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Meningococcal C Vaccine Associated With Decreased Canadian Cases Of Most Deadly Strain Of Meningitis

2009-03-03T16:00:00.000+02:00

Universal childhood vaccination against meningococcal C appears to reduce Canadian incidence of the most deadly strain of bacterial meningitis, reports new research published in the March issue of The Pediatric Infectious Disease Journal.

The Men C vaccine was introduced as part of universal immunization programs for children in Quebec and Alberta in 2002 and in British Columbia and Prince Edward Island in 2003.

By 2005, all Canadian provinces included Men C vaccine as part of routine childhood vaccinations. Staggered implementation across Canada offered researchers the opportunity to evaluate the universal vaccination program.

"There was a dramatic decline in provinces with the early immunization program, suggesting the program works," says Dr. Julie Bettinger, the study's lead author. Dr. Bettinger is a scientist in the Vaccine Evaluation Centre at the Child & Family Research Institute and assistant professor in the Department of Pediatrics at the University of British Columbia.

Prior to Men C universal vaccination, BC, Alberta, and Quebec had rates of meningococcal C disease that were nearly 4.5 times higher than the rest of Canada. The study reports that today these provinces have the lowest rates in Canada, from 0.41 cases per 100,000 people in 2002 down to 0.07 per 100,000 in 2006. The provinces with later introduction of universal Men C vaccination showed no major changes in the one year of follow up study, with annual rates of meningococcal C at 0.08 per 100,000 people in 2006.

"The numbers may seem small, but even one case of the disease is one too many," says Dr. Bettinger. "It can strike without warning and cause death or permanent physical or neurological disability. Because meningococcal infection is spread by saliva through coughing, sneezing, and kissing, it has the potential to become an epidemic. Universal vaccination is critical to control disease and prevent epidemics."

Meningitis is an infection of the lining that covers the brain and spinal cord. It can be caused by viruses and bacteria. The viral causes of meningitis are rarely life-threatening whereas the bacterial types are more deadly. There are five strains of meningitis caused by the meningococcal bacteria (called serogroups A, B, C, Y, and W135). Meningococcal vaccines protect against A, C, Y, W135 with the Men C public vaccination programs targeting the meningococcal C bacteria. The researchers did not observe significant changes in the rates of other strains causing meningitis following introduction of the meningococcal C vaccination program.

Infection with the meningococcal bacteria develops suddenly into a medical emergency that must be treated in hospital with IV antibiotics. Initial symptoms include fever, headache, stiff neck, vomiting, and drowsiness while in infants it may show as irritability and lethargy. It can cause gangrene leading to amputation of limbs, blindness, deafness, brain damage, and cognitive and neurological disability. Children, adolescents, and immuno-compromised individuals are most vulnerable to infection.

Meningococcal C is the most fatal strain of bacterial meningitis. It infects approximately 250 Canadian children and adults each year, according to the BC Centre for Disease Control. For every 100 children who get sick, up to 15 will die. Those who survive may face life-long disability.

The Men C vaccine is provided free to all children in BC along with the regular childhood vaccinations. Infants need two doses: one needle at two months of age and then another at 12 months. The vaccine is also provided to people who may be vulnerable because they are missing a spleen, they have a weak immune system, are transplant recipients, or they have a cochlear (inner ear) implant.

The Men C vaccine is the first product suitable for infants offering long-term immunity against meningococcal C and it became commercially available in 2001. Previously, adolescents or adults received a different vaccine which provided protection for about three years.

For the study, the 12 pediatric centres involved with the Canadian Immunization Monitoring Program, Active (IMPACT), carried out surveillance in collaboration with local public health officials. IMPACT meningococcal surveillance is administered by the Canadian Paediatric Society and funded by Sanofi Pasteur. Its surveillance centres are located in Newfoundland, Nova Scotia, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and BC.

"What's needed next is a vaccine against meningococcal B," says Dr. Bettinger. "This is the Holy Grail of vaccine research."

Notes:

The Child & Family Research Institute (CFRI) conducts discovery research, clinical investigation, and applied health research to benefit the health of children and families. It is the largest research institute of its kind in Western Canada. CFRI works in close partnership with BC Children's Hospital and Sunny Hill Health Centre for Children, and BC Women's Hospital & Health Centre, agencies of the Provincial Health Services Authority; BC Children's Hospital Foundation; the University of British Columbia and Simon Fraser University. For more information, visit http://www.cfri.ca/.

Source: Jennifer Kohm

Child & Family Research Institute

Restricting Access To Patient Records Will Damage Patient Care, Say Top Researchers

2009-03-03T10:00:00.000+02:00

Moves to restrict researchers' access to patient record data will undermine patient care, say top researchers in an article published by the medical journal Pulse. Heads of some of the UK's top research organizations warn that over-protectiveness over the safety of public data will result in UK patients not having access to clinical trials treatments.

The UK government has dropped a key pledge to grant researchers the right in the NHS constitution to access identifiable medical records without needing to get patient consent - this was after an uproar among General Practitioners (GPs).

In order to select clinical trial participants, the researchers say it is essential to be able to access patient data without having to seek consent first. The researchers suggest safe havens be set up so they might access anonymous patient data.

Sir Mark Walport, director of the Wellcome Trust - said the NHS Constitution was "going in the right direction" but Government was dithering over allowing access to anonymous patient data. "It is becoming harder and harder to do research that was previously easy to do. If you actually explain to patients about how their data is going to be used, then they are happy for it to be used."

Sir Mark says the argument is being distorted by concern over high profile data leaks from government agencies "None of these were related to medical research - not one," he said.

Professor Peter Weissberg, Medical Director, British Heart Foundation, said patients could gain access to "gold standard" treatment in clinical trials, but this was being jeopardized by Government moves to curb access to medical records.

Weissberg added "We run the risk of unpicking everything that we have done before, and we may not be able to do landmark studies such as the Heart Protection Study in this country."

Click here to view article online.

About PulseToday

PulseToday is the GP's website in the UK providing general practice news, clinical education and practice information to GPs and primary care staff.

You can register on this site to get access to further information by visiting:

www.pulsetoday.co.uk/subscribemenu.asp

Written by - Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Regular Screening For Colorectal Cancer Remains Effective In Preventing And Detecting Disease Early

2009-03-02T16:00:00.000+02:00

As the nation marks National Colorectal Cancer Awareness Month this March, the American Cancer Society is encouraging Americans to get lifesaving screening tests that have been proven to reduce the risk of the third leading cause of cancer death in both men and women.

According to the recent Annual Report to the Nation on cancer (sponsored in part by the American Cancer Society), progress continues to be made in the fight against colorectal cancer (commonly referred to as colon cancer), with incidence and mortality rates continuing to experience a steady decline due in part to an increase in screening. From 1998 to 2005, colon cancer incidence dropped by 2.8% per year in men and 2.2% per year in women. Deaths rates have fallen by 4.3% in both men and women from 2002 to 2005. The American Cancer Society recommends routine screening for men and women starting at age 50, and earlier testing for those at higher than average risk. Regularly scheduled screening can not only detect cancer at an early and more treatable stage, but can also prevent cancer from developing by removing precancerous polyps before they become cancerous.

Despite evidence showing colorectal screening can save lives and the availability of several options for patients, only about half of the U.S. population aged 50 and older has been tested recently for colon cancer. Among those who have not been screened for colon cancer, reasons include lack of access to affordable care, and that clinicians are not recommending screening when they should. Other barriers include lack of knowledge of the importance of screening, of the treatability of colon cancer when detected early, and of available testing options. Screening is critical as more than half of all colon cancer deaths could be prevented if everyone who should get screened did so.

"Colon cancer is one of the only cancers that can be prevented through regular testing" said Durado D. Brooks, M.D., director of prostate and colorectal cancer, American Cancer Society. "The declines in incidence and mortality from colorectal cancer can be attributed to prevention and early detection of the disease through screening, as well as increasingly effective treatment."

In March 2008, the American Cancer Society, along with the American College of Radiology and the U.S. Multi-Society Task Force on Colorectal Cancer released the first-ever consensus guidelines for colorectal screening. The guidelines now include two new tests - stool DNA and CT colonography, also known as virtual colonoscopy. The guidelines also for the first time indicate a preference for screening tests that can not only detect cancer early but also detect precancerous polyps before they turn cancerous.

One major barrier to colon cancer screening is a lack of health insurance. Many studies show that people who are uninsured are substantially less likely to be screened for colon cancer - while nearly half (48.3 percent) of men and women ages 50 to 64 with private insurance had a recommended colon cancer screening test in the past 10 years, only one in five (18.8 percent) of those who lacked insurance had received recommended screening. In addition, insurance status strongly influences survival among those diagnosed with colon cancer - individuals with private insurance who are diagnosed with Stage II colon cancer have better survival outcomes than individuals who are uninsured or receive Medicaid and are diagnosed with Stage I.

The American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society, is working to pass the Colorectal Cancer Prevention, Early Detection and Treatment Act. This legislation establishes a program administered by the Centers for Disease Control and Prevention (CDC) that would provide vital colon cancer screenings, treatment and follow-up services to low-income, uninsured and underinsured men and women ages 50 to 64. Additionally, this program will support training for health providers based on research that has shown physician recommendation is a critical factor for patients in deciding to get screening tests, and will support public information and education programs for the prevention and detection of colon cancer and promoting the benefits of cancer screenings targeted both at the general public and medically underserved populations.

A number of lifestyle factors impact colon cancer risk. Studies indicate that men and women who are overweight are more likely to develop and die from colon cancer, and a diet high in red or processed meat is known to increase risk of developing the disease. Studies also show that high levels of physical activity may cut the risk of colon cancer in half. The American Cancer Society recommends engaging in moderate activity for at least 30 minutes on five or more days per week and substituting high consumption of red and processed meat with a healthy diet rich in plant sources, whole grains, and five or more servings of fruits and vegetables.

Age remains the most important risk factor for colon cancer. Risk increases with age, with more than 90 percent of cases diagnosed in individuals aged 50 and older. A personal or family history of the disease also increases risk. An estimated 148,810 cases of colorectal cancer were expected to occur in 2008, and 49,960 deaths were also expected.

