A 14-year old British schoolgirl died on Monday shortly after receiving a vaccine against the human papilloma virus (HPV), the most common cause of cervical cancer.
The girl was a pupil at Blue Coat Church of England School and Music College in Coventry and was given the Cervarix anti-cancer jab as part of a national programme to immunise teenage girls against cervical cancer.
Dr Caron Grainger, Joint Director of Public Health for NHS Coventry and Coventry City Council, told the press that the girl was taken to Coventry's University Hospital shortly after she took ill, but sadly she died later that day.
"Our sympathies are with the girl's family and friends at this difficult time," said Grainger, explaining that although the incident happened shortly after the girl received the vaccine:
"No link can be made between the death and the vaccine until all the facts are known and a post mortem takes place."
Meanwhile, as a precautionary step, NHS Coventry have quarantined the batch of vaccine that was used, and the regulatory authority has been informed, said Grainger, adding that.
"We are conducting an urgent and full investigation into the events surrounding this tragedy."
In a letter to parents dated Monday, headteacher of the co-educational school, Dr Julie Roberts, wrote that during the vaccination session "an unfortunate incident occurred" and one of the girls suffered a "rare, but extreme reaction to the vaccine".
Roberts, who was newly appointed this term, wrote in her letter that a number of other girls "also reported being unwell and some were sent home", and urged parents of all girls who had received the vaccination to be "extra vigilant" of any signs or symptoms.
The most common adverse reaction after Cervarix is supposed to be a mild to moderate short lasting pain at the site of the injection, although other reactions may also include headache, muscle pain, fatigue and a low grade fever.
Roberts urged any parents who may be concerned about their daughter's reaction to the vaccine to contact their own GP.
Since September 2008 there has been a national programme in the UK to vaccinate girls aged 12 to 13 against HPV, and there is also a three-year catch up campaign that will offer the vaccine to 13 to 18 year olds.
The NHS said the plan is to deliver the vaccination, which comprises three injections over six months, mainly through secondary schools.
The HPV is one of a family of viruses that affects the skin and mucosa, the moist membranes that line the body, for example the cervix (the neck of the womb in a woman's body), the anus, mouth and throat.
There are more than 100 types of HPV, and of these about 40 affect the genital area, some high risk and some low. Some types of HPV that affect the genital area cause abnormal tissue growth (pre-cancerous lesions) that can lead to cancer. Other types can cause genital warts.
About 3,000 women are diagnsed with cervical cancer in the UK every year, and about 1,000 die from it.
The types of HPV that can lead to cervical cancer are transmitted sexually. Although Cervarix only protects against two strains of HPV, these are the two that cause more than 70 per cent of cervical cancers.
The vaccination is not compulsory, and according to a report from the BBC about a million girls are thought have received it safely in the UK.
When the NHS selected Cervarix many people were surprised, thinking they would opt for Gardasil, the vaccine used by most other countries, including the US.
The tragedy prompted Shadow Health Secretary Andrew Lansley to call for an urgent investigation into the tragic death, and repeat his urge to the government to reveal the results of the assessments comparing Cervarix and Gardasil that led them to choose the former when most other countries chose the latter.
Dr Pim Kon, the medical director at GlaxoSmithKline (GSK) UK, the company that makes Cervarix, told the press that their deepest sympathies were with the family and friends of the young girl who died. According to a report from the BBC, Kon added that:
"We are working with the Department of Health and MHRA (Medicines and Healthcare products Regulatory Agency) to better understand this case, as at this stage the exact cause of this tragic death is unknown."
According to GSK, the vast majority of suspected adverse reactions to Cervarix have either been in connection with recognized side effects or due to the injection process and not the vaccine itself.
Sources: Coventry NHS, Blue Coat School, BBC News.
Updated Advaxis Phase I Survival Data Indicates Long-Term Immune Protection!
The Phase I trial of ADXS11-001, the lead vaccine candidate of Advaxis, Inc. (OTCBB: ADXS), the company that pioneered the live, attenuated Listeria monocytogenes (Lm) vaccine, has shown thirty-six (36) month survival in three (3) of the thirteen (13) evaluable patients treated with Advaxis' therapeutic cancer vaccine, indicating the possibility of persistent immune protection.
The patients had participated in the first human trial of a live Listeria vaccine for the treatment of advanced, recurrent, metastatic cervix cancer in women who have failed prior cytotoxic treatment. Advaxis is tracking the survival of these patients at three (3) month intervals.
These mortality figures substantially exceed the median survival rate established by the National Cancer Institute's Gynecologic Oncology Group (GOG), which varies between 3.8 and 6.2 months in studies of patients who have failed prior cytotoxic treatment including chemotherapy with various agents (GOG Protocol #127).
Earlier this year, Advaxis published in the medical journal Vaccine the fact that four (4) of thirteen (13) evaluable patients, treated with ADXS11-001, experienced tumor reductions, two (2) patients had their lesions disappear and fifty-three percent (53%) survived more than one (1) year; thus, posting a median survival rate of 347 days. Although this trial was designed to assess safety, not efficacy or survival, three (3) of the thirteen (13) patients or twenty-three percent (23%) evaluable for efficacy are still alive at over 1,000 days, post-dosing with the study drug, as of September 29, 2009.
About the ADXS11-001 Immunotherapy
ADXS11-001 is a therapeutic vaccine, unlike currently marketed prophylactic vaccines, that treats women who have already developed cervical cancer as a result of human papilloma virus (HPV) infection; the most prevalent sexually transmitted disease in the US today.
Earlier this year, the US Food and Drug Administration (FDA) granted Advaxis an IND for a Phase II clinical trial in human papilloma virus- (HPV) caused cervical intraepithelial neoplasia (CIN), which is pre-cancerous and a precursor to cervix cancer. For further information on ADXS11-001, please visit:http://www.advaxis.com/lc.htm.
The patients had participated in the first human trial of a live Listeria vaccine for the treatment of advanced, recurrent, metastatic cervix cancer in women who have failed prior cytotoxic treatment. Advaxis is tracking the survival of these patients at three (3) month intervals.
These mortality figures substantially exceed the median survival rate established by the National Cancer Institute's Gynecologic Oncology Group (GOG), which varies between 3.8 and 6.2 months in studies of patients who have failed prior cytotoxic treatment including chemotherapy with various agents (GOG Protocol #127).
Earlier this year, Advaxis published in the medical journal Vaccine the fact that four (4) of thirteen (13) evaluable patients, treated with ADXS11-001, experienced tumor reductions, two (2) patients had their lesions disappear and fifty-three percent (53%) survived more than one (1) year; thus, posting a median survival rate of 347 days. Although this trial was designed to assess safety, not efficacy or survival, three (3) of the thirteen (13) patients or twenty-three percent (23%) evaluable for efficacy are still alive at over 1,000 days, post-dosing with the study drug, as of September 29, 2009.
About the ADXS11-001 Immunotherapy
ADXS11-001 is a therapeutic vaccine, unlike currently marketed prophylactic vaccines, that treats women who have already developed cervical cancer as a result of human papilloma virus (HPV) infection; the most prevalent sexually transmitted disease in the US today.
Earlier this year, the US Food and Drug Administration (FDA) granted Advaxis an IND for a Phase II clinical trial in human papilloma virus- (HPV) caused cervical intraepithelial neoplasia (CIN), which is pre-cancerous and a precursor to cervix cancer. For further information on ADXS11-001, please visit:http://www.advaxis.com/lc.htm.
Baxter Receives EMEA Positive Opinion For CELVAPAN H1N1 Pandemic Influenza Vaccine!
Baxter International Inc. (NYSE:BAX) announced that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMEA) granted its "positive opinion" for CELVAPAN H1N1pandemic vaccine using Baxter's Vero cell technology. This positive opinion confirms the acceptability of Baxter's regulatory submission to obtain final marketing authorization and licensure of the product.
CELVAPAN H1N1 is the first cell culture-based and non-adjuvanted vaccine to receive a positive opinion in the European Union. Initial quantities of vaccine have already been delivered to a number of countries, including the UK and Ireland, for use in their national vaccination programs, and are awaiting product release subject to final marketing authorization being granted by the European Commission.
Presently, Baxter is confirming the safety and immunogenicity of CELVAPAN H1N1 in clinical trials. The company is conducting two randomized trials in 400 healthy adults age 18 and over and in 400 children and adolescents to supplement the licensure post-approval with appropriate clinical data. These trials are evaluating the safety and immunogenicity of the vaccine at dose levels of 7.5µg and 3.75µg. Once countries initiate national vaccination programs using CELVAPAN H1N1, Baxter will also conduct a large-scale observational study with CELVAPAN in 9,000 people of different age groups, including children.
Preliminary safety data in adults and the elderly indicate that the vaccine is well tolerated in these age groups. The observed systemic and local reactions are similar to those generally experienced after vaccination with licensed seasonal influenzavaccines. Immunogenicity data from the first vaccination in adults are due later this month. The current dosing schedule, as specified in the EMEA mock-up licensure for CELVAPAN using another virus strain, calls for two 7.5 µg doses of vaccine to be given 21 days apart. Baxter expects the data from the trial of healthy adults to indicate whether a single dose may be possible for CELVAPAN H1N1. This study will also determine whether a lower dose, 3.75µg, is sufficient to induce the necessary immune response.
"We are pleased that the regulatory submission and the preliminary clinical trial data uphold the extensive work done by Baxter and the support received from key Ministries of Health in developing a pandemic vaccine," said Hartmut J. Ehrlich, M.D., vice president of global research and development for Baxter BioScience. "We are looking forward to analyzing the immunogenicity data for our cell culture-derived, non-adjuvanted vaccine to assess the potential of a one dose regimen."
About Baxter's Pandemic Vaccine Development
Earlier this year, the EMEA granted mock-up licensure for CELVAPAN using a different strain with pandemic potential, which was tested in five completed clinical trials worldwide in more than 1,300 people. In addition, more than 3,500 people have been vaccinated using the same strain during an ongoing Phase III study. Mock-up licensure is a regulatory pathway for pandemic vaccines that was created by the EMEA in 2004. This pathway allows for the development, evaluation and licensure of a company's pandemic candidate vaccine using an available influenza strain that has the potential to cause a pandemic. Once a pandemic is declared and the influenza virus strain causing the pandemic is identified, the mock-up licensure allows for fast track approval of a pandemic vaccine containing the actual pandemic strain.
Baxter received the H1N1 strain for testing and evaluation from the U.S. Centers for Disease Control and Prevention (a WHO Collaborating Center) in early May. The company then undertook pre-production testing and evaluation of the virus strain to assess its growth characteristics in the company's proprietary Vero cell culture technology.
Baxter initiated commercial production in early June, and made its first commercial product within 12 weeks of receipt of the virus. The company produces bulk CELVAPAN H1N1 vaccine at its large-scale commercial facility in Bohumil, Czech Republic, and then sends the vaccine to Vienna, Austria for the final formulation, fill and finish before distribution. Baxter completed production of the first batches of CELVAPAN H1N1 vaccine in late July and initiated its first delivery within two weeks. The company continues to deliver vaccine on an ongoing basis to national public health authorities.
Baxter initiated its license application for CELVAPAN H1N1 in July based on the EMEA published guidelines for pandemic vaccine marketing authorization. The company conducted rigorous testing of the H1N1 based vaccine and submitted additional data for vaccine development, product quality and manufacturing processes specific to that strain. Other non-E.U. countries may choose to evaluate the company's EMEA submission and licensure as the basis for their national health authority's authorization for use of the vaccine.
More information on CELVAPAN H1N1 clinical trials is available here.
CELVAPAN H1N1 is the first cell culture-based and non-adjuvanted vaccine to receive a positive opinion in the European Union. Initial quantities of vaccine have already been delivered to a number of countries, including the UK and Ireland, for use in their national vaccination programs, and are awaiting product release subject to final marketing authorization being granted by the European Commission.
Presently, Baxter is confirming the safety and immunogenicity of CELVAPAN H1N1 in clinical trials. The company is conducting two randomized trials in 400 healthy adults age 18 and over and in 400 children and adolescents to supplement the licensure post-approval with appropriate clinical data. These trials are evaluating the safety and immunogenicity of the vaccine at dose levels of 7.5µg and 3.75µg. Once countries initiate national vaccination programs using CELVAPAN H1N1, Baxter will also conduct a large-scale observational study with CELVAPAN in 9,000 people of different age groups, including children.
Preliminary safety data in adults and the elderly indicate that the vaccine is well tolerated in these age groups. The observed systemic and local reactions are similar to those generally experienced after vaccination with licensed seasonal influenzavaccines. Immunogenicity data from the first vaccination in adults are due later this month. The current dosing schedule, as specified in the EMEA mock-up licensure for CELVAPAN using another virus strain, calls for two 7.5 µg doses of vaccine to be given 21 days apart. Baxter expects the data from the trial of healthy adults to indicate whether a single dose may be possible for CELVAPAN H1N1. This study will also determine whether a lower dose, 3.75µg, is sufficient to induce the necessary immune response.
"We are pleased that the regulatory submission and the preliminary clinical trial data uphold the extensive work done by Baxter and the support received from key Ministries of Health in developing a pandemic vaccine," said Hartmut J. Ehrlich, M.D., vice president of global research and development for Baxter BioScience. "We are looking forward to analyzing the immunogenicity data for our cell culture-derived, non-adjuvanted vaccine to assess the potential of a one dose regimen."
About Baxter's Pandemic Vaccine Development
Earlier this year, the EMEA granted mock-up licensure for CELVAPAN using a different strain with pandemic potential, which was tested in five completed clinical trials worldwide in more than 1,300 people. In addition, more than 3,500 people have been vaccinated using the same strain during an ongoing Phase III study. Mock-up licensure is a regulatory pathway for pandemic vaccines that was created by the EMEA in 2004. This pathway allows for the development, evaluation and licensure of a company's pandemic candidate vaccine using an available influenza strain that has the potential to cause a pandemic. Once a pandemic is declared and the influenza virus strain causing the pandemic is identified, the mock-up licensure allows for fast track approval of a pandemic vaccine containing the actual pandemic strain.
