Researchers at Ben-Gurion University of the Negev (BGU) have discovered that gene mutations that once helped humans survive may increase the possibility for diseases, including cancer.

The findings were recently the cover story in the journal Genome Research.

The team of researchers from BGU’s National Institute for Biotechnology in the Negev (NIBN) set out to look for mutations in the genome of the mitochondria, a part of every cell responsible for energy production that is passed exclusively from mothers to their children. The mitochondria are essential to every cell’s survival and our ability to perform the functions of living.

“Our ancestors responded to environmental changes, such as climate shift, with mutations that increased their chances of survival. But today, these same mutations predispose us toward complex diseases such as cancer,” according to researcher Dr. Dan Mishmar, a molecular biologist from the Department of Life Sciences at BGU. “Although mitochondria’s role in the emergence of new species has been investigated recently, the idea that they are responsible for our susceptibility to illness startles many.”

To test this hypothesis, the researchers analyzed the genome mitochondria mutations from 98 unrelated individuals. Combinations of mutations tended to occur in tumors in precisely the same DNA building blocks that changed during evolution. The team also found that the mitochondrial genome of humans who migrated out of Africa to Europe 100,000 years ago carried seven mutations found in almost all of today’s Europeans.

“The concept that the same principles that drive evolution toward the emergence of new species govern the emergence of diseases is new,” Mishmar explains. “A clinician looks at the genome of a tumor, or other disease, and compares it to the normal population, looking for new mutations that do not occur there. I assume the mutations are already part of the population and have had a survival function. When these same mutations reoccur in the correct environment, they can cause disease.”

As reported in the leading journal Genome Research, “We show, strikingly, that evolution repeated itself in cancer. If we better understand how evolution moved, we can understand the genetic basis of many complex disorders. Since mitochondria play a central role in disease, if we understand how they work and the way they changed our ability to survive in different conditions in ancient times, we can understand the mechanics of the disease. And we’ll understand a lot about the way certain people develop diseases and others have a lower tendency toward those same diseases. This may lead to new methods of disease prevention or cures.”

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On The Net:

American Associates, Ben-Gurion University of the Negev

Cancer experts at Johns Hopkins say a study tracking 774 prostate cancer patients for a median of eight years has shown that a three-way combination of measurements has the best chance yet of predicting disease metastasis.

The new prediction method comprises the length of time it takes for PSA (prostate-specific antigen) to double, Gleason score (a numeric indicator of prostate cancer aggressiveness as seen under the microscope), and the interval between surgical removal of the prostate and the first detectable PSA level. According to Johns Hopkins investigators, combining these three measurements more accurately estimates risk that the cancer has spread than do other methods and should help determine which patients may benefit from additional therapy when PSA levels rise after surgery to remove the prostate.

Findings from the study presented at the June 2009 annual meeting of the American Society of Clinical Oncology (ASCO) may also help resolve the debate on when and in what form secondary treatments should occur.

“There is much debate on whether to prescribe immediate treatment for a man whose PSA begins to rise after he has had prostate cancer surgery, or to delay it,” says Emmanuel Antonarakis, M.D., Johns Hopkins Kimmel Cancer Center investigator. “Studies suggest that most men live the same length of time overall whether they receive therapy at the first sign of a rising PSA or wait until the cancer has spread to other sites.”

After reviewing the records of 774 men whose PSA rose after surgery to remove the prostate, the researchers found that Gleason score and two measurements for PSA were the strongest risk factors for prostate cancer metastasis. Men with Gleason scores in the highest range, between eight and 10, were twice as likely to develop metastatic cancer. In men whose PSA became detectable within three years after surgery, cancer was more than three times more likely to spread to other organs. Finally, men whose PSA doubled the fastest, within three months, were more than 20 times more likely to develop metastatic cancer than men whose PSA look longer than 15 months to double.

For men enrolled in the study, it took a median of 10 years for the disease to reappear on imaging scans. “The 10-year average will not apply to every man, so we wanted to know what factors put men at higher risk for their cancer progressing earlier,” says Mario Eisenberger, M.D., professor of oncology at the Johns Hopkins Kimmel Cancer Center.

