beverage.

Professor Spiegelhalter aimed to help people understand how the way they behave can affect their life expectancy by explaining it in a simple way.

He recommended using the notion of aging quicker or slower, and that people should consider the daily impact of lifestyle habits as "microlives" - half hours of expected length of life. Since a microlife is almost equal to one millionth of life after a person is 35, a half hour of adult life expectancy can be referred as this term.

The professor gathered and analyzed data from population studies and found that, "averaged over a lifetime habit", a person can lose a microlife by:
  • being 5kg overweight
  • smoking two cigarettes
  • eating a burger
  • having 2 or 3 alcoholic drinks
  • watching 2 hours of TV
However, a person can add microlives to their life expectancy by:
  • having no more than one alcoholic beverage a day
  • exercising
  • taking statins
  • eating fruits and veggies
Microlives can also be used when talking about demographic factors as well, for instance, being a woman rather than a man is a gain of 4 microlives a day, being alive in 2010 instead of 1910 adds 15 a day, and being a Swedish male rather than a Russian male adds 21 a day.

This simple way of explaining how daily habits affect a person's length of life helps all readers roughly compare between the sizes of persistent risks. Professor Spiegelhalter explained that it is based on "speed of aging", a metaphor which has been successful in helping people quit smoking.

"So each day of smoking 20 cigarettes (10 microlives) is as if you are rushing towards your death at 29 hours rather than 24." Professor Spiegelhalter said.

He added that the study had many limitations and emphasizes that these evaluations are estimated and came from several suppositions. Nevertheless, he said that they "bring long term effects into the present and help counter temporal discounting, in which future events are considered of diminishing importance."

Regardless of the limitations, he believes that "a reasonable idea of the comparative absolute risks associated with chronic exposures can be vividly communicated in terms of the speed at which one is living one's life."

Professor Spiegelhalter concluded:

"Of course, evaluation studies would be needed to quantify any effect on behavior, but one does not need a study to conclude that people do not generally like the idea of getting older faster."
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Elderly Aspirin Users More Likely To Develop Macular Degeneration

Regular aspirin use has been linked to a significantly increased risk of age-related macular degeneration (AMD), according to a recent study published in JAMA.

Macular degeneration is a condition which largely affects the elderly and results in a progressive loss of vision. It occurs when the retina becomes damaged, leading to a slow decline in retinal function. A recent study stated that age related macular degeneration is set to increase, with 20% of people above the age of 60 already presenting early signs of the condition.

According to background information in the study:

"Aspirin use in the United States is widespread, with an estimated 19.3 percent of adults reporting regular consumption, and reported use increases with age. The results of cross-sectional studies of aspirin use and its relation to age-related macular degeneration (AMD) have been inconsistent.

AMD is a potentially blinding condition for which prevalence and incidence are increasing with the increased survival of the population, and regular use of aspirin is common and becoming more widespread in persons in the age range at highest risk for this disease. Therefore, it is imperative to further examine this potential association."

The study, led by Barbara E. K. Klein, M.D., M.P.H., of the University of Wisconsin School of Medicine and Public Health, Madison, attempted to identify whether aspirin is associated with an increased risk of AMD.

They analyzed data from the Beaver Dam Eye Study, a longitudinal population-based study of age-related eye diseases. A total of 4,926 people participated in the study.

Every five years, from 1998-1990 through 2008-2010, examinations were carried out. They asked them about their aspirin use, in particular whether they took aspirin more than twice a week for over 3 months.

Over the course of the study they found that 512 people developed early AMD and 117 developed late AMD.

A higher percentage of regular aspirin users were found to develop late AMD compared to nonusers (1.8 percent vs. 1.0 percent). 1.4 percent of the aspirin users developed neovascular AMD compared to only 0.6 percent of nonusers.

There was no association found between aspirin use and incidence of early AMD.

The authors concluded:

"Our findings are consistent with a small but statistically significant association between regular aspirin use and incidence of neovascular AMD. Additional replication is required to confirm our observations. If confirmed, defining the causal mechanisms may be important in developing methods to block this effect to prevent or retard the development of neovascular AMD in persons who use aspirin, especially to prevent CVD."
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African American Women Avoid Exercise Because Of Hair Maintenance

The main reason why many African American women avoid exercise is because of hair care and maintenance, according to a study published in JAMA.

The research, led by Amy J. McMichael, M.D., found that complications of hair care is the main reason why African-American women don't exercise as much as they'd like to.

McMichael specializes in and teaches dermatology at Wake Forest Unviersity. She noticed that many of her female African American patients were overweight and she wanted to understand the reason why. About four out of every five African American women are overweight or obese according to data released by The U.S. Department of Health & Human Services' Office of Minority Health.

She said:

"I treat a lot of African American women in our clinic and had noticed how many of them are overweight, and I wanted to know why," she said. "I'm treating them for dermatology related issues, but as a doctor this was even more concerning because excess weight puts these women at risk for hypertension, diabetes and other serious problems."

A total of 103 African American women aged 21 to 60 participated in the study. They were each given a questionnaire asking them about their physical activity and hair care maintenance. It asked what specific exercises the women did and how much time and money they spent styling their hair. They all understood the importance of exercise, however nearly 40 percent said that they didn't exercise due to the fact that it causes them to have issues with their hair.

A lot of African American women use chemical products or heat straighteners to straighten their hair and as a result their hair becomes very fragile. If you overwash fragile hair there is a chance that it will break off easily, this is why a lot of the women can't easily wash their hair after exercise and avoid it all together.

The research began several years ago and early findings were revealed at the annual International Symposium of the L'Oréal Institute for Ethnic Hair & Skin Research in 2007.

McMichael concluded:

"We have now identified the problem - hair care does seem to be a factor - and it is one that is not easily solvable. Somebody might say, 'Oh, just cut your hair,' but that does not make sense. We have to figure out better ways to address this issue."
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Cannabis Does Not Reduce Pain, It Makes It More Bearable

Using cannabis for pain relief does help, however, it makes pain more bearable rather than getting rid of it, researchers from Oxford University's Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) reported in the journal Pain.

The authors added that people in pain act differently to cannabis, according to their brain imaging study.

The principal psychoactive constituent of cannabis is called tetrahydrocannabinol (THC). The researchers found that when volunteers took oral tablets of THC, they tended to find the experience of pain more tolerable. There was no evidence that THC reduced pain intensity.

Several studies have found that cannabis is associated with some kind of improvement in pain symptoms. Researchers from McGill University Health Centre (MUHC) and McGill University reported in CMAJ in 2010 that patients with chronic neuropathic pain experienced pain relief, improved mood and better quality sleep after smoking cannabis.

Scientists from Imperial College London found that Cannador, another cannabis plant extract, effectively relives pain after major surgery. They reported their findings in the journal Anerthesiology.

Cannabis sativa2
THC is one of 400 compounds found in the Cannabis plant

According to MRI brain imaging scans in this latest study, areas of the brain that interpret pain were not affected significantly when people took THC. It appears that cannabis affects people's emotional state in a way that makes pain less awful.

Lead researcher, Dr Michael Lee, said:

"We have revealed new information about the neural basis of cannabis-induced pain relief. Cannabis does not seem to act like a conventional pain medicine. Some people respond really well, others not at all, or even poorly. Brain imaging shows little reduction in the brain regions that code for the sensation of pain, which is what we tend to see with drugs like opiates. Instead cannabis appears to mainly affect the emotional reaction to pain in a highly variable way."

Health care professionals and administrators say that chronic (long-term) pain is a complex healthcare problem. In order to help patients effectively manage their pain, different approaches are needed, which can include physical therapy, psychological support, and medications.

For a number of patients who have not responded adequately to drugs, cannabis or cannabis-based medications are an effective way of controlling their pain. Many, however, report no benefits from cannabis and some undesirable side effects.

Dr. Lee said "We know little about cannabis and what aspects of pain it affects, or which people might see benefits over the side-effects or potential harms in the long term. We carried out this study to try and get at what is happening when someone experiences pain relief using cannabis.

Our small-scale study, in a controlled setting, involved 12 healthy men and only one of many compounds that can be derived from cannabis. That's quite different from doing a study with patients. My view is the findings are of interest scientifically but it remains to see how they impact the debate about use of cannabis-based medicines. Understanding cannabis' effects on clinical outcomes, or the quality of life of those suffering chronic pain, would need research in patients over long time periods."