Baxter received the H1N1 strain for testing and evaluation from the U.S. Centers for Disease Control and Prevention (a WHO Collaborating Center) in early May. The company then undertook pre-production testing and evaluation of the virus strain to assess its growth characteristics in the company's proprietary Vero cell culture technology.
Baxter initiated commercial production in early June, and made its first commercial product within 12 weeks of receipt of the virus. The company produces bulk CELVAPAN H1N1 vaccine at its large-scale commercial facility in Bohumil, Czech Republic, and then sends the vaccine to Vienna, Austria for the final formulation, fill and finish before distribution. Baxter completed production of the first batches of CELVAPAN H1N1 vaccine in late July and initiated its first delivery within two weeks. The company continues to deliver vaccine on an ongoing basis to national public health authorities.
Baxter initiated its license application for CELVAPAN H1N1 in July based on the EMEA published guidelines for pandemic vaccine marketing authorization. The company conducted rigorous testing of the H1N1 based vaccine and submitted additional data for vaccine development, product quality and manufacturing processes specific to that strain. Other non-E.U. countries may choose to evaluate the company's EMEA submission and licensure as the basis for their national health authority's authorization for use of the vaccine.
More information on CELVAPAN H1N1 clinical trials is available here.
Teleconference Discussion Of Results From Cocaine Vaccine Study!
What
Teleconference on newly released results from a National Institute on Drug Abuse sponsored trial of an anti-cocaine treatment vaccine
Who
NIDA Director Dr. Nora Volkow and lead investigator, Dr. Thomas Kosten, Baylor College of Medicine
When
Monday, October 5th
4:00 to 5:00pm Eastern Daylight Time
Where
Operator assisted live dial-in event at: 888-567-1602 (U.S. and Canada) or (201) 604-5049 (international callers).
Doctors Volkow and Kosten will discuss the findings of a study in the October issue of Archives of General Psychiatry evaluating the safety and efficacy of a vaccine to treat cocaine addiction. Currently there is no FDA-approved medication for treating cocaine addiction.
Source
The National Institute on Drug Abuse
Teleconference on newly released results from a National Institute on Drug Abuse sponsored trial of an anti-cocaine treatment vaccine
Who
NIDA Director Dr. Nora Volkow and lead investigator, Dr. Thomas Kosten, Baylor College of Medicine
When
Monday, October 5th
4:00 to 5:00pm Eastern Daylight Time
Where
Operator assisted live dial-in event at: 888-567-1602 (U.S. and Canada) or (201) 604-5049 (international callers).
Doctors Volkow and Kosten will discuss the findings of a study in the October issue of Archives of General Psychiatry evaluating the safety and efficacy of a vaccine to treat cocaine addiction. Currently there is no FDA-approved medication for treating cocaine addiction.
Source
The National Institute on Drug Abuse
New American Medical Association Video Answers Physicians' Health-Reform Questions!!!!!!
As health reform legislation moves forward in Congress, a new American Medical Association (AMA) online video aims to answer physicians' questions on leading elements of health reform important to patients and physicians.
"The new video aims to reach a wide audience of physicians by answering key questions about health reform," said AMA President J. James Rohack, M.D. "Throughout the summer, the AMA reached out to physicians in tele-town hall meetings to set the record straight on the benefits of health-system reform, and this video answers the frequently asked questions."
AMA board members - physicians elected by their peers - answered questions to help broaden physicians' understanding of the evolving health-reform issues in a format that would not add a burden to the many demands on physicians' time.
Many physicians expressed concern about Medicare cuts that threaten seniors' access to care, and AMA board members explain that repeal of the flawed Medicare physician payment formula is included in the House bill and must be a part of health reform. The AMA emphasizes its support of medical liability reforms that increase patient access and help slow health-care spending, and board members note that the administration has taken an important first step to address the cost of defensive medicine by allowing states to implement alternative reforms. Other topics addressed in the video include how to strengthen the physician workforce and optimize quality of care through health reform.
"Physicians are working for a better health system for their patients," said Dr. Rohack. "The AMA is committed to communicating with America's physicians and patients and providing critical information during this historic health-reform debate."
"The new video aims to reach a wide audience of physicians by answering key questions about health reform," said AMA President J. James Rohack, M.D. "Throughout the summer, the AMA reached out to physicians in tele-town hall meetings to set the record straight on the benefits of health-system reform, and this video answers the frequently asked questions."
AMA board members - physicians elected by their peers - answered questions to help broaden physicians' understanding of the evolving health-reform issues in a format that would not add a burden to the many demands on physicians' time.
Many physicians expressed concern about Medicare cuts that threaten seniors' access to care, and AMA board members explain that repeal of the flawed Medicare physician payment formula is included in the House bill and must be a part of health reform. The AMA emphasizes its support of medical liability reforms that increase patient access and help slow health-care spending, and board members note that the administration has taken an important first step to address the cost of defensive medicine by allowing states to implement alternative reforms. Other topics addressed in the video include how to strengthen the physician workforce and optimize quality of care through health reform.
"Physicians are working for a better health system for their patients," said Dr. Rohack. "The AMA is committed to communicating with America's physicians and patients and providing critical information during this historic health-reform debate."
National Community Pharmacists Association Applauds House Of Representatives For Passing Bill Maintaining Seniors' Access To Durable Medical!
The U.S. House of Representatives passed H.R. 3663, a bill introduced yesterday by Reps. Zach Space (D-OH) and Lee Terry (R-NE) extending the accreditation deadline for pharmacies providing MedicarePart B Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) from Sept. 30 to Dec. 31, 2009. The extension enables seniors to continue getting valuable health care supplies like diabetes testing strips from community pharmacies without disruption as Congress weighs separate legislative action to exempt pharmacists from the regulation. In response, Bruce T. Roberts, RPh, National Community Pharmacists Association (NCPA) executive vice president and CEO issued the following statement:
"Seniors are the real winners from this vote. This bill would allow seniors to continue relying on their pharmacists to help manage diseases like diabetes. "For community pharmacies today represents a clear line of demarcation. Some have become accredited suppliers of durable medical equipment. But for most independent community pharmacies, the accreditation requirements were far too expensive and time-consuming. It's all the more frustrating since nearly two dozen other state-licensed health care providers have already been exempted from the rule. "Unless this law is enacted, tomorrow morning thousands of community pharmacies will no longer be able to offer these supplies and patients will experience an unwelcome disruption in their health care regimen. The Senate must now act as quickly as possible so the President can sign it into law."
The accreditation requirements are time-consuming, costly and redundant for community pharmacists, who are already subject to regulation at the state level. NCPA has helped its members navigate the process. Those suggested actions can be found here. The regulations target perpetrators of DMEPOS fraud, which is not something associated with pharmacists. However, they are the only health care providers not yet exempted from the requirements. As a result, an exemption community pharmacy has been a primary focus of NCPA's efforts with Congress and with the Centers for Medicare and Medicaid Services (CMS).
"Seniors are the real winners from this vote. This bill would allow seniors to continue relying on their pharmacists to help manage diseases like diabetes. "For community pharmacies today represents a clear line of demarcation. Some have become accredited suppliers of durable medical equipment. But for most independent community pharmacies, the accreditation requirements were far too expensive and time-consuming. It's all the more frustrating since nearly two dozen other state-licensed health care providers have already been exempted from the rule. "Unless this law is enacted, tomorrow morning thousands of community pharmacies will no longer be able to offer these supplies and patients will experience an unwelcome disruption in their health care regimen. The Senate must now act as quickly as possible so the President can sign it into law."
The accreditation requirements are time-consuming, costly and redundant for community pharmacists, who are already subject to regulation at the state level. NCPA has helped its members navigate the process. Those suggested actions can be found here. The regulations target perpetrators of DMEPOS fraud, which is not something associated with pharmacists. However, they are the only health care providers not yet exempted from the requirements. As a result, an exemption community pharmacy has been a primary focus of NCPA's efforts with Congress and with the Centers for Medicare and Medicaid Services (CMS).
New Articles To Protect Vulnerable Populations During An Influenza Pandemic Published In Special Issue Of American Journal Of Public Health..!
New articles released outline the needs of vulnerable populations during an influenzapandemic, including children, people with disabilities and low-income communities. These articles, which were developed by the Centers for Disease Control and Prevention, appear in a special influenza preparedness issue of the American Journal of Public Health, published by the American Public Health Association.
Public health emergencies have made clear the necessity of taking into special consideration the challenges and risks that vulnerable populations present. The papers highlighted in the special issue were developed prior to the current H1N1 pandemic and for a potential severe influenza pandemic. Up-to-date information and guidance on H1N1 influenza can be found at http://www.flu.gov.
With an expected resurgence of the H1N1 virus in the United States this fall, these articles should help to minimize the risk and stem the spread of the virus in these communities, including the following vulnerable populations:
- Children - Children are a vulnerable segment of the population, dependent on others for providing their food, shelter, transportation and medical care. Those under the age of 18 years account for approximately 74 million residents of the United States.
- Racial and ethnic minority populations - Broad disparities in underlying health status and social factors such as socioeconomic disadvantages; cultural, educational and linguistic barriers; and lack of access to and use of health care contribute to why racial and ethnic minority populations are more vulnerable in the event of influenza pandemic.
- Public housing, single-parent and low-income families - Data suggest that poverty, in addition to exposing individuals to more acute and chronic stressors, weakens an individual's ability to cope with new problems and difficulties.
- People with disabilities - People with disabilities, particularly those who require personal assistance and those who reside in congregate care facilities, may be at increased risk during an influenza pandemic because of disrupted care or the introduction of the virus by their caregivers.
- Farmworkers - Whether working with livestock or crops, farmworkers may also be more vulnerable than the general population to human influenza pandemics as a result of living conditions, suboptimal access to health services and potential communication barriers resulting from language and culture.
- Local jails - Persons held in correctional facilities in the United States have high rates of infectious and chronic diseases, mental illness, substance dependency and homelessness prior to jail booking, than the general public. During an influenza pandemic, these health and socioeconomic issues would likely make jail inmates particularly vulnerable because of their compromised immune systems and possible diminished capacity to understand the importance of taking medication.
"Only when the nation is prepared to protect those who are most vulnerable will we be assured that we have in place an effective and efficient preparedness and response system," noted Dr. Sonja Hutchins of the CDC and guest editor of the special supplement. "These articles helped us shape our strategies to respond to and contain the H1N1 virus among vulnerable populations, but also may help to combat future pandemics and other public health emergencies."
In May, articles for pregnant women, home health care workers, tribal communities and immigrants and refugees, which are also included in this supplement, were made available in a special early release by the American Journal of Public Health.
Public health emergencies have made clear the necessity of taking into special consideration the challenges and risks that vulnerable populations present. The papers highlighted in the special issue were developed prior to the current H1N1 pandemic and for a potential severe influenza pandemic. Up-to-date information and guidance on H1N1 influenza can be found at http://www.flu.gov.
With an expected resurgence of the H1N1 virus in the United States this fall, these articles should help to minimize the risk and stem the spread of the virus in these communities, including the following vulnerable populations:
- Children - Children are a vulnerable segment of the population, dependent on others for providing their food, shelter, transportation and medical care. Those under the age of 18 years account for approximately 74 million residents of the United States.
- Racial and ethnic minority populations - Broad disparities in underlying health status and social factors such as socioeconomic disadvantages; cultural, educational and linguistic barriers; and lack of access to and use of health care contribute to why racial and ethnic minority populations are more vulnerable in the event of influenza pandemic.
- Public housing, single-parent and low-income families - Data suggest that poverty, in addition to exposing individuals to more acute and chronic stressors, weakens an individual's ability to cope with new problems and difficulties.
- People with disabilities - People with disabilities, particularly those who require personal assistance and those who reside in congregate care facilities, may be at increased risk during an influenza pandemic because of disrupted care or the introduction of the virus by their caregivers.
- Farmworkers - Whether working with livestock or crops, farmworkers may also be more vulnerable than the general population to human influenza pandemics as a result of living conditions, suboptimal access to health services and potential communication barriers resulting from language and culture.
- Local jails - Persons held in correctional facilities in the United States have high rates of infectious and chronic diseases, mental illness, substance dependency and homelessness prior to jail booking, than the general public. During an influenza pandemic, these health and socioeconomic issues would likely make jail inmates particularly vulnerable because of their compromised immune systems and possible diminished capacity to understand the importance of taking medication.
"Only when the nation is prepared to protect those who are most vulnerable will we be assured that we have in place an effective and efficient preparedness and response system," noted Dr. Sonja Hutchins of the CDC and guest editor of the special supplement. "These articles helped us shape our strategies to respond to and contain the H1N1 virus among vulnerable populations, but also may help to combat future pandemics and other public health emergencies."
In May, articles for pregnant women, home health care workers, tribal communities and immigrants and refugees, which are also included in this supplement, were made available in a special early release by the American Journal of Public Health.
FDA Transparency Task Force To Hold 2nd Public Meeting On Ensuring That Agency Information Is Useful, Understandable, Accessible..!
The U.S. Food and Drug Administration will seek comments on how to ensure that information on FDA activities and decision-making is useful, understandable, and accessible to the public, during a daylong public meeting on Nov. 3, 2009.
The meeting is scheduled for 9 a.m. to 3 p.m. at the National Transportation Safety Board Conference Center, 429 L'Enfant Plaza, S.W., Washington, D.C., 20594. The purpose of the meeting is to receive detailed comments on three specific issues related to transparency at the FDA:
- Early communication about emerging safety issues concerning FDA-regulated products
- Disclosure of information about product applications that are abandoned, i.e., no work is being done or will be undertaken to have the application approved, or withdrawn by the applicant before approval
- Communication of agency decisions about pending product applications.
The FDA formed an internal Transparency Task Force in response to the Obama Administration's commitment to achieve "an unprecedented level of openness in Government." The Task Force is developing recommendations for making useful and understandable information about FDA activities and decision-making more readily available to the public in a timely manner and in a user-friendly format, while appropriately protecting confidential information.
The task force held its first daylong meeting in June 2009.
Those interested in attending the public meeting must register by 5 p.m. on Oct. 27, 2009. Submit electronic or written comments by Nov. 6, 2009. Submit electronic comments to http://www.regulations.gov. Submit written comments to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Room 1061, Rockville, MD 20852.