The American Cancer Society is dedicated to eliminating cancer as a major health problem by saving lives, diminishing suffering and preventing cancer through research, education, advocacy and service. Founded in 1913 and with national headquarters in Atlanta, the Society has 13 regional Divisions and local offices in 3,400 communities, involving millions of volunteers across the United States. For more information anytime, call toll free 1-800-ACS-2345 or visit http://www.cancer.org.

American Cancer Society

Obese Children Should Have Gastric Bands To Manage Diabetes Says UK Expert

2009-03-02T10:00:00.000+02:00

A UK expert is recommending, on the basis of a study, that obese children from the age of 15 onwards who have weight-related diabetes should have gastric bands fitted to make their stomachs much smaller so they lose weight. This should be a last resort because there are serious health risks, and should only be considered when all other methods, such as diet and exercise, have failed.

Weight loss is a recognized way of controlling diabetes, but recent research shows children find it difficult to stick to a strict diet and exercise programme.

The Daily Telegraph reported today, Monday 2 March, that Professor Julian Shield of Bristol University and Bristol Royal Hospital for Children, who did a weight loss study of 73 teenagers with type 2 diabetes and found they had increased rather than reduced their weight over 12 months, told the press on Sunday that:

"We have reached the point where it is necessary because of the significant threat of mortality and the morbidity of this disease. There needs to be a formal scientific trial of this method in adolescents."

He said the children they see with type 2 diabetes find it very hard to lose weight by other means and they have all the health problems they see in adults with diabetes.

"They are suffering high blood sugars, they are hypertensive and they have high blood fats. Their health is seriously at risk," said Shield.

A gastric band is an inflatable silicone ring that a surgeon fits around the top of the stomach. The idea is that with a smaller stomach the person can't eat as much. It costs the NHS about 2,500 pounds per procedure. The fatality rate is less than one per cent but up to 10 per cent of patients can have serious complications.

According to a report in the Daily Mail, Shield said that diabetic adults can lose 60 to 70 per cent of their excess weight with gastric banding, which he recommended in preference to gastric bypass surgery because it has fewer potential complications. He said research from the US suggested gastric banding was effective in 90 per cent of cases of adolescents aged 18 and 19.

In the UK doctors have tended to use diet and exercise to help obese diabetic children lose weight, but Shield said this was "tinkering around the edges" and gastric banding was a potential cure for these patients.

Cases of type 2 diabetes have been rising steeply in Britain in line with obesity, although typically a disease of middle age, it is now happening in all age groups. 17 per cent of British children are now obese, about 900,000 in total, said Shield, and about 1,400 of them have type 2 diabetes, at a rate of 100 new cases a year.

A representative of the National Obesity Forum told the Daily Mail that he supported Shield's suggestion.

GP Dr David Haslam told the paper that:

"The epidemic of obesity has reached a desperate place when we are talking about a 15-year-old having surgery but that is the situation we are in, because having type 2 diabetes will knock at least 20 years off their lives."

Gastric banding has been available through the NHS for children under 18 since 2006, but it is only used in very rare cases.

Click here for NHS information on Obesity Treatment.

Sources: Daily Mail, Daily Telegraph.

Written by: Catharine Paddock, PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Obama Administration Expected To Begin Process Of Rescinding HHS Conscience Rule

2009-03-01T10:00:00.000+02:00

The Obama administration is expected to begin the process to rescind the HHS provider "conscience" rule, two months after former President George W. Bush's administration enacted the rule in one of its final policy initiatives, the Los Angeles Times reports. The rule prohibits the allocation of federal funds to health entities that do not accommodate workers who refuse to provide health services or information they object to on moral or religious grounds. Seven states and two family-planning groups have filed lawsuits challenging the rule, claiming that it emphasizes the religious beliefs of medical providers at the expense of patients' health. Some critics also oppose the broad language of the rule, which states that it covers any "activity related in any way to providing medicine, health care and other service relative to health and welfare." Supporters of the regulation maintain that the rule is needed to protect health workers who object to providing certain services, such as prescribing birth control or emergency contraception.

The Times reports that Obama, who supports abortion rights, has been expected to overturn several Bush administration policies that restrict access to reproductive health services. At the same time, Obama "has also been sensitive to the explosiveness of the reproductive rights issue," according to the Times. For example, last month Obama, "without official ceremony," rescinded the "Mexico City" policy, which banned U.S. funding for international groups that use their own funds to provide abortion information or services, the Times reports. According to the Times, HHS' plan to overturn the conscience rule "is being made equally quietly as most of Washington focuses on the president's blockbuster budget plan."

Officials on Thursday said the administration plans to allow a standard 30-day comment period on the conscience rule before it finalizes the decision to overturn the rule. According to one official, who was not authorized to speak on the record about the policy, the administration believes that the rule "is a complex issue that requires a thoughtful process where all voices can be heard." According to officials, the administration is considering drafting a new rule that would clarify what services health workers could reasonably refuse to provide. The officials said the administration aims to clarify the rule rather than to compel physicians to provide abortions. According to one official, the Bush administration's rule "created confusion about the scope and original intent of the law." The official continued, "Not only does it make it harder for women to get the care they need, but it is worded so vaguely, that some have argued it could limit counseling, family planning, even blood transfusions and end-of-life care" (Levey, Los Angeles Times, 2/27).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

Discovery Provides Hope For Sufferers Of Disfiguring Bone Disease

2009-02-28T10:00:00.000+02:00

Researchers at the University of East Anglia (UEA) have made a major genetic discovery that could lead to the effective treatment for sufferers of craniosynostosis - a severe childhood bone disease.

Craniosynostosis develops in the womb and affects one in every 2500 live births. Bones in the skulls and face of sufferers fuse together prematurely causing a range of distressing developmental problems. Some of the affected children also suffer from defects in the limbs, brain, kidneys and lungs. Depending on the severity of their disease and its underlying cause, children suffering with craniosynostosis survive from as little as a few days to as long as early adulthood.

Led by Dr Mohammad Hajihosseini, the UEA scientists focused on Apert Syndrome - the most severe of the craniosynostosis range of diseases that is caused by mutations in a gene called Fibroblast Growth Factor Receptor 2 (FGFR2). They identified a key offending molecule FGF10 and demonstrated for the first time that 'dampening down' the levels of this offending molecule can reverse the effects of the disease.

Published this month in the journal 'Developmental Dynamics', the findings are the culmination of five years work and vastly increase our understanding of this tragic childhood disease.

"The next step is to research how best to translate this discovery into an effective treatment," said Dr Hajihosseini. "Given the appropriate funding, in the not too distant future a gel or similar vehicle could be developed that can be surgically applied to the fusing joints of the skull thus reversing the effects of the disease."

University of East Anglia

http://www.uea.ac.uk

Alzheimer's Plaques Play Bigger Role

2009-02-27T16:00:00.000+02:00

Researchers in the US studying mice with and without amyloid-beta plaques in their brains (the plaques that are characteristic of Alzheimer's disease) found that contrary to current thinking, the plaques don't just damage the neurons they are close to but may well affect signalling in other parts of the brain through their influence on extensive networks of astrocyte brain cells.

The study was the work of researchers from the MassGeneral Institute for Neurodegenerative Disease (MGH-MIND) at Massachusetts General Hospital in Charlestown, and is published in the 27 February online issue of Science.

Simply speaking, mammals have two main types of brain cell: neurons that send electrical and chemical signals and glia cells that support, control, and look after them. An astrocyte is a type of star-shaped glia cell that not only provides passive support to neurons, but as scientists discovered in the 1990s, they also send signals using calcium ions that move from cell to cell like waves, and these waves can travel a long way in the brain.

Astrocytes are found everywhere in the brain and they account for about half the volume of it.

Plaques are left over bits of cell that clump together and stick to neurons, disrupting their ability to send signals; they are more common in older brains and one of the hallmarks of Alzheimer's disease.

The authors explained in their background information that although we already know that senile plaques disrupt the neurons they stick to (focal disruption), we don't know much about how astrocytes behave in Alzheimer's disease. With this study they showed that senile plaques make astrocytes hyperactive; not just the ones nearby, but also others quite far away from the focal neuron site.

Lead author Kishore Kuchibhotla of MGH-MIND told the press:

"Our work suggests that amyloid plaques might have a more complex role in altering brain function than we had thought."

"Plaques develop rapidly and have been shown to cause relatively acute, localized neuro-toxicity," he added, explaining that their work shows astrocytes "could provide a network mechanism that may stretch the impact of plaques to more distant areas of the brain."

For this study Kuchibhotla and colleagues used a method called "multiphoton fluorescence lifetime imaging microscopy" to measure and trace the calcium waves travelling along astrocyte networks in the brains of gentically altered laboratory mice with and without some of the hallmarks of Alzheimer's disease, such as the amyloid-beta plaques. (Using a dye they "labelled" astrocytes so that when they were active they lit up and when they switched off they went dark).

They found that resting calcium levels were high throughout the astrocyte network in mice with plaques, not just where they happened to be near individual plaques.

Using time-lapsed images they found that changes in calcium waves in astrocytes were more frequent and synchronized across long distances and uncoupled from what was happening near the neurons.

The researchers also found some rare calcium waves travelling between cells: these were only present in mice with amyloid-beta plaques and the waves appeared to start near plaques and spread radially from them for at least 200 micrometers.

They concluded that:

"Although neurotoxicity is observed near amyloid-[beta] deposits, there exists a more general astrocyte-based network response to focal pathology."

Kuchibhotla said that:

"This is the first clear evidence in a live animal model that amyloid plaques perturb calcium signaling across the astrocyte network via a neuron-independent mechanism."

"It has been suggested that these intercellular calcium waves, which previously had been observed only in response to some sort of external stimulus, indicate the existence of or response to a traumatic insult," he added, explaining that while their results support this idea, what we still don't know is whether the calcium signals they observed actually protect or harm cells.

"We've only begun to scratch the surface of how plaque deposition impacts astrocyte function," said Kuchibhotla.

An important question for future research will be how the increased activity of astrocytes affects the ways neurons work, and another will be whether it increases or limits the formation of plaques.

"Synchronous Hyperactivity and Intercellular Calcium Waves in Astrocytes in Alzheimer Mice."