Dr. Lee and team carried out several MRI scans on 12 participants at the FMRIB center in Oxford, England.

The volunteers were divided into two groups:
  • The THC group - participants were given a 15 mg THC tablet. THC is one of 400 different compounds found in the cannabis plant. It is the one that gives recreational smokers the "high".
  • The placebo group - the participants were given a dummy drug that looked just like the tablet those in the other group were taking
Then the groups were swapped, so that each participant eventually had been tested with THC and placebo.

The volunteers had either 1% capsaicin cream rubbed on the skin of one leg, or a dummy cream. Capsaicin is the ingredient of chillies; when rubbed on skin it causes a burning, painful sensation. Then the ones who received the dummy cream received the 1% capsaicin cream and those that had received the pain-inducing cream received the dummy cream.

In all, each participant underwent four situations:
  • They took a THC tablet and had the pain-inducing cream applied to their skin.
  • They took a THC tablet and had the dummy cream applied to their skin.
  • They took a placebo tablet and had the pain-inducing cream applied to their skin
  • They took a placebo tablet and had the dummy cream applied to their skin
In each different situation they had an MRI scan - a total of four scans per participants.

They were asked to describe the intensity and unpleasantness of their pain in each situation. The volunteers had to describe how intense the burning sensation was, and how much of a bother the pain was.

They found that with THC, many of the volunteers said the pain bothered them less, but did not report any change in the burning sensation.

Even though their findings showed that THC's average effect was statistically significant, people's reaction to pain after taking the compound varied considerably. Half of them reported a "clear change in how much the pain bothered them."

The participants' reports regarding how unpleasant their pain was were backed up by MRI scan results. An area in the bran called the anterior mid-cingulate cortex, which has many functions, including the emotional aspects of pain, became less active after participants took THC.

The scans also showed that activity changed in the right amygdala, which correlated with the reduction in the unpleasantness of the pain after people had taken THC. Experts already know that pain can "prime" the right side of the amygdala.

The scientists were particularly interested in how closely the right amygdala and the primary sensorimotor area (a part of the cortex) were connected. The strength of the connection between these two brain areas correlated well with the THC's varying effects on the pain the participants had reported.

The scans may help doctors predict who may benefit from taking cannabis for the relief of pain, the authors wrote.

Dr. lee said:

"We may in future be able to predict who will respond to cannabis, but we would need to do studies in patients with chronic pain over longer time periods."
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CDC Reports HIV Infection Rates Steady

The number of new human immunodeficiency virus (HIV) infections nationwide has continued to remain stable, according to a new report by the Centers for Disease Control and Prevention.

HIV is still a serious issue, with an estimated 47,500 new infections in the United States in 2010. Certain groups, including latinos, gay and bisexual men of all ethnicities, and African Americans, remain disproportionately affected.

Two other significant trends were also noted: early signs of a reduction in new HIV infections among black women as well as a worrisome and consistent rise in new infections among bisexual and gay men.

Homosexual men continue to be the group that is most affected. New infections for this group rose from 26,700 in 2008 to 29,800 in 2010. These men account for four percent of the U.S. population, however, they make up 63 percent of the total of new infections.

Previous research suggests that individual risk behavior does not represent the disproportionate presence of HIV among men who have sex with men.

Other factors that contribute include: a high incidence of HIV among men having sex with other men (MSM), causing a higher risk of HIV exposure with each sexual experience; the high proportion of MSM who do not know about their infection; stigma and homophobia; lack of insurance and worries about confidentiality; and high rates of some STDs. Also MSM typically underestimate their own personal risk.

Women account for 66 percent of new HIV cases among heterosexuals, however, that portion has declined since 2007.

Blacks account for 14 percent of the population and represent about 44 percent of new HIV infections, while hispanics account for 16 percent of the population and make up 21 percent of new infections. New infections continued to be steady among Hispanics and blacks between 2008 and 2010, according to the CDC. These numbers show that minorities are still disproportionately affected.

Whites make up a third (31 percent) of all new HIV infections but had a much lower infection rate than Hispanics or African Americans. There was no significant change in total HIV incidence among whites from 2008 to 2010.

The research indicates that the annual number of new infections has continued to be steady even though there has been a rise in the number of people living with HIV. This suggests that treatment, prevention programs, and testing are all having a significant impact. However, rates of new infections remain too high.

The CDC has planned a new approach in an attempt to achieve an AIDS-free generation. They will focus on the following five areas:
  • Supporting Prevention Programs
  • Tracking the Epidemic
  • Supporting HIV Prevention
  • Raising Awareness
  • Supporting Structural Interventions
More involvement will also be put into action among community leaders from the African American, Latino and gay populations. The CDC hopes all people will be able to get the facts regarding HIV, get tested and take proper actions to protect their partners and themselves.
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Surgical Errors Occur More Than 4,000 Times A Year In The U.S.

Events that should never occur in surgery ("never events") happen at least 4,000 times a year in the U.S. according to research from Johns Hopkins University.

The findings, published in Surgery, is the first of its kind to reveal the true extent of the prevalence of "never events" in hospitals through analysis of national malpractice claims. They observed that over 80,000 "never events" occurred between 1990 and 2010.

They estimate that at least 39 times a week a surgeon leaves foreign objects inside their patients, which includes stuff like towels or sponges. In addition surgeons performing the wrong surgery or operating on the wrong body part occurs around 20 times a week.

Marty Makary, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine, said:

"There are mistakes in health care that are not preventable. Infection rates will likely never get down to zero even if everyone does everything right, for example. But the events we've estimated are totally preventable. This study highlights that we are nowhere near where we should be and there's a lot of work to be done."

The researchers believe that this finding could help ensure that better systems are developed to prevent these "never events" which should never happen.

The study examined data from the National Practitioner Data Bank which handles medical malpractice claims to calculate the total number of wrong-site-, wrong-patient and wrong-procedure surgeries.

Over 20 years. they found more than 9,744 paid malpractice claims which cost over $1.3 billion. Of whom 6.6% died, while 32.9% were permanently injured and 59.2% were temporarily injured.

Around 4,044 never events occur annually in the U.S., according to estimates made by the research team who analyzed the rates of malpractice claims due to adverse surgical events.

Many safety procedures have been implemented in medical centers to avoid never events, such as timeouts in the operating rooms to check if surgical plans match what the patient wants. In addition to this, an effective way of avoiding surgeries that are performed on the wrong body part is using ink to mark the site of the surgery. In order to prevent human error, Makary notes that electronic bar codes should be implemented to count sponges, towels and other surgical instruments before and after surgery.

It is a requirement that all hospitals report the number of judgments or claims to the NPDB. Makary did note, however, that these figures could be low because sometimes items left behind after surgery are never discovered.

Most of these events occurred among patients in their late 40s, surgeons of the same age group accounted for more than one third of the cases. More than half (62%) of the surgeons responsible for never events were found to be involved in more than one incident.

Makary comments the importance of reporting never events to the public. He stresses that by doing so, patients will have more information about where to go for surgery as well as putting pressure on hospitals to maintain their quality of care. Hospitals should report any never events to the Join Commission, however this is often overlooked and more enforcement is necessary.
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Close To One-Third Of Children With Food Allergies Are Bullied

Food allergies can pre-dispose children to being bullied at school, suggests a new study published today in Pediatrics.

The study examined 251 families from a New York City food allergy clinic and discovered that nearly one-third of kids have been bullied because of their food allergy.

The bullying happened on school grounds and resulted in teasing.

In most instances, the kids reported that classmates threatened them with the food to which they were allergic. They would wave it in front of them, throw it at them or promised they would put it in their food undetected.

Of the families who were surveyed, 45.5 percent of the kids and 36.3 percent of their parents reported that the child had been bullied or tormented for any reason. Besides that, 24.7 percent of the parents and 31.5 percent of the kids confirmed they had been bullied specifically because of their food allergy.

Results of the study showed that bullying is associated with reduced quality of life as well as increased distress in parents and children, regardless of the severity of the food allergy. Parents were aware about the bullying in just 52.1 percent of the cases. When parents knew about the bullying, the children's quality of life improved.

