The human species is dependent for its survival on the billions of microorganisms that inhabit multiple environmental niches within and on the human body. While microbes are commonly associated with diseases and infections, they are also vital in essential, beneficial roles such as digestion, where they help synthesize vitamins and ferment complex indigestible carbohydrates.

The overwhelming majority of microbial species (>99%) resist cultivation in the laboratory. However, recent advances in microbial genomics and sequencing technology have allowed researchers to study microbes in their natural environment. The identification and characterization of these microbial communities will undoubtedly establish links between these microorganisms and disease, their roles in the development of the immune system and their overall impact on human evolution.

Claire Fraser-Liggett, director of the Institute for Genome Sciences at the University of Maryland School of Medicine and a globally recognized microbial genomics scientist, is a lead researcher with the Human Microbiome Project (HMP), an international National Institutes of Health roadmap initiative to study the impact of microbes on human health and disease.

Fraser-Liggett’s research focuses on microbes’ roles in the development of the immune system and their overall impact on human health. Her HMP research has particular emphasis on the human gastrointestinal tract, since this environment is home to the largest number of microbial “partners.” One of the ultimate goals of the HMP is to better understand our microbiota, and, in the future, to be able to optimize the beneficial effects of microbiota for each individual.

“The human GI tract contains the densest concentration of bacteria in our bodies, and studying these GI microbes gives us insights into health and illness in the developed world and in developing countries,” said Fraser-Liggett.

Fraser-Liggett presented a talk at the American Society for Biochemistry and Molecular Biology’s annual meeting titled “The Role of Microbial Communities in Health and Disease” on Monday, April 26. 

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On the Net:

• Federation of American Societies for Experimental Biology
• American Society for Biochemistry and Molecular Biology

New research has confirmed that bad habits, such as smoking, drinking, eating fatty foods, and not getting enough exercise, can cut 12 years off of your life.

A team of researchers studied 4,886 British adult men and women for two decades. They observed four different habits to find out which subjects smoked tobacco regularly, drank two (for women) or three (for men) alcoholic beverages daily, failed to complete at least two hours of physical activity weekly, and ate fewer than three combined servings of fruits and vegetables each day.

Of those who participated in the study, 314 participated in each of the bad habits. Twenty-nine percent of them (91) died during the study. Conversely, 387 individuals practiced none of the high-risk behaviors, and only eight-percent (32) of them passed away during the 20 year span. All subjects were at least 18 years of age, with 44 being the average age.

“The combined effect of poor health behaviors on mortality was substantial, indicating that modest, but sustained, improvements to diet and lifestyle could have significant public health benefits,” lead author Elisabeth Kvaavik of the University of Oslo said, according to the UK newspaper The Daily Mail.

“Developing more efficacious methods by which to promote healthy diets and lifestyles across the population should be an important priority of public health policy,” Dr. Kvaavik added.

According to Associated Press (AP) Medical Writer Lindsey Tanner, “The U.S. government generally recommends at least 4 cups of fruits or vegetables daily for adults, depending on age and activity level; and about 2 1/2 hours of exercise weekly”¦ June Stevens, a University of North Carolina public health researcher, said the results are in line with previous studies that examined the combined effects of health-related habits on longevity.”

The study was published in Monday’s edition of the Archives of Internal Medicine.

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On the Net:

• Archives of Internal Medicine
• University of Oslo

Analysis: Using hospital mortality rates to judge hospital performance: A bad idea that just won’t go away

Mortality rates are a poor measure of the quality of hospital care and should not be a trigger for public inquiries such as the investigation at the Mid Staffordshire hospital, argue experts in a paper published on bmj.com today.

The hospital standardized mortality ratio (HSMR) is used to measure the quality and safety of hospital care in the United Kingdom and around the world. The ratio identifies hospitals where more patients die than would be expected (‘bad’ hospitals) and hospitals with fewer deaths than expected (‘good’ hospitals).

The validity of this ratio has been criticized because it may not adequately adjust for the type of patients treated at a particular hospital (case mix) or account for measurement errors between hospitals. Yet it continues to be used as a measure of quality.

Richard Lilford from the University of Birmingham and Peter Pronovost from Johns Hopkins University School of Medicine, say that “hospital mortality rates are a poor diagnostic test for quality” and “they should not be used to calculate excess deaths resulting from poor care.” They point out that Mid Staffordshire hospital “was blamed for 400 excess deaths on this precarious basis.”

They believe that “the practice is kept alive by well-meaning decision makers who want the idea that mortality reflects quality to be true.”

There is an argument for use of hospital mortality rates as an initial signal for scientific study. But they warn that public inquiries can lead to hospitals being unjustly singled out and may undermine improvements in other areas.

The authors are not arguing that health care providers should be exempt from accountability or that patients should not be protected. On the contrary, they say “the search for robust measurements should not be impeded by fixing prematurely on a parameter that offers false hope.”

As such, they strongly advocate measuring quality by observing selected outcomes (such as blood stream infection rates) that really do reflect quality of care. Above all, however, they argue for increasing use of direct measures of the quality of care by checking hospital case notes as recommended by the House of Commons Select Committee. “Examining selected case notes to ensure that the correct treatment has been given and errors avoided is much more informative than trying to pick out ‘bad apples’ using the blunt instrument of hospital wide mortality rates,” they say.

“If we really want to improve care, then managers are going to have to learn more statistics and statisticians more management. In the meantime, performance management of medical care by hospital mortality is not the answer,” they conclude.

These views are supported in an accompanying editorial which suggests turning to more specialized sources of data to measure the quality of hospital care. Professor Nick Black at the London School of Hygiene & Tropical Medicine says that a shift to this approach “would gain the credibility and support of clinicians and provide a much richer and more valid account for the public of how a hospital was performing.”