Kishore V. Kuchibhotla, Carli R. Lattarulo, Bradley T. Hyman, and Brian J. Bacskai.

Science 2009, 323 (5918), 1211 published online 27 February 2009.

DOI: 10.1126/science.1169096

Click here for Abstract.

Sources: Journal abstract, Massachusetts General Hospital press statement.

Written by: Catharine Paddock, PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Experimental Vaccine Protects Animals From Deadly Ebola Virus; May Prove Effective In Developing The First Human Vaccine

2009-02-27T10:00:00.000+02:00

Protection against Ebola, one of the world's deadliest viruses, can be achieved by a vaccine produced in insect cells, raising prospects for developing an effective vaccine for humans, say scientists at the Southwest Foundation for Biomedical Research (SFBR) in San Antonio.

"The findings are significant in that the vaccine is not only extremely safe and effective, but it is also produced by a method already established in the pharmaceutical industry," says SFBR's Ricardo Carrion, Ph.D., one of the primary authors of the study. "The ability to produce the vaccine efficiently is attractive in that production can be scaled up quickly in the case of an emergency and doses can be produced economically."

The new study was published in the January 2009 issue of the journal Virology, and was supported by the National Institutes of Health. Jean Patterson, Ph.D., also of SFBR, participated in the research.

Ebola viruses, which cause severe bleeding and a high fatality rate in up to 90 percent of patients, have no effective treatment or vaccine. Since its first identification in Africa in 1987, Ebola outbreaks have caused some 1,800 human infections and 1,300 deaths. Outbreaks have become increasingly frequent in recent years, and are likely to be caused by contact with infected animals followed by spread among humans through close person-to-person contacts. Ebola viruses cause acute infection in humans, usually within four to 10 days. Symptoms include headache, chill, muscle pain, followed by weight loss, delirium shock, massive bleeding and organ failure leading to death in two to three weeks.

Ebola viruses are considered a dangerous threat to public health because of their high fatality rate, ability to transmit person-to-person, and low lethal infectious dose. Moreover, their potential to be developed into biological weapons causes grave concern for their use as a bioterrorism agent. While some vaccines show protection in non-human primate studies, the strategies used may not be uniformly effective in the general human population due to pre-existing immunity to the virus-based vaccines.

In the new study, a vaccine using Ebola virus-like particles (VLPs) was produced in insect cells using traditional bio-engineering techniques and injected into laboratory mice. A VLP vaccine is based upon proteins produced in the laboratory that assemble into a particle that, to the human immune system, looks like the virus but cannot cause disease.

Two high-dose VLP immunizations produced a high level immune response in mice. And when the twice-immunized mice were given a lethal dose of Ebola virus, they were completely protected from the disease. In contrast, mice that were not immunized had a very low immune system response and became infected. In another experiment, a three low-dose VLP immunization effectively boosted immune system response in mice and protected them against the Ebola virus. This finding is important because it demonstrates that since the vaccine produces immunization in dilute quantities, many more vaccine doses can be generated compared with a poorly immunogenic vaccine.

VLPs are attractive candidates for vaccine development because they lack viral genomic material and thus are not infectious, are safe for broad application, and can be administered repeatedly to vaccinated individuals to boost immune responses.

The findings will be validated in additional animal systems. The vaccine will then undergo FDA safety and efficacy testing prior to use in humans in potentially five years.

Collaborators on the study included Richard Compans, Ph.D., and Chinglai Yang, Ph.D., of the Emory University School of Medicine in Atlanta.

SFBR is one of the world's leading independent biomedical research institutions dedicated to advancing health worldwide through innovative biomedical research. Located on a 332-acre campus on the northwest side of San Antonio, Texas, SFBR partners with hundreds of researchers and institutions around the world, targeting advances in the fight against cardiovascular disease, diabetes, obesity, cancer, psychiatric disorders, problems of pregnancy, AIDS, hepatitis, malaria, parasitic infections and a host of other infectious diseases. For more information on SFBR, go to http://www.sfbr.org.

Southwest Foundation for Biomedical Research (SFBR)

PO Box 760549

San Antonio

TX 78245-0549

United States

http://www.sfbr.org

New Analysis Indicates Community Health Centers Lack Resources To Provide Poor And Rural Communities With Much Needed Vision Care Services

2009-02-26T16:00:00.000+02:00

A new analysis from The George Washington University School of Public Health and Health Services indicates that a lack of access to eye care services for residents in rural and low-income areas has become a major public health crisis in America. The report "Assessing the Need for On-Site Eye Care Professionals in Community Health Centers" analyzed the services provided by community health centers across the country, and revealed that visual health and access to comprehensive eye exams for rural and low-income populations is severely lagging.

Rural and low-income populations are at greater risk for undiagnosed and untreated eye and vision problems and are less likely to receive comprehensive eye examinations. Therefore, federally-funded community health centers in underserved communities are often the only option to improve the visual health of residents living in these areas, however 70 percent of community health centers do not offer on-site vision care services.

"The American Optometric Association is committed to increasing access to eye care for all Americans," said Dr. Barry Barresi, executive director of the American Optometric Association (AOA). "We have a responsibility to help ensure that essential primary eye care services are offered at these facilities. Greater access to preventive eye care can lead to diagnosis and treatment before loss of vision becomes severe or untreatable."

Dr. Barresi and others at the AOA have been working with health care leaders and advocates to expand access to eye health care provided at community health centers since 2006 when a letter of agreement was signed by the AOA, the National Association of Community Health Centers (NACHC), the New England Eye Institute (NEEI) and the Massachusetts League of Community Health Centers (MLCHC). The organizations all supported this study and advocate for access to high quality, comprehensive and affordable vision care for all medically underserved populations in community health centers.

"The National Association of Community Health Centers is happy to see this analysis as one of the results of our partnership with the American Optometric Association, the New England Eye Institute and the Massachusetts League of Community Health Centers," said Tom Curtin, M.D., senior vice president and chief medical officer of the NACHC. "This research will allow all the partners to continue working together to develop strategies to increase evidence-based vision services for our rural and underserved populations."

The analysis listed the major barriers to providing on-site comprehensive eye care services as the inability to afford the necessary space and equipment, difficulties with Medicaid, Medicare and private insurance reimbursement, and discrepancies in Medicaid coverage and benefits across states.

"The study confirms that there is an eye and vision care access crisis in America's most vulnerable communities," said Randy Brooks, O.D., president-elect of the AOA. "With firmly established links between healthy vision and success in education and employment, it's not acceptable to have less than one-third of community health facilities offering primary eye and vision care on site. This dire situation makes it even more important that AOA-backed legislation like the National Health Service Corps Improvement Act (HR 1884 in the 110th Congress), a bi-partisan bill to expand access to primary eye and vision care in underserved areas, be given fast-track consideration on Capitol Hill."

Although greater access to preventive eye exams can often lead to the diagnosis and treatment of conditions before vision loss becomes severe or untreatable, few third-party payers mandate such coverage. Under current Medicaid rules, only some children who meet specific qualifications are entitled to vision examination and treatment services. The AOA's foundation, Optometry's Charity™, has programs in place, such as InfantSEE® and VISION USA™, which provide free eye assessments or assistance to cover the cost of eye care for infants, children and adults.

Additional findings from the report include:

Eleven percent of health centers report having full-time eye care professionals (those with paid eye care professionals utilize optometrists to staff their centers);

Only four percent of community health centers surveyed plan to expand or build capacity for on-site eye care in the next 12 months;

73 percent of health centers do not plan to purchase instruments or equipment to provide comprehensive eye care over the next year;

Only 10 percent of health centers have on-site optical space with an eyeglass frame inventory for patients to select, order, pick up, and have adjustments to complete eyeglass orders.

The analysis also indicated that patients may lack general understanding about the need for routine eye exams. Experts agree that strategies to improve access to vision care must include increased efforts to educate consumers about the importance of routine eye examinations. Additionally, health care advocates advise that a more detailed evaluation of the type and quality of eye care should be conducted to help health centers identify cost-effective practices, and to evaluate the cost of vision health. Experts also advise that additional research should be conducted to assess the value of having an eye care professional on-site and the impact on reducing or eliminating vision disparities.

"For nearly 40 years New England Eye Institute faculty optometrists and our students at The New England College of Optometry have transformed the lives of hundreds of thousands of health center patients by improving their visual health," said Roger Wilson, O.D., vice president for Health Center Programs at the NEEI. "This remarkable accomplishment is due to our enduring collaboration with the Massachusetts League of Community Health Centers and greater Boston area health centers."

About the American Optometric Association (AOA)

The American Optometric Association represents approximately 36,000 doctors of optometry, optometry students and paraoptometric assistants and technicians. Optometrists serve patients in nearly 6,500 communities across the country, and in 3,500 of those communities are the only eye doctors. Doctors of optometry provide two-thirds of all primary eye care in the United States.

American Optometric Association doctors of optometry are highly qualified, trained doctors on the frontline of eye and vision care who examine, diagnose, treat and manage diseases and disorders of the eye. In addition to providing eye and vision care, optometrists play a major role in a patient's overall health and well-being by detecting systemic diseases such as diabetes and hypertension.

Prior to optometry school, optometrists typically complete four years of undergraduate study, culminating in a bachelor's degree. Required undergraduate coursework for pre-optometry students is extensive and covers a wide variety of advanced health, science and mathematics. Optometry school consists of four years of post-graduate, doctoral study concentrating on both the eye and systemic health. In addition to their formal training, doctors of optometry must undergo annual continuing education to stay current on the latest standards of care.

American Optometric Association

Cannabis Researchers In Appeal For Volunteers

2009-02-26T10:00:00.000+02:00

People are being urged to take part in a new study which aims to investigate the links between cannabis use and mental health. Past and present cannabis users, as well as those who have never touched the drug, are needed to take part in the project, which is being led by researchers at Nottingham Trent University.

The project involves participants responding to an anonymous survey via an online link: http://tinyurl.com/ntusurvey.

The research team, based in the university's School of Social Sciences, is looking to establish whether users are more prone to developing schizotypal personality, and whether that risk is lessened if they stop using the drug. They also want to examine if the effects of cannabis consumption on schizotypal personality are reversible and if there are differences in the levels of schizotypal personality traits between low, medium and high users.