The authors conclude that bullying is frequent in children with food allergies. They point out when parents are aware their children are being bullied, the kid's quality of life is better.

The research team believes that pediatricians and parents should screen for bullying in children with food allergies in order to decrease stress and better the standard of life for these kids.

In 2011 a study presented at the Food Allergy and Anaphylaxis Meeting by the European Academy of Allergy and Clinical Immunology reported that food allergies are associated with anxiety and loneliness in children. In fact, one out of five allergic children do not attend classmates' parties and one in four always bring "safe food" with them.

The burden of food allergies increasing to a life-threatening situation can be worrisome for a child. Normal activity and social lifestyles can be limited due to the constant requirement of avoiding certain foods.

A separate study from 2010 says that children with food allergies are bullied and teased in school, even by teachers. This study correlates with the current one, saying that being diagnosed with a food allergy is emotional for a child. The researchers emphasized adding bullying to the stress already felt by an allergic child is "downright dangerous."
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Antibiotic No Better For Coughs, Uncomplicated Chest Infections Than No Medication

Amoxicillin, the antibiotic doctors often prescribe for persistent coughs caused by uncomplicated chest infections such as bronchitis, is no more effective at easing symptoms than no medication at all, even in older patients. This was the finding of the largest randomised placebo controlled trial of antibiotics for lower respiratory tract infections (LRTI) done to date.

The study, which was led by the University of Southampton in the UK, is from the GRACE (Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium and was funded by the European Community's Sixth Framework Programme.

A paper on the findings appears in the 19 December online issue of The Lancet Infectious Diseases.

First author Paul Little, Professor of Primary Care Research at Southampton, says in a statement:

"Patients given amoxicillin don't recover much quicker or have significantly fewer symptoms."

In fact, he adds, using amoxicillin to treat patients with respiratory infections who don't have pneumonia could not only be ineffective, but might actually harm them.

"Overuse of antibiotics, which is dominated by primary care prescribing, particularly when they are ineffective, can lead to side effects such as diarrhea, rash, vomiting and the development of resistance," he explains.

The European Centre for Disease Prevention and Control (ECDC) recently put out a statement saying that antibiotic resistance remains a major threat to public health around the world, and for the large part, the cause is misuse of antibiotics.

Chest infections, also known as lower respiratory tract infections (LRTI), are one of the most common acute illnesses treated in primary care settings in developed countries.

There is a lot of controversy about whether LRTI, especially in older people, should be treated with antibiotics, especially since viruses are thought to cause most of them, and previous studies have shown inconsistent results.

A recent study presented at CHEST 2012, the annual meeting of the American College of Chest Physicians, also suggests antibiotics are not successful in treating cough due to the common cold in children.

For this latest GRACE study, the researchers recruited 2,061 adults attending primary care practices with straightforward mild chest infections. The practices were located in 12 European countries: England, Wales, Netherlands, Belgium, Germany, Sweden, France, Italy, Spain, Poland, Slovenia, and Slovakia.

The participants were randomly assigned to be prescribed either amoxicillin or a placebo, to be taken three times a day for seven days.

The prescribing general practitioners (GPs) assessed their patients' symptoms at the start of the study period, and the patients also filled in diaries of their daily symptoms.

When they analyzed this data, the researchers found there was little difference in how severe the symptoms were or how long they lasted for, between the amoxicillin and placebo groups.

Even in those aged 60 and over with no other illnesses, antibiotics seemed to offer little benefit over placebo.

Patients in the antibiotic group reported significantly more side effects, including rash, nausea and diarrhea.

The researchers did conclude, however, that while most people seem to get better on their own, there is a small number of patients who do benefit from antibiotics, and "the challenge remains to identify these individuals," says Little.

In an accompanying commentary, Philipp Schuetz, from the University of Basel in Switzerland, notes:

"Little and colleagues have generated convincing data that should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients in whom pneumonia is not suspected."

However, the question remains, he says, of whether this "one-size-fits-all approach can be further improved".

He suggests perhaps one way to avoid the "toxic effects and costs" of antibiotics and "the development of resistance in the other patients", is to test for "specific blood biomarkers of bacterial infection", so as to "identify the few individuals who will benefit from antibiotics despite the apparent absence of pneumonia".

Written by Catharine Paddock PhD
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Tracking The Origins Of HIV

Human immunodeficiency virus (HIV) may have affected humans for much longer than is currently believed. Alfred Roca, an assistant professor in the College of Agricultural, Consumer and Environmental Sciences at the University of Illinois, thinks that the genomes of an isolated West African human population provide important clues about how the disease has evolved.

HIV is thought to have originated from chimpanzees in central Africa that were infected with simian immunodeficiency virus (SIV), a retrovirus. "If you look at the diversity present across SIV in chimpanzees, it suggests that they have had it for tens of thousands of years," Roca said.

HIV-1 Type M, which accounts for 90 percent of human infections, is believed to have crossed the species barrier into human populations between 1884 and 1924. Roca said that it may have crossed much earlier and many times, selecting for genetic resistance in isolated rural populations while remaining undetected.

"Some of the scientific literature suggests that the persistence of HIV in humans required population densities typical of the larger cities that appeared in West Central Africa during the colonial era," he said.

Perhaps an even more important factor is that, before modern medicine and vaccinations, infectious diseases such as smallpox killed large numbers of people. People with compromised immune systems may have succumbed first, preventing the immunodeficiency virus from spreading.

If HIV crossed the species barrier many times, it is possible that selection favored protective genetic variants in the affected populations. Roca and his co-investigators looked for evidence of this selection in the Biaka genomes.

The Biaka are a human community that inhabits forests in the range of the chimpanzee subspecies believed to be the source of the current HIV pandemic. The researchers compared Biaka genomes with the genomes of four other African populations who live outside the chimpanzee's range.

Biaka genotypes were available through the Human Genome Diversity Project, which collected biological samples from 52 different population groups across the world. The project genotyped these diverse human communities for single nucleotide polymorphisms (SNPs, pronounced "snips"), or genomic variation, at around 650,000 locations across the genome.

Previous research that used cell lines made in the 1980s from individuals who had AIDS or were believed to be at risk for it had identified 26 genomic locations as being involved in resistance to HIV. Kai Zhao, a graduate student working in Roca's laboratory, examined these locations.

Zhao ran all 10 possible pairwise comparisons for the five human populations and looked for selection signatures. Specifically, selection for a genetic trait tends to reduce diversity in the surrounding genomic region within the affected population, increasing the differences between populations.

The researchers looked at the genomic regions that contain genes known to have a protective effect against HIV to see if there was any overlap with the selection signatures. Eight of the comparisons found overlap. Seven involved the Biaka.

They identified four genes in these overlaps that code for proteins affecting either the ability of HIV to infect the host cell or the disease progression. The researchers also found that for several genes, SNPs associated with protection against HIV-1 were common among the Biaka.

Roca cautions that these results should not be considered definitive. It is not possible to rule out false positives.

"You may detect a signature of selection, but it doesn't necessarily mean that selection has caused it. It's just a good sign that selection may have occurred," he said. Also, the signature of selection may span several genes, of which only one is actually protective against HIV-1.

However, he said that the results are intriguing and indicate that this line of research is worth pursuing.

"If additional studies confirm that these genes have undergone selection and that human populations in the region have some genetic resistance to HIV-1, one could try to find additional genes in the population that may also be protective against HIV but have not yet been identified," he said.

"The mechanism by which these genes work could be determined," he continued. "It could open up a new line of research for fighting retroviruses."
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Life With A Tic Disorder

More than one in every ten schoolchildren suffers from a transient tic disorder, and 1% have a particular type of tic disorder known as Tourette syndrome. In this issue of Deutsches Arzteblatt International, Andrea G. Ludolph of the Universitatsklinikum Ulm and her coauthors report on the available modes of diagnosis and treatment for these disorders (Dtsch Arztebl Int 2012; 109(48): 821).