This should be accompanied by the abandonment of HMSRs, which are not fit for purpose, he concludes.

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On the Net:

• BMJ-British Medical Journal

A new study shows that when it comes to networks of protein fibers, individual fibers play a substantial role in effectively strengthening an entire network of fibers. The research, published by Cell Press in the April 20th issue of the Biophysical Journal, describes a mechanism that explains how individual fibrin fibers subjected to significant strain can respond by stiffening to resist stretch and helping to equitably distribute the strain load across the network.

Fibrin is a fibrous protein that assembles into a remarkably strong mesh-like network and forms the structural framework of a blood clot. Failure of a clot can have fatal consequences. For example, if a portion of the clot breaks away and is carried downstream by the flowing blood, it can cause a stroke or heart attack. Although previous research has characterized the mechanical properties and behavior of fibrin networks on a macroscopic level, much less is known about the behavior of individual fibrin fibers and the distribution of strain from one fiber to the next.

“We know that network strength is determined in part by the maximum strain individual fibers can withstand, so it is of particular interest to determine how the high strain and failure characteristics of single fibrin fibers affect the overall strength of the network,” says senior study author Dr. Michael R. Falvo from the Department of Physics and Astronomy at the University of North Carolina at Chapel Hill. “Further, determining how strain is shared among the constituent fiber segments in a network under imposed stress is crucial to understanding failure modes of networks and their strength.”

Dr. Falvo and colleagues used a combined fluorescence/atomic force microscope nanomanipulation system to stretch two dimensional fibrin networks to the point of failure while recording the strain of individual fibers. “Specifically, we observed that as fibers were stretched, they became stiffer than the surrounding fibers at lower strains; this allowed the more strained, stiffer fibers, to distribute the strain load to the less strained fibers and reduce strain concentrations,” explains Dr. Falvo. “So in effect, strain stiffening in the individual fibers acts to distribute strain equitably throughout the network and thereby strengthen it.”

The strain concentration reduction effect described in this study may be part of an important physiological mechanism to strengthen blood clots under high shear conditions in the blood stream. The authors note that along with this physiological insight, their findings bring about a better understanding of this remarkable strengthening mechanism and may help to guide new design strategies for engineered materials.

Researchers include Nathan E. Hudson, University of North Carolina at Chapel Hill, Chapel Hill, NC; John R. Houser, University of North Carolina at Chapel Hill, Chapel Hill, NC; E. Timothy O’Brien, University of North Carolina at Chapel Hill, Chapel Hill, NC; Russell M. Taylor Jr., University of North Carolina at Chapel Hill, Chapel Hill, NC; Richard Superfine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Susan T. Lord, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Michael R. Falvo, University of North Carolina at Chapel Hill, Chapel Hill, NC.

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On the Net:

• Cell Press
• Biophysical Journal

Psychologist finds both good and evil actions improve performance of a physical task

New research from Harvard University suggests that moral actions may increase our capacity for willpower and physical endurance. Study participants who did good deeds — or even just imagined themselves helping others — were better able to perform a subsequent task of physical endurance.

The research, published in the journal Social Psychological and Personality Science, shows a similar or even greater boost in physical strength following dastardly deeds.

Researcher Kurt Gray, a doctoral student in psychology at Harvard, explains these effects as a self-fulfilling prophecy in morality.

“People perceive those who do good and evil to have more efficacy, more willpower, and less sensitivity to discomfort,” Gray says. “By perceiving themselves as good or evil, people embody these perceptions, actually becoming more capable of physical endurance.”

Gray’s findings run counter to the notion that only those blessed with heightened willpower or self-control are capable of heroism, suggesting instead that simply attempting heroic deeds can confer personal power.

“Gandhi or Mother Teresa may not have been born with extraordinary self-control, but perhaps came to possess it through trying to help others,” says Gray, who calls this effect “moral transformation” because it suggests that moral deeds have the power to transform people from average to exceptional.

Moral transformation has many implications, he says. For example, it suggests a new technique for enhancing self-control when dieting: help others before being faced with temptation.

“Perhaps the best way to resist the donuts at work is to donate your change in the morning to a worthy cause,” Gray says.

It may also suggest new treatments for anxiety or depression, he says: Helping others may be the best way of regaining control of your own life.

Gray’s findings are based on two studies. In the first, participants were given a dollar and told either to keep it or to donate it to charity; they were then asked to hold up a 5 lb. weight for as long as they could. Those who donated to charity could hold the weight up for almost 10 seconds longer, on average.

In a second study, participants held a weight while writing fictional stories of themselves either helping another, harming another, or doing something that had no impact on others. As before, those who thought about doing good were significantly stronger than those whose actions didn’t benefit other people.

But surprisingly, the would-be malefactors were even stronger than those who envisioned doing good deeds.

“Whether you’re saintly or nefarious, there seems to be power in moral events,” Gray says. “People often look at others who do great or evil deeds and think, ‘I could never do that’ or ‘I wouldn’t have the strength to do that.’ But in fact, this research suggests that physical strength may be an effect, not a cause, of moral acts.”

Gray’s research was supported by the Canadian Social Sciences and Humanities Research Council and the Institute for Humane Studies.

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On the Net:

• Harvard University
• Social Psychological and Personality Science

Both partners must be strongly committed to saving their marriage

The largest, most comprehensive clinical trial of couple therapy ever conducted has found that therapy can help even very distressed married couples if both partners want to improve their marriage. The study also involved the longest and most comprehensive follow-up assessment of couple therapy ever conducted.
 
“It takes only one person to end a marriage but two people to make it work,” said Andrew Christensen, a UCLA professor of psychology and lead author of the study, which appears in the April issue of the Journal of Consulting and Clinical Psychology, a publication of the American Psychological Association.
 