An increase in PSA, or prostate specific antigen, occurs in approximately 20 percent to 30 percent of men after surgery to remove the cancerous prostate, says Antonarakis. In these patients, the newly emerging prostate cancer cells are rarely detectable on imaging scans. When faced with the likelihood that their cancer has spread, many men opt to undergo hormone therapy, which blocks testosterone production, a fuel for prostate cancer. The side effects, which mimic those of menopausal women, include hot flashes, night sweats, osteoporosis, metabolic syndrome and coronary disease, and can be debilitating, says Antonarakis.

Besides immediate hormone therapy, other options for men whose PSA is rising are to use hormone therapy intermittently, enroll in clinical trials testing experimental therapies or combinations of them, or to “watch and wait” until imaging scans can locate metastatic disease.

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On The Net:

Johns Hopkins Medical Institutions

Obesity rates among Americans have increased again over the past year in 23 states, according to a new annual report.

The Trust for America’s Health issued the report alongside the Robert Wood Johnson Foundation on Wednesday.

The groups found that obesity rates among adults in America are now more than 25 percent in 31 states, and more than 20 percent in 49 states, along with Washington, D.C.

In 1991, no state had an obesity rate of more than 20 percent, and in 1980 the average for adult obesity was 15 percent.

The only state to be listed at less than 20 percent obesity was Colorado, with 18.7 percent, compared to 18.4 percent at last year’s check-up.

Mississippi ranked the highest overall for the fifth consecutive year with an adult obesity rate of 32.5 percent as well as the highest rate of obesity among children ““ ages 10 to 17 ““ with 44.4 percent.

“Eight of the 10 states with the highest rates of obese and overweight children are in the South. Childhood obesity rates have more than tripled since 1980,” according to the report, titled “F as in Fat”.

Researchers also found that the economic crisis could worsen the national obesity epidemic because it could translate into an increase in the price of nutritious foods, causing families to become more stressed and eat less healthy meals.

Additionally, the report noted that obesity is weighing the US health care system down and causing costs to increase drastically.

“Our health care costs have grown along with our waist lines,” said Jeff Levi, executive director of Trust for America’s Health,

“The obesity epidemic is a big contributor to the skyrocketing health care costs in the United States. How are we going to compete with the rest of the world if our economy and workforce are weighed down by bad health?”

TFAH issued a report showing that the generation of “baby boomers” has a higher rate of obesity across the board, when compared to previous generations.

“As the Baby Boomer generation ages, obesity-related costs to Medicare and Medicaid are likely to grow significantly because of the large number of people in this population and its high rate of obesity. And, as Baby Boomers become Medicare-eligible, the percentage of obese adults age 65 and older could increase significantly. Estimates of the increase in percentage of obese adults range from 5.2 percent in New York to 16.3 percent in Alabama,” said the report.

“It’s not going to be solved in the doctor’s office but in the community, where we change norms,” Levi said.

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On the Net:

• F as in Fat 2009 – Trust for America’s Health

An effort enabled by the new economic stimulus package could lead to informing the medical community on which therapies are the most effective in treating a variety of major health issues.

Congress has allotted $1.1 billion in order to begin the process of determining the most cost-effective treatments for health problems such as hearing loss, back pain, prostate cancer and irregular heartbeat.

Regulators hope that by finding which treatments work best, doctors and patients will save time and money from the current plan that involves a series of hit-or-miss treatments.

As a part of the American Recovery and Reinvestment Act (ARRA), Congress directed the Institute of Medicine (IOM) “to recommend national priorities for research questions to be supported by CER (comparative effectiveness research) and ARRA funds.”

Issued on June 30, the IOM’s “Initial National Priorities for Comparative Effectiveness Research” report lays out a list of the top 100 medical issues to be addressed by Congress using the stimulus funds.

“Clinical research provides health care providers with information on the natural history of disease, clinical presentations of disease, and diagnostic and treatment options,” according to the report.

“All too often, the information necessary to inform these medical decisions is incomplete or unavailable, resulting in more than half of the treatments delivered today without clear evidence of effectiveness.

“This uncertainty contributes to great variability in managing clinical problems, with costs and outcomes differing markedly across the country.”

The report provides a definition for CER as “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care.

The report issues a “list of priorities” to be focused on using the national investment for CER, including:

– Compare the effectiveness of treatment strategies for atrial fibrillation including surgery, catheter ablation, and pharmacologic treatment.

– Compare the effectiveness of the different treatments (e.g., assistive listening devices, cochlear implants, electric-acoustic devices, habilitation and rehabilitation methods [auditory/oral, sign language, and total communication]) for hearing loss in children and adults, especially individuals with diverse cultural, language, medical, and developmental backgrounds.