Tic disorders usually take a benign course; in about 90% of patients, the tics regress spontaneously in adolescence. Specific treatment is indicated only if the tics are severe or cause evident psychosocial stress. On the other hand, 80% to 90% of all patients with Tourette syndrome have comorbid disorders such as attention deficit - hyperactivity disorder, depression, anxiety, or obsessive-compulsive disorder. These comorbidities often impair patients' quality of life more than the tics themselves do, and their treatment is, therefore, a priority.

At present, tics cannot be cured, nor is there any treatment aimed at their cause, which remains unknown. Moreover, there is no available treatment that can improve all of the potential symptoms of Tourette syndrome simultaneously while also treating all of its comorbidities. Atypical neuroleptic drugs are the agents of first choice in the treatment of tics, but, before any drug treatment is begun, all patients should first undergo a trial of behavior therapy, whose beneficial effect has been documented by sound scientific evidence. The state of the evidence regarding pharmacotherapy for Tourette syndrome is still poor.
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Desire For Expensive, High-Status Goods Is Related To Feelings Of Social Status

A desire for expensive, high-status goods is related to feelings of social status - which helps explain why minorities are attracted to bling, a new study suggests.

Previous research had shown that racial minorities spend a larger portion of their incomes than do whites on conspicuous consumption - buying products that suggest high status.

But a new study showed that whites could be induced to crave expensive, high-status products if they imagined themselves in a low-status position.

These findings cast doubt on the notion that urban minorities have developed a corrosive "bling culture" that is unique to them, said Philip Mazzocco, lead author of the study and assistant professor of psychology at Ohio State University's Mansfield campus.

"Minorities don't buy high-status products because of some 'bling culture.' It is a basic psychological tendency that we all share when we're feeling inferior in some part of our life," Mazzocco said.

"Anyone who is feeling low in status is going to try to compensate. And in our capitalistic, consumption-oriented society, one way to compensate is to buy high-status products."

Mazzocco conducted the study with Derek Rucker, Adam Galinsky and Eric Anderson of Northwestern University. The findings appear in a recent issue of the Journal of Consumer Psychology.

For the study, the researchers conducted several related experiments.

In the first experiment, 146 American adults - about half white and half black - were told they would be participating in a study of consumer preferences. They were asked to rate how positively or negatively they viewed 10 products on a nine-point scale from "extremely negative" to "extremely positive."

Five of the products had been rated by a separate group of people as high in status (fur coat, cuff links, caviar, an Italian suit and Italian loafers), while five were rated as relatively low in status (vacuum cleaner, sofa, refrigerator, washing machine and an unbranded shirt).

The study found that, overall, blacks had more positive evaluations of the high-status products than did whites. But more importantly, blacks who considered their race to be an important part of their identity rated high-status goods higher than did blacks who had lower racial identification.

There was no such difference among whites in the study.

"Because African Americans are seen as lower in status in our society, those who identify more strongly with being black are more likely to compensate by seeking high-status goods," Mazzocco said.

A second study provided more evidence of the role that status plays in conspicuous consumption. In this experiment, 117 white college students were asked to write a story in which they imagined themselves as a character with certain demographic characteristics.

In all cases, the demographic characteristics - including income - remained the same. But half of the students were asked to imagine their character was white, and half were told their character was black.

Afterward, the participants were asked to rate the desirability of high-status and low-status products. Findings showed that the white students who imagined themselves as a black character rated the high-status products as more desirable than did the white students who imagined themselves as white characters.

"We called this vicarious conspicuous consumption. White students who temporarily identified with a low-status racial group showed an increased desire for high-status products," Mazzocco said.

The findings don't relate only to race, he said. Another study showed that other situations involving status can affect how people feel about conspicuous consumption.

In this experiment, 50 white adults were again asked to write a story imagining themselves as a specific character. In this case, the character was always described as being white. But in half the cases the character was a janitor (a low-status job) and in the other half the character was a brain surgeon (a high-status job).

The findings were clear. Participants who imagined themselves as a janitor had more positive evaluations of high-status products than did the participants who imagined themselves as brain surgeons.

In a final experiment, 69 white adults wrote a story in which they imagined themselves as a white or black character. In this case, they rated their desire to own or purchase specific high- and low-status products. They were then asked to rate the level of social status of the character they wrote about, on a scale of 1 to 10.

In this case, the participants who wrote about the black character were more likely to say they wanted to purchase the high-status products, similar to findings in the earlier studies. And they also rated their character as having lower social status than did the participants who wrote about a white character.

"This provides additional evidence that it is a perception of having low status that is driving the increased preference for high-status products," Mazzocco said.

"It suggests that people don't like being in a low-status situation, and they compensate for that by trying to acquire high-status products."

Mazzocco said having this knowledge may help people as they're shopping.

"If you're in a store and find yourself craving an expensive 60-inch flat-screen TV, think about why you want it. It may not be because of the positive attributes of the TV, but because you have a feeling of low status in some part of your life at that time.

"Think about parts of your identity where you excel. Maybe you're a good father or mother, or a good student or a good friend. There are many parts to our identity, and it may help to call to mind parts where we feel we have higher status when we're shopping."

Mazzocco said future studies will examine whether people can resist conspicuous consumption when they call to mind parts of their lives where they feel they have high status.

Written by Jeff Grabmeier
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Can Instilling Racial Pride In Black Teens Lead To Better Educational Outcomes?

African American adolescents tend to have more success in school if their parents instill in them a sense of racial pride, reducing their vulnerability to the effects of racial discrimination from teachers and peers.

This is the conclusion of a University of Pittsburgh study published this fall in the journal Child Development. Titled "Parental Racial Socialization as a Moderator of the Effects of Racial Discrimination on Educational Success Among African American Adolescents," the research article shows that when African American parents use racial socialization - talking to their children or engaging in activities that promote feelings of racial knowledge, pride, and connection - it offsets racial discrimination's potentially negative impact on students' academic development.

Preparing the adolescents for possible bias was also a protective factor, though a combination of this preparation and racial socialization was found to be ideal in moderating the possible damaging effects of racial discrimination by teachers or fellow students. The Pitt study was supported by a grant from the National Institute of Child Health and Human Development.

"Our findings challenge the notion that 'race blindness' is a universally ideal parenting approach, especially since previous research has shown that racially conscious parenting strategies at either extreme - either 'race blindness' or promoting mistrust of other races - are associated with negative outcomes for African American youth," said lead author Ming-Te Wang, Pitt assistant professor of psychology in education, who coauthored the study with Harvard's James P. Huguley.

"When African American parents instill a proud, informed, and sober perspective of race in their sons and daughters, these children are more likely to experience increased academic success," said Wang.

Although previous studies have shown that parental racial socialization is beneficial to the mental health of African American youth, few researchers have looked at how daily experiences with racial discrimination in a school context are related to the child's educational prospects.

Scholarly research has shown that African American students, males in particular, are at risk for being unfairly disciplined, being discouraged from taking advanced classes, or receiving lower grades than they deserved, all because of their race. Other studies point to negative peer treatment because of race - getting into fights, being bullied, or not being selected for teams or activities.

Wang and Huguley explored how racial discrimination relates to the students' educational outcomes, specifically grade-point averages, educational aspirations, the sense of belonging to a school, and cognitive engagement, which is the initiative a student takes in his or her own learning. And they set out to determine how the outcomes are affected by parental racial socialization.

Using a combination of questionnaires and face-to-face interviews of both students and parents, the study examines the home and school racial experiences of 630 African American high school students in a diverse but mostly Black urban area on the East Coast of the United States.

Unlike other studies that focus on low-income families, this project involved participants who came from a wide range of socioeconomic backgrounds. The median household income range was $46,000-$50,000, and 40 percent of the parents or guardians had a college degree.

Overall, the study found racial pride to be the most powerful factor in protecting children from the sting of discriminatory behavior. It directly and positively related to three out of four academic outcomes - grade-point averages, educational aspirations, and cognitive engagement - and was directly related to resilience in the face of discrimination. Preparation for bias was directly related to only one outcome - the sense of belonging to a school.

"Our study provides empirical evidence that the longstanding practice in the African American community of cultivating racial pride and preparing children to face racial bias in society should be considered among appropriate and beneficial practices in parenting Black children," said Wang, who plans to conduct the same kind of research with Latino and Asian American teenagers.
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Saturday, November 24, 2012

60% Of Largest U.S. Cities Now Have Smoke-Free Laws

Out of the 50 largest cities in America, 30 are now protected by smoke free laws which ban smoking from all indoor parts of bars, restaurants and private work areas, according to a recent report released by the CDC (Centers for Disease Control and Prevention).