The study included 134 married couples, 71 in Los Angeles and 63 in Seattle. Most were in their 30s and 40s, and slightly more than half had children. The couples were “chronically, seriously distressed” and fought frequently, but they were hoping to improve their marriages.
 
“We didn’t want couples who would get better on their own,” Christensen said. “We wanted couples who were consistently unhappy. We excluded almost 100 couples who wanted couple therapy but who did not meet our criteria of consistent and serious distress.”
 
The couples received up to 26 therapy sessions within a year. Psychologists conducted follow-up sessions approximately every six months for five years after therapy ended.
 
The couples all participated in one of two kinds of therapy. The first, traditional behavioral couple therapy, focuses on making positive changes, including learning better ways of communicating, especially about problems, and better ways of working toward solutions. The second, integrative behavioral couple therapy, uses similar strategies but focuses more on the emotional reactions and not just the actions that led to the emotional reactions. In this approach, couples work at understanding their spouse’s emotional sensitivities.
 
Christensen uses the integrative therapy, the second approach, which he described in his 2000 book “Reconcilable Differences” (Guilford Press). The couples who used this approach read the book as part of their treatment, while the couples in the traditional therapy group read a different self-help book.
 
When the therapy sessions were over, about two-thirds of the couples overall had shown significant clinical improvement.
 
“Given this population, that’s a good figure,” said Christensen, who for more than 30 years has been working with couples in therapy, as well as training and supervising others doing couple therapy.
 
“If couples do not improve in 26 sessions, that is a bad sign,” he said. “This is not psychoanalysis.”
 
The integrative therapy approach was significantly more effective than traditional therapy over the first two years of follow-up. The difference between the treatments, however, was not dramatic and did not last as the years went on.
 
Five years after treatment ended, about half the couples were significantly improved from where they were at the start of treatment, about a quarter were separated or divorced, and about a quarter were unchanged.
 
At that five-year mark, about a third of the couples were “normal, happy couples,” said Christensen, who considers that figure to be quite good, given the serious and persistent distress with which these couples entered treatment.
 
For another 16 percent, their marriage was significantly improved and was tolerable, if not very happy.
 
“They’re clearly better and their marriages might last,” Christensen said.
 
“We know from many studies that couple therapy can be beneficial to couples, although it certainly does not help all couples,” he said. “We also know distressed couples tend not to get better on their own.”
 
For therapy to work, both partners have to be strongly committed to saving the marriage, and both need to be willing to do their share to work at the relationship and not just blame the other, Christensen said. How couples do at the end of therapy is a good predictor of how they will do five years later.
 
Many couples who get separated and divorced either do not go to therapy or go to therapy much too late, when one person has already decided to separate or divorce. Couples are often better served by starting therapy when they “get stuck in negative patterns that they can’t get out of on their own,” he said.
 
Christensen has been married for more than 25 years. Does his work help his own marriage?
 
“It’s important that I not try to be the expert on marriage with my own wife,” he said. “I am probably more open to seeing her point of view as a result of being a couples therapist.”
 
Online therapy
 
Christensen and Brian Doss, an assistant professor of psychology at the University of Miami, have a five-year grant from the National Institute of Child Health and Human Development to develop an online training program for couples and to assess its effectiveness. The program is based on integrative behavioral couple therapy.
 
Couples who are interested in participating in this new online therapy study may sign up at www.OurRelationship.com.
 
“Therapy is so expensive and so time-consuming,” Christensen said. “There will always be a place for therapy for couples, but ideally, there will also be an effective online program that can help many couples for little or no cost.
 
“Our goal is to make couple interventions much more broadly available, inexpensive and not so time-consuming. I would like to reach many more couples. I would like couples not to have to go to a therapist’s office once a week but to be able to benefit from their own computer. That will not help every couple, but it is our belief that we can help a substantial number of couples with an online intervention. Eventually, I would like this online approach to be available to everyone.”
 
Co-authors on the Journal of Consulting and Clinical Psychology study are Brian Baucom, a former UCLA graduate student in psychology who is now a lecturer at the University of Southern California, and David Atkins and Jean Yi, former graduate students in psychology at the University of Washington “” Atkins is now a research associate professor and Yi a staff scientist at the University of Washington School of Medicine.
 
The Journal of Consulting and Clinical Psychology is the premier journal in psychology for intervention studies, including treatment of depression and anxiety, as well as couples treatment.
 
In “Reconcilable Differences,” Christensen notes that people in marriages are unlikely to change fundamental aspects of themselves, no matter how much their spouses demand it.
 
“People cannot change their basic essence even if they try, and it is futile to demand that they do so,” he said when the book came out. “To love and marry someone, you must accept the essence of the other person; you must accept who he or she is. You can push for change at the periphery but not at the core. Marriage is a package deal. You don’t get a line-item veto over your partner’s personality where you can discard the traits you don’t like.”
 
All couples have conflicts, he said. His book helps couples learn how to recover from arguments more quickly, reduce the number of arguments and minimize the anger and resentment that often accompany arguments. Christensen’s co-author on the book was Neil S. Jacobson, who was professor of psychology at the University of Washington until his death in 1999.
 
“The crimes of the heart are usually misdemeanors, even though they sometimes feel like felonies,” Christensen said.
 
Couples fight about all kinds of things, but most common are “daily slights, inattentive acts and routine disrespects that hurt and anger us,” he said. For example, a husband may show little interest when his wife talks about her day.
 
“Most of the change we seek in our relationships is gradual change in everyday behavior,” Christensen said. “Do more of the housework, spend more time with the kids, don’t be so critical, pay more attention when I talk to you, be more ambitious at work, put more energy into our relationship.”
 
Many couples address conflict with “toxic cures,” including accusation, blame, coercion, defensiveness, avoidance and denial, Christensen and Jacobson wrote.
 