– Compare the effectiveness of primary prevention methods, such as exercise and balance training, versus clinical treatments in preventing falls in older adults at varying degrees of risk. 

– Compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others.

– Compare the effectiveness of different strategies of introducing biologics into the treatment algorithm for inflammatory diseases, including Crohn’s disease, ulcerative colitis, rheumatoid arthritis, and psoriatic arthritis.

– Compare the effectiveness of various screening, prophylaxis, and treatment interventions in eradicating methicillin resistant Staphylococcus aureus (MRSA) in communities, institutions, and hospitals.

“Health care decisions too often area matter of guesswork because we lack good evidence to inform them,” committee co-chair Harold Sox, editor, Annals of Internal Medicine, American College of Physicians of Internal Medicine, Philadelphia, said in a statement.

“For example, we spend a great deal on diagnostic tests for coronary heart disease in this country, but we lack sufficient evidence to determine which test is best.”

The committee narrowed down a list of 1,268 suggested items to create the list of the top 100 issues which need to be addressed.

“This report lays the foundation for an ongoing enterprise to provide the evidence that health care providers need to make better decisions and achieve better results,” said co-chair Sheldon Greenfield, Donald Bren Professor of Medicine and executive director, Health Policy Research Institute, University of California, Irvine. 

“To make the most of this enterprise, HHS will need to ensure that the results are translated into practice and that the public is involved in priority setting to ensure that the research is relevant to everyday health care.”

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On the Net:

• Institute of Medicine

The frontiers of cell transplantation for cardiac repair are discussed in the current issue of Cell Transplantation (Vol. 18 No.3), now available on-line without charge at http://www.ingentaconnect.com/content/cog/ct.

Two studies are highlighted, one by a Brazil-based research team who looked at two different bone marrow cell delivery methods following myocardial infarction, and a second study from a team of researchers in Germany who used bone marrow stem cell transplants to repair limb ischemia with a goal of preventing amputations.

Two delivery techniques for stem cells

With evidence mounting that cell-based therapies can repair the injured myocardium following acute infarction, a Brazil-based research team addressed questions of the best way to safely deliver bone-marrow mononuclear cells (BMMNC) derived from the same patient (autologous cells) to the heart, following a heart attack caused by a prolonged interruption of blood flow leading to changes in the electrocardiogram (ST elevation myocardial infarction). They compared two different delivery techniques ““ through the anterograde intra-coronary (ICA) or via the retrograde intra-coronary artery vein (ICV). Researchers used radiolabeled cells to evaluate cell distribution patterns in the heart and their relationship with left ventricle function improvement.

“BMMNC retention by damaged heart tissue was apparently higher when the anterograde approach was used, although further studies are required to confirm this data,” said corresponding author Dr. Hans Dohman of the Hospital Pro-Cardiaco in Rio de Janeiro, Brazil.

While previous reports observed that microvascular obstruction impairing cell uptake by the heart could be an issue, the team hypothesized that an intravenous approach may overcome that potential.

“We hypothesized that an intravenous approach might overcome this issue since the passage (diapedesis) of circulating cells into the adjacent cardiac tissue occurs on the venous side of microcirculation,” added Dr. Dohman. “In addition, we found that the grade of obstruction of microcirculation does not correlate with the efficiency of cell delivery to the infarcted tissue.”

The research team also found that higher cell retention correlated with better changes in observed ejection fraction from baseline to a six-month follow-up.

“Our data point toward a causal relationship between the total number of cells that participate in infarct repair and the final enhancement of cardiac function,” concluded Dr. Dohman.

Contact: Hans Dohman, Hospital Pro-Cardiaco, Rua Dona Mariana 219, Botafogo, Rio de Janeiro, Brasil. CEP: 22280-000 Tel. (55) 21-21311584 [email protected]

Bone marrow cell transplants for limb ischemia

Bone marrow cell transplantation has been shown to induce new blood vessel growth (angiogenesis) and foster improvements in patients with ischemic artery disease. This study, conducted by a Berlin-based group, evaluated the long-term effects of intermuscular, autologous bone marrow cell (aBMC) transplants in patients at major risk for amputation due to the loss of blood flow to a limb (limb ischemia) and who have failed or who are not candidates for surgical techniques to remove or bypass blockages. Patients who have failed surgical steps have high rates of amputation. In this study, 90 percent of patients participating in the study had been scheduled for major amputations; their long-term limb salvage rate was 53 percent.