The report states that at the end of 2000, only one of these 50 cities had these types of laws, and by October 5, 2012, 16 were protected with local comprehensive smoking laws, while 14 had state comprehensive laws.

A study published in August of this year said that although smoking rates have dropped, other types of tobacco usage has increased.

In 2000, only about 3% of American were covered by smoke-free laws, now, almost 50% of Americans live smoke-free because of these local and state laws. Previous studies have revealed that smoke-free laws dramatically help lower exposure to secondhand smoke and improve health among the public. For example, the laws have helped reduce heart attack rates. For the first time since 2012, last week, the people of North Dakota voted to approve a comprehensive smoke-free law statewide.

CDC Director Thomas R. Frieden, M.D., M.P.H, commented:

"Communities have made tremendous progress eliminating smoking from worksites and public places in 60 percent of big cities in the United State. Smoke-free laws save lives and don't hurt business. If we can protect workers and the public in the remaining 20 largest cities, 16 million people would be better protected from cancer and heart disease caused by secondhand smoke."

The recent trial, tittled "Comprehensive Smoke-Free Laws - 50 Largest U.S. Cities, 2000 and 2012" was published in the CDC's Morbidity and Mortality Weekly Report this week and stated that out of the 20 cities that do not have comprehensive smoke-free laws, 10 are southern cities. Also, 10 of the 20 cities that do not currently have the laws are found in states that do not allow smoking bans to be considered more important than any other law.

Tim McAfee, M.D., M.P.H., director of the CDC's Office on Smoking and Health, added:

"Hundreds of cities and countries have passed their own smoke-free laws, including many communities in the south. If we continue to progress as we have since 2000, all Americans could be protected from secondhand smoke exposure in workplaces and public places by 2020."

The 2006 Surgeon General's Report notes that secondhand smoke is always dangerous; it results in the development of heart disease and lung cancer in people who don't even smoke themselves. In addition, secondhand smoke can cause SIDS (sudden infant death syndrome), asthma, ear infections, and respiratory problems in babies and children.

Cigarette smoke kills around 443,000 Americans every year, 46,000 from heart disease and 3,400 by lung cancer in people who do not smoke, solely due to secondhand smoke exposure.
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New Respiratory Coronavirus Claims Second Victim

Another person with a severe acute respiratory infection (SARI) caused by a novel coronavirus 2012 has died, the World Health Organization (WHO) announced on Friday. The second victim, like the first, died in Saudi Arabia.

The announcement follows enhanced surveillance in Saudi Arabia and Qatar that has identified 4 new cases (3 in Saudi Arabia, 1 in Qatar), including the second death, the United Nations health agency reports.

Human coronoviruses are so called because of the crown-like projections on their surfaces. First identified in the 1960s, they are a large family of viruses that cause illnesses in animals and humans.

The illnesses they cause include respiratory infections such as the common cold and SARS (severe acute respiratory syndrome). In 2002, an oubreak of SARS spread from Hong Kong around the world, killing around 800 people.

However, according to information published on the WHO website at the end of September, the new coronavirus is genetically quite distinct from SARS.

The WHO says globally, the total of lab-confirmed cases of novel coronavirus 2012 notified to them is now 6, with 4 of them (including 2 deaths) linked to Saudi Arabia and 2 to Qatar (one reported from the UK and the other from Germany).

Two of the recently confirmed cases in Saudi Arabia are "epidemiologically linked" and from the same family and household. One person died and the other has since recovered, says the WHO.

Two other family members have also been tested: so far one is negative and the result of the other is not yet available.

According to the UK's Health Protection Agency (HPA), the newly reported case from Qatar, was lab-confirmed by them in November. The patient was initially treated in Qatar in October, but then transferred to Germany, and has now been discharged.

The WHO is now reviewing these new developments to see if there is a need to revise the interim case definition it published at the end of September, and any guidance relating to it.

The UN agency says in the meantime:

"Investigations are ongoing in areas of epidemiology, clinical management, and virology, to look into the likely source of infection, the route of exposure, and the possibility of human-to-human transmission of the virus. Close contacts of the recently confirmed cases are being identified and followed up."

The international agency says there is a need for more studies to better understand the virus, and encourages all members of the UN to continue their surveillance of severe acute respiratory infections (SARI).

It is likely the virus is present in more than just two countries, says the WHO, and it suggests patients with unexplained pneumonias should be tested for the new coronavirus, even if they have not been travelling to the two affected countries or are otherwise associated with them.

"In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated regardless of where in the world they occur," it urges.

More information from the WHO on coronavirus infections.
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Positive View On Aging May Help Recovery From Severe Disability

New research from the US finds that older people who have a positive view on aging are more likely to recover from severe disability than those who hold negative stereotypes about being older. It calls for more studies to investigate whether promoting positive age stereotypes extends independent living later in life.

Reporting in JAMA this week, the researchers, from Yale School of Public Health, say their study is the first to examine the link between positive age stereotypes and recovery from disability in older persons.

Lead author Becca R. Levy is associate professor of epidemiology (chronic diseases) and of psychology, and is also director of the School's division of social and behavioral sciences. She tells the press in a statement that the findings suggest "how the old view their aging process could have an effect on how they experience it".

"In previous studies, we have found that older individuals with positive age stereotypes tend to show lower cardiovascular response to stress and they tend to engage in healthier activities, which may help to explain our current findings," she adds.

She and her colleagues explain in their background information how few studies have looked at why some older people recover from disability and others do not.

"We considered a new culture-based explanatory factor: age stereotypes (defined as beliefs about old people as a category)," they write.

For their study, they compared participants with different views of aging, categorizing them as having either a positive stereotype or a negative stereotype. Altogether there were 598 individuals, all at least aged 70, and free of disability at the start of the study, which covered about 11 years. They were members of a health plan in greater New Haven, Connecticut.

From March 1998 to December 2008, the participants were interviewed monthly, and they also underwent home-based assessment every 18 months.

The researchers based their measure of recovery on participants being able to carry out four activities of daily living (ADLs): bathing, dressing, moving from a chair, and walking. Doing well in these activities is linked to lower use of healthcare and longevity.

They assessed age stereotypes from responses to the question, "when you think of old persons, what are the first 5 words or phrases that come to mind?"

They scored the responses from 1 for the most negative (eg "decrepit"), to 5 for the most positive (eg "spry") and then averaged them.

The researchers found participants with a positive age stereotype were 44% more likely to fully recover from severe disability than those with a negative age stereotype.

Those with a positive view on aging also showed a significantly lower rate of decline in ability to perform their daily tasks.

The researchers suggest:

"Positive age stereotypes may promote recovery from disability through several pathways: limiting cardiovascular response to stress, improving physical balance, enhancing self-efficacy, and increasing engagement in healthy behaviors."

"Further research is needed to determine whether interventions to promote positive age stereotypes could extend independent living in later life," they urge.
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Revolutionary Stem Cell Treatment Repairs Spinal Cord Injuries In Paralyzed Dogs

Scientists have used a special cell to regenerate damaged parts of dogs' spines. Researchers are cautiously excited about these results which could potentially have a future role in the treatment of human patients with similar spinal injuries.

For many years, scientists have been aware that olfactory ensheathing cells (OEC) could be helpful in treating the damaged spinal cord because of their distinctive properties. The unique cells have the capacity to support nerve fiber growth that preserves a pathway between the nose and the brain.

Earlier studies consisting of laboratory animals have shown that OECs can be helpful in regeneration of the parts of nerve cells that pass on signals (axons). OECs were used as a bridge linking damaged and undamaged tissues in the spinal cord. A Phase 1 trial in humans with spinal cord injuries has determined that the procedure is safe.

The current study, published in the journal Brain, is the first double-blinded, randomized, controlled study to examine the effectiveness of these transplants to increase function in spinal cord injuries. The trial used animals with spontaneous and accidental spinal cord injuries. This method resembled closely the way the procedure could potentially work for human patients.