As a result, “we end up hurt, angry, defensive and frustrated “” and our conflicts perpetuate themselves,” Christensen said.
 
In marital conflicts, there are often “three sides to every story” “” hers, his and an outsider’s, who often would see partial truth in each version.
 
Every couple starts out with differences that could potentially damage the relationship, Christensen and Jacobson wrote. The approach they endorse is to accept your partner and not try to change her or him. Or, in the words of one of Christensen’s colleagues, “Choose well, then work like hell.”

By Stuart Wolpert, UCLA

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On the Net:

• UCLA
• Journal of Consulting and Clinical Psychology

Candy-like appearance and flavorings may increase appeal to infants and youth

A tobacco company’s new, dissolvable nicotine pellet–which is being sold as a tobacco product, but which in some cases resembles popular candies–could lead to accidental nicotine poisoning in children, according to a new study from the Harvard School of Public Health (HSPH), the Northern Ohio Poison Control Center, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). The researchers also say the candy-like products could appeal to young people and lead to nicotine addiction as well.

The study appears in an advance online edition of the journal Pediatrics on April 19, 2010 and will appear in a later print issue.

In 2009, the R.J. Reynolds Tobacco Company launched a dissolvable nicotine product called Camel Orbs, which according to the company’s promotional literature contains 1 mg nicotine per pellet and is flavored with cinnamon or mint. The company also introduced Camel Strips (to contain 0.6 mg nicotine per strip) and Sticks (to contain 3.1 mg nicotine per strip).

It appears that the product is intended as a temporary form of nicotine for smokers in settings where smoking is banned. However, the potential public health effect could be disastrous, particularly for infants and adolescents, said Professor Gregory Connolly, lead author of the study and director of the Tobacco Control Research Program at HSPH.

Ingestion of tobacco products by infants and children is a major reason for calls to poison control centers nationwide. In 2007, 6,724 tobacco-related poisoning cases were reported among children five years of age and under. Small children can experience nausea and vomiting from as little as 1 mg of nicotine.

“This product is called a ‘tobacco’ product, but in the eyes of a 4-year-old, the pellets look more like candy than a regular cigarette. Nicotine is a highly addictive drug and to make it look like a piece of candy is recklessly playing with the health of children,” said Connolly.

The researchers computed, based on median body weight, how much nicotine ingestion would lead to symptoms of poisoning in children: A one-year-old infant could suffer mild to moderate symptoms of nicotine poisoning by ingesting 8 to 14 Orbs, 14 Strips or 3 Sticks; ingesting 10 to 17 Orbs, 17 Strips or 3 to 4 Sticks could result in severe toxicity or death. A four-year-old child could have moderate symptoms by ingesting 13 to 21 Orbs, 14 Strips or 4 Sticks and could suffer severe toxicity or death by consuming 16 to 27 Orbs, 27 Strips or 5 Sticks. The researchers report that a poison control center in Portland, Oregon, a test market for Orbs, reported a case in which a three-year old ingested an Orbs pellet.

R.J. Reynolds claims that Orbs packaging is “child resistant,” but the researchers say adults could unknowingly leave the pellets out in the open where children could easily access them. The researchers also say that the candy-like appearance and flavoring and ease-of-use of the product could appeal to children.

“Unintentional Childhood Poisonings Through Ingestion of Conventional and Novel Tobacco Products,” Gregory N. Connolly, Patricia Richter, Alfred Aleguas Jr., Terry F. Pechacek, Stephen B. Stanfill, Hillel R. Alpert, Pediatrics, online April 19, 2010.

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On the Net:

• Harvard School of Public Health
• Pediatrics

WASHINGTON, D.C. “” Vitamins and calcium supplements appear to reduce the risk of breast cancer, according to findings presented at the American Association for Cancer Research 101st Annual Meeting 2010.

“It is not an immediate effect. You don’t take a vitamin today and your breast cancer risk is reduced tomorrow,” said Jaime Matta, Ph.D., professor in the Ponce School of Medicine in Puerto Rico. “However, we did see a long-term effect in terms of breast cancer reduction.”

Matta said the findings suggest that the calcium supplements are acting to enhance DNA repair capacity, a complex biological process involving more than 200 proteins that, if disrupted, can lead to cancer.

“This process involves at least five separate pathways and is critical for maintaining genomic stability,” said Matta. “When the DNA is not repaired, it leads to mutation that leads to cancer.”

The study included 268 women with breast cancer and 457 healthy controls. Women were more likely to have breast cancer if they were older, had a family history of breast cancer, had no history of breastfeeding and had lower DNA repair capacity.

Vitamin supplements appeared to reduce the risk of breast cancer by about 30 percent. Calcium supplements reduced the risk of breast cancer by 40 percent. After controlling for the level of DNA repair capacity, calcium supplements were no longer as protective, but the link between vitamin supplements and breast cancer reduction remained.

“We’re not talking about mega doses of these vitamins and calcium supplements, so this is definitely one way to reduce risk,” said Matta.

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On the Net:

• American Association for Cancer Research
• AACR 101st Annual Meeting 2010

WASHINGTON ““  The socioeconomic status of a country has long been considered a potentially significant factor in the availability of high-quality health-care interventions and even a determinant of long-term patient outcomes. A new study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation reports that in Europe, socioeconomic factors have a direct correlation to the rates and outcomes of stem cell transplantation for patients with acute myeloid leukemia (AML). This study was published online today in Blood, the official journal of the American Society of Hematology.

“Stem cell transplantation is an expensive procedure requiring well-equipped transplant units; advanced, long-term supportive care; and highly qualified medical and nursing staff, so it may be expected that access to these transplants as well as outcome of the procedure would depend on socioeconomic factors varying among and within countries,” said lead study author Sebastian Giebel, MD, of the Department of Clinical and Experimental Oncology at the Comprehensive Cancer Center of the Maria Sklowdowska-Curie Memorial Institute in Gliwice, Poland. 