Finally, they will be exploring whether having a family history of schizophrenia could increase levels of schizotypal traits.

Researcher Dr Antonio Castro said: "We need as many people as possible to take part in the online survey so we get a good cross-section of participants before we begin to analyse the results. The study comes at an extremely interesting time, following the government's reclassification of cannabis from a Class C to a Class B drug."

Nottingham Trent University

Gender Divide In Scotland's Alcohol-Related Deaths

2009-02-25T16:00:00.000+02:00

More than twice as many men die every year in Scotland from alcohol misuse than women, a study by the Medical Research Council (MRC) and the University of Glasgow has revealed.

The findings show that men's death rate from alcohol is 38 deaths per 100,000, while women's rate is 16 per 100,000. On average, the study found that 999 Scottish men and 448 women die from the health consequences of alcohol-abuse each year.

The study comes as the Scottish Government prepares to publish its new strategic approach to tacking alcohol misuse, which was put out to consultation last year. Scotland has one of the highest rates of mortality due to cirrhosis of the liver in Western Europe.

The university report, which consolidates existing data showing that alcohol-related fatalities in both genders have doubled over the past 10 years, also found that death rates within Scotland vary considerably. Most alcohol-related deaths occur in the Greater Glasgow area, though the authors identified areas with high rates in all regions of the country. However, researchers say the findings go against the prevailing public perception that alcohol abuse is more prevalent among young women.

The report was carried out by Dr Carol Emslie of the MRC's Social and Public Health Sciences Unit and Dr Richard Mitchell, of the University of Glasgow's Public Health department and published online at http://www.biomedcentral.com.

Dr Carol Emslie, of the MRC Social and Public Health Sciences Unit, said the aim of the study was to establish a clearer picture of the gender and geographical divide in alcohol-related deaths in Scotland.

"We wanted to find out whether environment influenced the rate of alcohol-related deaths in both men and women across Scotland. In doing this, we looked at three main questions - which areas have the highest rates of alcohol-related death in Scotland; are these areas the same for men and women; and are there areas in Scotland where the gap between men and women's alcohol-related death rates is unusually large or small?" said Dr Emslie.

Dr Richard Mitchell added: "Scotland is facing a huge public health problem which will require strong and radical action by the Scottish government. What is interesting is that although the study shows remarkable differences from place to place in alcohol-related deaths, the areas in which alcohol-related deaths are a particular problem for men are largely the same for women. "The results suggest to us that both men and women are vulnerable to the social, economic and cultural pressures which can make people drink too much."

In carrying out their research Dr Mitchell and Dr Emslie divided Scotland into 144 areas based on the last population census. "These areas were about half a parliamentary constituency in size with a typical population 35,000 people," explained Dr Mitchell.

It is the first time such a detailed scale has been used in a study of this kind. The researchers obtained records of alcohol-related deaths between 2000 and 2005 for each of these areas from the General Register Office for Scotland.

"We used the National Statistics definition of 'alcohol-related deaths' which includes chronic liver disease and cirrhosis. We calculated rates of alcohol-related death separately for men and women. Our method took account of any differences in the population size of each of our 144 areas and the rates can be compared from area to area. We also looked for areas in which women's alcohol-related mortality rates were unusually small or unusually large, compared to the men's rate for that area," continued Dr Mitchell.

Most of the areas with very high alcohol-related death rates are found in Greater Glasgow. However, rural areas in the Highlands also featured in the 25 areas with the highest rates for men and women; Inverness West and Eilean Siar (Western Isles) for example.

"In the vast majority of areas, 136 out of 144, the gap between men's and women's alcohol-related death rate was as expected; areas with high rates for men tended to have high rates for women. Similarly, areas with low rates of alcohol-related death for men tended to have low rates for women. There was no clear pattern to the eight unusual areas in which the gap between men's and women's alcohol-related death rate was either smaller or larger than expected," said Dr Mitchell.

Medical Research Council

Update Presented On Disease In Pork Plant Workers

2009-02-25T10:00:00.000+02:00

More than a year after developing a unique neurological disorder, the affected pork processing plant workers have improved, but all have some continuing symptoms and many have ongoing mild pain, according to a study released today that will be presented at the American Academy of Neurology's 61st Annual Meeting in Seattle, April 25 to May 2, 2009.

The workers developed symptoms such as walking difficulties, weakness, numbness and tingling in the arms and legs, pain and fatigue. All had worked in or near the area where compressed air was used to extract pig brains. All plants have discontinued the practice.

For the study, researchers reexamined 24 of the workers affected at plants in Minnesota and Indiana. Of those, 17 were treated with immune therapy such as steroids. Sixteen people improved with treatment; 12 had marked improvement, two had moderate improvement and two had mild improvement. Six of the people who had no treatment also improved after they were no longer exposed to the pig brain mist.

Neurologists have identified the illness as a new disorder that is a sensory predominant polyradiculoneuropathy. The patients all have a unique antibody not seen before. The disease affects the nerves, and can usually be identified by standard tests (nerve conduction studies and EMG), although in four mild cases specialized tests were needed to detect the abnormalities. The disease seems to improve with treatment and removal of exposure to pig brain.

The disorder likely has an autoimmune basis, with workers exposed to the pig brains developing an autoimmune response that caused nerve damage. The researchers hope that further studies on this disease will aid understanding of other autoimmune disorders. "There are other autoimmune disorders where the trigger is not known, so this case with a known trigger could provide us with an opportunity to understand how an antigen can trigger the body's immune system to produce disease," said study author P. James B. Dyck, MD, of the Mayo Clinic in Rochester, MN, and a Fellow of the American Academy of Neurology.

Additional details on the patients' testing and outcomes will be presented at the AAN Annual Meeting.

The study was supported by the National Institute of Neurological Disorders and Stroke.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as multiple sclerosis, restless legs syndrome, Alzheimer's disease, narcolepsy, and stroke.

For more information about the American Academy of Neurology, visit http://www.aan.com.

The AAN 61st Annual Meeting, the world's largest gathering of neurology professionals, takes place April 25 to May 2, 2009, in Seattle. Visit http://www.aan.com/am for more information.

To access 2009 AAN Annual Meeting abstracts available February 25, 2009, visit http://www.aan.com/go/science/abstracts.

Late-breaking abstracts will be featured in press release at the 2009 AAN Annual Meeting in Seattle.

American Academy of Neurology (AAN)

1080 Montreal Ave.

St. Paul

MN 55116

United States

http://www.neurology.org

Promptly After Their Release, Most US Prison HIV-Infected Inmates Do Not Get Proper Treatment

2009-02-24T22:00:00.000+02:00

Within 30 days of their release from prison, around 80 percent of HIV-infected inmates in Texas did not fill a first prescription for antiretroviral treatment. According to a study in the February 25 issue of JAMA, the pause in the treatment could have dangerous health consequences.

The authors write: "The U.S. prison system has become an important front in the effort to treat and control the spread of human immunodeficiency virus (HIV) infection, serving as the principal screening and treatment venue for thousands of individuals with or at high risk for HIV infection who have limited access to community-based health care. Many inmates are offered HIV testing for the first time while incarcerated, and three-quarters of inmates with HIV infection initiate treatment during incarceration."

Suitable medical help to antiretroviral therapy (ART) is a challenge, since most former inmates do not have private or public health insurance in the early months after their liberation. The authors say, "Those who discontinue ART at this time are at increased risk of developing a higher viral burden, resulting in greater infectiousness and higher levels of drug resistance, potentially creating reservoirs of drug-resistant HIV in the general community." There is no information on the degree to which HIV-infected inmates experience a break in ART following release.

A study in the nation's major state penitentiary system was conducted by Jacques Baillargeon, Ph.D., University Of Texas Medical Branch, Galveston, and team. The research evaluated the percentage of HIV-infected inmates who filled a prescription for ART medication in the two months after their release from detention. Between January 2004 and December 2007, all of the 2,115 HIV-infected inmates released from the Texas Department of Criminal Justice prison System who were receiving ART prior to their release, were included in the study.

A first ART prescription was filled by 5.4 percent (115) of the former inmates within ten days of release, by 17.7 percent (375) within one month, and by 30 percent (634) within two months, in the entire study group. One of the findings was that non-Hispanic whites were more likely to fill a prescription within ten and thirty days compared to Hispanic and African American inmates. Ex-prisoners with an undetectable viral load had a higher probability of filling a prescription than those with a detectable viral load at release. Within the first two months, inmates released on parole were more likely to fill a prescription than inmates with a regular, unsupervised release. Ex-prisoners receiving formal aid in completing an AIDS Drug Assistance Program application had a higher probability of filling a prescription than inmates with no assistance.

The authors write, "In this 4-year study of HIV-infected inmates released from the nation's largest state prison system, we found that only 5 percent of released inmates filled a prescription for ART medications soon enough (i.e., within 10 days after release) to avoid treatment interruption." A pause in treatment was experienced in a least 90 percent of the inmates, in all the subgroups examined. The treatment interruption lasted at least a month for more than 70 percent, and at least two months for more than 60 percent.

"These exceedingly high rates of treatment interruption suggest that most inmates face significant administrative, socioeconomic, or personal barriers to accessing ART when they return to their communities. Future prospective and in-depth qualitative studies are needed to more rigorously examine these barriers. Adequately addressing a public health crisis of this scale and complexity will require carefully coordinated efforts between academic institutions, the criminal justice system, and public health agencies," the authors write. "In particular, greater coordination between state and local agencies, health care institutions, and community-based organizations is needed to reduce this high rate of treatment interruption among newly released inmates."

JAMA. http://www.medicalnewstoday.com/301[8]:848-857

Written by Stephanie Brunner (B.A.)

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Tackling Human Cost Of Alcohol Misuse Requires Tough Action, Says Doctors' Leader, BMA Scotland

2009-02-24T16:00:00.000+02:00

Commenting on Alcohol Statistics published today [Tuesday 24 February 2009], Dr Peter Terry, chairman of the BMA in Scotland, said:

"This publication is a demonstration of the serious reality of Scotland's alcohol problem. Alcohol misuse costs the NHS more than £405 million pounds each year, that's more than £1 million every day and the human cost is far greater. The health consequences of regularly drinking over and above the recommended daily limits, and of binge drinking are serious and severe.