The study included 34 dogs that all suffered critical spinal cord injuries (SCIs). A year or more after the injury, the dogs were without the ability to use their legs and were unable to feel pain in their hind legs and adjoining areas.

Stem cell image
Researchers say that paralysis was reversed in Jasper the dachshund using cells grown from the lining of his nose.
Several of the dogs were dachshunds, who are extremely prone to this type of injury. Dogs in general are more likely to experience SCIs because they can be caused by a slipped disc, which is normally a minor injury in humans.

One group involved in the study received OECs from the lining of their own nose injected into the injured area. The other group of dogs were injected with only the liquid in which the cells were transplanted. The researchers and the owners were both in the dark about which dogs received which type of injections.

The dogs were analyzed for adverse reactions during a 24 hour period before being returned to their owners. After that, they were tested every month for neurological function and to have their walking manner assessed on a treadmill while being supported in a harness. Specifically, the researchers watched to see if the dogs could coordinate the movement of their front and back legs.

The groups of dogs that received the OEC injection had significant improvement that was not present in the other group. The OEC injection group was able to move previously paralyzed legs and coordinate these movements with their front quarters.

This suggests that in these particular dogs, neuronal messages were being relayed across the formerly damaged part of the spinal cord. The researchers found that the new nerve connections causing this recovery were happening over short distances within the spinal cord and not among long distances needing the brain to connect with the spinal cord.

Professor Robin Franklin, a co-author of the study from the Welcome Trust-MRC Cambridge Stem Cell Institute, University of Cambridge, said:

"Our findings are extremely exciting because they show for the first time that transplanting these types of cell into a severely damaged spinal cord can bring about significant improvement.

We're confident that the technique might be able to restore at least a small amount of movement in human patients with spinal cord injuries but that's a long way from saying they might be able to regain all lost function. It's more likely that this procedure might one day be used as part of a combination of treatments, alongside drug and physical therapies, for example."

The authors emphasize that human patients with a spinal cord injury rate a restoration in sexual function and continence much greater than better mobility. Some dogs in the study got back their bowel and bladder control but the number was not satistically exceptional.

Dr Rob Buckle, Head of Regenerative Medicine at the MRC, commented:

"This proof of concept study on pet dogs with the type of injury sustained by human spinal patients is tremendously important and an excellent basis for further research in an area where options for treatment are extremely limited. It's a great example of collaboration between veterinary and regenerative medicine researchers that has had an excellent outcome for the pet participants and potentially for human patients."
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Prescription Drug Addiction Is Now An Epidemic

The abuse of prescription drugs is currently an epidemic because doctors are treating pain differently now than in past years.

Drug abuse was recently referred to as an "epidemic" in a newspaper article by a Nebraska State Patrol investigator. "Clinically, it's a very common problem," added Aly Hassan, M.D., assistant professor of psychiatry in the University of Nebraska Medical Center College of Medicine.

The '90s were considered to be the decade of treatment of pain, the Dr. explained. Not only was there a change in medication, but there was also a change in policy.

"An important aspect of that was to consider pain as the fifth vital sign," he said. The other four vital signs are:
  • pulse rate
  • body temperature
  • blood pressure
  • respiratory rate
Doctors' offices frequently have signs hanging that ask patients to rank their pain on a scale from 1 to 10. According to Dr. Hassan, this is not because people these days are weaker and can not handle the pain, it is because pain is very serious and people need to receive the proper treatment.

"The experience of pain is not only somatic. It's not just the nerve being stimulated," Dr. Hassan said. A patient's vital signs are impacted by acute pain, causing a change in the person's quality of health. However, with treatment, the vital signs become normalized.

For that reason, doctors began to emphasize the importance of treating pain, but that meant more drugs.

The drug prescribed the most in 2011 was hydrocodone, according to WebMD. However, the medical field was not too concerned about people becoming addicted to their prescribed drugs, at least at first.

"The pain patient can be treated with narcotics with little risk of developing the self-destructive behavior characteristic of addiction," stated a 1990 report: "The Use of Narcotics for the Treatment of Chronic Pain," by the Sacramento-El Dorado Medical Society.

In 2012, Dr. Hassan pointed out that several of these drugs have similar characteristics to other addictive drugs:
  • absorb quickly
  • the half-like of the medicine staying in your system goes very fast
"The opiates are very addictive for that reason," Dr. Hassan said, because it makes a person want to take another one.

This puts clinicians in a bad situation because it is their job to prescribe these potentially addictive drugs. "This is beyond the level of an individual practitioner," Dr. Hassan said. "This is really a state problem or even a national problem."
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Heart Attack Risk Higher With Job Loss

New research on older adults in the US finds that being unemployed, experiencing multiple job loss and even going for short periods without work is tied to a greater risk for heart attack (acute myocardial infarction, AMI) compared with no job loss. The researchers suggest people who suffer multiple job losses have a risk for heart attack that is on a par with smoking.

Matthew E. Dupre and colleagues from Duke University, Durham, North Carolina, write about their findings in the November 2012 online first issue of JAMA's Archives of Internal Medicine.

There is lots of evidence that unemployment is a major source of strain, something that is affecting a growing number of adult Americans. However, there is little research on how the build up of multiple job loss and being out of work affects the risk of having a heart attack (AMI).

The Study

For their analysis, Dupre and colleagues looked at the links between aspects of unemployment and the risk for AMI in 13,451 adult Americans aged between 51 and 75 years who took part in the Health and Retirement Study, where participants underwent follow up interviews every two years between 1992 and 2010.

They found several aspects of past and present employment status raised the risk for a cardiovascular event, and:

"Although the risks for AMI were most significant in the first year after job loss, unemployment status, cumulative number of job losses and cumulative time unemployed were each independently associated with increased risk for AMI," they write.

The median age of the group was 62, and over the whole follow up period the data covered 165,169 person-years of observation, during which 1,061 (7.9%) of the participants reported having a heart attack.

At the start of the study period, 14% of the participants were out of work, 69.7% had one or more cumulative job losses, and 35.1% reported having spent some time out of work.

Using statistical tools to calculate hazard ratios, the researchers worked out that risk for heart attack was a significant 35% higher among the unemployed compared to those who had not experienced job loss.

On a Par with Smoking, Other Hazards

The more jobs people lost, the higher their risk for heart attack, the researchers found (22% for one job loss, rising to 63% for those who had lost four or more jobs).

And the risk of having a heart attack was "particularly elevated" during the first twelve months of unemployment (27% higher risk), but not after that, they write.

They also note that the higher risk for heart attack linked to multiple job loss is on a par with other more traditional risk factors, such as smoking, type 2 diabetes and high blood pressure.

New Era of Looking at Job Loss and Health

The researchers call for further studies to look more closely at how work-related disparities in the population could be affecting risk for heart attack so as to identify targets for health initiatives.

They say this is especially important, given the current economic climate and the projected increases in job instability and unemployment in the US.

In an accompanying commentary, William T. Gallo of the City University of New York, says the study marks the start of a new era where we look more closely at how changes in socioeconomic factors like job loss affect heath.

"Sufficient evidence exists of the negative influence of job loss on health. The next generation of studies should identify reasonable pathways from job separation to illness so that nonoccupational interventions may be developed and targeted to the most vulnerable individuals," he adds.
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Diabetes Rises "Dramatic", CDC Report

Over the past decade and a half, the United States has seen a "dramatic" rise in rates of diagnosed diabetes, according to a study from the Centers for Disease Control and Prevention (CDC). The study editors suggest the rise is likely due to people with diabetes living longer as well as increases in diabetes cases.

A report on the study is published in the 16 November issue of the CDC's Morbidity and Mortality Weekly Report (MMWR).

Diabetes Rises Across the US

The report shows that between 1995 and 2000 the prevalence of diagnosed diabetes in all states of the US, plus the District of Columbia and Puerto Rico, increased by 50% or more in 42 states, and by 100% in 18 states.

Ann Albright, director of CDC's Division of Diabetes Translation, says in a press statement that in 1995, there were only three states, the District of Columbia and Puerto Rico, where 6 out of 100 people or more had been diagnosed with diabetes.

"By 2010, all 50 states had a prevalence of more than 6%", she adds.

By region, the largest increases are in the South, followed by the West, Midwest and Northeast, says report first author Linda Geiss.