“Our results suggest that aBMC transplants have the potential to treat severely ischemic limbs,” said corresponding author Dr. Berthold Amann of the Franziskuskrankenhaus Berlin-Vascular Center. “Among the patients in whom limb salvage was successful and amputation avoided, the leg was also pain-free and usable.”

Dr. Amann noted that the patients with limb salvage had better baseline perfusion than the eventually amputated patients. Among the limb-salvaged group, analgesic consumption was reduced by 62 percent and their total walking distance improved from zero to 40 meters.

“This study found that after aBMC, in addition to being spared amputation, a critically ischemic leg can have increased blood flow and support wound healing while patients have reduced pain,” concluded Dr. Amann.

Researchers suggested that their results are yet to be confirmed, but a double-blind, placebo controlled study is currently underway.

“Should ours and other studies prove this therapy to be effective, adoption by hospitals other than large academic centers will require a simple method for processing the bone marrow,” added Dr. Amann.

Contact: Dr. Berthold Amann, Dept. of Internal Medicine, Franziskuskrankenhaus, Berlin Vascular Center, 10787 Berlin, Germany. Tel: (49) 30-2638-3601 [email protected]

“The use of bone marrow derived cells for improvement in ischemic muscle in the heart or leg is very promising,” said Amit N. Patel, associate professor of surgery at the University of Utah School of Medicine and the cardiovascular, skin, other tissue section editor of Cell Transplantation. “Both articles demonstrate that the route of delivery is one of the key determinants in having positive outcomes in the early clinical trials.”

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On The Net:

Cell Transplantation Center of Excellence for Aging and Brain Repair

 People with ankle injuries who do not respond successfully to initial treatment may have a second chance at recovery, thanks to two new procedures developed to restore the injured area, according to a study published in the July 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

The study reviews emerging techniques that have proven successful in treating injuries to the talus, the small bone, which is located between the heel bone and the lower bones of the leg. The talus helps form the ankle joint.

Although most injuries to the talus can be successfully treated using traditional “first-line” therapies involving removal of dead tissue (called “debridement”) and drilling, about one-fifth to one-quarter of people with ankle injuries need additional “second-line” restorative treatment to heal successfully, said lead author Matthew Mitchell, MD, an orthopaedic surgeon in private practice in Casper, Wyoming.

The two new techniques rely on cells grown in a lab, and eliminate the need for ostetomy (cutting the bone of the tibia) in some cases, he said.

• Autologous chondorcyte implantation, or ACI, involves removing cartilage cells from the knee or the ankle and growing them in a lab. Once grown, the cartilage is transplanted to the talus. ACI usually involves an ostetomy in order to implant the cells.
• In matrix-induced autologous chondrocyte implantation, or MACI, cells are grown on a special backing material, or “matrix,” and then transplanted to the talus. In the authors’ experience, an osteotomy is not necessary to implant the cells.

Of these two techniques, the newer MACI technique may offer the most benefits to the patient, according to Dr. Mitchell.

“Both ACI and MACI show a lot of promise, but I think the advantage of MACI is that an osteotomy is not necessary in order to successfully implant the matrix,” he said. “You only need to make an incision to place the graft, which decreases the morbidity of the procedure quite a bit.”

“In my experience so far with this emerging technique in Australia, the results have been as good as, or better than, other restorative techniques,” he added. MACI is currently considered investigational by the FDA in the United States.

Traditional restorative techniques involve removing a cartilage donor plug from the knee and implanting it over the ankle injury, or “lesion.” This requires an operation on the knee and cutting the bone (osteotomy) of the tibia to accomodate the graft.

As a result, these traditional techniques involve potential problems, including:

• pain in the donor knee
• tissue damage in the donor knee
• tissue damage in the ankle as a result of osteotomy

“In most individuals, results are favorable with reparative techniques, such as debridement and drilling,” said Dr. Mitchell. “The lesions that are problematic and which don’t respond well to reparative treatments are lesions that are larger, and those which are fairly deep, as well as lesions which have a cyst-like structure. Whether or not an ankle “lesion” requires additional treatment after an initial reparative procedure often depends upon several factors, including: size, depth and structure of the legion.