In this study, a team of researchers led by Dr. Giebel evaluated the association of the Human Development Index (HDI) with rates and outcomes (both short- and long-term) of AML patients treated with hematopoietic stem cell transplantation (HSCT).  Using data on 16,403 patients from 30 European countries between 2001-2005, the team compared socioeconomic status with HSCT procedure rates. They then analyzed long-term outcomes (primarily leukemia-free survival, or LFS) related to HSCT for a sub-group of 2,015 AML patients who had received an HLA-matched allogeneic (using donor cells rather than one’s own cells) HSCT.

The HDI is used by the United Nations to measure the socioeconomic status of countries across three basic categories: longevity (expressed as a life expectancy index, or LEI), knowledge (expressed as education index, or EI) and standard of living (measured by gross domestic product index, or GDPI).  Based on the HDI, countries are considered to have a low, intermediate, or high development status. Most European states fall into the “high” category, but there are some variations so, for the purpose of this study, countries were categorized into five distinct HDI ranges.

Results of the study found that in Europe, the HDI was associated with both rates and results of HSCT for acute leukemia, with the strongest association related to the few countries in the highest HDI group (eight countries). With regard to rates of HSCT procedures, the team found significant correlations between HDI and total HSCTs performed for AML patients. The strongest associations were found between transplant rates and scores related specifically to LEI and GDPI, suggesting that not only purely economic conditions, but also the organization of the health-care and educational systems likely translate into availability of HSCT.

With regard to patient outcomes, transplants performed in countries in the highest HDI group were associated with significantly higher LFS (68%), which resulted mainly from reduced risk of relapse, as compared with the other four HDI groups (56%, 59%, 63%, and 58%, respectively, in order of increasing HDI score).

“We believe there is still room for improvement in most European states to reach the outcomes achieved by the highest-HDI states, and identifying the factors that contribute to these differences is critical,” said Dr. Giebel.  “Our study was retrospective in nature, so we would encourage further prospective studies with detailed patient and procedural characteristics to help understand the true differences and design interventions to improve outcomes worldwide.”

Previous studies have demonstrated some association of socioeconomic status (SES) with access to HSCT and mortality after transplantation in other parts of the world, but the association had not previously been studied across Europe, where diversity of SES may be less pronounced and most countries are considered well-developed. However, differences remain with regard to standard of living, education, and organization of health care, which may be reflected in the variations in HDI. Variable factors suggested by the study authors may include compliance with chemotherapy protocol, health insurance coverage, educational status, and availability of care.

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On the Net:

American Society of Hematology

DALLAS — More than two-thirds of patients in a British study were unaware they suffered a minor stroke and almost one-third delayed seeking medical attention for more than 24 hours, according to a report in Stroke: Journal of the American Heart Association.

Many studies have focused on patients’ responses to major strokes, but few have examined patients’ awareness of minor strokes. So researchers studied patients’ behaviors and attitudes and found the participants frequently failed to recognize when they were having a minor stroke and therefore failed to seek immediate medical care.

Surprisingly, people of all demographics “” regardless of age, gender, education and socioeconomic status “” showed an overall lack of awareness about how to recognize a stroke, said Arvind Chandratheva, a clinical research fellow in the Stroke Prevention Research Unit in the Department of Clinical Neurology at the University of Oxford in the United Kingdom.

In the study, researchers analyzed 1,000 patients in the United Kingdom (average age 73), of whom 459 had transient ischemic attacks (TIAs) and 541 suffered a minor stroke.

Minor stroke was defined as minimal deficits based on the NIH Stroke scale assessing consciousness, vision, sensation, movement, speech and language. TIA, sometimes known as a “mini stroke,” occurs when a blood clot temporarily clogs an artery and blocks blood flow to the brain. TIAs and minor strokes don’t typically cause permanent harm, but early treatment is critical to prevent the possibility of a stroke with permanent neurological deficits.

Researchers, investigating factors that cause delays in seeking timely treatment, found that:

— Sixty-eight percent of TIA patients and 69 percent of minor stroke patients didn’t know the cause of their symptoms.
— Only 47 percent of TIA patients and 46 percent of minor stroke patients sought medical attention within three hours “” when a clot-busting drug is approved to treat some strokes.
— Sixty-seven percent of TIA patients and 74 percent of minor stroke patients sought medical attention within 24 hours. TIA patients who didn’t correctly recognize their symptoms were less likely to call emergency services.
— Seventy-seven percent of patients went to their primary care physicians first instead of seeking emergency medical care.
— Thirty percent of patients experiencing a recurrent stroke didn’t seek timely medical attention.

These figures “indicate a lack of public awareness that TIA is a medical emergency,” Chandratheva said.

TIA patients were more likely to delay seeking medical care if their motor or speech function were normal, if symptoms didn’t last long, or if they experienced symptoms on a Friday, a weekend or a holiday, researchers said. The findings suggest a need for more public education, researchers said.

“There has been very little sustained public education, but for a prolonged impact, sustained national campaigns are required,” Chandratheva said.

Stroke is the No. 3 killer and a leading cause of long-term severe disability in the United States, according to American Heart Association statistics. About 15 percent of strokes are preceded by a TIA, which is a strong predictor of being at risk for a major stroke. In the United States, where awareness about minor stroke is also low, TIA can affect up to a half million people. Because many study participants went to their primary care physicians first, the researchers said that primary care physicians can play an active role in educating patients about the signs of TIA.

“Primary care physicians have to have the systems in place to refer high-risk TIA patients directly to dedicated hospital TIA services where they can be assessed, imaged and treated immediately,” Chandratheva said.