The states showing the largest increases are Oklahoma (226%), Kentucky (158%), Georgia (145%), Alabama (140%), and Washington (135%).

The report shows that in 2010, six states plus Puerto Rico have a diagnosed diabetes rate of at least 10 adults in 100. The six states, all in the South and Appalachia, are Alabama, Mississippi, South Carolina, Tennessee, Texas and West Virginia.

"These data also reinforce findings from previous studies, which indicate that the prevalence of diagnosed diabetes is highest in the southern and Appalachian states," adds Geiss.

The states with the lowest diabetes rates in 2010, that is between 6.0 and 6.9%, are Alaska, Colorado, Connecticut, Iowa, Minnesota, Montana, North Dakota, Oregon, South Dakota, Wisconsin, Vermont and Wyoming.

Telephone Survey

Geiss and colleagues analyzed data from the Behavioral Risk Factor Surveillance System, an annual telephone survey that asks adults (people aged 18 and over) across the US a range of questions about their health.

The survey asks people whether a doctor has ever told them they have diabetes, and while it does not distinguish between type 1 and type 2 diabetes, it is known that 90 to 95% of diabetes patients in the US have type 2, which can be prevented through lifestyle changes.

The figures exclude women told that they had diabetes only during pregnancy, and people told they had prediabetes or borderline diabetes.

Obesity Highlighted as a Driver of Diabetes

The report editors suggest the main driver of these increases is the rise in incidence of diabetes in the US since 1990. This could be as a result of many things, including changes in how the disease is diagnosed, improved ways of detecting it, changes in the population (for instance more older people and minorities who have an increased risk for the disease), and a rise in the risk factors, such as obesity and sedentary lifestyles.

"Although the contribution of each factor to increasing diabetes incidence cannot be discerned, the increase in diabetes prevalence coincides with the increase in obesity prevalence across the United States," they note.

Albright says:

"These rates will continue to increase until effective interventions and policies are implemented to prevent both diabetes and obesity."

CDC Initiatives

The CDC says it is working with a number of partners to offer ways to prevent type 2 diabetes and reduce complications in people who have already been diagnosed with the disease.

One of these is the National Diabetes Prevention Program, that helps people change their lifestyle to reduce risk of developing type 2 diabetes. This is done through a network of classes aimed particularly at obese and overweight people.

Another initiative is the National Diabetes Education Program, which provides resources to prevent or delay the onset of type 2 diabetes, promote early diagnosis, and improve the treatment and outcomes for patients.

And the latest initiative, whose launch coincides with this report, is the Diabetes Interactive Atlases, "which provides data for diagnosed diabetes, obesity and leisure-time physical inactivity at the national, state and county levels".

The Interactive Atlases also include motion charts showing trends in the growth of diabetes and obesity across the US and within its states.
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Nanoparticles Stop Multiple Sclerosis In Mice

A breakthrough new experimental treatment that uses nanoparticles covered with proteins to trick the immune system, managed to stop it attacking myelin and halt disease progression in mice with relapsing remitting multiple sclerosis (MS). The researchers say the approach may also be applicable to other auto-immune diseases such as asthma and type 1 diabetes.

Corresponding author Stephen Miller is the Judy Gugenheim Research Professor of Microbiology-Immunology at Northwestern University Feinberg School of Medicine in Chicago in the US. He says in a statement:

"We administered these particles to animals who have a disease very similar to relapsing remitting multiple sclerosis and stopped it in its tracks."

"We prevented any future relapses for up to 100 days, which is the equivalent of several years in the life of an MS patient," he adds.

The study results suggest the nanoparticles are as effective as using patients' own white blood cells to deliver the antigen, an approach that is being tested in a phase I/II trial in MS patients. Using nanoparticles would be much cheaper and easier, say the researchers.

Miller and colleagues report their study, which was funded by the Myelin Repair Foundation, the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health (NIH), and the Juvenile Diabetes Research Foundation, in the 18 November online issue of Nature Biotechnology.

Multiple Sclerosis (MS)

An auto-immune disease is where the immune system mistakenly attacks healthy tissue as well as clearing away harmful pathogens and cell debris. The type of tissue it attacks gives rise to different diseases.

In the case of Multiple Sclerosis (MS), the auto-immune target is myelin, the protein that forms the protective sheath that insulates nerve fibers in the brain, spinal cord and eyes and preserves the vital electrical signals they carry.

When the myelin is destroyed, the electrical signals can't travel, and the result is the characteristic symptoms of MS, which range from mild limb numbness to paralysis or blindness.

About 80% of MS patients have the relapsing remitting form of the disease, where there are periods of symptom flare-up (relapse) interspersed with periods where they stop (remit), either partially or completely.

Protein-Covered Biodegradable Nanoparticles Trick the Immune System

The researchers used biodegradable nanoparticles covered with myelin proteins or antigens to trick the immune system into treating myelin as "friendly". The nanoparticles are made from the same material as dissolvable stitches, except they are much smaller, about 200 times thinner than human hair.

For their study, they injected the nanoparticles, bearing their myelin antigen cargo, into mice bred to develop a disease similar to the human form of relapsing remitting MS.

The particles travelled to the spleen, a key immune system organ that removes unwanted materials such as old and dying cells from the blood, makes new blood cells and stores blood platelets.

Once in the spleen, the particles were engulfed by macrophages, white blood cells that literally gobble up and digest pathogens and unwanted materials and then send signals to other immune cells to target those materials.

But the effect in this case was to make the immune system view the nanoparticles as ordinary dying blood cells and nothing to be concerned about. This created immune tolerance to the myelin antigen by directly inhibiting the myelin responsive T cells. It also increased the numbers of regulatory T cells and further calmed the autoimmune response.

"Resets" Rather than Shuts Down Immune System

An attractive feature of this study is it shows a potential therapy that does not suppress the whole immune system as do current therapies for MS, which make patients more vulnerable to everyday infections and put them at higher risk for cancer.

Instead, the nanoparticles, with their myelin antigens, "reset" the immune system to normal. The result is it stops treating myelin as an alien invader and stops attacking it.

Christine Kelley, National Institute of Biomedical Imaging and Bioengineering director of the division of Discovery Science and Technology at the NIH, says:

"The key here is that this antigen/particle-based approach to induction of tolerance is selective and targeted. Unlike generalized immunosuppression, which is the current therapy used for autoimmune diseases, this new process does not shut down the whole immune system."

Biodegradable Material Is Already FDA Approved

The nanoparticles Miller and colleagues used are made of a polymer called Poly(lactide-co-glycolide) (PLG), which comprises lactic acid and glycolic acid, both natural metabolites in the human body. PLG is most commonly used for biodegradable sutures or dissolvable stitches.

Because PLG is already approved by the US Food and Drug Administration (FDA) for other uses, this should make it easier to get approval for using it to move this research from mice to human subjects.

The nanoparticles used in this study were developed by co-corresponding author Lonnie Shea, professor of chemical and biological engineering at Northwestern's McCormick School of Engineering and Applied Science.

The researchers tested different sizes of nanoparticles and found 500 nanometers was the best at resetting the immune response.

Potential for Treating Range of Auto-Immune Diseases

Miller says:

"The beauty of this new technology is it can be used in many immune-related diseases. We simply change the antigen that's delivered."

Shea and Miller are currently testing the nanoparticles to treat type 1 diabetes and airway diseases such as asthma.

Nanoparticles offer an attractive alternative to other approaches: they can be readily produced in a laboratory and standardized for manufacturing. This suggests therapies based on these mateials would be cheaper and more accessible to a general population.

Scott Johnson, CEO, president and founder of the Myelin Repair Foundation, says:

"The overarching goal is to ensure this important therapeutic pathway has its best chance to reach patients, with MS and all autoimmune diseases."
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Blood Flow Changes, Not Hormones, Explain Growth Of Benign Tumors In Pregnant Women

Meningiomas are a common type of benign brain tumor that sometimes grows dramatically in pregnant women. A new study suggests that this sudden tumor growth likely results from "hemodynamic changes" associated with pregnancy, reports the November issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study also identifies some key characteristics associated with rapid growth of meningiomas in pregnant women. The lead author was Dr. Eriks A. Lusis of Washington University School of Medicine, St Louis, Mo.