"These alcohol statistics clearly illustrate why tough action is needed to tackle alcohol misuse in Scotland. The BMA supports a wide-ranging strategy that tackles price and availability, particularly measures to end the deep discounting of alcohol where it is sold for ridiculously cheap prices. However, individuals too have a responsibility and that is why we want to see compulsory labelling of all alcohol products so that people can make informed choices about how much they drink."

Alcohol misuse is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems. Binge drinking and severe intoxication can cause muscular incoordination, blurred vision, stupor, hypothermia, convulsions, depressed reflexes, respiratory depression, hypotension and coma.

In 2008, BMA Scotland published a briefing paper on 'Tackling alcohol misuse'. This is available online here.

Alcohol Statistics Scotland 2009 is available on the ISD website: http://www.isdscotland.org/isd/CCC_FirstPage.jsp

http://www.bma.org.uk

Marshall Lindheimer, M.D., Of The University Of Chicago Receives 2009 DeLee Humanitarian Award

2009-02-24T10:00:00.000+02:00

An internationally recognized authority on kidney disease and hypertension during pregnancy, Marshal D. Lindheimer, MD, professor emeritus in the Departments of Obstetrics & Gynecology and of Medicine and in the Committee on Clinical Pharmacology and Pharmacogenomics at the University of Chicago, will receive the 2009 Joseph Bolivar DeLee Humanitarian Award from the Board of Directors of Chicago Lying-in Hospital, part of the University of Chicago Medical Center.

The award will be presented at the board's annual dinner on Saturday evening, March 7, 2009, at the Standard Club, 320 S. Plymouth Court, Chicago.

Named after Joseph Bolivar DeLee, MD, a pioneer in the field of obstetrics and founder of the Chicago Lying-in Hospital, the award is presented annually to an individual who has made an extraordinary contribution to the health care of women and infants.

Previous winners include Lasker Award-winner Elwood V. Jensen, PhD; human genetics pioneer Mary-Claire King, PhD; M. Jocelyn Elders, MD, the first African American appointed as Surgeon General of the United States; Robert G. Edwards PhD, the scientist who made in-vitro fertilization possible; as well as Georgeanna Seegar Jones, MD, and Howard W. Jones, MD, who opened the first successful in-vitro fertilization clinic in the United States.

"Marshall Lindheimer has changed the way we think about the kidney during pregnancy," said Arthur Haney, MD, professor and chair of obstetrics and gynecology at the University of Chicago. "He brought a new level of rigor to the study of hypertension, especially during pregnancy, and in the process has taught us all a lot about how the kidney responds to the unusual physical stresses related to reproduction. He is also a devoted clinician, sought after by other physicians for his expertise in medical problems during pregnancy."

One of the world's leading authorities on kidney function, blood pressure control, and water-level maintenance during pregnancy, Lindheimer is widely known for his research on preeclampsia, a form of hypertension that remains a leading cause of maternal and fetal mortality worldwide.

In collaboration with Adrian Katz he described how the kidney reabsorbs the large increases in filtered sodium during pregnancy. With another University of Chicago colleague, Edward Ehrlich, Lindheimer elucidated the roles of the hormones aldosterone and progesterone in sodium and potassium regulation during pregnancy.

Working with John Davison, of Newcastle upon Tyne University, England, Lindheimer mapped out how regulation of the hormone vasopressin affected fluid retention during pregnancy. Understanding this process led them to predict the existence of an as-yet-unrecognized disease, now known as "transient diabetes insipidus during pregnancy." After finding such patients they were able to treat them.

More recently, Lindheimer focused on clinical trials and translational studies designed to prevent preeclampsia, such as a large multicenter randomized trials testing low-dose aspirin and supplemental dietary calcium to prevent this disease. He also was involved in a large observational trial centered in underdeveloped nations to determine if measuring circulating antiangiogenic proteins could predict preeclampsia.

"By bringing the subject of the kidney and pregnancy to the attention of internists and obstetricians in a readable and comprehensible way, and by his own contributions to our collective base of knowledge, he has made an outstanding contribution that has directly impacted the care of patients with renal disease and changed the clinical practice of nephrology," said Arthur Herbst, MD, Joseph B. DeLee Distinguished Service Professor Emeritus of obstetrics and gynecology at the University of Chicago.

The author of more than 250 original articles, 115 chapters and 7 edited texts, Lindheimer's contributions have earned him several honors, including the Chesley Award for Research in Hypertension in Pregnancy, a Lifetime of Service award from the National Kidney Foundation of Illinois, a Lifetime of Advocacy award from the Preeclampsia Foundation, and the Belding Scribner Award from the American Society of Nephrology. He and his wife, Jacqueline celebrated their fiftieth wedding anniversary last November.

The DeLee Award is presented each year by the Chicago Lying-in Hospital Board of Directors, which supports programs to advance education, research and patient care relating to women's and infants' health at the University of Chicago Medical Center.

Joseph Bolivar DeLee was a leading advocate for greater safety in childbirth. His concern for women in labor led him to open a small dispensary on Chicago's Maxwell Street in 1895, which became known as the Chicago Lying-in Hospital and Dispensary. The facility and its services grew in size and reputation. In 1931, DeLee opened the 140-bed Chicago Lying-in Hospital on the Medical Center campus and became the first chairman of obstetrics and gynecology at the University of Chicago.

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Article adapted by Medical News Today from original press release.

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Chicago Lying-in board members Lee and Arthur Herbst will serve as honorary chair for the annual dinner. Jenny L. Whitlock and Marjorie E. Sherman serve as chair and co-chair.

Source: John Easton

University of Chicago Medical Center

Mail And Electronic Reminders May Increase Colon Cancer Screening

2009-02-23T22:00:00.000+02:00

Mailed reminders to patients appear to promote colon cancer screening, according to a report in the February 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. In addition, electronic reminders to physicians appear to increase screening among patients with more frequent primary care visits.

"Colorectal cancer is the secondary leading cause of cancer mortality [death] in the United States," according to background information in the article. "Screening programs involving fecal occult blood testing, flexible sigmoidoscopy and colonoscopy lower the incidence of colorectal cancer by removing precancerous adenomas, detect cancers at more curable early stages and reduce colorectal cancer mortality." Although national guidelines suggest that average-risk adults age 50 and older should be screened for colorectal cancer, only 60 percent report up-to-date testing.

Thomas D. Sequist, M.D., M.P.H., of Brigham and Women's Hospital, Harvard Vanguard Medical Associates and Harvard Medical School, Boston, and colleagues studied screening rates and colorectal adenoma (tumor) detection for 21,860 patients (age 50 to 80) of 110 physicians from April 2006 to June 2007. Fifty-five physicians were randomly assigned to receive electronic reminders during office visits with patients overdue for screening. Additionally, 10,930 patients were randomly assigned to receive mailings containing an educational pamphlet, a fecal occult blood test kit and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy. Screening rates and detection of colorectal adenomas (tumors) were noted 15 months after the start of the intervention.

Screening rates for patients who received mailings were higher than for those who did not (44 percent vs. 38.1 percent). The mailings were more effective among older patients - patients age 50 to 59 experienced a 3.7 percent increase, patients age 60 to 69 had a 7.3 percent increase and patients age 70 to 80 experienced a 10.1 percent increase in screening rates. While patients of physicians receiving electronic reminders had screening rates similar to patients of physicians who did not receive reminders (41.9 percent vs. 40.2 percent), electronic reminders tended to increase screening rates among patients with three or more primary care visits (59.5 percent vs. 52.7 percent).

"Detection of adenomas tended to increase with patient mailings (5.7 percent vs. 5.2 percent) and physician reminders (6 percent vs. 4.9 percent)," the authors write, but these increases were not statistically significant.

"Patient mailings produced modest increases in rates of colorectal cancer screening, whereas electronic physician reminders tended to promote screening only among patients who have more frequent primary care visits," they conclude. "These complementary approaches have the potential to promote the overarching goal of widespread screening to reduce the incidence, morbidity and mortality of colorectal cancer."

Arch Intern Med. 2009;169[4]:364-371.

Archives of Internal Medicine

Government Of Canada Works With Saskatchewan To Help Prevent Drug Use Among The Province's Youth

2009-02-23T16:00:00.001+02:00

Rob Clarke, Member of Parliament for Desnethe-Missinippi-Churchill River, announced today on behalf of Leona Aglukkaq, Minister of Health, that the Government of Canada is supporting the Drug Awareness and Prevention project that will strengthen drug prevention among youth in northern Saskatchewan. The project is one of several initiatives being supported across Canada through the Drug Strategy Community Initiatives Fund.

"As part of the National Anti-Drug Strategy, the Government of Canada is proud to support community-based projects such as this one that help youth stay away from drugs," said Minister Aglukkaq. "This project will also help improve the community's ability to keep youth on the right track."

Through the Drug Awareness and Prevention project, the Pre-Cam Community School will develop and promote targeted education activities and other prevention initiatives that help curb drug use among young people.

"During my time in law enforcement in Saskatchewan, I saw first hand the consequences that drugs have in northern communities," said Mr. Clarke. "I am very pleased to be involved in the support being provided to this school."

Initiatives such as this one are another step in implementing the Government of Canada's National Anti-Drug Strategy which was announced by Prime Minister Stephen Harper in October 2007.

The federal Drug Strategy Community Initiatives Fund provides financial support for health promotion and prevention projects at the national, provincial and local levels. It addresses a wide range of illicit drug use issues, especially among vulnerable populations such as youth. The Pre-Cam Community School will receive up to $106,750 in financial support for this important project.

Please visit the National Anti-Drug Strategy website for more information.

Health Canada

National Nurses Week (NNW) 2009 Celebrates Nurses' Building A Healthy America

2009-02-23T16:00:00.000+02:00

The American Nurses Association (ANA) has announced the theme of National Nurses Week 2009, "Nurses: Building a Healthy America." National Nurses Week is celebrated annually from May 6, also known as National Nurses Day, through May 12, the birthday of Florence Nightingale, the founder of modern nursing.