“Once you’ve performed a reparative technique and the patient still doesn’t heal properly, then we would move on to a second-line restorative treatment,” he said

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Image Caption: This is a line drawing of the ankle.
Credit: Your Orthopaedic Connection (C) American Academy of Orthopaedic Surgeons

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On The Net:

American Academy of Orthopaedic Surgeons

A Boston doctor says eating peanut butter can be a healthy choice.

Dr. Walter Willett of the Harvard School of Public Health in Boston says the presence of some saturated fat doesn’t automatically kick peanut butter into the camp of unhealthy foods.

Olive oil, wheat germ, and even tofu — all considered to be ‘healthy’ foods — have some saturated fat, Willett says in a statement.

It’s the whole package of nutrients, not just one or two, that determines how good a particular food is for health.

Peanut butter has nutrients including fiber and some vitamins and minerals — especially potassium. Unsalted peanut butter has a terrific potassium-to-sodium ratio, which counters the harmful cardiovascular effects of a sodium surplus, Willett says. Even salted peanut butter still has about twice as much potassium as sodium.

Numerous studies have shown that people who regularly include nuts or peanut butter in their diets are less likely to develop heart disease or type 2 diabetes than those who rarely eat nuts, Willett says in the Harvard Heart Letter.

Two Indiana University studies conducted among nationally representative samples of adult American men and women show that vibrator use during sexual interactions is common, with use being reported by approximately 53 percent of women and 45 percent of men ages 18 to 60. Not only is vibrator use common, but the two studies also show that vibrator use is associated with more positive sexual function and being more proactive in caring for one’s sexual health.

The studies, led by researchers at the Center for Sexual Health Promotion in IU’s School of Health, Physical Education and Recreation, are the first to publish data about vibrator use from nationally representative samples of the U.S. population. This lack of data has existed despite a longstanding practice by many physicians and therapists to recommend vibrator use to help treat sexual dysfunctions or to improve sexual enjoyment.

One study surveyed women. The other surveyed men. Both were published this week by the “Journal of Sexual Medicine,” a leading peer-reviewed journal in the area of urology and sexual health.

“The study about women’s vibrator use affirms what many doctors and therapists have known for decades — that vibrator use is common, it’s linked to positive sexual function such as desire and ease of orgasm, and it’s rarely associated with any side effects,” said Debby Herbenick, associate director of the Center for Sexual Health Promotion.

Michael Reece, director of the Center for Sexual Health Promotion, said the studies are important for the contributions they make to an understanding of the sexual behaviors and sexual health of adults in today’s society.

“The study about male vibrator use is additionally important because it shows that vibrator use is also common among men, something that has not been documented before,” Reece said. “Also, both studies help us to further understand the way in which American consumers are turning to the marketplace for products that promote their sexual health, and that has important economic implications.”

The studies are the first to document insights into how and why people use vibrators, examine side effects and to explore associations with sexual health behaviors, sexual enjoyment and quality of life measures.

The studies were funded by Church & Dwight Co. Inc., maker of Trojan® brand sexual health products. Here are some of the findings from the studies, which involve survey responses from 2,056 women and 1,047 men ages 18-60.

For women:

• More than half of the women (52.5 percent) had used a vibrator with nearly one in four having done so in the past month.
• Vibrator users were significantly more likely to have had a gynecological exam during the past year and to have performed genital self-examination during the previous month.
• Vibrator use was positively related to several aspects of sexual function (desire, arousal, lubrication, orgasm, pain and overall function) with recent vibrator users scoring themselves higher on most sexual function domains, suggesting more positive sexual function.
• Most women (71.5 percent) reported having never experienced any side effects associated with vibrator use. Those side effects that were reported were typically rare and of a short duration.

For men:

• The prevalence of men who had incorporated a vibrator into sexual activities during their lives was 44.8 percent, with no statistical differences between the rates of vibrator use between men who identified as heterosexual and those who identified as gay or bisexual.
• Heterosexual men most commonly reported having used vibrators during foreplay or intercourse with a female partner, with 91 percent of those who had used a vibrator reporting that they had done so during such activities with women.
• Of men who have used vibrators, 10 percent had done so in the past month, 14.2 percent in the past year and 20.5 percent more than one year ago.
• Men who reported having used vibrators, particularly those with more recent use, were more likely to report participation in sexual health promoting behaviors, such as testicular self-exam.
• Men who had used vibrators recently also scored themselves higher on four of the five domains of sexual function, as measured by the International Index of Erectile Function (erectile function, intercourse satisfaction, orgasmic function and sexual desire).