Researchers said it’s uncertain if the pattern would be found in other populations or healthcare systems.

Co-authors are: Daniel S. Lasserson, M.A., M.B.B.S.; Olivia C. Geraghty, M.R.C.P; and Peter M. Rothwell, M.D., Ph.D. Author disclosures are on the manuscript.

The study was funded by the UK Medical Research Council, National Institute of Health Research, U.K. Stroke Association, Dunhill Medical Trust and NIHR Biomedical Research Centre, Oxford.

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On the Net:

American Heart Association

Embryos containing genetic material from a man and two women have been produced in a project that researchers are hailing as a “ray of hope” for thousands of families troubled by rare genetic diseases that can lead to heart failure, blindness, diabetes and even infant mortality.

The technique used has researchers hopeful that it could be offered to women within three years. But the study is likely to re-spark the debate over the ethics of embryo research and “designer babies.”

Women who suffer from diseases of the mitochondria — the cells inside their eggs that create energy — may have a realistic hope of receiving effective treatment that would save their offspring from debilitating diseases.

Faults in the mitochondria can cause about 150 known diseases. One in 6,500 persons is affected by such conditions, which can include fatal liver failure, strokes, blindness, epilepsy, muscular dystrophy and deafness.

The team of researchers and scientists at Newcastle University has shown that it may be possible to bypass these diseases by replacing the defective mitochondria cells, dubbed “batteries.”

The process begins by taking a fertilized egg from a mother with malfunctioning mitochondria, before extracting the healthy DNA that contains all of the genetic information on how her child will develop.

Next, scientists take a fertilized egg from a second donor mother. The second egg is stripped of almost all of its DNA, leaving just the egg shell containing the healthy mitochondria battery.

The two elements are then combined — the healthy DNA from the natural mother and father placed in the donor mother’s egg — to create a healthy new fertilized egg.

The technique could allow doctors to ensure that genetic defects are not passed from the mother to their children. Many of the diseases passed from the mother to the child have no known cures, and the technique could ensure that the mother and father won’t have to fight with the debate to have children or not.

“A child born using this method would have correctly functioning mitochondria, but in every other respect would get all their genetic information from their father and mother,” said Prof Doug Turnbull, who led the research. “What we’ve done is like changing the battery on a laptop…the energy supply now works properly, but none of the information on the hard drive has been changed.”

The team expressed that less than 0.2 percent of the DNA from the donor mother could be found in the new egg. The team has performed the technique on 80 fertilized eggs. They were all grown in a lab for 24 hours before the exchange was made. Each egg was allowed to continue to develop for another six to eight days to check for problems.

All eggs were donated by couples undergoing fertility treatments. All were unsuitable to be used during the IVF process.

Currently, under the Human Fertilization and Embryology Act of 2009, it is illegal to create babies using embryos which have been manipulated in the laboratory. However, charities called on the government to allow the use of the technique once testing proves it is safe and effective.

A provision within the Act may allow for such a move to be given the go-ahead if secondary legislation was brought by the Health Secretary. But other campaigners said that the creation of embryos using three parents were unethical and warned that long-term consequences were unknown.

Sharon Bernardi, 44, from Sunderland, has a form of mitochondrial disease that she inherited from her mother. The condition has claimed the lives of six of her children, who all died within a few hours of birth. Her only son, Edward, 20, has a form of mitochondrial disease known as Leigh’s disease and needs constant care.

“It will be too late for me but it would be an amazing thing if scientists and doctors can prevent this in the future,” Bernardi told reporters.

A spokesman for the Department of Health said that there are serious ethical considerations that would need to be taken into consideration before any decisions could be made. “Any proposed regulations would be subject to significant public consultation and Parliamentary debate before they could become law.”

The study was funded by the Muscular Dystrophy Campaign, the Medical Research Council and the Wellcome Trust.

The results of the study are published in the journal Nature.

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On the Net:

• Newcastle University
• Nature

The growing use of smokeless tobacco, chewing tobacco and snuff by teenagers is causing great concerns for health experts, who suggest athletes in Major League Baseball are inadvertently influencing young people to take up the dangerous habit.

The use of smokeless tobacco by teens has increased in recent years, overturning a long trend in declining usage of all tobacco products by teens, Terry Pechacek of the Centers for Disease Control and Prevention told a U.S. congressional panel. Data that will be released in the next few months will show an increase in the use of smokeless tobacco products in mostly white and Hispanic teen males, he said.

Pechacek said the problem has been steadily rising over the past several years, adding that the CDC is concerned most high school students think smokeless tobacco is much safer than cigarettes. But, the truth of the matter is, smokeless tobacco can cause cancers of the mouth, throat, esophagus and even pancreas.

Joe Garagiola, a former baseball player, sportscaster, and one-time user of chewing tobacco, said the league should ban the use of smokeless tobacco by its players. “Like many other players I thought being a Major League player meant you had to chew,” he told the Reuters in a recent interview. He said he decided to quit when his daughter asked him if he was going to die from it.

“Get together guys, ban tobacco and anyone who uses it is penalized. Get it out of our game,” he said.

Tobacco products have been banned from the Minor League since 1993. Extending the ban to the majors would have to be done as a collective bargaining agreement with the players union, Robert Manfred, executive vice president for labor relations and human resource for Major League Baseball, told the committee.

The ban is currently opposed by the union, according to David Prouty, the chief labor counsel for the Major League Baseball Players Association. “We believe baseball players should not be prohibited from using substances that are perfectly legal and available to the general public,” he told the panel.

According to research, about one-third of Major League players report using smokeless tobacco, reports Gregory Connolly, professor at the Harvard School of Public Health.

“The use of smokeless tobacco by players has a powerful role model effect on youth particularly among young males in sport, some of whom ironically remain addicted in future careers as professional athletes,” Connolly told Reuters. 