"This year's theme reflects the commitment nurses make every day in building a healthy America for the public we serve," said ANA President Rebecca M. Patton, MSN, RN, CNOR. "ANA has long advocated for meaningful health system reform and in 2008 re-released ANA's Health System Reform Agenda, (http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/HSR.aspx) an ANA blueprint for reform that focuses on the basic "core" of essential health care services, which is essential in building a healthy America for everyone."

During National Nurses Week, ANA reaffirms its commitment to improve the quality of health care and the working conditions of nurses. The growing shortage of RNs poses a real threat to the nation's health care system and the public's health, and ANA is dedicated to fighting for a workplace environment that will encourage current nurses to continue in their careers, and inspire young men and women to consider nursing as a profession.

Annually, National Nurses Week focuses on highlighting the diverse ways in which registered nurses are working to improve health care. From bedside nursing in hospitals and long-term care facilities to the halls of research institutions, state legislatures, and Congress, the depth and breadth of the nursing profession is meeting the expanding health care needs of American society.

For more information on National Nurses Week, please visit here.

The ANA is the only full-service professional organization representing the interests of the nation's 2.9 million registered nurses through its 51 constituent member nurses associations, its 23 organizational affiliates, and its workforce advocacy affiliate, the Center for American Nurses. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

American Nurses Association

Randomized, Placebo-Controlled, Double-Blind, Crossover Study With Tolterodine And Darifenacin In Healthy Participants > Or = 50 Years

2009-02-23T10:00:00.000+02:00

UroToday.com - The measurement of heart rate is increasingly being recognized as an important prognostic indictor1, 2. Higher heart rates are associated with greater risk of myocardial infarction and total mortality. Large long-term follow-up studies have been performed in healthy males, females, hypertensive patients, those with structural heart disease and other populations3-7. All the data are consistent - higher heart rates are associated with a poorer prognosis. The mechanism by which higher heart rates are associated with adverse outcomes remains uncertain. Several possibilities exist including the following:

1. There may be a direct effect of heart rate itself,

2. Heart rate may be a marker of cardiac parasympathetic tone8,

3. Heart rate may reflect sympathetic activation.

It is likely that reduced parasympathetic tone at least in part is an important contributor. Higher vagal tone has been consistently documented as a marker of improved survival. Whatever may be the mechanism, even small increments in heart rate (as low as 3 beat/minute increments) is associated with a poorer prognosis9. Move than just that, changes in heart rate over time are associated with outcomes and small changes upward and downward with the same magnitude is related to outcomes.

The best marker for heart rate changes is uncertain. This may be one of the reasons only recently that this issue has been carefully evaluated and yet now it is being considered a low tech predictor of coronary events6. A resting pulse can be challenging as a predictor since it reflects only one point in time and that point can be influenced by many extraneous variables. Alternatively it may be time to redefine what we consider to be tachycardia even from a resting heart rate measurement10.

In our study11, we performed a carefully controlled assessment of heart rate evaluating it over a 24-hour period. There was a significant difference between tolterodine and darifenacin when compared to placebo. Tolterodine was associated with an increase in heart rate versus darifenacin and versus placebo. Darifenacin was not associated with any increase in heart rate versus placebo. This was true considering the mean heart rate and the increase in heart rate greater than 5 beats/minute using a categorical analysis.

These data are consistent with the present knowledge of the drugs - tolterodine is a relatively nonselective antimuscarinic and darifenacin is relatively selective for the M3 receptors. Since M2 receptor activation is responsible for sinus node slowing but M3 receptor activation does not have any substantial effect on the sinus node, blockade of this receptor selectively should not affect heart rate by blocking the effects of vagal activation of the sinus node.

The implications of this study are that there are differences in cardiovascular effects of antimuscarinics when treating patients with overactive bladder. Vagal tone can be in part abolished by antimuscarinics that are relatively non-selective. While no cardiovascular outcomes data yet support the use of one antimuscarinic over another, based on data in many populations indicating that an increased heart rate indicates increased risk of mortality and other concerning endpoints, these data should warrant careful consideration about the use of non-selective antimuscarinic to treat overactive bladder.

1. Greenland P, Daviglus ML, Dyer AR, Liu K, Huang CF, Goldberger JJ, Stamler J. Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality: the Chicago Heart Association Detection Project in Industry. Am J Epidemiol. 1999;149(9):853-862.

2. Mensink GB, Hoffmeister H. The relationship between resting heart rate and all-cause, cardiovascular and cancer mortality. Eur Heart J. 1997;18(9):1404-1410.

3. Jouven X, Empana JP, Schwartz PJ, Desnos M, Courbon D, Ducimetiere P. Heart-rate profile during exercise as a predictor of sudden death. N Engl J Med. 2005;352(19):1951-1958.

4. Fox K, Borer JS, Camm AJ, Danchin N, Ferrari R, Lopez Sendon JL, Steg PG, Tardif JC, Tavazzi L, Tendera M. Resting heart rate in cardiovascular disease. J Am Coll Cardiol. 2007;50(9):823-830.

5. Fox K, Ford I, Steg PG, Tendera M, Robertson M, Ferrari R. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet. 2008;372(9641):817-821.

6. Hsia J, Larson JC, Ockene JK, Sarto GE, Allison MA, Hendrix SL, Robinson JG, LaCroix AZ, Manson JE. Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study. Bmj. 2009;338:b219.

7. Okin PM, Wachtell K, Kjeldsen SE, Julius S, Lindholm LH, Dahlof B, Hille DA, Nieminen MS, Edelman JM, Devereux RB. Incidence of Atrial Fibrillation in Relation to Changing Heart Rate over Time in Hypertensive Patients: The LIFE Study. Circ Arrhythmia Electrophysiol. 2008;1:337-343.

8. Olshansky B, Sabbah HN, Hauptman PJ, Colucci WS. Parasympathetic nervous system and heart failure: pathophysiology and potential implications for therapy. Circulation. 2008;118(8):863-871.

9. Jouven X, Empana JP, Escolano S, Buyck JF, Tafflet M, Desnos M, Ducimetiere P. Relation of heart rate at rest and long-term (>20 years) death rate in initially healthy middle-aged men. Am J Cardiol. 2009;103(2):279-283.

10. Gopinathannair R, Sullivan RM, Olshansky B. Slower Heart Rates for Healthy Hearts: Time to Redefine Tachycardia? Circ Arrhythmia Electrophysiol. 2008;1(1):321-322.

11. Olshansky B, Ebinger U, Brum J, Egermark M, Viegas A, Rekeda L. Differential pharmacological effects of antimuscarinic drugs on heart rate: a randomized, placebo-controlled, double-blind, crossover study with tolterodine and darifenacin in healthy participants > or = 50 years. J Cardiovasc Pharmacol Ther. 2008;13(4):241-251.

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Gore Recognizes Physicians As "Pioneers In Performance" For Exceptional Work In The Field Of Endovascular Therapy

2009-02-22T10:00:00.000+02:00

W. L. Gore & Associates (Gore) announced it has honored seven physicians as "Pioneers in Performance" for exceptional work in the field of endovascular therapy. These practitioners were recognized by Gore for their unrelenting dedication to advancing endovascular therapy and minimally invasive treatment options for patients worldwide. The work performed by these individuals has expanded therapeutic options for at-risk patients, as endovascular therapy has now replaced a number of open surgical procedures.

The following physicians were recognized during the International Congress on Endovascular Interventions XXII held in Scottsdale, Arizona, February 6-12, 2009:

- Jacques Bleyn, MD, Antwerp Blood-Vessel Center (Antwerp, Belgium), for the development of the endoluminal "throughpass" in the superficial femoral artery.

- Michael Dake, MD, Stanford University (Palo Alto, California), for his work in advancing endoluminal treatment of thoracic aortic disease.

- Edward Diethrich, MD, Arizona Heart Institute (Phoenix, Arizona), for pioneering the multi-disciplinary approach to endovascular therapy.

- Jon Matsumura, MD, Northwestern Memorial Hospital (Chicago, Illinois), for his excellence in clinical trials and research.

- Juan Parodi, MD, Jackson Memorial Hospital (Miami, Florida) for his innovative solutions in endovascular therapy.

- Claudio Schönholz, MD, Medical University of South Carolina (Charleston, South Carolina), for initiating broad novel concepts in the interventional treatment of the vascular anatomy.

- Frank Veith, MD, Cleveland Clinic (Cleveland, Ohio), for expanding the clinical awareness of endovascular treatment.

"We are proud to recognize these 'Pioneers' for their extraordinary contributions to the endovascular community," said John Sininger, Gore Medical Products Divisional Leader. "Gore prides itself on continually pursuing new, innovative technologies that improve patients' lives. The work and dedication of these researchers and clinicians are critical in helping us develop products that embody innovation, reliability and proven performance."

"In order to truly advance treatments, and to provide better care to patients, it is very important for physicians in the field to work hand in hand with product manufacturers," said Michael Dake, MD. "Gore understands and values this critical relationship as a means to innovation. It is an honor to be recognized as a pioneer in endovascular therapy."

The collaboration between Gore and physician pioneers has resulted in the development of minimally invasive treatment options for safely and effectively managing patients with aneurysms including the GORE TAG® Thoracic Endoprosthesis and the GORE EXCLUDER® AAA Endoprosthesis. These important partnerships have also yielded first in class products such as the GORE VIABAHN® Endoprosthesis with Heparin Bioactive Surface which is used to treat patients with peripheral vascular disease (PVD); and the GORE Flow Reversal System which minimizes the risk of emboli reaching the brain during critical stages of carotid artery stenting (CAS), expanding treatment options for broad patient populations with carotid artery disease.

About W. L. Gore & Associates

The Gore Medical Products Division has provided creative therapeutic solutions to complex medical problems for three decades. During that time, more than 25 million innovative Gore Medical Devices have been implanted, saving and improving the quality of lives worldwide. The extensive Gore Medical family of products includes vascular grafts, endovascular and interventional devices, surgical meshes for hernia repair, soft tissue reconstruction, staple line reinforcement and sutures for use in vascular, cardiac and general surgery. Gore was recently named one of the best companies to work for by Fortune magazine for the 12th consecutive year. For more information, visit http://www.goremedical.com.