The study specifically sought to establish nationally representative rates of vibrator use among men and women in the United States. Vibrators are electrical devices that produce pulses of variable amplitude and frequency to enhance sexual arousal in men and women by stimulating the genitals. Marketed widely to women through the Internet, women’s magazines, boutiques and in-home sex toy parties, they also are available in drug stores and other mainstream retailers.

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On The Net:

Indiana University

Swedish researchers have discovered that babies born by Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery, according to the July issue of Acta Paediatrica.  

It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.

Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then three to five days after the birth. It was analysed to see the degree of DNA-methylation in the white blood cells – a vital part of the immune system.

This showed that the 16 babies born by C-section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by C-section so that there were no longer significant differences between the two groups.

“Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks” says Professor Mikael Norman, who specialises in paediatrics at the Karolinska Institutet in Stockholm, Sweden. “Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life.

“That is why we were keen to look at DNA-methylation, which is an important biological mechanism in which the DNA is chemically modified to activate or shut down genes in response to changes in the external environment. As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells.”

The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed.

“Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNA-methylation that we found in human infants are linked to differences in birth stress.

“We know that the stress of being born is fundamentally different after planned C-section compared to normal vaginal delivery. When babies are delivered by C-section, they are unprepared for the birth and can become more stressed after  delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb.”

The authors point out that the surgical procedure itself may play a role in DNA-methylation and that factors other than the delivery method need to be explored in more detail.

“In our study, neonatal DNA-methylation did not correlate to the age of the mother, length of labour, birth weight and neonatal CPR levels – proteins that provide a key marker for inflammation” says Professor Norman. “However, although there was no relation between DNA-methylation and these factors, larger studies are needed to clarify these issues.”

Professor Norman states that the Karolinska study clearly shows that gene-environment interaction through DNA-methylation is more dynamic around birth than previously known.

“The full significance of higher DNA-methylation levels after C-section is not yet understood, but it may have important clinical implications” he says.

“C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early “Ëœepigenetic’ programming of the immune system may have a role to play.”

The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries.

  “Although we do not know yet how specific gene expression is affected after C-section deliveries, or to what extent these genetic differences related to the mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research” concludes lead author Titus Schlinzig, a research fellow at the Karolinska Institutet.

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On The Net:

AlphaGalileo

The two leading bodies representing GPs in the UK have backed a call by the Wellcome Trust for clearer guidance for GPs to ensure medical records can be safely used in research.

Patient records in general practice surgeries are a unique resource of information which can help medical researchers improve their understanding of disease, develop potential new treatments and improve patient care. The increasing use of electronic records should make it easier for researchers to use this information.

The public are generally supportive of this research: two-thirds of people would consider allowing personal health information to be shared for research purposes. However, this information is both sensitive and private and the public, patients and healthcare professionals must all have confidence that the security of personal information is safeguarded.

Today, the Wellcome Trust, the UK’s largest medical research charity, publishes guidelines for best practice in the use of patient records for research purposes. The report was reached during a national consensus meeting held in 2008 with GPs, researchers and patient groups.

The guidelines ““ Towards Consensus for Best Practice ““ have been endorsed by the British Medical Association (BMA), the independent trade union and professional association for doctors and medical students, and the Royal College of General Practitioners (RCGP), the professional membership body for family doctors in the UK and abroad.

Three overarching principles form the basis on which the guidelines were agreed. They are:

Patient confidentiality and privacy must be safeguarded
GPs and healthcare professionals should play the role of patient’s advocate
Public awareness and understanding of the use of records in research should be improved.
“We welcome the endorsement by the BMA and the Royal College of General Practitioners of the guidelines for the use of patient records from general practice for research,” says Sir Mark Walport, Director of the Wellcome Trust. “There are over 44,000 GPs in the UK, and their support is essential if we are to maintain trust in how patients’ medical records are accessed for research purposes. The public strongly support medical research and researchers in turn must support the public by working to the highest standards.”

“This report provides valuable guidance to GPs,” says Dr Vivienne Nathanson, Head of Science and Ethics at the BMA. “The first priority of GPs must be to deliver high-quality healthcare. But they must also protect patients if their records are to be used in research and ensure that the confidentiality of patient data is safe and secure at all times.”

RCGP Chairman Professor Steve Field said: “Quality research has enabled us to make some amazing advances in the treatment and care of our patients. GPs and researchers need to work in partnership to ensure that we gain the best evidence to guide future improvements .GPs will find these new guidelines extremely useful, they are an excellent first step towards ensuring best practice.”