There is no fee to register for the meeting and registration is on a first-come, first-served basis. Seating is limited and early registration is recommended. Registration on the day of the public meeting will be permitted on a space-available basis, beginning at 7:30 a.m.
A media room with dial-up Internet access will be provided. Please note there is no wireless service within the NTSB Conference Center. Those who cannot attend the meeting can view it via live Webcast.
The Webcast will be archived and available for viewing on the FDA Web site.
For more information:
Advance Display of Federal Register Notice to publish Oct. 5, 2009
FDA Transparency Task Force
The meeting is scheduled for 9 a.m. to 3 p.m. at the National Transportation Safety Board Conference Center, 429 L'Enfant Plaza, S.W., Washington, D.C., 20594. The purpose of the meeting is to receive detailed comments on three specific issues related to transparency at the FDA:
- Early communication about emerging safety issues concerning FDA-regulated products
- Disclosure of information about product applications that are abandoned, i.e., no work is being done or will be undertaken to have the application approved, or withdrawn by the applicant before approval
- Communication of agency decisions about pending product applications.
The FDA formed an internal Transparency Task Force in response to the Obama Administration's commitment to achieve "an unprecedented level of openness in Government." The Task Force is developing recommendations for making useful and understandable information about FDA activities and decision-making more readily available to the public in a timely manner and in a user-friendly format, while appropriately protecting confidential information.
The task force held its first daylong meeting in June 2009.
Those interested in attending the public meeting must register by 5 p.m. on Oct. 27, 2009. Submit electronic or written comments by Nov. 6, 2009. Submit electronic comments to http://www.regulations.gov. Submit written comments to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Room 1061, Rockville, MD 20852.
There is no fee to register for the meeting and registration is on a first-come, first-served basis. Seating is limited and early registration is recommended. Registration on the day of the public meeting will be permitted on a space-available basis, beginning at 7:30 a.m.
A media room with dial-up Internet access will be provided. Please note there is no wireless service within the NTSB Conference Center. Those who cannot attend the meeting can view it via live Webcast.
The Webcast will be archived and available for viewing on the FDA Web site.
For more information:
Advance Display of Federal Register Notice to publish Oct. 5, 2009
FDA Transparency Task Force
E Coli O157 In Surrey: Update, UK!
The Health Protection Agency (HPA) reports that the total number of cases of E. Coli O157 linked to Godstone Farm in Surrey is 88.
Three children remain in hospital all of whom are described by the hospital today as 'stable'.
The next update will be posted on the HPA website on Monday October 5.
Notes
- Escherichia coli (commonly referred to as E. coli) O157 bacteria usually causediarrhoea which settles within seven days without treatment. The diarrhoea may contain blood. Occasionally, serious kidney and blood complications can occur. Good hygiene is very important in preventing person-to person spread and small children should be supervised with hand washing after using the toilet and before eating.
- E. Coli O157 is a species of bacteria commonly found in the intestines of humans and animals. There are many different types of E. coli, and while some live in the intestine quite harmlessly, others may cause a variety of diseases. The bacterium is found in faeces and can survive in the environment.
- To avoid getting strains capable of causing intestinal disease people should avoid eating undercooked meat, in particular inadequately cooked minced beef and avoid drinking unpasteurised milk. Individuals working with uncooked meats or on farms should pay close attention to good hygiene practices, as should visitors to farms.
- It is important to always wash your hands with soap after going to the toilet and before and after handling food.
- Hand washing in young children should be supervised, especially after handling animals or their surroundings, for instance on a visit to a farm.
More information: http://www.hpa.org.uk/ecoliVTEC
Three children remain in hospital all of whom are described by the hospital today as 'stable'.
The next update will be posted on the HPA website on Monday October 5.
Notes
- Escherichia coli (commonly referred to as E. coli) O157 bacteria usually causediarrhoea which settles within seven days without treatment. The diarrhoea may contain blood. Occasionally, serious kidney and blood complications can occur. Good hygiene is very important in preventing person-to person spread and small children should be supervised with hand washing after using the toilet and before eating.
- E. Coli O157 is a species of bacteria commonly found in the intestines of humans and animals. There are many different types of E. coli, and while some live in the intestine quite harmlessly, others may cause a variety of diseases. The bacterium is found in faeces and can survive in the environment.
- To avoid getting strains capable of causing intestinal disease people should avoid eating undercooked meat, in particular inadequately cooked minced beef and avoid drinking unpasteurised milk. Individuals working with uncooked meats or on farms should pay close attention to good hygiene practices, as should visitors to farms.
- It is important to always wash your hands with soap after going to the toilet and before and after handling food.
- Hand washing in young children should be supervised, especially after handling animals or their surroundings, for instance on a visit to a farm.
More information: http://www.hpa.org.uk/ecoliVTEC
Urologic Oncology Services Expanded At Cancer Institute Of NJ...!
Urologic Oncology Services Expanded At Cancer Institute Of NJ
Keeping with its mission of offering a comprehensive array of services to patients, The Cancer Institute of New Jersey (CINJ) has expanded its Urologic Oncology Program, which has gained formal recognition as a Section of Urologic Oncology under the Department of Surgery at UMDNJ-Robert Wood Johnson Medical School. The program provides highly specialized care for patients with tumors of the genitourinary tract including cancers of the prostate, testis, kidney, and bladder. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.
CINJ's Section of Urologic Oncology is a leader in laparoscopic renal procedures and has extensive experience with robotic prostatectomy, which boasts such patient benefits as shorter hospital stays, lower blood loss, and faster recovery. Leading this effort is Isaac Yi Kim, MD, PhD, associate professor of surgery at UMDNJ-Robert Wood Johnson Medical School, who is an expert in the area of robotic prostatectomy and developed the Athermal Intrafascial Robotic or AIR prostatectomy. The AIR procedure spares more nerves than the traditional method and leads to faster recovery of sexual function and bladder control. CINJ has developed a Center of Excellence for robotic surgery and Kim and colleagues have performed more than 550 robotic prostatectomies over the last four years alone.
In addition to its extensive prostate cancer focus, the Section of Urologic Oncology is also building on its excellence in bladder and kidney cancers, having just recruited a pair of urologic oncologists with special expertise in these areas. Michael E. Karellas, MD, is a urologic oncologist at CINJ and an assistant professor of surgery at UMDNJ-Robert Wood Johnson Medical School. Dr. Karellas, who recently completed fellowship training at Memorial Sloan-Kettering Cancer Center (MSKCC), has a clinical interest in the treatment of bladder cancer. Thomas L. Jang, MD, MPH, is a urologic oncologist at CINJ and an assistant professor of surgery at UMDNJ-Robert Wood Johnson Medical School, who specializes in kidney cancer. Dr. Jang, who also just completed fellowship training at MSKCC, will be responsible for building the program's new prostate cancer database, which will link histological and clinical data from prostate cancer tumors in an effort to further facilitate translational research.
The Section of Urologic Oncology and the Dean and Betty Gallo Prostate Cancer Center offer a wide breadth of clinical trials for patients with tumors of the genitourinary tract as well as several trials studying the prevention of prostate cancer. In addition, the Dean and Betty Gallo Prostate Cancer Center provides a hub for basic and clinical research specific to prostate cancer and serves as a forum for prostate cancer outreach and education activities.
"I am thrilled to welcome Drs. Karellas and Jang to New Jersey's only National Cancer Institute-designated Comprehensive Cancer Center," said Dr. Kim. "Their experience complements an already strong team with varied and unique expertise and will help us grow the program even more."
Additional information about CINJ's Urologic Oncology Program can be found at:http://www.cinj.org/treatment/urologic.html.
CINJ's Section of Urologic Oncology is a leader in laparoscopic renal procedures and has extensive experience with robotic prostatectomy, which boasts such patient benefits as shorter hospital stays, lower blood loss, and faster recovery. Leading this effort is Isaac Yi Kim, MD, PhD, associate professor of surgery at UMDNJ-Robert Wood Johnson Medical School, who is an expert in the area of robotic prostatectomy and developed the Athermal Intrafascial Robotic or AIR prostatectomy. The AIR procedure spares more nerves than the traditional method and leads to faster recovery of sexual function and bladder control. CINJ has developed a Center of Excellence for robotic surgery and Kim and colleagues have performed more than 550 robotic prostatectomies over the last four years alone.
In addition to its extensive prostate cancer focus, the Section of Urologic Oncology is also building on its excellence in bladder and kidney cancers, having just recruited a pair of urologic oncologists with special expertise in these areas. Michael E. Karellas, MD, is a urologic oncologist at CINJ and an assistant professor of surgery at UMDNJ-Robert Wood Johnson Medical School. Dr. Karellas, who recently completed fellowship training at Memorial Sloan-Kettering Cancer Center (MSKCC), has a clinical interest in the treatment of bladder cancer. Thomas L. Jang, MD, MPH, is a urologic oncologist at CINJ and an assistant professor of surgery at UMDNJ-Robert Wood Johnson Medical School, who specializes in kidney cancer. Dr. Jang, who also just completed fellowship training at MSKCC, will be responsible for building the program's new prostate cancer database, which will link histological and clinical data from prostate cancer tumors in an effort to further facilitate translational research.
The Section of Urologic Oncology and the Dean and Betty Gallo Prostate Cancer Center offer a wide breadth of clinical trials for patients with tumors of the genitourinary tract as well as several trials studying the prevention of prostate cancer. In addition, the Dean and Betty Gallo Prostate Cancer Center provides a hub for basic and clinical research specific to prostate cancer and serves as a forum for prostate cancer outreach and education activities.
"I am thrilled to welcome Drs. Karellas and Jang to New Jersey's only National Cancer Institute-designated Comprehensive Cancer Center," said Dr. Kim. "Their experience complements an already strong team with varied and unique expertise and will help us grow the program even more."
Additional information about CINJ's Urologic Oncology Program can be found at:http://www.cinj.org/treatment/urologic.html.
Fight Diabetic Non-Healing Wounds Lying Down..!
More than 18-million people in the United States, or 6.3% of the population, have diabetes, according to the American Diabetes Association.
Unfortunately, when someone becomes diabetic, chronic non-healing wounds often develop, most often in the legs and feet. These wounds can be uncomfortable and even life-threatening.
There are many types of treatments. One of the most painless and successful is hyperbaric oxygen therapy (HBOT).
Hyperbaric oxygen therapy is a specialized medical treatment inside a pressurized chamber, in which a patient breathes 100 percent oxygen at greater than normal atmospheric pressure.
The Center for Wound Care at Northwest Hospital in Randallstown, Maryland uses HBOT to treat stubborn, non-healing diabetic ulcers.
When the oxygen, which is delivered into the bloodstream, it helps fight certain infections and stimulates the growth of new blood vessels, which generally improves circulation.
"Patients receiving HBOT can see dramatic results as early as two weeks from the start of treatment. "Another big benefit is that this therapy is noninvasive," says Alan S. Davis, M.D., F.A.C.S, director of the Center for Wound Care and HBOT at Northwest Hospital. "If standard wound therapies prove to be inadequate within a certain time frame, HBOT should be considered and can be done at the same time patients are receiving other treatment."
Once the patient is comfortably positioned inside the HBOT chamber, air pressure is gradually increased.
A patient may experience fullness in the ears as a result. However, a technician instructs him or her about how to help clear the pressure and relieve any discomfort.
Most treatment sessions in the chamber last approximately two hours. During this time, patients watch TV or videos, relax or sleep.
In addition to treating diabetic wounds, HBOT also treats osteomyelitis, post-radiation complications and compromised skin flaps, among other things.
The HBOT program at Northwest Hospital has earned accreditation from the influential Undersea and Hyperbaric Medical Society. Fewer than 100 programs in the United States have achieved this designation.
Unfortunately, when someone becomes diabetic, chronic non-healing wounds often develop, most often in the legs and feet. These wounds can be uncomfortable and even life-threatening.
There are many types of treatments. One of the most painless and successful is hyperbaric oxygen therapy (HBOT).
Hyperbaric oxygen therapy is a specialized medical treatment inside a pressurized chamber, in which a patient breathes 100 percent oxygen at greater than normal atmospheric pressure.
The Center for Wound Care at Northwest Hospital in Randallstown, Maryland uses HBOT to treat stubborn, non-healing diabetic ulcers.
When the oxygen, which is delivered into the bloodstream, it helps fight certain infections and stimulates the growth of new blood vessels, which generally improves circulation.
"Patients receiving HBOT can see dramatic results as early as two weeks from the start of treatment. "Another big benefit is that this therapy is noninvasive," says Alan S. Davis, M.D., F.A.C.S, director of the Center for Wound Care and HBOT at Northwest Hospital. "If standard wound therapies prove to be inadequate within a certain time frame, HBOT should be considered and can be done at the same time patients are receiving other treatment."
Once the patient is comfortably positioned inside the HBOT chamber, air pressure is gradually increased.
A patient may experience fullness in the ears as a result. However, a technician instructs him or her about how to help clear the pressure and relieve any discomfort.
Most treatment sessions in the chamber last approximately two hours. During this time, patients watch TV or videos, relax or sleep.
In addition to treating diabetic wounds, HBOT also treats osteomyelitis, post-radiation complications and compromised skin flaps, among other things.
The HBOT program at Northwest Hospital has earned accreditation from the influential Undersea and Hyperbaric Medical Society. Fewer than 100 programs in the United States have achieved this designation.
New Study Evaluates Surgical Masks Vs. N95 Respirators For Preventing Influenza Among Health Care Workers!
Surgical masks appear to be no worse than, and nearly as effective as N95 respirators in preventing influenza in health care workers, according to a study released early online today by JAMA. The study was posted online ahead of print because of its public health implications. It will be published in the November 4 issue of JAMA.
Influenza is the most important cause of medically attended acute respiratory illness worldwide and the authors write there is heightened concern this year because of the influenza pandemic due to the H1N1 virus. "Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse," the authors provide as background information in the article. "Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance."
Mark Loeb, M.D., M.Sc., from McMaster University, Hamilton, Ontario, Canada, and colleagues conducted a randomized controlled trial of 446 nurses in eight Ontario hospitals to compare the surgical mask with the N95 respirator in protecting health care workers against influenza. The nurses were randomized into two groups: 225 were assigned to receive surgical masks and 221 were assigned to receive the fitted N95 respirator which they were to wear when caring for patients with febrile (fever) respiratory illness. The primary outcome of the study was laboratory-confirmed influenza. Effectiveness of the surgical mask was assessed as non-inferiority of the surgical mask compared with the N95 respirator.