Gore Medical Products Division

Peanut Product Recall Taken Over By Texas Dept Of Health After PCA-Plainview Fails To Respond

2009-02-21T16:00:00.000+02:00

The DSHS (Texas Department of State Health Services) issued a recall order to the Peanut Corporation of America's Plainview plant - but got no response. Consequently, the DSHA says it is taking over the recall of products shipped from Peanut Corporation of America's Planview plant.

The DSHA says that all manufacturers, distributors and retails who have received products from the company in 2008 should take appropriate action to protect consumers. The DSHS expects to find more customer lists from previous years in the company's records.

On Feb. 12 the Texas Health Dept. ordered The Peanut Corporation of America's Plainview plant to recall all products after one of its inspectors found dead rodents, rodent excrement and bird feathers in a crawl space and an unsealed air handling system that was pulling debris from the crawl space into production areas of the plant. The recall refers to goods shipped from the company since it started in March 2005.

Some firms that had received goods from PCA-Plainview have already issued recall notices after seeing news media coverage of the recall order. Notices are posted online at http://www.fda.gov. Consumers are being asked to watch for additional notices. Companies that may have received peanut products from PCA-Plainview are advised to contact their immediate suppliers for more information.

The DSHS has written to Stewart Parnell, PCA-Plainview Director, saying it will seek payment form PCA for the cost of carrying out the recall.

Source - Texas Department of State Health Services (DSHA)

Written by Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Bacteria In Urinary Infections Make Burglar's Tools

2009-02-21T10:00:00.000+02:00

Bacteria that cause urinary tract infections (UTIs) make more tools for stealing from their host than friendly versions of the same bacteria found in the gut, researchers at Washington University School of Medicine in St. Louis and the University of Washington have found.

The tools, compounds called siderophores, allow the bad bacteria to steal iron from their hosts, making it easier for the bacteria to survive and reproduce. But they also provide a potential way to target the bad strains of bacteria for eradication without adversely affecting the good strains, researchers report in a study published online Feb. 20 by PLoS Pathogens.

"When we treat an infection with antibiotics, it's like dropping a bomb nearly everything gets wiped out, regardless of whether it's helpful or harmful," says lead author Jeff Henderson, M.D., Ph.D., a Washington University infectious disease specialist who treats patients with UTIs at Barnes-Jewish Hospital. "We'd like to find ways to target the bad bacteria and leave the good bacteria alone, and these siderophores are a great lead in that direction."

UTIs are one of the most common infections, causing around $1.6 billion in medical expenses every year in the United States. Half of all women will experience a UTI at some point in their lives, and recurrent UTIs affect 20 to 40 percent of these patients. Scientists believe 90 percent of all UTIs are caused by the bacterium Escherichia coli (E. coli).

The E. coli that cause UTIs may come from the human gut, where several strains of the bacteria reside. Scientists think some of those strains help their human hosts by aiding digestion and blocking other infectious organisms. To study how friendly and infection-causing E. coli strains differ, Henderson and colleagues at the Center for Women's Infectious Disease Research at Washington University used a new approach called metabolomics. Instead of examining genes, metabolomics analyzes all the chemicals produced by a cell, which includes bacterial growth signals, toxins and waste products.

"This allows us to look at the end products of many genes working together," says senior author Scott Hultgren, Ph.D., the Helen L. Stoever Professor of Molecular Microbiology. "We assess what all the various assembly lines are producing and which products disease-causing bacteria prefer to make, such as certain siderophores."

Bacteria studied in the experiment came from recurrent UTI patients treated at the University of Washington. Researchers cultured both E. coli from stool samples and urine samples. They found that the strains from urine made more yersiniabactin and salmochelin, two siderophores that help bacteria scavenge iron to support their own survival.

Iron is an important nutrient typically kept under tight control by the host, and there's evidence that a back-and-forth contest centered on iron has been raging for millennia between disease-causing microbes and the hosts they exploit. For example, studies suggest that humans may make a protein that specifically blocks particular bacterial siderophores.

There may be multiple ways to take advantage of the infectious bacterial strains' reliance on siderophores. Researchers will try to block or disrupt the activity of the proteins that make siderophores, but they also may use what Henderson calls a "Trojan horse" strategy.

"To steal iron, siderophores have to be sent out from the cell, bind to the iron, and then be taken back into the cell," he explains. "If we can design an antibiotic that looks like a siderophore, we might be able to trick only disease-causing bacteria into taking up the drug while leaving other bacteria alone."

Henderson JP, Crowley JR, Pinkner JS, Walker JN, Tsukayama P, Stamm WE, Hooton TM, Hultgren SJ. Quantitative metabolomics reveals an epigenetic blueprint for iron acquisition in uropathogenic Escherichia coli. PLoS Pathogens 5(2): e1000305. doi:10.1371/journal.ppat.1000305

Funding from the Burroughs Wellcome Fund and the National Institutes of Health supported this research.

Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

Washington University in St. Louis

1 Brookings Dr., Campus Box 1070

St. Louis

MO 63130

United States

http:// www.wustl.edu

Unhealthy Living Doubles Stroke Risk, Study

2009-02-20T10:00:00.000+02:00

Researchers who studied 20,000 middle aged and elderly UK residents for 10 years found that those who lived unhealthy lives characterized by smoking, lack of exercise, drinking too much alcohol and not eating enough fruit and vegetables, were twice as likely to have a stroke as counterparts with much healthier lifestyles.

The study was the work of first author Dr Phyo K Myint, clinical senior lecturer in the School of Medicine at the University of East Anglia in Norwich and in the Department of Public Health and Primary Care at the University of Cambridge, and colleagues and was published online in the BMJ on 19 February.

While there is clear evidence that individual lifestyle factors such as smoking and diet are linked with higher risk of heart attack and stroke, the impact of several factors combined has been less clear until now.

For the study, Myint and colleagues examined data from the Norfolk cohort of participants enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The whole of EPIC involves over half a million adults from all over Europe who enrolled in the 1990s.

The Norfolk contingent comprised 20,040 community-dwelling men and women aged 40 to 79 with no history of stroke or heart attack when they joined in 1993 to 1997 and were followed unto 2007.

The researchers gave one point for each of four health behaviours: being a current non-smoker, not being physically inactive, drinking only a moderate amount of alcohol (one to 14 units a week) and eating at least 5 portions of fruit and vegetables a day. The fruit and vegetable intake was assessed as blood levels of vitamin C (greater than or equal to 50 micromol per litre).

Thus a person who scored 4 had the "healthiest" lifestyle while a person who scored 0 had the "unhealthiest" lifestyle, based on these four health behaviours.

The results showed that:

There were 599 incident strokes over an average follow up of 11.5 years (total of 229,993 person-years).

After adjusting for other potential confounders such as age, sex, BMI, blood pressure, cholesterol, diabetes, use of aspirin, socioeconomic status, there was a significant trend (P
The relative risk of stroke for participants who scored 3 out of 4 on health behaviours was 1.15 compared to those who scored 4 out of 4.

For participants who scored 2 out of 4 the relative risk was 1.58 and those who scored 1 out 4 it was 2.18.

And the relative risk for participants who scored 0 out of 4 was 2.31.

These patterns remained when the researchers looked at the figures in subgroups according to sex, age, BMI, socioeconomic status and after excluding deaths within two years.

A significantly higher percentage of women scored 4 than men.

About 260 participants (one per cent of the cohort) scored 0; this was linked to an absolute stroke rate of 5.8 per cent (15 of them had a stroke during the follow up).

About 5,000 of the cohort (25 per cent) had a maximum score of 4; this was linked with an absolute stroke risk of 1.7 per cent.

The authors concluded that:

"Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women."

They said these findings support the idea that small changes to lifestyle can change one's chances of having a stroke.

BBC News reported that Myint told to the press:

"Over the study period we observed six people for every 100 participants who had no health behaviours suffered a stroke compared to about one to two people for every 100 participants who had four positive health behaviours."

"Together with the substantial existing body of evidence about modifiable behaviours and stroke risk, this may provide further encouragement to make entirely feasible changes which have the potential to have a major impact on stroke."

A stroke is when part of the brain stops working because of a lack of blood supply, for instance due to a blockage, or a hemhorrage. It is the leading cause of disability in adults in Europe and the US. In the UK it is the second leading cause of death, with heart attacks being the first and cancer the third.

"Combined effect of health behaviours and risk of first ever stroke in 20 040 men and women over 11 years' follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study."

Phyo K Myint, Robert N Luben, Nicholas J Wareham, Sheila A Bingham, Kay-Tee Khaw.

BMJ 2009;338:b349.

Published online 19 February 2009, doi:10.1136/bmj.b349

Click here for Abstract.

Sources: Journal abstract, BBC News.

Written by: Catharine Paddock, PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Women Only: Cramps, Bloating And Now, Tooth Erosion?

2009-02-19T10:00:00.000+02:00

Monthly menstrual cycles produce many uncomfortable, and sometimes painful, symptoms, which can include cramps, headaches and bloating. With more intense, painful menstruation, a condition otherwise known as dysmenorrhea, regular vomiting also is a symptom. This monthly recurrence can cause severe tooth erosion, according to a study in the November/December 2008 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.

This condition often masquerades as an eating disorder, since both dysmenorrhea and bulimia nervosa cause noticeable erosion on the back of the front teeth of the top jaw as a result of the exposure to stomach acid. However, it is imperative that patients understand the main distinguishing factor between the two conditions.

"Whereas bulimia nervosa is a voluntary act - the woman induces vomiting herself - dysmenorrhea is involuntary," says Mohamed Bassiouny, DMD, MSc, PhD, author of the study. "Contractions in the uterus or the abdominal wall force the patient to vomit without any cause."

Due to its uncontrollable force, dysmenorrhea also creates a different erosion pattern on the teeth. "A dentist can tell when a patient suffers from bulimia or dysmenorrhea, due to the distinct erosion patterns," says Dr. Bassiouny. "When vomiting is voluntary, the individual controls the direction and force," he says. "The tongue creates a tunnel which protects, in most instances the back teeth. When a patient has dysmenorrhea, the erosion affects almost all surfaces of the dentition to varying extents."