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On the Net:

• CDC
• Major League Baseball Players Association
• Image Courtesy Wikipedia

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in elderly people. All papers related to DISH demonstrate a consistent and marked increase of the disease with advancing age. Various local structural lesions such as oropharyngeal tumors, vascular pathologies, retropharyngeal abscesses, and anterior cervical osteophytes may lead to mechanical esophageal dysphagia.

A research article to be published on April 7, 2010 in the World Journal of Gastroenterology addresses this question. A research team led by Dr. Berrin Karadag reported a case of a geriatric patient with diffuse idiopathic skeletal hyperostosis.

This study concluded that DISH should be considered an important, although rare, cause of dysphagia among older adults. However, it should not be accepted as the cause of dysphagia until all other causes have been ruled out.

Reference: Karadag B, Cat H, Aksoy S, Ozulu B, Ozturk AO, Oguz S, Altuntas Y. A geriatric patient with diffuse idiopathic skeletal hyperostosis. World J Gastroenterol 2010; 16(13): 1673-1675

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On the Net:

• World Journal of Gastroenterology Article

“Love and marriage,” sang philosopher Frank Sinatra, “is an institute you can’t disparage.” Especially, a new Tel Aviv University study suggests, when a happy marriage may help to prevent fatal strokes in men.

The first study of its kind to assess the quality of a marriage and its association with stroke risk, Prof. Uri Goldbourt of Tel Aviv University’s Neufeld Cardiac Institute found a correlation between reported “happiness” in marriage and the likelihood that a man will die from stroke. Drawn from data collected from 10,000 men, all of them civil servants, beginning in 1965, the research was presented to experts at the American Stroke Association’s International Conference earlier this year.

In the retrospective study, men were surveyed about their happiness levels and marital status; 34 years later, a follow-up study determined how many of the men died from stroke. Single men were found to have a 64% higher risk of a fatal stroke than married men. The quality of the marriage appeared to matter as well “” men in an unhappy union had a 64% higher risk of a fatal stroke than those who reported being happy in their marriage.

A foundation for future study

“The association we’ve found adjusts for factors such as age, blood type and cholesterol levels,” Prof. Goldbourt notes, but he cautions that his results are only preliminary, taking into consideration only a few of many possible variables while laying the groundwork for future research. The survey measured fatal strokes only, not those that were survived, for example. And similar data was not collected from women. “It’s too bad we don’t have that kind of information,” Prof. Goldbourt notes.

Dr. Goldbourt hopes that his research will be taken up by younger researchers as a foundational study. While many studies today report the benefits of marriage, the negative effects of an unhappy marriage may be hidden. It is plausible, Prof. Goldbourt’s study suggests, that a bad marriage is just as bad for one’s health as not being married at all.

Happiness is no magic bullet

Prof. Goldbourt describes his new research as “a hypothesis generator” instead of statistical proof, because only about 4% of the men reported being completely satisfied and happy in their marriage. And the study didn’t include follow-up research on the different kinds of strokes men can succumb to. “Happiness may very well likely create healthier men and reduce the risk of a fatal stroke,” he says, “but we don’t have all the information necessary to say that this is the magic bullet.”

Previous medical studies have suggested that happiness can stave off the flu, promote positive cardiac health, and may even help people fight cancer. Much more research is needed on the happiness question, Prof. Goldbourt says, taking into account such factors as medication and the effects of happiness over time.

“We have opened a new channel of research into factors associated with death-by-stroke risk. Until that research is done, the best way to avoid one,” Prof. Goldbourt concludes, “is still to maintain a healthy lifestyle.”

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On the Net:

• Tel Aviv University
• American Stroke Association

Young and middle-age Americans are becoming obese earlier in life than their parents and grandparents and sets up a generation for shorter lives and poorer health

It was a provocative prediction that due to the obesity epidemic Baby Boomers may outlive their children.

But a new study by the University of Michigan Health System on obesity trends shows Americans are getting heavier younger and carrying the extra weight for longer periods over their lifetime.

As a result, the study suggests the impact on chronic diseases and life expectancy may be worse than previously thought. The findings will be published April 12 in the International Journal of Obesity.

Researchers used a wide range of national data on children and adults born between 1926 and 2005 to reveal the troubling trend of younger generations becoming obese earlier in life than their parents and grandparents.

According to the study, 20 percent of those born 1966-1985 were obese by ages 20-29. Among their parents, those born 1946-1955, that level of obesity was not reached until ages 30-39, not until ages 40-49 for individuals born between 1936-1945, and obesity prevalence was even later ““ during the 50’s ““ for those born between 1926-1935.

Further research is needed to understand the future effect the obesity trend will have on diabetes rates and mortality.

“Many people have heard that Americans are getting heavier,” says lead author Joyce Lee, M.D., M.P.H., a pediatric endocrinologist at the U-M C.S. Mott Children’s Hospital and assistant professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School. “But it’s very important to understand who the obesity epidemic is affecting.

“Our research indicates that higher numbers of young and middle-age American adults are becoming obese at younger and younger ages,” she says.

Evidence shows body mass index, a calculation of fat and weight, increases with age, and children who are obese are more likely to become obese adults.

Obesity is a well-known contributor to type 2 diabetes, cardiovascular disease, disability and premature death.

The prediction, made in 2005, for a reduced life expectancy in the 21st century, was based on obesity prevalence from the period 1988-1994, the mid-point of the obesity epidemic, and included much older adults, born 1885-1976, a generation that had much lower obesity rates over their lifetime.

The federally funded U-M study shows obesity trends were worse for women and blacks, a bad sign for reversing racial disparities in health, U-M authors say. Among 20-29-year-olds, born 1976-1985, 20 percent of whites were obese compared to 35 percent of blacks in that age group.