Between September 23, 2008 and December 8, 2008, "influenza infection occurred in 50 nurses (23.6 percent) in the surgical mask group and in 48 (22.9 percent) in the N95 respirator group (absolute risk difference -0.73 percent)," indicating non-inferiority of the surgical mask the authors report. Even among those nurses who had an increased level of the circulating pandemic 2009 H1N1 influenza strain, non-inferiority was demonstrated between the surgical mask group and the N95 respirator group for the 2009 influenza A(H1N1).
"Our data show that the incidence of laboratory-confirmed influenza was similar in nurses wearing the surgical mask and those wearing the N95 respirator. Surgical masks had an estimated efficacy within 1 percent of N95 respirators," the authors write. "That is, surgical masks appeared to be no worse, within a prespecified margin, than N95 respirators in preventing influenza."
In conclusion the authors state: "Our findings apply to routine care in the health care setting. They should not be generalized to settings where there is a high risk for aerosolization, such as intubation or bronchoscopy, where use of an N95 respirator would be prudent. In routine health care settings, particularly where the availability of N95 respirators is limited, surgical masks appear to be non-inferior to N95 respirators for protecting health care workers against influenza."
Influenza is the most important cause of medically attended acute respiratory illness worldwide and the authors write there is heightened concern this year because of the influenza pandemic due to the H1N1 virus. "Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse," the authors provide as background information in the article. "Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance."
Mark Loeb, M.D., M.Sc., from McMaster University, Hamilton, Ontario, Canada, and colleagues conducted a randomized controlled trial of 446 nurses in eight Ontario hospitals to compare the surgical mask with the N95 respirator in protecting health care workers against influenza. The nurses were randomized into two groups: 225 were assigned to receive surgical masks and 221 were assigned to receive the fitted N95 respirator which they were to wear when caring for patients with febrile (fever) respiratory illness. The primary outcome of the study was laboratory-confirmed influenza. Effectiveness of the surgical mask was assessed as non-inferiority of the surgical mask compared with the N95 respirator.
Between September 23, 2008 and December 8, 2008, "influenza infection occurred in 50 nurses (23.6 percent) in the surgical mask group and in 48 (22.9 percent) in the N95 respirator group (absolute risk difference -0.73 percent)," indicating non-inferiority of the surgical mask the authors report. Even among those nurses who had an increased level of the circulating pandemic 2009 H1N1 influenza strain, non-inferiority was demonstrated between the surgical mask group and the N95 respirator group for the 2009 influenza A(H1N1).
"Our data show that the incidence of laboratory-confirmed influenza was similar in nurses wearing the surgical mask and those wearing the N95 respirator. Surgical masks had an estimated efficacy within 1 percent of N95 respirators," the authors write. "That is, surgical masks appeared to be no worse, within a prespecified margin, than N95 respirators in preventing influenza."
In conclusion the authors state: "Our findings apply to routine care in the health care setting. They should not be generalized to settings where there is a high risk for aerosolization, such as intubation or bronchoscopy, where use of an N95 respirator would be prudent. In routine health care settings, particularly where the availability of N95 respirators is limited, surgical masks appear to be non-inferior to N95 respirators for protecting health care workers against influenza."
Childhood Cancer Survivors Exercise Less, Increasing Diabetes Risk..!
In a study of adults who survived cancer as children, St. Jude Children's Research Hospital investigators found that many survivors lead sedentary lifestyles and are more likely to be less physically active than their siblings. Childhood cancer survivors are at greater risk ofdiabetes, obesity and heart disease than the rest of the population.
Cancer treatments such as cranial radiation can damage the hypothalamus and pituitary; the result is an abnormal metabolism, which increases the risk of obesity and diabetes. Also, chemotherapy with the drug anthracycline increases the risk of heart disease; and radiation to the body can cause blood vessels to become less pliant.
"Physical activity is a key step that survivors can take to reduce the health risk of these effects," said Kiri Ness, Ph.D., of the Epidemiology and Cancer Control department at St. Jude. "Medical center programs to encourage physical activity in adult survivors could help significantly. However, one problem is that researchers have not firmly established the factors that affect cancer survivors' participation in physical activity."
To understand those factors, Ness and her colleagues drew data from the Childhood Cancer Survivor Study (CCSS), a St. Jude-led consortium of 30 centers in the United States and Canada. The study gathers extensive data from the participating centers on more than 20,000 childhood cancer survivors who received diagnoses between 1970 and 1986.
The researchers analyzed 9,301 CCSS participants' answers to questions about their physical activity; as a comparison, the scientists also analyzed the same answers given by 2,886 siblings. The investigators compared those answers with information on physical activity obtained from a massive health survey database maintained by the Centers for Disease Control and Prevention.
Because of the cohort's large size, the researchers explored the relationships between health and exercise in all the different types of cancer. Also, because the cohort is older, Ness and her colleagues were able to investigate adult behaviors and relate them back to the data on their childhood cancers.
"Thus, we could identify who has the highest risk of having an inactive lifestyle," Ness said. "Knowing this makes it possible to begin to design interventions that will address the problems that put survivors at most risk."
The researchers found that the cancer survivors showed significant deficits in physical activity compared to their siblings. Survivors were less likely than their siblings to meet physical activity guidelines and more likely to report inactive lifestyles.
"It was particularly striking that 23 percent of the survivors reported that they were completely inactive over the previous month, compared with 14 percent of their siblings," Ness said.
The researchers' analysis revealed that survivors of medulloblastoma, a type of brain tumor, and osteosarcoma, a type of bone cancer, reported the most inactive lifestyles. Also associated with inactivity were treatments with cranial irradiation or amputation as well as other factors, including gender, race, age and education level. If survivors smoked, were underweight or obese or had suffered from depression, they were also prone to inactivity.
Ness hopes the findings will spark more research on the role of fitness in cancer survivors' quality of life, as well as the design of facilities and programs to encourage good fitness in survivors.
"For instance, if we know that patients with medulloblastoma who received cranial irradiation are at a high risk for having inactive lifestyles as adults, we might design a rehabilitation program they can undergo while they are still children to encourage physical activity as they age," she said.
Ness and her colleagues plan to investigate whether programs to encourage exercise in both children and adult childhood cancer survivors can help them avoid obesity, diabetes and other health problems.
Experts Available:
Kiri Ness, Ph.D., is an assistant member is the St. Jude Department of Epidemiology and Cancer Control. Ness' research focuses on cancer survivors, working with children and adults, many of whom have chronic diseases as a result of the cancer or its treatment. Ness can offer expertise on topics such as clinical and population measurement of physical performance and disability; exercise and physical activity intervention for chronic disease in childhood; the impact of disability on quality of life and life satisfaction; and obesity and metabolic syndrome in long-term cancer survivors.
Les Robinson, Ph.D., is chair of the St. Jude Epidemiology and Cancer Control department and co-leader of the Cancer Prevention and Control Program at St. Jude, a multi-disciplinary team endeavor to conduct cancer-related research on outcomes and interventions among pediatric and adolescent populations. He is an expert on the epidemiology and etiology of childhood cancer; cancer survivorship; outcomes research and clinical trials in cancer prevention and control. Robinson is a principle investigator with the Childhood Cancer Survivor Study.
Cancer treatments such as cranial radiation can damage the hypothalamus and pituitary; the result is an abnormal metabolism, which increases the risk of obesity and diabetes. Also, chemotherapy with the drug anthracycline increases the risk of heart disease; and radiation to the body can cause blood vessels to become less pliant.
"Physical activity is a key step that survivors can take to reduce the health risk of these effects," said Kiri Ness, Ph.D., of the Epidemiology and Cancer Control department at St. Jude. "Medical center programs to encourage physical activity in adult survivors could help significantly. However, one problem is that researchers have not firmly established the factors that affect cancer survivors' participation in physical activity."
To understand those factors, Ness and her colleagues drew data from the Childhood Cancer Survivor Study (CCSS), a St. Jude-led consortium of 30 centers in the United States and Canada. The study gathers extensive data from the participating centers on more than 20,000 childhood cancer survivors who received diagnoses between 1970 and 1986.
The researchers analyzed 9,301 CCSS participants' answers to questions about their physical activity; as a comparison, the scientists also analyzed the same answers given by 2,886 siblings. The investigators compared those answers with information on physical activity obtained from a massive health survey database maintained by the Centers for Disease Control and Prevention.
Because of the cohort's large size, the researchers explored the relationships between health and exercise in all the different types of cancer. Also, because the cohort is older, Ness and her colleagues were able to investigate adult behaviors and relate them back to the data on their childhood cancers.
"Thus, we could identify who has the highest risk of having an inactive lifestyle," Ness said. "Knowing this makes it possible to begin to design interventions that will address the problems that put survivors at most risk."
The researchers found that the cancer survivors showed significant deficits in physical activity compared to their siblings. Survivors were less likely than their siblings to meet physical activity guidelines and more likely to report inactive lifestyles.
"It was particularly striking that 23 percent of the survivors reported that they were completely inactive over the previous month, compared with 14 percent of their siblings," Ness said.
The researchers' analysis revealed that survivors of medulloblastoma, a type of brain tumor, and osteosarcoma, a type of bone cancer, reported the most inactive lifestyles. Also associated with inactivity were treatments with cranial irradiation or amputation as well as other factors, including gender, race, age and education level. If survivors smoked, were underweight or obese or had suffered from depression, they were also prone to inactivity.
Ness hopes the findings will spark more research on the role of fitness in cancer survivors' quality of life, as well as the design of facilities and programs to encourage good fitness in survivors.
"For instance, if we know that patients with medulloblastoma who received cranial irradiation are at a high risk for having inactive lifestyles as adults, we might design a rehabilitation program they can undergo while they are still children to encourage physical activity as they age," she said.
Ness and her colleagues plan to investigate whether programs to encourage exercise in both children and adult childhood cancer survivors can help them avoid obesity, diabetes and other health problems.
Experts Available:
Kiri Ness, Ph.D., is an assistant member is the St. Jude Department of Epidemiology and Cancer Control. Ness' research focuses on cancer survivors, working with children and adults, many of whom have chronic diseases as a result of the cancer or its treatment. Ness can offer expertise on topics such as clinical and population measurement of physical performance and disability; exercise and physical activity intervention for chronic disease in childhood; the impact of disability on quality of life and life satisfaction; and obesity and metabolic syndrome in long-term cancer survivors.
Les Robinson, Ph.D., is chair of the St. Jude Epidemiology and Cancer Control department and co-leader of the Cancer Prevention and Control Program at St. Jude, a multi-disciplinary team endeavor to conduct cancer-related research on outcomes and interventions among pediatric and adolescent populations. He is an expert on the epidemiology and etiology of childhood cancer; cancer survivorship; outcomes research and clinical trials in cancer prevention and control. Robinson is a principle investigator with the Childhood Cancer Survivor Study.
Baylor Health Care System To Transform South Dallas Recreation Center Into New Diabetes Institute!..
South Dallas residents are 30 percent more likely to be admitted to a hospital due todiabetes or a diabetes-related condition than other city residents. In fact by 2010, 13 percent of those living in South Dallas will be diabetic.
Baylor Health Care System is reaching out to the traditionally underserved neighborhood, transforming a local recreation center into the area's first and only diabetes health and wellness institute. Baylor will invest $15 million in the project with the mission of saving lives through improved diabetes care, education and research. The new institute is expected to open in Spring 2010.
The focus of the Diabetes Health and Wellness Institute at Juanita J. Craft Recreation Center (Institute) will not only be on treatment, but prevention as well.
The Institute will provide:
- Full-time, on-site physician and nurse practitioner*
- Visiting medical specialists*
- Referral coordinator for specialty and ancillary care
- Diabetes management educator
- Affordable diabetes medications
- Nutrition and healthy cooking classes
- Exercise programs including running and walking clinics and weight training
More About Diabetes In Texas
- According to the Texas Diabetes Council, the prevalence of diabetes in Texans (18 and older) rose to 10.3 percent in 2007
- More than 1.8 million adults in Texas are diabetic, 460,000 are believed to be undiagnosed
- Diabetes is slightly more common in women than men (10.8 percent vs. 9.9 percent)
- Diabetes rates are higher among African Americans (12.9 percent), Hispanics (12.3 percent) and other minorities (11.8 percent) than Whites (8.5 percent)
- The prevalence of diabetes increases with age (2.7 percent for people under 30, 32.2 percent for people 65 and older)
- Diabetes rates decrease as education levels increase (15.8 percent among those without a high school diploma, 6.9 percent among those who attended college)
- One-of-every-five health care dollars is spent caring for someone with diagnosed diabetes
Baylor Health Care System is reaching out to the traditionally underserved neighborhood, transforming a local recreation center into the area's first and only diabetes health and wellness institute. Baylor will invest $15 million in the project with the mission of saving lives through improved diabetes care, education and research. The new institute is expected to open in Spring 2010.
The focus of the Diabetes Health and Wellness Institute at Juanita J. Craft Recreation Center (Institute) will not only be on treatment, but prevention as well.
The Institute will provide:
- Full-time, on-site physician and nurse practitioner*
- Visiting medical specialists*
- Referral coordinator for specialty and ancillary care
- Diabetes management educator
- Affordable diabetes medications
- Nutrition and healthy cooking classes
- Exercise programs including running and walking clinics and weight training
More About Diabetes In Texas
- According to the Texas Diabetes Council, the prevalence of diabetes in Texans (18 and older) rose to 10.3 percent in 2007
- More than 1.8 million adults in Texas are diabetic, 460,000 are believed to be undiagnosed
- Diabetes is slightly more common in women than men (10.8 percent vs. 9.9 percent)
- Diabetes rates are higher among African Americans (12.9 percent), Hispanics (12.3 percent) and other minorities (11.8 percent) than Whites (8.5 percent)
- The prevalence of diabetes increases with age (2.7 percent for people under 30, 32.2 percent for people 65 and older)
- Diabetes rates decrease as education levels increase (15.8 percent among those without a high school diploma, 6.9 percent among those who attended college)
- One-of-every-five health care dollars is spent caring for someone with diagnosed diabetes
Alcohol ups men's sexual performance!