Dr. Bassiouny also notes that many women are affected by dysmenorrhea without knowing that the condition exists. "Roughly 52 percent of the population suffers from the condition," he says, "and women who are affected by dysmenorrhea usually do not detect the damage to their teeth until later in life." In his research, women become aware of dysmenorrhea's effects on teeth in their 50s or 60s, whereas women who suffer from bulimia do so most commonly in their 20s or 30s due to the fast rate of destruction by the frequent voluntary vomiting. The symptoms of dysmenorrhea, he says, can occur every three to four weeks and even outside of the traditional cycle, and last between 10-12 days.

When severe erosion occurs, "the tooth enamel is worn down, exposing the nerve endings of the teeth, which results in tooth sensitivity," says Connie White, DDS, FAGD, spokesperson for the AGD. Although erosion is not reversible, Dr. White says, dentists can help reduce the effects of the acid on the teeth by advising them on proper care. Patients should "rinse the mouth thoroughly during episodes of vomiting and avoid immediate brushing of the area. Brushing right after vomiting actually worsens the effects of the acid because it rubs the acid into the teeth."

According to Dr. Bassiouny, to treat the condition it is imperative that women inform all health professionals of the symptoms. "The condition and associated dental fallout are not purely medical or purely dental," he says. "Women who suffer from dysmenorrhea need to be treated by a gynecologist for internal causes and by the dentist to restore and prevent further damage to the dentition. This coordinated effort of management is the best course of action."

Dental effects of dysmenorrhea:

-- Teeth may show loss of enamel

-- Exposed dentin of affected teeth may appear brownish

-- Sensitivity due to dental erosion

-- Teeth appear shorter

-- Disfigurement of facial esthetics

The AGD is a professional association of more than 35,000 general dentists dedicated to staying up-to-date in the profession through continuing education. Founded in 1952, the AGD has grown to become the world's second largest dental association, which is the only association that exclusively represents the needs and interests of general dentists.

More than 786,000 persons are employed directly in the field of general dentistry. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Academy of General Dentistry

http://www.agd.org

Is It Just Pain...or Is It Fibromyalgia?

2009-02-18T16:00:00.000+02:00

Months of constant pain, restless sleep and being drained of energy will make anyone seek help. Yet after the doctor has prescribed three different treatment regimens, the pain remains, the sleep is still restless and the body still lacks the proper energy to function. The patient becomes discouraged, as each attempt at healing the problem proves fruitless.

Because its symptoms are quite common and laboratory tests are generally normal, people with fibromyalgia were once told that their condition was 'all in their head,' the Arthritis Foundation says on its website. However, medical studies have proven that fibromyalgia does indeed exist, and it is estimated to affect about 2% of the U.S. population today. Research is being done to identify the causes of fibromyalgia, as well as treatments and a cure. Because the syndrome varies in each patient, an individualized health plan is the best option. These include (but are not limited to) prescription medications, herbal supplements, massage, exercise, healthy eating and physical therapy.

In the accompanying video, Dr. David Ferrera offers details on a new study called the Engage Fibromyalgia Study currently underway that may help Fibromyalgia patients find a treatment option for their condition.

You can view the video here.

Engage Fibromyalgia Study

Fifth U.S. Hand Transplant Patient Heads Home To NY

2009-02-18T10:00:00.000+02:00

The United States' fifth hand transplant recipient, Jan "Erik" Hondusky, is heading back home to Massena, New York this week after a three-month stay in Louisville under the care of Kleinert Kutz and University of Louisville surgeons.

Kleinert Kutz and UofL hand surgeons performed the Hondusky's hand transplant at Louisville's Jewish Hospital Hand Care Center on November 24, 2008, during a record nine-hour surgical procedure. Warren C. Breidenbach, M.D., with Kleinert Kutz and University of Louisville assistant clinical professor of surgery, led the team of five hand surgeons, 10 hand fellows and a two-member anesthesiology team from Hand Care Center Anesthesia.

"I cannot wait to get home and pick up my granddaughter with two hands and give big two-handed hugs to all my family and friends, said Hondusky. "This has been an awesome event in my life and I have made many new friends here in Louisville. I cannot thank everyone enough -- the doctors, nurses, therapists, donor family and others who have helped me here in Louisville."

The New York resident is a 43-year-old production worker who injured his dominant right hand in a furnace accident on April 12, 2006, when his hand was crushed and burned thus requiring amputation. He used a prosthetic hand to perform daily living activities before the transplant procedure.

Lead hand transplant surgeon Dr. Breidenbach said, "Erik continues to work on mobility exercises and strengthening the muscle groups in the hand and arm using light weights. Functional activities for grasping, releasing and pinching continue to improve, as well. He can perform such daily living activities as washing his hair with both hands, holding a phone with his new right hand, shaking hands in greeting, opening a door, writing with a pen, grasping a water bottle, throwing and bouncing a ball, and picking up objects three inches wide. He can lift a bucket weighing 12 pounds with his right hand and a 20 pound crate with two hands." Hondusky will continue therapy three times week after returning home.

Kadiyala Ravindra, M.D., University of Louisville assistant professor of surgery, who manages the anti-rejection drug therapy for Hondusky said, "Erik has had a few mild rejection episodes over the past three months, which were not surprising, and we were able to treat each with medication. He is doing remarkably well and we expect him to continue to do so."

Hondusky received one dose of Campath, an immunosuppressive medication, during surgery and is on mono-therapy -- one drug for most of the past three months. Maintaining a patient on one drug as opposed to two or three, reduces the risk of rejection. Risks associated with immunosuppressive drugs include a higher incidence of cancer, infections and other disorders.

"Reducing the number of drugs a patient is on will continue to reduce the risks associated with hand transplantation and we believe we can achieve this with our patients going forward," said Ravindra. "We will also continue to monitor him very closely for signs of rejection with biopsies and other laboratory tests."

A hand transplant, unlike a solid organ transplant, involves multiple tissues (skin, muscle, tendon, bone, cartilage, fat, nerves and blood vessels) and is called composite tissue allotransplantation.

A partnership of physicians and researchers at Jewish Hospital Hand Care Center, Kleinert Kutz and the University of Louisville developed the pioneering procedure. Breidenbach and his team are the only surgeons to perform hand transplants in the U.S. To date, there have been a total of 40 hands transplanted on 32 patients around the world.

Kentuckiana Organ Donor Affiliates (KODA) worked very closely with the Indiana Organ Procurement Organization to coordinate the hand donation with the family and hospital. Without the help of these organ procurement agencies and the family, this procedure could not have taken place.

The fifth U.S. hand transplant is sponsored by the Department of Defense, Office of Naval Research and Office of Army Research to further research in the composite tissue allotransplantation program.

Jewish Hospital

http://www.jewishhospital.org

BDA Reaction To ITV Tonight Programme, UK

2009-02-17T16:00:00.000+02:00

The BDA has moved to reassure patients about the safety of their mercury amalgam fillings after the screening on 16 February of an ITV Tonight programme. The programme, while noting the longstanding use of mercury amalgam fillings and a consensus across all four UK Departments of Health that they are safe, may nonetheless have prompted patients to question the safety of fillings they may already have or are intending to have.

Allergic reactions to mercury in dental amalgam have been reported, but according to the European Commission these are very rare. Some local adverse effects are occasionally seen with filling materials, including allergic reactions, but the incidence is low and normally readily managed. Patients who are concerned should talk to their dentist.

Speaking after the programme, BDA Scientific Adviser Professor Damien Walmsley said:

"It is important to remember that dental amalgam has been used as a safe, durable and cost-effective material for more than 150 years. Its safety has been the subject of numerous reviews, including a recent one by the EU Commission's Scientific Committee. That review concluded that there was no evidence of increased risk of adverse systemic effects. However, pregnant women should avoid or delay any dental intervention or medication during pregnancy."

The British Dental Association publishes two briefing documents on dental fillings. The Dental Amalgam Fact File The Dental Amalgam Fact File provides a full consideration of the evidence for the safety of amalgam fillings. Dental Fillings The Facts is a patient leaflet that provides information about the advantages and disadvantages of the various materials available for use in dental restorations, including amalgam.

British Dental Association

CMA Praises Changes In HIT Funding That Will Allow Many California Pediatricians To Participate

2009-02-17T10:00:00.000+02:00

The California Medical Association applauded congressional leaders today for passing an economic stimulus package that extends Health Information Technology (HIT) funding to many pediatricians who would have been excluded under previous versions of the legislation.

The compromise package cleared the House and is expected to pass the Senate later today and be signed by President Obama next week.

"Federal funding for electronic medical record systems is great news for physicians and their patients, who will see their care enhanced as a result," said Dr. Dev A. GnanaDev, CMA President. "CMA is especially grateful to House Speaker Nancy Pelosi and Congressman Henry Waxman for listening to our concerns about HIT funding and making changes to ensure that pediatricians in our state can benefit, too."

The stimulus package establishes national standards for electronic medical records systems and provides $20 billion for doctors to acquire them.

In order to qualify, physicians must take Medicare patients or treat at least 30 percent of their patients through Medicaid or the State Children's Health Insurance Program (SCHIP). At CMA's urging, congressional leaders added language to the legislation to allow different standards to be used for pediatricians, many of whom do not meet the 30 percent threshold in California, and flexibility to take into account other factors unique to individual states.

The California Medical Association represents more than 35,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California.

California Medical Association

Analysis Of Intramuscular EMG Signals

2009-02-16T16:00:00.000+02:00

Muscle contraction is associated to electrical signals. Heart contraction generates ECG signals. Muscle contraction generates EMG signals.

EMG signals may be picked up using intramuscular needles, intramuscular wires or surface (non invasive) electrodes. The review discusses the modalities of intramuscular detection and their combination with surface detection to extract information about central and peripheral phenomena.

Such information provides insight into fatigue mechanisms and motor control strategies as well as on certain pathologies of the neuromuscular system.

Philosophical Transactions A

Each issue of Philosophical Transactions A is devoted to a specific area of the mathematical, physical and engineering sciences. This area will define a research frontier that is advancing rapidly, often bridging traditional disciplines.

Philosophical Transactions A is essential reading for mathematicians, physicists, engineers and other physical scientists. Find out more about the journal.

Editor: Sir Michael Pepper, FRS

Impact Factor 2007: 1.520

Citation: Phil. Trans. R. Soc. A

Frequency: Every two weeks

The Royal Society