'Dramatic Growth' of Meningiomas in Pregnant Women

From the records of four university medical centers, the researchers identified 17 women with meningiomas requiring surgery during pregnancy, or shortly afterward. Meningiomas are relatively common, usually benign (noncancerous) tumors that arise in the tissues lining the brain (meninges). They cause problems when they grow large enough to affect brain functions.

Over the years, there have been several reports of meningiomas enlarging or becoming symptomatic during pregnancy. For this reason - and because meningiomas occur more often in women than men - it has sometimes been assumed that rapid tumor growth is related to changes in hormone levels during pregnancy. Dr. Lusis and colleagues sought to evaluate this theory, as well as to look at other characteristics of meningiomas in pregnant women.

Surgery for meningioma was successful in 16 of the 17 patients; the remaining patient died before surgery. Most of the women developed meningioma-related symptoms during the third trimester of pregnancy or within eight days after delivery. The most common symptoms of enlarging meningioma were changes in vision and facial paralysis or other cranial nerve palsies.

Most of the tumors were located in the skull base region and were typical, "low-grade" benign tumors. At surgery, the tumors showed an unusual "hypervascular" pattern, which was not seen in other cases of meningioma in non-pregnant patients. There was also a high rate of edema (swelling) in and around the tumor.

These and other findings strongly suggested that the rapid tumor growth resulted from "potentially reversible hemodynamic changes" - changes in blood flow - related to pregnancy. The pattern did not support the theory that meningioma growth resulted from "hormone-induced cellular proliferation."

The results may help to explain the uncommon but well-documented occurrence of rapid meningioma growth during pregnancy. Since most meningiomas don't cause any symptoms, they may go undetected. Even if they are detected, they may require no treatment unless they grow.

Together with previous evidence, the findings may have implications for the management of meningiomas in women of child-bearing age. Dr. Lusis and coauthors write, "[F]or the vast majority of women of child bearing age, we would not consider the presence of residual or unresected meningioma to be a contraindication to pregnancy." In contrast, for patients with evidence of tumor growth or swelling, the authors suggest they might consider treating the tumor before pregnancy.
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Ribosome Regulates Viral Protein Synthesis, Revealing Potential Therapeutic Target

Viruses can be elusive quarry. RNA viruses are particularly adept at defeating antiviral drugs because they are so inaccurate in making copies of themselves. With at least one error in every genome they copy, viral genomes are moving targets for antiviral drugs, creating resistant mutants as they multiply. In the best-known example of success against retroviruses, it takes multiple-drug cocktails to corner HIV and narrow its escape route.

Rather than target RNA viruses themselves, aiming at the host cells they invade could hold promise, but any such strategy would have to be harmless to the host. Now, a surprising discovery made in ribosomes may point the way to fighting fatal viral infections such as rabies.

Results were published online in Proceedings of the National Academy of Sciences.

The ribosome has traditionally been viewed as the cell's molecular machine, automatically chugging along, synthesizing proteins the cell needs to carry out the functions of life. But Amy Lee, a former graduate student in the program of virology, and Sean Whelan, HMS professor of microbiology and immunobiology, now say the ribosome appears to take a more active role, regulating the translation of specific proteins and ultimately how some viruses replicate.

The researchers were studying differences between how viruses and the host cells they infect carry out the process of translating messenger RNAs (mRNAs) into proteins. Focusing on protein components found on the surface of the ribosome, they discovered a protein that some viruses depend on to make other proteins, but that the vast majority of cellular mRNAs do not need.

Called rpL40, this ribosomal protein could represent a target for potential treatments; blocking it would disable certain viruses while leaving normal cells largely unaffected.

"Because certain viruses are very sensitive to the presence and absence of these ribosomal proteins, it might be a useful way for us to think about targeting ribosomes for therapeutic purposes from an antiviral standpoint," said Whelan. "This is a way to think about interfering with rabies virus infection. There are no therapeutics for rabies infection."

The team screened protein constituents of the ribosome to see which ones might be involved in specialized protein synthesis. Studying the vesicular stomatitis virus, a rhabdovirus in the same family as the rabies virus, they found that its mRNAs depended on rpL40 but only 7 percent of host-cellular mRNAs did. Some of the cellular mRNAs that depend upon rpL40 were stress response genes.

Experiments in yeast and human cells revealed that a class of viruses, which includes rabies and measles, depended on rpL40 for replication.

"This work reveals that the ribosome is not just an automatic molecular machine but instead also acts as a translational regulator," said first author Amy Lee, who is now a post-doctoral researcher at the University of California, Berkeley.

The concept of targeting cellular functions such as protein synthesis for antiviral therapies is being explored by a number of research groups, but there are no drugs based on this.

"We think the principle is bigger than just this single protein," Whelan said. "Viruses have an uncanny way of teaching us new biology all the time."
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Decline In Availability And Use Of ECT, A Key Treatment For Depression

Electroconvulsive therapy (ECT) is considered the most effective treatment option for patients with severe depression who cannot find symptom relief through antidepressant medications or psychotherapy. In a new study, researchers at Butler Hospital and Bradley Hospital in Rhode Island found a sharp decline in the availability and use of ECT in general hospitals across the U.S. The findings were published online in the journal Biological Psychiatry.

The researchers analyzed data from a nationally representative survey of US general hospitals, the Nationwide Inpatient Sample (NIS), conducted annually by the Agency for Healthcare Research and Quality (AHRQ). They took information from between five and eight million patient discharge records at 1,000 hospitals nationwide between the years 1993 through 2009 and found that the annual number of hospital stays in which ECT was administered fell 43 percent over the 17 year period, from more than 1.2 million to 720,000. Researchers also found a dramatic decline in the percentage of hospitals conducting ECT, from 55 percent to 35 percent of facilities with a psychiatric unit. The percentage of inpatients with severe, recurrent major depression treated in hospitals conducting ECT fell from 71 to 45 percent. But for depressed patients treated in hospitals that conduct ECT, the proportion who received the procedure remained stable.

"The data strongly support the impression that psychiatric units in general hospitals are discontinuing use of ECT and that this is driving the decline in the number of severely depressed inpatients receiving the procedure," said Brady Case, MD, an assistant professor of psychiatry and human behavior at Brown University and director of the Health Services Research Program at Bradley Hospital. "Growing pressures to avoid the inpatient treatment costs and length of stay associated with ECT may be one factor associated with this trend. We didn't have information on provider and patient attitudes, but as facilities cease conducting ECT, we can expect that fewer clinicians and inpatients are exposed to the option, reinforcing the turn away from ECT." Researchers also note the FDA approval of new treatment alternatives, like vagus nerve stimulation and transcranial magnetic stimulation, as possible influences.

Declines in ECT availability and use were particularly dramatic in elderly patients, a group traditionally thought to benefit most from the procedure. "Decreased availability of ECT for older patients with severe depression is of major concern, since a significant proportion of this group fails to benefit from available medication treatments. In such cases, ECT can literally be a life-saving intervention," said Lawrence Price, MD, clinical and research director at Butler Hospital and professor of psychiatry and human behavior at Brown University.

The researchers also noted a key finding they observed throughout the 15-year study period: depressed inpatients from poor neighborhoods and those who were publicly insured or uninsured were less likely to receive care from hospitals conducting ECT. "Access to ECT for less affluent patients has concerned the field for some time, but these data really drive home the reality. The worry is that ECT may be part of a tiered system of psychiatric care that deprives the disadvantaged of one of our most effective treatments," according to Price.

The researchers acknowledge that a limitation of the study is its exclusion of data from freestanding psychiatric facilities. Case and his colleagues note that psychiatric hospitals less commonly offer ECT than general hospitals, possibly because the procedure requires a level of medical support more readily available in general hospitals. Because of this, and the fact that psychiatric hospitals have accounted for a declining proportion of inpatient mental health care, the researchers argue that this exclusion is unlikely to have offset the declines they observed.

The data also do not include information on outpatient ECT, but many severely ill patients are inappropriate for outpatient ECT initiation. Case concedes that while "changing pharmacologic treatment practices for depression have received an immense amount of attention, we still know very little about how and where ECT is being used, especially outside of academic medical centers."
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