 According to News.com.au , the boffins believe that the latest finding will reassure blokes who worry about the affects of drinking on their sex lives. Until now, it has been widely believed that boozing could cause erectile dysfunction, commonly called ‘brewer's droop'. However, the latest study of 1580 Australian men has shown the reverse may be true – since drinkers reporting as many as 30 per cent fewer problems than teetotalers. In fact, binge drinkers had lower rates of erectile dysfunction than those who never drank, although this type of drinking can cause other health problems. According to lead researcher Dr Kew-Kim Chew, of Western Australia's Keogh Institute for Medical Research, who told The Sunday Telegraph, men who drank within safe guidelines appeared to have the best erectile function. "We found that, compared to those who have never touched alcohol, many people do benefit from some alcohol, including some people who drink outside the guidelines,'''' Dr Chew said. | ||
Provectus Initiates Phase 1 Trial Of PV-10 For Liver Cancer!
Provectus Pharmaceuticals, Inc. (OTC BB: PVCT), a development-stage oncology and dermatology biopharmaceutical company, has initiated a Phase 1 study of PV-10 for liver cancer. The study will enroll up to six subjects with cancer metastatic to the liver or with recurrent liver cancer. PV-10 is the company's lead oncology drug candidate that is also currently undergoing Phase 2 study for metastaticmelanoma.
The primary objective of the open-label study is to determine the safety and tolerability of a single intralesional injection of PV-10 in patients with cancer of the liver. Additional objectives are to assess the distribution and retention of PV-10 in the injected lesion, tumor response and viability, and plasma pharmacokinetics of PV-10 following intralesional injection. In each of two planned dose cohorts there will be three subjects. Dose escalation will occur following assessment of safety and tolerability in the first cohort. Dr. Paul Goldfarb, M.D., of Sharp Memorial Hospital in San Diego, will be the Principal Investigator for the study, which is expected to begin enrolling subjects within the next several weeks.
Dr. Craig Dees, PhD, CEO of Provectus said, "Patients with liver cancer currently have very little choice and a terrible prognosis if the cancer cannot be fully removed through surgery, as the disease is usually deadly within months. We hope to demonstrate that PV-10, which has shown excellent selectivity for melanoma, will be a viable therapeutic for liver cancer and cancers metastatic to the liver."
Malignant lesions in the liver arising from primary hepatocellular carcinoma (HCC) or metastases from a wide range of cancers represent an ongoing treatment challenge for oncologists. HCC is one of the most common malignancies worldwide, and its incidence is rapidly increasing in the United States. The liver is a common site of metastases from solid tumors, particularly those arising in the gastrointestinal tract. Other tumors, such as lung and breast cancer and melanoma, also readily spread to the liver.
About PV-10
PV-10 is a proprietary, injectable formulation of Rose Bengal, a compound that has been in use for nearly thirty years by ophthalmologists to assess damage to the eye. It has also been used as an intravenous diagnostic to detect ailments of the liver. Rose Bengal has an established safety history, a short half-life in the bloodstream, and is excreted via the liver and kidneys. Provectus has discovered a novel use for Rose Bengal based on the observation that it is selectively toxic to cancer calls via a process called chemoablation whereby cells undergo a form of cell death that mimics both features of necrosis and apoptosis.
The primary objective of the open-label study is to determine the safety and tolerability of a single intralesional injection of PV-10 in patients with cancer of the liver. Additional objectives are to assess the distribution and retention of PV-10 in the injected lesion, tumor response and viability, and plasma pharmacokinetics of PV-10 following intralesional injection. In each of two planned dose cohorts there will be three subjects. Dose escalation will occur following assessment of safety and tolerability in the first cohort. Dr. Paul Goldfarb, M.D., of Sharp Memorial Hospital in San Diego, will be the Principal Investigator for the study, which is expected to begin enrolling subjects within the next several weeks.
Dr. Craig Dees, PhD, CEO of Provectus said, "Patients with liver cancer currently have very little choice and a terrible prognosis if the cancer cannot be fully removed through surgery, as the disease is usually deadly within months. We hope to demonstrate that PV-10, which has shown excellent selectivity for melanoma, will be a viable therapeutic for liver cancer and cancers metastatic to the liver."
Malignant lesions in the liver arising from primary hepatocellular carcinoma (HCC) or metastases from a wide range of cancers represent an ongoing treatment challenge for oncologists. HCC is one of the most common malignancies worldwide, and its incidence is rapidly increasing in the United States. The liver is a common site of metastases from solid tumors, particularly those arising in the gastrointestinal tract. Other tumors, such as lung and breast cancer and melanoma, also readily spread to the liver.
About PV-10
PV-10 is a proprietary, injectable formulation of Rose Bengal, a compound that has been in use for nearly thirty years by ophthalmologists to assess damage to the eye. It has also been used as an intravenous diagnostic to detect ailments of the liver. Rose Bengal has an established safety history, a short half-life in the bloodstream, and is excreted via the liver and kidneys. Provectus has discovered a novel use for Rose Bengal based on the observation that it is selectively toxic to cancer calls via a process called chemoablation whereby cells undergo a form of cell death that mimics both features of necrosis and apoptosis.
Healthy pregnancy diet!
When a woman gets the news of her pregnancy, she also gets a lot of advices regarding the diet during pregnancy, what to eat and what not to eat. As the mother is responsible for the health of the unborn baby, so the most important things are healthy pregnancy diet that concerns the well being of the mother and her baby.
For the proper development and growth of the unborn baby a healthy diet is very important. To make sure that the baby has a trouble free journey into the world, it is important to follow a nutritious and healthy diet regime. From her regular diet, a pregnant woman must consume more than 300 calories. For whole nine months, eating and digesting so many calories a day can be a tedious task at first glance but at least she can do it for her baby, thinking about the welfare of her baby.
With proper consultation with the dietitian, diet for healthy pregnancy must be planned. For the betterment of your ‘happy days’, try to have a balanced diet. Pregnancy exercises and timely medical examinations are very important factors for a healthy pregnancy. Pregnant woman has to keep her mood always happy as it will help in the development of her child’s mental health and it is as important as the physical health. To ensure and safeguard a happy and healthy pregnancy, take healthy diet during pregnancy.
Healthy Pregnancy Diet:
During the first trimester of the pregnancy, the signs of morning sickness and cravings are experienced by a pregnant woman. For the health of unborn baby, a balanced diet must be maintained. The foods that must be a part of the daily diet of a pregnant woman are following.
High Fiber Diet:
A pregnant woman must include fiber rich foods in her daily diet. Fiber rich foods are the best source for all the requirements of unborn baby. Food products like whole wheat breads, rice, whole grains, raw fruits, cereals, loads of green leafy vegetable and cooked beans are the high fiber diet. During pregnancy, these foods are a great source of energy. A pregnant woman must include around 5-10 servings of high fiber diet in the daily diet and Meat, fish dairy and poultry in adequate quantity as well.
Calcium and Vitamins:
In the healthy diet during pregnancy Calcium rich foods and those high in vitamin and minerals should be included. To avoid any complications in the pregnancy, decent levels of vitamin D and folic acid must be maintained. Fish, fruits and vegetables must be eaten by the pregnant woman to maintain the Protein levels, omega-3 fatty acids and vitamin C levels. For healthy blood circulation, Iron rich food must be consumed. Pregnant woman can opt for calcium and vitamin supplements on the doctor’s advice.
Distribution of Meals:
During pregnancy, a better way is that distribution of the meal into equal 5-6 mini meals rather than 3-4 whole meals. Expecting mother must consume at least 3 servings of dairy products, 27 mg of iron, 1200 mg of calcium, 70 mg of vitamin C and vitamin A (less than 1000 IU) each day. At least 6 to 8 glasses of water must be consumed everyday, it is important.
Things to Avoid During Pregnancy
During pregnancy, there are some things that must be avoided, as they might cause trouble to the health of the mother as well as the child. Raw meat items, soft cheeses fishes which are high on mercury levels, and deli meats are the Foods which are avoided during pregnancy. To prevent food poisoning during pregnancy, these foods must be avoided. In order to safeguard the health of the child and the mother-to-be, along with these food items, alcohol and smoking must be completely avoided.
Premature babies, mental retardation and low weight in the newborn babies are held by drinking alcohol, so Stop drinking alcohol. Pregnant woman has to control the intake of coffee, chocolates and cola drinks to minimize the daily caffeine intake to maximum 300 mg a day. For weight loss or any such purposes, do not try to follow a diet.
For more information of healthy pregnancy diet see
10 Ways to Beat Back Pains.......?
10 Ways to Beat Back Pain
Eighty percent of all men suffer from back pain. Feel better faster with our guide to preventing injury, standing taller, and looking leaner—instantly.
1. Aim for a Dozen Crunches Every Day
Seventy-five percent of all lower-back problems can be prevented by building your abs muscles. When your abs are weak, the muscles of your butt and the backs of your legs have to work harder to keep your spine stable.
2. Change Posture Frequently
This varies the location of the stress on your spine, instead of focusing all of it on the same area. Try putting your feet up or leaning your chair back, while maintaining the natural arch in your back.
3. Squeeze Your Butt Muscles When You Lift Weights over Your Head
You'll force your body into a position that automatically stabilizes your spine, which lowers your risk of back injuries.
4. Leave Work at 5 p.m.
A University of Massachusetts study found that men who worked overtime had a 61 percent higher risk of an on-the-job injury than those who punched out after 8 straight hours, with back pain topping the list of complaints.
5. Trade Your Office Chair for a Swiss Ball
Use it instead of a desk chair for 15 to 20 minutes every hour. Not only will the ball keep you in perpetual motion, but it'll also strengthen your core muscles, alleviating another side effect of too much sitting: back pain.
6. Drink a Glass of Milk
Not only does research show that low levels of D can increase your risk of osteoporosis by as much as 300 percent, but a recent study found that 80 percent of back-pain sufferers were light on vitamin D.
7. Adjust Your Car Seat
If you recline the seat so far back that you have to crane your neck to see in front of you, you're putting a dangerous strain on the lower neck. You should be able to see a full view of the road with your head against the headrest.
8. Readjust Your Pillows
If you're a side sleeper, draw your legs up toward your chest and place a pillow between your knees. If you sleep on your back, place a pillow under your knees to save 8 hours of back stress. And if you like sleeping on your gut, stuff a small pillow under your abdomen to keep your lower back from sagging.
9. Lose the Wallet
Sitting on a thick billfold can put pressure on your sciatic nerve, the major nerve running through the buttocks.
10. See Your Tailor
Your aching back may be due to one of your legs being shorter than the other. Even a short imbalance can cause the spine to curve to the short side when you walk or run. Ask your tailor for a quick measurement, and if necessary, see your doctor.
Eighty percent of all men suffer from back pain. Feel better faster with our guide to preventing injury, standing taller, and looking leaner—instantly.
1. Aim for a Dozen Crunches Every Day
Seventy-five percent of all lower-back problems can be prevented by building your abs muscles. When your abs are weak, the muscles of your butt and the backs of your legs have to work harder to keep your spine stable.
2. Change Posture Frequently
This varies the location of the stress on your spine, instead of focusing all of it on the same area. Try putting your feet up or leaning your chair back, while maintaining the natural arch in your back.
3. Squeeze Your Butt Muscles When You Lift Weights over Your Head
You'll force your body into a position that automatically stabilizes your spine, which lowers your risk of back injuries.
4. Leave Work at 5 p.m.
A University of Massachusetts study found that men who worked overtime had a 61 percent higher risk of an on-the-job injury than those who punched out after 8 straight hours, with back pain topping the list of complaints.
5. Trade Your Office Chair for a Swiss Ball
Use it instead of a desk chair for 15 to 20 minutes every hour. Not only will the ball keep you in perpetual motion, but it'll also strengthen your core muscles, alleviating another side effect of too much sitting: back pain.
6. Drink a Glass of Milk
Not only does research show that low levels of D can increase your risk of osteoporosis by as much as 300 percent, but a recent study found that 80 percent of back-pain sufferers were light on vitamin D.
7. Adjust Your Car Seat
If you recline the seat so far back that you have to crane your neck to see in front of you, you're putting a dangerous strain on the lower neck. You should be able to see a full view of the road with your head against the headrest.
8. Readjust Your Pillows
If you're a side sleeper, draw your legs up toward your chest and place a pillow between your knees. If you sleep on your back, place a pillow under your knees to save 8 hours of back stress. And if you like sleeping on your gut, stuff a small pillow under your abdomen to keep your lower back from sagging.
9. Lose the Wallet
Sitting on a thick billfold can put pressure on your sciatic nerve, the major nerve running through the buttocks.
10. See Your Tailor
Your aching back may be due to one of your legs being shorter than the other. Even a short imbalance can cause the spine to curve to the short side when you walk or run. Ask your tailor for a quick measurement, and if necessary, see your doctor.
Scientists Create Wireless Heart Pump...
Scientists in New Zealand have announced the development of a wireless heart pump that could prove to be an effective alternative to heart transplant surgery.
"We would very much like for it to be the preferred choice for patients to be able to choose this type of pump over a heart transplant, said David Budgett of the University of Auckland.
Scientists said the wireless pump uses magnetic fields to transfer power through a person’s skin rather than using wire cables. This allows for continuous power.
The pump was created through collaboration between scientists from The University of Auckland’s Bioengineering Institute, Department of Electrical and Computer Engineering and Department of Physiology.
Scientists also said they created a new company, called TETCor, that will market the new technology.
“This new wireless heart pump weights only 92 grams and measures just seven centimeters by three centimeters,” said TETCor CEO Dr Simon Malpas.
“It uses a coil outside a person’s body to generate a magnetic field. A second coil placed inside a person’s body, near the collar bone, picks up the signal from this field and creates power for the pump.”
“These wireless heart pumps could be implanted in about 50,000 people each year around the world within 10 years. It’s probably the most extreme implantable medical device you can get. If these pumps stop, you only have about one minute to live.”
TETCor has licensed the technology to the US medical company MicroMed, creating a joint partnership that will combine the power transfer technology with the pump technology, and plan to begin patient trials within 24 months.