“What is particularly worrisome is that obesity trends are worse for blacks compared to whites,” Lee says. “Black Americans already experience a higher burden of obesity-related diseases and the obesity trends will likely magnify those racial disparities in health.”

Additional authors: Subrahmanyam Pilli, Child Health Evaluation and Research Unit in the U-M Division of Pediatrics; Carla C. Keirns, Department of Preventative Medicine, Stony Brook University; Matthew M. Davis, M.D., M.A.P.P., associate professor of pediatrics and communicable diseases and internal medicine at the U-M Medical School, co-director of the Robert Wood Johnson Foundation Clinical Scholars Program at the U-M, faculty investigator of CHEAR, and associate professor of public policy at U-M’s Gerald R. Ford School of Public Policy; Sandeep Vijan, M.D., M.S., associate professor of internal medicine at U-M Medical School; Gary Freed, M.D., MPH, professor of pediatrics and communicable diseases, and director of the CHEAR unit, William H. Herman, M.D., MPH, professor of internal medicine at the U-M Medical School and professor of epidemiology at the U-M School of Public Health; and James Gurney, Ph.D., associate professor of pediatrics and communicable diseases.

Funding: National Institute of Diabetes and Digestive and Kidney Diseases, and the Clinical Sciences Scholars Program of University of Michigan

Reference: International Journal of Obesity, Issue, 34.4, April 12, 2010. Details on the research results and a slideslow of figures are available at www.heavieryounger.com

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On the Net:

• University of Michigan Health System
• U-M Hot Topics: Childhood obesity clinical experts list
• University of Michigan C.S. Mott Children’s Hospital
• Child Health Evaluation and Research Unit

An unprecedented upturn in the number of older Americans who delay retirement is likely to continue and even accelerate over the next two decades, a trend that should help ease the financial challenges facing both Social Security and Medicare, according to a new RAND Corporation study.

While government projections suggest the number of older Americans who remain employed is likely to plateau over the coming decade, RAND researchers say a more likely scenario is that the increase in delaying retirement that began in the late 1990s is likely to gain speed.

Because the trend holds broad benefits for the nation, lawmakers may want to consider reforms that would dismantle barriers that discourage some older people from remaining employed and even consider changes that would encourage employers to hire older workers.

“Changes in pensions, longer life expectancy, less disability at older ages and more women in the workforce are all trends that are gaining momentum and are likely to cause more Americans to delay retirement,” said Julie Zissimopoulos, study co-author and an economist at RAND, a nonprofit research organization. “Even without new policy changes to encourage the behavior, there are good reasons to conclude that the trend will be propelled forward.”

In a report published in the Journal of Economic Perspectives, RAND researchers examine a wide array of evidence that suggests that delayed retirement or partial retirement are likely to increase and discuss the many ways that the tectonic shift in work patterns may benefit the United States.

The nation’s population is growing older as Baby Boomers reach retirement age, leaving proportionately fewer people in the workforce to pay taxes and support the social programs that provide a safety net to older Americans. Longer work lives for many Americans will help to ease that imbalance and the financial stress it puts on Social Security and Medicare, according to researchers.

After more than a century of decline, the number of older American men and women in the workforce began to rise modestly during the 1990s. While about 17 percent of Americans aged 65 to 75 were employed in 1990, the proportion is expected to rise to 25 percent in 2010. A jump in employment among those aged 75 and older also has been seen.

Despite the steady increase in employment among older Americans, the federal Bureau of Labor Statistics predicts the trend will begin to flatten this year for men aged 65 to 74 and by 2020 for men age 75 and older. The agency predicts a similar plateau for women beginning in 2020.

But RAND researchers say the forces that are causing people to delay retirement or reenter the workforce are strong enough to propel the current trend forward until at least 2030.

A principal reason why retirement rates have dropped is because of an evolution in the skill composition of the nation’s workforce, according to the study. As American workers have gained more education, they have achieved jobs that are more fulfilling, they face fewer physical demands in the workplace and they are paid more for their efforts.

Adding to this phenomenon is the rise in the number of dual-earner families. Since couples tend to retire together and men often are older than their spouse, men may stay in the work force longer to accommodate their wives’ work lives, according to the study.

While there have been several changes made to Social Security that encourage people to work longer, researchers say those changes appear to be a secondary force behind the trend observed thus far.

“More older Americans are extending their work lives both because they want more income and because their improved health allows a longer work life,” said report co-author Nicole Maestas, a RAND economist. “Further encouraging longer work lives may prove beneficial to both individuals and the nation as a whole.”

Additional incentives are on the horizon that may fuel the future growth of the number of older Americans delaying retirement.

Changes to Social Security that delay full benefits from age 65 to age 67 will not be fully in force until 2022, and there have been discussions about further extending the threshold as well. In addition, as labor force participation among younger women has risen over time, women have become increasingly likely to qualify for Social Security benefits on their own work record. As a result, women now more than ever face direct incentives to extend their work lives in order to qualify for higher benefits.

In addition, as people live longer more Americans may need to extend their work lives to accumulate wealth to provide for their needs during old age.

Researchers say that lawmakers may want to consider policies that would further aid older Americans who want to delay retirement. Such measures include eliminating measures in some pension plans that penalize recipients who continue working and improving the public’s understanding of retirement and pension rules.

“We should consider removing the disincentives to delaying retirement and let people make the decision about whether they want to remain in the work force or not,” Zissimopoulos said.

The research was supported by a grant from the National Institute on Aging and was conducted through the RAND Labor and Population program. The program examines issues involving U.S. labor markets, the demographics of families and children, social welfare policy, the social and economic functioning of the elderly, and economic and social change in developing countries.

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On the Net:

• RAND Corporation
• Journal of Economic Perspectives