The report includes guidelines on the use of anonymised, coded and identifiable data from patient records, and the use of privacy-enhancing technologies, including safe havens, encryption and honest brokers. It also sets out recommendations on how to identify potential participants for a particular study, how they should be approached, the level of consent required and the provision of sufficient information that a potential participant may make an informed decision on whether to participate.

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On The Net:

Wellcome Trust

U.S. researchers say they are designing affordable in-home health monitors for caregivers to monitor the elderly.

Four years ago, University of Houston researchers led by Driss Benhaddou began using off-the-shelf technology to develop a wireless health-monitoring system in conjunction with the Abramson Center for the Future of Health and The Methodist Hospital Research Institute.

The technology uses processor boards found in a variety of electronics, which cost only about $70 each. You could wire a whole home for about $1,000, Benhaddou said in a statement. Our system will allow for such things as vital sign monitoring and location tracking using low-cost technologies and offering fast response times for caregivers.

Benhaddou said a patient whose movement is being monitored — perhaps because of Alzheimer’s or dementia — can wear the quarter-size sensor on a belt or piece of clothing. A patient being monitored for vital signs — such as temperature, heart beat and oxygen level — needs to wear the sensor on his or her skin.

The body sensor communicates with sensors in various rooms and with a hub, which would be connected to the Internet and communicate with a caregiver’s smartphone or hand held computer — a personal digital assistant. Benhaddou said the system needs to be simple enough so caregivers can do the installations on their own.

Much is often said about the glaring statistics showing that some racial and ethnic minorities face greater risks than whites when it comes to health.

Nina T. Harawa, an Assistant Professor and researcher at Charles Drew University, says today’s disparities are linked to many factors, including economics, access to health care and the impact of living in a race conscious society.

But in the recent issue of Ethnicity and Disease, she writes that the concept of race is often misunderstood or inconsistently used when examining differences (or “disparities”) in health outcomes.

“There is no gold standard for the use of race in health research,” said Harawa, who co-wrote the article with Assistant Professor Chandra L. Ford, PhD, of the UCLA School of Public Health.

Harawa said there are no readily agreed-upon standards for measuring someone’s race, as in the case of gauging someone’s age. Nevertheless, race has been used to categorize people since before the country’s founding.

Efforts to simplify the complexities of race”” including genetic, cultural and socioeconomic variations””have made race-related research “a minefield of often premature and ultimately wrong conclusions,” she said.

To understand health disparities in the various population groups, she said, researchers need to understand how today’s racial categories evolved from the negative assumptions made hundreds of years ago to justify slavery.

“Advancing our ability to address racial/ethnic disparities in health requires a historically informed understanding of these issues, including how the notion of fixed and distinct races became fixed in the American mind,” she wrote.

A report, titled “Health Disparities: A Case for Closing the Gap”, recently released by the U.S. Health and Human Services, shows significant disparities:

• 48 percent of all African American adults suffer from a chronic disease compared to 39 percent of the general population.
• Eight percent of White Americans develop diabetes while 15 percent of African Americans, and 14 percent of Hispanics and 18 percent of American Indians develop diabetes.
• African Americans are 15 percent more likely to be obese than Whites.

“Minorities and low income Americans are more likely to be sick and less likely to get the care they need,” said Health and Human Services Secretary Kathleen Sebelius after the release of her report earlier this month. However, Dr. Harawa points out there are also exceptions, such as first generation Latino immigrants who have health advantages in many areas despite high levels of poverty and generally low levels of education. Further, Black immigrants frequently experience much better health outcomes than do other Black populations in the US.

Unfortunately, today’s race and ethnic categories often fail to make these distinctions.

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On The Net:

Charles Drew University of Medicine and Science

An emergency rule intended to reduce the number of deaths and injuries associated with Hawaiian air tours was followed by a 47 percent reduction in sightseeing crashes, according to a new study by researchers from the Johns Hopkins Bloomberg School of Public Health’s Center for Injury Research and Policy.

However, the proportion of crashes that resulted in lives lost actually increased after the rule change due to an increase in crashes that resulted from poor visibility, which tend to be exceptionally fatal. The report is published in the July issue of Aviation, Space, and Environmental Medicine.