"We would very much like for it to be the preferred choice for patients to be able to choose this type of pump over a heart transplant, said David Budgett of the University of Auckland.
Scientists said the wireless pump uses magnetic fields to transfer power through a person’s skin rather than using wire cables. This allows for continuous power.
The pump was created through collaboration between scientists from The University of Auckland’s Bioengineering Institute, Department of Electrical and Computer Engineering and Department of Physiology.
Scientists also said they created a new company, called TETCor, that will market the new technology.
“This new wireless heart pump weights only 92 grams and measures just seven centimeters by three centimeters,” said TETCor CEO Dr Simon Malpas.
“It uses a coil outside a person’s body to generate a magnetic field. A second coil placed inside a person’s body, near the collar bone, picks up the signal from this field and creates power for the pump.”
“These wireless heart pumps could be implanted in about 50,000 people each year around the world within 10 years. It’s probably the most extreme implantable medical device you can get. If these pumps stop, you only have about one minute to live.”
TETCor has licensed the technology to the US medical company MicroMed, creating a joint partnership that will combine the power transfer technology with the pump technology, and plan to begin patient trials within 24 months.
Current Life Expectancy Trends And Challenges: Will We Live To Be 100 Years?
A review in this week's edition of The Lancet discusses the challenges of an aging population. If current life expectancy trends continue, more than half of babies born in rich nations today will live to 100 years. Not only are we living longer, but those added years are spent with less disability and fewer limitations on daily life than in the past. In addition, preliminary evidence suggests shortened working weeks over extended working lives might further extend increases in life expectancy and health. The review is the work of Professor Kaare Christensen, of the Danish Ageing Research Centre, University of Southern Denmark, Denmark, and colleagues.
During the 20th century, enormous increases in life expectancy of more than 30 years have been seen in most developed countries. Death rates in nations with the longest life-expectancy, such as Japan, Sweden, Spain suggest that, even if health conditions do not improve, three-quarters of babies will live to see their 75th birthdays. If life expectancy continues to improve at the same rate, most babies born in rich nations since 2000 can expect to live to 100 years. Consequently, disease and disability rates in old age will have an increasing effect on the sustainability of modern society. The increases in life expectancy in rich countries, apparent since 1840, show no signs of slowing.
The authors explain: "The linear increase in record life expectancy for more than 165 years does not suggest a looming limit to human lifespan. If life expectancy were approaching a limit, some deceleration of progress would probably occur. Continued progress in the longest living populations suggests that we are not close to a limit, and further rise in life expectancy seems likely."
In rich nations, mortality in people older than 80 years is still declining. According to data from more than thirty developed countries, in 1950 the probability of survival from age 80 to 90 years was on average 15 to 16 percent for women and 12 percent for men. In 2002, these values were 37 percent and 25 percent. Since the death rates of children and young adults are very low in these nations, additional increases in life expectancy will be achieved through further improvements in the oldest age groups.
The authors use Germany as a case study. They demonstrate how the German population will be significantly older and smaller than it is now, in 2050. This prediction is as well representative of other developed nations.
Due to more people living longer, overall cancer incidence is rising. Other chronic diseases such as diabetes and arthritis are also rising. Cardiovascular disease prevalence is also increasing. This is attributed to the fact that cardiovascular mortality is decreasing. As a result more people are alive with it since less are dying from it, in any particular age group. The answer to quality of life in old age is functional ability, and how it affects the activities of daily living (ADL). The activities that are central to self-care are called basic ADL. They are:
• bathing or showering
• continence
• dressing
• feeding
• transferring from bed and chair
Disability in instrumental ADL refers to disabilities affecting a broad range of activities such as:
• doing laundry
• handling drugs
• housekeeping
• managing finances
• preparation of food
• shopping
• telephone use
• using transport
After measuring these indicators, there is increasing evidence suggesting that disability prevalence has been declining.
A common indicator of disability-free life expectancy is being developed by the European Health Expectancy Monitoring Unit. It is named healthy life years (HLY). Time trends are available for 14 European countries between 1995 and 2003. Individuals who answer to the European Community Household Panel question "Are you hampered in your daily activities by any physical or mental health problem, illness or disability?" by "moderate" or "severe", are defined as disabled. On the basis of this measure, differences in HLY in European countries are large, even among countries with similar yearly rates of increase in life expectancy.
Some countries show a rise:
• For men: Austria, Belgium, Italy, Finland, and Germany.
• For women: Belgium, Italy and Sweden.
Some countries show stagnation:
• For men: France, Greece, Ireland, and Spain.
• For women: Austria, Denmark, UK, Finland, France, Spain, and UK.
Some countries show reduction:
• For men: Denmark, Portugal, Netherlands, Sweden, and UK.
• For women: Germany, Greece, Ireland, Netherlands, and Portugal.
This is estimated in the proportion of years spent disability-free at ages 65 years and older. Inequalities in HLY are even greater if all 25 countries of the EU are considered.
A series of studies has reported larger improvements in disability-free life expectancy than in life expectancy. A comparison of four health surveys in France concludes that gains in life expectancy over recent decades might have added years with moderate difficulties but not years with severe difficulties. This finding is corroborated by German and Belgian research. The authors explain: "Continued improvement of health trajectories depends on improvement in elderly people, although the foundation for this progress might partly be based on enhanced living conditions and lifestyle early in life. Progress towards improvement of health is likely to depend on public health efforts to - for example, combat smoking, obesity, low levels of exercise, poor diets, and excess drinking, and to provide improved living conditions and care for elderly people with several ailments."
The issue is whether we are not only living longer, but also better. For people younger than 85 years, most of the evidence suggests a postponement of limitations and disabilities. This is despite an increase in chronic diseases and conditions. This apparent contradiction is at least partly accounted for by early diagnosis, improved treatment, and amelioration of prevalent diseases so that they are less disabling. People younger than 85 years are living longer. Generally, they are capable to manage their daily activities for longer than were previous cohorts.
The situation is not as obvious for people aged older than 85 years. There is little information. Also, there is widespread concern that exceptional longevity has grim results both for individuals and for societies. The authors debate on the "common view in clinical medicine and among some gerontologists that the substantial rise in proportion of exceptionally long-lived individuals in successive birth cohorts is the result of help given to an increasing proportion of frail and ill people into advanced old age, with huge personal and societal costs."
According to Danish research, the proportion of independent individuals is similar in those aged 100 to those aged 92 to 93 years. Consequently, the fact that more people live longer puts a greater burden on society as a whole. But exceptional longevity does not mean exceptional levels of disability. However, it is the overall financial burden of aging populations that is causing most concern to developed nations. The old-age dependency ratio is the number of people aged over 65 years divided by those of working ages (15 to 64 years). In Germany, for every 100 people aged 15 to 64 years, the number aged 65 and over has gone from 16 in 1956 to 29 in 2006, and is expected to reach 60 by 2056.
The authors recommend a redistribution of employment as a possible strategy to cope with the economic implications of aging. They remark: "If people in their 60s and early 70s worked much more than they do nowadays, then most people could work fewer hours per week than is currently common - if they worked correspondingly more years of their longer lives. ...Preliminary evidence suggests that shortened working weeks over extended working lives might further contribute to increases in life expectancy and health. Redistribution of work will, however, not be sufficient to meet the coming challenges. Even if the health of individuals at any particular age improves, there could be an increased total burden if the number of individuals at that age rises sufficiently."
They write in conclusion: "Increasing numbers of people at old and very old ages will pose major challenges for health-care systems. Present evidence, however, suggests that people are not only living longer than they did previously, but also they are living longer, with less disability and fewer functional limitations."
"Ageing populations: the challenges ahead"
Kaare Christensen, Gabriele Doblhammer, Roland Rau, James W Vaupel
Lancet 2009; 374: 1196-208
The Lancet
During the 20th century, enormous increases in life expectancy of more than 30 years have been seen in most developed countries. Death rates in nations with the longest life-expectancy, such as Japan, Sweden, Spain suggest that, even if health conditions do not improve, three-quarters of babies will live to see their 75th birthdays. If life expectancy continues to improve at the same rate, most babies born in rich nations since 2000 can expect to live to 100 years. Consequently, disease and disability rates in old age will have an increasing effect on the sustainability of modern society. The increases in life expectancy in rich countries, apparent since 1840, show no signs of slowing.
The authors explain: "The linear increase in record life expectancy for more than 165 years does not suggest a looming limit to human lifespan. If life expectancy were approaching a limit, some deceleration of progress would probably occur. Continued progress in the longest living populations suggests that we are not close to a limit, and further rise in life expectancy seems likely."
In rich nations, mortality in people older than 80 years is still declining. According to data from more than thirty developed countries, in 1950 the probability of survival from age 80 to 90 years was on average 15 to 16 percent for women and 12 percent for men. In 2002, these values were 37 percent and 25 percent. Since the death rates of children and young adults are very low in these nations, additional increases in life expectancy will be achieved through further improvements in the oldest age groups.
The authors use Germany as a case study. They demonstrate how the German population will be significantly older and smaller than it is now, in 2050. This prediction is as well representative of other developed nations.
Due to more people living longer, overall cancer incidence is rising. Other chronic diseases such as diabetes and arthritis are also rising. Cardiovascular disease prevalence is also increasing. This is attributed to the fact that cardiovascular mortality is decreasing. As a result more people are alive with it since less are dying from it, in any particular age group. The answer to quality of life in old age is functional ability, and how it affects the activities of daily living (ADL). The activities that are central to self-care are called basic ADL. They are:
• bathing or showering
• continence
• dressing
• feeding
• transferring from bed and chair
Disability in instrumental ADL refers to disabilities affecting a broad range of activities such as:
• doing laundry
• handling drugs
• housekeeping
• managing finances
• preparation of food
• shopping
• telephone use
• using transport
After measuring these indicators, there is increasing evidence suggesting that disability prevalence has been declining.
A common indicator of disability-free life expectancy is being developed by the European Health Expectancy Monitoring Unit. It is named healthy life years (HLY). Time trends are available for 14 European countries between 1995 and 2003. Individuals who answer to the European Community Household Panel question "Are you hampered in your daily activities by any physical or mental health problem, illness or disability?" by "moderate" or "severe", are defined as disabled. On the basis of this measure, differences in HLY in European countries are large, even among countries with similar yearly rates of increase in life expectancy.
Some countries show a rise:
• For men: Austria, Belgium, Italy, Finland, and Germany.
• For women: Belgium, Italy and Sweden.
Some countries show stagnation:
• For men: France, Greece, Ireland, and Spain.
• For women: Austria, Denmark, UK, Finland, France, Spain, and UK.
Some countries show reduction:
• For men: Denmark, Portugal, Netherlands, Sweden, and UK.
• For women: Germany, Greece, Ireland, Netherlands, and Portugal.
This is estimated in the proportion of years spent disability-free at ages 65 years and older. Inequalities in HLY are even greater if all 25 countries of the EU are considered.
A series of studies has reported larger improvements in disability-free life expectancy than in life expectancy. A comparison of four health surveys in France concludes that gains in life expectancy over recent decades might have added years with moderate difficulties but not years with severe difficulties. This finding is corroborated by German and Belgian research. The authors explain: "Continued improvement of health trajectories depends on improvement in elderly people, although the foundation for this progress might partly be based on enhanced living conditions and lifestyle early in life. Progress towards improvement of health is likely to depend on public health efforts to - for example, combat smoking, obesity, low levels of exercise, poor diets, and excess drinking, and to provide improved living conditions and care for elderly people with several ailments."
The issue is whether we are not only living longer, but also better. For people younger than 85 years, most of the evidence suggests a postponement of limitations and disabilities. This is despite an increase in chronic diseases and conditions. This apparent contradiction is at least partly accounted for by early diagnosis, improved treatment, and amelioration of prevalent diseases so that they are less disabling. People younger than 85 years are living longer. Generally, they are capable to manage their daily activities for longer than were previous cohorts.
The situation is not as obvious for people aged older than 85 years. There is little information. Also, there is widespread concern that exceptional longevity has grim results both for individuals and for societies. The authors debate on the "common view in clinical medicine and among some gerontologists that the substantial rise in proportion of exceptionally long-lived individuals in successive birth cohorts is the result of help given to an increasing proportion of frail and ill people into advanced old age, with huge personal and societal costs."
According to Danish research, the proportion of independent individuals is similar in those aged 100 to those aged 92 to 93 years. Consequently, the fact that more people live longer puts a greater burden on society as a whole. But exceptional longevity does not mean exceptional levels of disability. However, it is the overall financial burden of aging populations that is causing most concern to developed nations. The old-age dependency ratio is the number of people aged over 65 years divided by those of working ages (15 to 64 years). In Germany, for every 100 people aged 15 to 64 years, the number aged 65 and over has gone from 16 in 1956 to 29 in 2006, and is expected to reach 60 by 2056.
The authors recommend a redistribution of employment as a possible strategy to cope with the economic implications of aging. They remark: "If people in their 60s and early 70s worked much more than they do nowadays, then most people could work fewer hours per week than is currently common - if they worked correspondingly more years of their longer lives. ...Preliminary evidence suggests that shortened working weeks over extended working lives might further contribute to increases in life expectancy and health. Redistribution of work will, however, not be sufficient to meet the coming challenges. Even if the health of individuals at any particular age improves, there could be an increased total burden if the number of individuals at that age rises sufficiently."
They write in conclusion: "Increasing numbers of people at old and very old ages will pose major challenges for health-care systems. Present evidence, however, suggests that people are not only living longer than they did previously, but also they are living longer, with less disability and fewer functional limitations."
"Ageing populations: the challenges ahead"
Kaare Christensen, Gabriele Doblhammer, Roland Rau, James W Vaupel
Lancet 2009; 374: 1196-208
The Lancet
Analysis Of National General Practitioner Patient Survey Data In England!
New research published on bmj.com today reports that the GP Patient Survey is a reliable and valid means of providing financial incentives to doctors. Moreover, there is little evidence to support concerns that it has led to unfair payments.
The GP Patient Survey is a component of the Government's commitment to make the NHS more reactive to patients' needs. In 2009, 5.5 million patients registered with over 8,000 general practices in England. They were surveyed about a series of issues, such as how easy or difficult it is for patients to make an appointment at their surgery, satisfaction with opening hours, and the quality of care received from their GP and practice nurses.
There were two questions on access to care linked directly to payments to GPs.
In July 2009, results were published. In general, patients reported favorable experiences and high levels of satisfaction with their general practices. However, numerous GPs argued that not enough patients were surveyed in some practices. In addition, the poor response rate implied that the survey results were prejudiced.
In order to find out more, a team of researchers led by Professor Martin Roland at the University of Cambridge and Professor John Campbell at Peninsula Medical School evaluated the strength of patient responses to the survey.
On the whole, the response rate was 38.2 percent (2.2 million responses). Just as with many other surveys, men, young people, and people living in underprivileged areas were less likely to respond. But the researchers found little indication that this would lead to any direct disadvantage to practices with either low or high response rates for the questions linked to payments.
The authors remark that the two questions which triggered payments to general practitioners were reliable measures of practice performance.
Overall, 97 percent of practices achieved the 90 percent limit for reliability for these two questions. There were 3 percent of practices with insufficient responses needed to meet this threshold. The authors recommend that superior numbers of patients from these practices should be sampled in future rounds of the survey.
"This study suggests that the current survey procedures result in reliable and valid survey estimates of performance at the practice level on the pay for performance items which we examined," write the authors. In addition, there is little indication to support the concern of some general practitioners that low response rates and selective non-response bias have led to systematic unfairness in payments attached to questionnaire scores.
In addition, the study provides a teaching for the UK and for other countries who are considering the use of patient experience as part of pay for performance schemes.
They write in conclusion: "Patient reported measures of quality are an important aspect of care, and the GP Patient Survey represents a major opportunity to improve care on a national scale. None the less, additional refinements of the measurement or compensation process and ongoing dialogue with practising doctors will be essential if the survey is to play an important role in improving in patient experience in the UK."
"Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in England"
Martin Roland, professor of health services research, Marc Elliott, senior statistician, Georgios Lyratzopoulos, clinical senior research associate, Josephine Barbiere, research assistant, Richard A Parker, research assistant, Patten Smith, director of research methods, Peter Bower, reader in health services research, John Campbell, professor of general practice and primary care
BMJ 2009; 339:b3851
doi:10.1136/bmj.b3851
bmj.com
The GP Patient Survey is a component of the Government's commitment to make the NHS more reactive to patients' needs. In 2009, 5.5 million patients registered with over 8,000 general practices in England. They were surveyed about a series of issues, such as how easy or difficult it is for patients to make an appointment at their surgery, satisfaction with opening hours, and the quality of care received from their GP and practice nurses.
There were two questions on access to care linked directly to payments to GPs.
In July 2009, results were published. In general, patients reported favorable experiences and high levels of satisfaction with their general practices. However, numerous GPs argued that not enough patients were surveyed in some practices. In addition, the poor response rate implied that the survey results were prejudiced.
In order to find out more, a team of researchers led by Professor Martin Roland at the University of Cambridge and Professor John Campbell at Peninsula Medical School evaluated the strength of patient responses to the survey.
On the whole, the response rate was 38.2 percent (2.2 million responses). Just as with many other surveys, men, young people, and people living in underprivileged areas were less likely to respond. But the researchers found little indication that this would lead to any direct disadvantage to practices with either low or high response rates for the questions linked to payments.
The authors remark that the two questions which triggered payments to general practitioners were reliable measures of practice performance.
Overall, 97 percent of practices achieved the 90 percent limit for reliability for these two questions. There were 3 percent of practices with insufficient responses needed to meet this threshold. The authors recommend that superior numbers of patients from these practices should be sampled in future rounds of the survey.
"This study suggests that the current survey procedures result in reliable and valid survey estimates of performance at the practice level on the pay for performance items which we examined," write the authors. In addition, there is little indication to support the concern of some general practitioners that low response rates and selective non-response bias have led to systematic unfairness in payments attached to questionnaire scores.
In addition, the study provides a teaching for the UK and for other countries who are considering the use of patient experience as part of pay for performance schemes.
They write in conclusion: "Patient reported measures of quality are an important aspect of care, and the GP Patient Survey represents a major opportunity to improve care on a national scale. None the less, additional refinements of the measurement or compensation process and ongoing dialogue with practising doctors will be essential if the survey is to play an important role in improving in patient experience in the UK."
"Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in England"
Martin Roland, professor of health services research, Marc Elliott, senior statistician, Georgios Lyratzopoulos, clinical senior research associate, Josephine Barbiere, research assistant, Richard A Parker, research assistant, Patten Smith, director of research methods, Peter Bower, reader in health services research, John Campbell, professor of general practice and primary care
BMJ 2009; 339:b3851
doi:10.1136/bmj.b3851
bmj.com
Smart Drugs: Should There Be Routine Doping Tests For Exam Students?..
An article in the Journal of Medical Ethics reports that the rising use of smart drugs or "nootropics" to enhance academic performance, could lead to routine doping tests in the future for exam students.
Vince Cakic of the Department of Psychology, from the University of Sydney, explains that despite raising many dilemmas about the legitimacy of chemically enhanced academic performance, these drugs will be near impossible to ban.
He finds similarities with doping in competitive sports. It is suggested that "95%" of elite athletes have used performance enhancing drugs.
He claims: "It is apparent that the failures and inconsistencies inherent in anti doping policy in sport will be mirrored in academia unless a reasonable and realistic approach to the issue of nootropics is adopted."
"But what this should be is far from clear, especially given the ready availability of these types of drugs for therapeutic use," declares Mr Cakic. He evokes the idea of urine tests for exam students.
He explains: "As laughable as it may seem, it is possible that scenarios such as this could very well come to fruition in the future. However, given that the benefits of nootropics could also be derived from periods of study at any time leading up to examinations, this would also require drug testing during non-exam periods."
"If the current situation in competitive sport is anything to go by, any attempt to prohibit the use of nootropics will probably be difficult or inordinately expensive to police effectively," he warns.
Originally, Nootropics were designed to help people with cognitive problems, such as dementia and attention deficit disorder. But now students with a threatening deadline have several options: modafinil (Provigil), methylphenidate (Ritalin), and amphetamine (Dexedrine).
Mr Cakic explains that the non-medical use of methylphenidate and amphetamine is as high as 25 percent on some US college campuses. It is particularly the case in colleges with more competitive admission criteria.
Drugs to enhance memory retention are brahmi, piracetam (Nootropil), donepezil (Aricept) and galantamine (Reminyl). And for boosting energy there is selegiline (Deprenyl).
The impact of these drugs is as yet "modest," says Mr Cakic. However more potent versions could be soon developed. He says: "The possibility of purchasing 'smartness in a bottle' is likely to have broad appeal to students." They are in quest of an advantage in an ever more competitive world.
There is disagreement on the proposal that these drugs should be prohibited for non-medical use because they give unfair advantage.
So far the only sensible reason to restrict the use of these smart drugs is that the long term safety of these drugs in healthy people is unclear. Mr Cakic carries on by pointing to the use of caffeine. It is known to enhance sporting performance. Therefore it is a form of 'cheating' that is tolerated because it is relatively harmless.
"Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology"
V Cakic
J Med Ethics 2009; 35: 611-15
doi:10.1136/jme.2009.030882
Journal of Medical Ethics
Written by Stephanie Brunner (B.A.)
Vince Cakic of the Department of Psychology, from the University of Sydney, explains that despite raising many dilemmas about the legitimacy of chemically enhanced academic performance, these drugs will be near impossible to ban.
He finds similarities with doping in competitive sports. It is suggested that "95%" of elite athletes have used performance enhancing drugs.
He claims: "It is apparent that the failures and inconsistencies inherent in anti doping policy in sport will be mirrored in academia unless a reasonable and realistic approach to the issue of nootropics is adopted."
"But what this should be is far from clear, especially given the ready availability of these types of drugs for therapeutic use," declares Mr Cakic. He evokes the idea of urine tests for exam students.
He explains: "As laughable as it may seem, it is possible that scenarios such as this could very well come to fruition in the future. However, given that the benefits of nootropics could also be derived from periods of study at any time leading up to examinations, this would also require drug testing during non-exam periods."
"If the current situation in competitive sport is anything to go by, any attempt to prohibit the use of nootropics will probably be difficult or inordinately expensive to police effectively," he warns.
Originally, Nootropics were designed to help people with cognitive problems, such as dementia and attention deficit disorder. But now students with a threatening deadline have several options: modafinil (Provigil), methylphenidate (Ritalin), and amphetamine (Dexedrine).
Mr Cakic explains that the non-medical use of methylphenidate and amphetamine is as high as 25 percent on some US college campuses. It is particularly the case in colleges with more competitive admission criteria.
Drugs to enhance memory retention are brahmi, piracetam (Nootropil), donepezil (Aricept) and galantamine (Reminyl). And for boosting energy there is selegiline (Deprenyl).
The impact of these drugs is as yet "modest," says Mr Cakic. However more potent versions could be soon developed. He says: "The possibility of purchasing 'smartness in a bottle' is likely to have broad appeal to students." They are in quest of an advantage in an ever more competitive world.
There is disagreement on the proposal that these drugs should be prohibited for non-medical use because they give unfair advantage.
So far the only sensible reason to restrict the use of these smart drugs is that the long term safety of these drugs in healthy people is unclear. Mr Cakic carries on by pointing to the use of caffeine. It is known to enhance sporting performance. Therefore it is a form of 'cheating' that is tolerated because it is relatively harmless.
"Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology"
V Cakic
J Med Ethics 2009; 35: 611-15
doi:10.1136/jme.2009.030882
Journal of Medical Ethics
Written by Stephanie Brunner (B.A.)
Exposure To Tobacco In Unborn Linked To Increased Risk Of Psychotic Symptoms In Later Adolescence..
A new UK study suggests that exposure to tobacco while in the womb is linked to an increased risk of a child developing psychotic symptoms during their teens.
The study was the work of researchers from Cardiff, Bristol, Nottingham and Warwick Universities and was published in the October issue of the British Journal of Psychiatry.
For the study the researchers looked at data on 6,356 12-year-olds taking part in the Avon Longitudinal Study of Parents and Children, which has been following the health and development of the children of over 14,000 mothers who enrolled during pregnancy in 1991 and 1992.
All the children underwent an interview assessment for psychotic-like symptoms, such as hallucinations or delusions, which revealed that just over 11 per cent of them (734) had definite or suspected symptoms of psychosis.
After analyzing the data, the researchers found a link between how much their mothers smoked in pregnancy and the risk of psychotic symptoms in the children. The link was described as a "dose-response effect" where the more a mother smoked while pregnant, the higher the chance that her child would later develop psychotic symptoms.
The researchers also looked at links between the pregnant mothers' use of alcohol and cannabis and higher risk of psychotic symptoms in their offspring.
They found that drinking alcohol during pregnancy was only linked to higher risk of the offspring developing psychotic symptoms for mothers who had drunk more than 21 units a week during the early stage of pregnancy.
Few mothers said they had smoked cannabis while pregnant, and the researchers found no link between use of this drug and later psychotic symptoms in the children. However this could be due to the low numbers.
The study did not examine the reasons for the link between the mothers' use of tobacco and the raised risk of psychotic symptoms in their offsprings' adolescent years, but the researchers speculated that one reason could be exposure to tobacco in the womb may indirectly affect children's impulse control, attention and thinking.
Between 15 and 20 per cent of pregnant women in the UK smoke tobacco.
Lead author Dr Stanley Zammit, a psychiatrist at Cardiff University's School of Medicine told the media that:
"In our cohort, approximately 19 per cent of adolescents who were interviewed had mothers who smoked during pregnancy."
Zammit said assuming the results were non-biased and did reflect an underlying cause and effect relationship then they would estimate that:
"About 20 per cent of adolescents in this cohort would not have developed psychotic symptoms if their mothers had not smoked."
This would mean that smoking during pregnancy may be an important risk factor for the development of psychotic experiences in the population at large, said Zammit.
In their conclusions, Zammit and colleagues called for further studies to investigate the underlying mechanism by which tobacco exposure may affect the development and function of the unborn child's brain.
"Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring."
Zammit S, Thomas K, Thompson A, Horwood J, Menezes P, Gunnell D, Hollis C, Wolke D, Lewis G and Harrison G.
British Journal of Psychiatry, Oct 2009; 195: 294 - 300.
DOI: 10.1192/bjp.bp.108.062471
The study was the work of researchers from Cardiff, Bristol, Nottingham and Warwick Universities and was published in the October issue of the British Journal of Psychiatry.
For the study the researchers looked at data on 6,356 12-year-olds taking part in the Avon Longitudinal Study of Parents and Children, which has been following the health and development of the children of over 14,000 mothers who enrolled during pregnancy in 1991 and 1992.
All the children underwent an interview assessment for psychotic-like symptoms, such as hallucinations or delusions, which revealed that just over 11 per cent of them (734) had definite or suspected symptoms of psychosis.
After analyzing the data, the researchers found a link between how much their mothers smoked in pregnancy and the risk of psychotic symptoms in the children. The link was described as a "dose-response effect" where the more a mother smoked while pregnant, the higher the chance that her child would later develop psychotic symptoms.
The researchers also looked at links between the pregnant mothers' use of alcohol and cannabis and higher risk of psychotic symptoms in their offspring.
They found that drinking alcohol during pregnancy was only linked to higher risk of the offspring developing psychotic symptoms for mothers who had drunk more than 21 units a week during the early stage of pregnancy.
Few mothers said they had smoked cannabis while pregnant, and the researchers found no link between use of this drug and later psychotic symptoms in the children. However this could be due to the low numbers.
The study did not examine the reasons for the link between the mothers' use of tobacco and the raised risk of psychotic symptoms in their offsprings' adolescent years, but the researchers speculated that one reason could be exposure to tobacco in the womb may indirectly affect children's impulse control, attention and thinking.
Between 15 and 20 per cent of pregnant women in the UK smoke tobacco.
Lead author Dr Stanley Zammit, a psychiatrist at Cardiff University's School of Medicine told the media that:
"In our cohort, approximately 19 per cent of adolescents who were interviewed had mothers who smoked during pregnancy."
Zammit said assuming the results were non-biased and did reflect an underlying cause and effect relationship then they would estimate that:
"About 20 per cent of adolescents in this cohort would not have developed psychotic symptoms if their mothers had not smoked."
This would mean that smoking during pregnancy may be an important risk factor for the development of psychotic experiences in the population at large, said Zammit.
In their conclusions, Zammit and colleagues called for further studies to investigate the underlying mechanism by which tobacco exposure may affect the development and function of the unborn child's brain.
"Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring."
Zammit S, Thomas K, Thompson A, Horwood J, Menezes P, Gunnell D, Hollis C, Wolke D, Lewis G and Harrison G.
British Journal of Psychiatry, Oct 2009; 195: 294 - 300.
DOI: 10.1192/bjp.bp.108.062471
US Breast Cancer Deaths Falling But Not For African Americans!!
Despite it being the most common cancer among women, death rates due to breast cancer continue to fall in the US, except for African Americans, where the rate remains steady.
A new American Cancer Society report, Breast Cancer Facts & Figures 2009-2010, released on 30 September, shows that breast cancer deaths have been falling in the US since the early 1990s, with the biggest drops in women under 50.
Researchers suggest the steady rate of decline is probably due to earlier detection through screening and improvements in treatments.
Chief executive officer of the American Cancer Society, Dr John R Seffrin told the media that:
"The steady drop in the breast cancer death rate means that this year alone, about 15,000 breast cancer deaths were avoided that would have occurred had rates not begun to drop."
"Since the early 1990s, that decline adds up to more than 130,000 grandmothers, mothers, and daughters who were alive, perhaps to celebrate another birthday, and even to go on to live a full, rich life," he added.
However, while giving cause to celebrate, the report points out a stark contrast between whites and African Americans.
As of 2006, breast cancer death rates were 38 per cent higher in African American women than white women.
The report highlights possible reasons for the disparity. While white women have higher incidence rates of breast cancer than African American women, two things stand out as different between the two groups. One is that incidence of breast cancer in white women has fallen at a rate of 2 per cent per year since 1999, while they have stayed steady among African American women, and the other is that African American women are more likely to be diagnosed at a later stage, when the cancer is less treatable.
Researchers suggest the dramatic reduction in the number of women using postmenopausal hormone replacement therapy (HRT) following the results of the 2002 Women's Health Initiative study that linked HRT to higher risk of breast cancer could account for some of the decline in breast cancer incidence.
The stable incidence rate among African American women may be partly because they were already low users of HRT, and use of screening like mammography has not gone up in this group.
The report also shows that the number of breast cancer survivors is growing, with figures from January 2006 giving a total of 2.5 million American women living with a history of the disease.
American Cancer Society national volunteer president Dr Elizabeth "Terry" TH Fontham, said:
"While there is much to celebrate in the fight against cancer, this report is also a strong reminder that far too many women still die of breast cancer and of the work yet to be done."
"We need to make sure all women have access to information to help them reduce their risk and to resources to ensure early detection and the best possible treatment," she added.
In a statement to the press, the American Cancer Society was keen to stress that some of the many positive things to emerge from cancer research is that we now know more than ever about the major risk factors for breast cancer, and that many of them are modifiable, including exercise and weight control.
The Society's chief medical officer, Dr Otis W Brawley also highlighted the link between the drop in incidence of breast cancer and reduction in use of HRT, which he referred to as another modifiable risk factor, however, he warned that:
"While that is gratifying to see, we remain concerned about obesity's potential to offset that drop, and lead to an increase in the incidence of breast cancer in the future."
Another way to increase chances of survival is better and earlier screening and detection. Mammograms can find breast cancers earlier, when they are easier to treat and chances of survival are higher.
The American Cancer Society recommends women over 40 should have yearly mammograms and breast exams, while women at high risk, such as those who may be carrying the BRCA gene mutations, should talk to their doctors about getting an MRI as well, they said.
Here are some more steps the Society recommends for women to reduce their risk of getting breast cancer:
* Eat a healthy diet and control your weight because being overweight and obese is a possible risk factor.
* Exercise 30 minutes a day on 5 or more days a week (45 to 60 mins may be even better for reducing breast cancer risk).
* Limit alcohol consumption to no more than 1 drink a day. Alcohol is clearly linked to increased risk of breast cancer.
* Go and see your doctor if you notice any changes in your breasts or are worried about them at all.
A new American Cancer Society report, Breast Cancer Facts & Figures 2009-2010, released on 30 September, shows that breast cancer deaths have been falling in the US since the early 1990s, with the biggest drops in women under 50.
Researchers suggest the steady rate of decline is probably due to earlier detection through screening and improvements in treatments.
Chief executive officer of the American Cancer Society, Dr John R Seffrin told the media that:
"The steady drop in the breast cancer death rate means that this year alone, about 15,000 breast cancer deaths were avoided that would have occurred had rates not begun to drop."
"Since the early 1990s, that decline adds up to more than 130,000 grandmothers, mothers, and daughters who were alive, perhaps to celebrate another birthday, and even to go on to live a full, rich life," he added.
However, while giving cause to celebrate, the report points out a stark contrast between whites and African Americans.
As of 2006, breast cancer death rates were 38 per cent higher in African American women than white women.
The report highlights possible reasons for the disparity. While white women have higher incidence rates of breast cancer than African American women, two things stand out as different between the two groups. One is that incidence of breast cancer in white women has fallen at a rate of 2 per cent per year since 1999, while they have stayed steady among African American women, and the other is that African American women are more likely to be diagnosed at a later stage, when the cancer is less treatable.
Researchers suggest the dramatic reduction in the number of women using postmenopausal hormone replacement therapy (HRT) following the results of the 2002 Women's Health Initiative study that linked HRT to higher risk of breast cancer could account for some of the decline in breast cancer incidence.
The stable incidence rate among African American women may be partly because they were already low users of HRT, and use of screening like mammography has not gone up in this group.
The report also shows that the number of breast cancer survivors is growing, with figures from January 2006 giving a total of 2.5 million American women living with a history of the disease.
American Cancer Society national volunteer president Dr Elizabeth "Terry" TH Fontham, said:
"While there is much to celebrate in the fight against cancer, this report is also a strong reminder that far too many women still die of breast cancer and of the work yet to be done."
"We need to make sure all women have access to information to help them reduce their risk and to resources to ensure early detection and the best possible treatment," she added.
In a statement to the press, the American Cancer Society was keen to stress that some of the many positive things to emerge from cancer research is that we now know more than ever about the major risk factors for breast cancer, and that many of them are modifiable, including exercise and weight control.
The Society's chief medical officer, Dr Otis W Brawley also highlighted the link between the drop in incidence of breast cancer and reduction in use of HRT, which he referred to as another modifiable risk factor, however, he warned that:
"While that is gratifying to see, we remain concerned about obesity's potential to offset that drop, and lead to an increase in the incidence of breast cancer in the future."
Another way to increase chances of survival is better and earlier screening and detection. Mammograms can find breast cancers earlier, when they are easier to treat and chances of survival are higher.
The American Cancer Society recommends women over 40 should have yearly mammograms and breast exams, while women at high risk, such as those who may be carrying the BRCA gene mutations, should talk to their doctors about getting an MRI as well, they said.
Here are some more steps the Society recommends for women to reduce their risk of getting breast cancer:
* Eat a healthy diet and control your weight because being overweight and obese is a possible risk factor.
* Exercise 30 minutes a day on 5 or more days a week (45 to 60 mins may be even better for reducing breast cancer risk).
* Limit alcohol consumption to no more than 1 drink a day. Alcohol is clearly linked to increased risk of breast cancer.
* Go and see your doctor if you notice any changes in your breasts or are worried about them at all.
More People Receiving HIV Treatment In Low And Middle Income Countries, Report..!
A new joint report shows that more than four million people in low and middle income coutries were receiving life-saving treatment for HIV at the end of 2008, representing over one third more than the year before and a ten-fold increase on the number five years earlier.
The new report was released on Wednesday and is titled "Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector Progress report, September 2009". It is the result of collaboration among the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
The report also highlights other gains in scaling up universal access, such as expansion of HIV testing and counselling, and improved access to services to stop HIV being passed from mother to child.
WHO Director-General Margaret Chan told the media that:
"This report shows tremendous progress in the global HIV/AIDS response."
However, we still need to do more, she urged.
"At least 5 million people living with HIV still do not have access to life-prolonging treatment and care," said Chan, explaining that many people in need of prevention still can't access services either.
"Governments and international partners must accelerate their efforts to achieve universal access to treatment," added Chan.
One area that is expanding very fast is access to antiretroviral therapy (ART). The authors reported that of the 9.5 million people in low and middle income countries who need ART, 33 per cent were receiving it in 2007 and only one year later, this figures went up to 42 per cent. The biggest expansion of ART access was in sub-Saharan Africa, where two-thirds of all HIV infections occur.
One of the reasons is that prices of the most commonly used ARTs have come down quite a lot in recent years: the cost of most first line treatments went down by 10 to 40 per cent between 2006 and 2008.
But second-line drugs are still expensive, said the report authors.
And although this recent progress is signficant, access to treatment is still far from meeting need, and many are worried that the current global economic crisis may undermine attempts to hold on to the gains. Many patients are still only being diagnosed too late to give ART a chance of success and many die in their first year of treatment.
The report's highlights show that:
* Among 66 countries covered, data on testing and counselling services shows that the number of health facilities offering them has gone up by 35 per cent between 2007 to 2008.
* The number of people using testing and counselling services has also gone up: 39 countries report a doubling in HIV tests between 2007 to 2008, and 93 per cent of all countries that reported data across all regions offered free HIV tests through public health outlets in 2008.
* But despite this progress the majority of people living with HIV don't know they have it.
* Part of the reason for the low uptake of HIV testing could be poor awareness of how one can become infected with HIV, together with fear of stigma and discrimination, said the report authors.
* Access to HIV services for women and children increased in 2008, with about 45 per cent of HIV-positive pregnant women receiving ART to prevent their babies being born with the virus. This is up from 35 per cent in 2007.
* In 2007 only 15 per cent of pregnant women in low and middle income countries received an HIV test. This figure went up to 21 per cent in 2008.
* 198,000 children needing ART received it in 2007: this figure went up to 275,700 in 2008, representing 38 per cent of the children who needed it.
* In 2008 more information became available about the groups that are most at risk of HIV infection, such as sex workers, men who have sex with men and injected drug users.
* While HIV programs are expanding as a whole, there are considerable technical, legal and sociocultural barriers to accessing HIV healthcare in the high risk groups.
Globally, AIDS is the leading cause of death among women of reproductive age.
Executive Director of UNICEF, Ann M Veneman said:
"Although there is increasing emphasis on women and children in the global HIV/AIDS response, the disease continues to have a devastating impact on their health, livelihood and survival."
Executive Director of UNAIDS, Michel Sidibé said all the evidence points to the number of people who will need HIV treatment rising dramatically in the next few years:
"Ensuring equitable access will be one of our primary concerns and UNAIDS will continue to act as a voice for the voiceless, ensuring that marginalized groups and people most vulnerable to HIV infection have access to the services that are so vital to their wellbeing and to that of their families and communities."
The new report was released on Wednesday and is titled "Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector Progress report, September 2009". It is the result of collaboration among the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
The report also highlights other gains in scaling up universal access, such as expansion of HIV testing and counselling, and improved access to services to stop HIV being passed from mother to child.
WHO Director-General Margaret Chan told the media that:
"This report shows tremendous progress in the global HIV/AIDS response."
However, we still need to do more, she urged.
"At least 5 million people living with HIV still do not have access to life-prolonging treatment and care," said Chan, explaining that many people in need of prevention still can't access services either.
"Governments and international partners must accelerate their efforts to achieve universal access to treatment," added Chan.
One area that is expanding very fast is access to antiretroviral therapy (ART). The authors reported that of the 9.5 million people in low and middle income countries who need ART, 33 per cent were receiving it in 2007 and only one year later, this figures went up to 42 per cent. The biggest expansion of ART access was in sub-Saharan Africa, where two-thirds of all HIV infections occur.
One of the reasons is that prices of the most commonly used ARTs have come down quite a lot in recent years: the cost of most first line treatments went down by 10 to 40 per cent between 2006 and 2008.
But second-line drugs are still expensive, said the report authors.
And although this recent progress is signficant, access to treatment is still far from meeting need, and many are worried that the current global economic crisis may undermine attempts to hold on to the gains. Many patients are still only being diagnosed too late to give ART a chance of success and many die in their first year of treatment.
The report's highlights show that:
* Among 66 countries covered, data on testing and counselling services shows that the number of health facilities offering them has gone up by 35 per cent between 2007 to 2008.
* The number of people using testing and counselling services has also gone up: 39 countries report a doubling in HIV tests between 2007 to 2008, and 93 per cent of all countries that reported data across all regions offered free HIV tests through public health outlets in 2008.
* But despite this progress the majority of people living with HIV don't know they have it.
* Part of the reason for the low uptake of HIV testing could be poor awareness of how one can become infected with HIV, together with fear of stigma and discrimination, said the report authors.
* Access to HIV services for women and children increased in 2008, with about 45 per cent of HIV-positive pregnant women receiving ART to prevent their babies being born with the virus. This is up from 35 per cent in 2007.
* In 2007 only 15 per cent of pregnant women in low and middle income countries received an HIV test. This figure went up to 21 per cent in 2008.
* 198,000 children needing ART received it in 2007: this figure went up to 275,700 in 2008, representing 38 per cent of the children who needed it.
* In 2008 more information became available about the groups that are most at risk of HIV infection, such as sex workers, men who have sex with men and injected drug users.
* While HIV programs are expanding as a whole, there are considerable technical, legal and sociocultural barriers to accessing HIV healthcare in the high risk groups.
Globally, AIDS is the leading cause of death among women of reproductive age.
Executive Director of UNICEF, Ann M Veneman said:
"Although there is increasing emphasis on women and children in the global HIV/AIDS response, the disease continues to have a devastating impact on their health, livelihood and survival."
Executive Director of UNAIDS, Michel Sidibé said all the evidence points to the number of people who will need HIV treatment rising dramatically in the next few years:
"Ensuring equitable access will be one of our primary concerns and UNAIDS will continue to act as a voice for the voiceless, ensuring that marginalized groups and people most vulnerable to HIV infection have access to the services that are so vital to their wellbeing and to that of their families and communities."
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