The Federal Aviation Administration (FAA) issued Special Federal Aviation Regulation (SFAR) 71 in 1994 in response to a spate of crashes of helicopter sightseeing tours that year. The regulation established minimum flight altitudes and clearances from terrain, emphasized passenger safety precautions, mandated performance plans prior to each flight, and required flotation equipment or the wearing of life preservers on flights beyond the shoreline.

“Our findings indicate that the 1994 Rule was followed by a reduction of almost half in the crash rate. On the other hand, crashes that occurred as a result of low visibility-often because of rain, fog, or clouds-increased from 5 percent to 32 percent of all air tour helicopter crashes in the 14 years after the new regulation,” said senior author Wren L. Haaland, a 2009 graduate of Johns Hopkins University who conducted the study as an undergraduate research assistant with the Bloomberg School’s Center for Injury Research and Policy.

“Our data suggest the FAA should reconsider the Rule’s clause that established a minimum flying altitude of 1,500 feet, as we know higher altitudes are associated with more cloud cover,” said Susan P. Baker, MPH, director of the study’s research and professor with the Injury Center. Clouds obscuring mountain peaks and passes are particularly common in Hawaii. The Hawaii Helicopter Operators Association appealed the Rule on the basis that the 1,500-feet above-ground-level minimum flying altitude would lead to crashes due to the prevalence of clouds at or above that altitude. The appeal was rejected by the U.S. Ninth Circuit Court of Appeals.

The researcher team analyzed data collected from the National Transportation Safety Board’s Aviation Accident Database, identifying 59 crashes of helicopter air tour flights in Hawaii from 1981 through 2008. Crashes in 1995 to 2008 were compared with those in 1981 to 1994. The greatest decreases occurred in crashes into the ocean, crashes not involving malfunctions, and nonfatal crashes. Aircraft malfunctions were the most common precipitating factor throughout the study period, occurring at similar frequencies pre- and post- regulations. The most common malfunction was loss of power, most often caused by improper maintenance. Forty-six tourists and 9 pilots died in 16 fatal crashes during the 28-year study period.

“The persistence of mechanical problems and malfunctions is noteworthy, since they were related to the majority of crashes and not addressed by the FAA’s 1994 Rule,” said Dennis F. Shanahan, MD, MPH, a co-author of the study. “This is an oversight, as many of these problems could be prevented through better mechanic training, closer FAA oversight, and increased emphasis from management on proper and thorough maintenance procedures. Helicopter tourism is popular in other areas such as Alaska and the Grand Canyon, and every precaution should be taken to save lives.”

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On The Net:

Johns Hopkins University Bloomberg School of Public Health

President Barack Obama’s signature on a bill this week to grant the Food and Drug Administration (FDA) regulatory authority over tobacco was historic, and represents a step in the march to eliminate tobacco use in this country by 2047, two national tobacco experts said today (June 25).

The pair published “Stealing a March in the 21st Century: Accelerating Progress in the 100-Year War Against Tobacco Addiction in the United States” in the July issue of the American Journal of Public Health. Michael Fiore and Timothy Baker, director and associate director of the University of Wisconsin-Madison Center for Tobacco Research and Intervention (UW-CTRI), respectively, chart milestones in beating tobacco addiction and map a battle plan to eradicate tobacco use in the next few decades. The researchers analyzed data from the 1960s, when the first systemic tracking of smoking rates began, until the present.

“Numerous observers have claimed over time that tobacco use has plateaued and progress against its use has stalled,” the authors write. “However, the remarkable decline in rates of tobacco use since the 1960s belies this claim and underscores the remarkable success of tobacco control efforts to date.”

Data from the Centers for Disease Control and Prevention show adults smoking between 1965 and 2007 dropped by an average of one half of one percentage point per year, from 42 percent to the current rate of about 20 percent rate. While this rate of decline hasn’t occurred each year, the overall decrease has been quite steady.

The two researchers urge a nationwide effort designed to accelerate the rate of decline over the next 50 years through:

Substantial increases in federal and state tobacco excise taxes.
A national clean-indoor air law.
Elimination of nicotine from tobacco products.
Funds for an aggressive mass media campaign to counter the tide of tobacco industry ads and sponsorships.
A ban on tobacco advertising, promotion and sponsorship.
Evidence-based counseling and medication for every smoker who wants to quit.
Protecting young people, particularly those 17 and younger, from starting to smoke. Research shows that a major genetic risk for lifelong nicotine dependence can be suppressed if young people avoid daily smoking prior to age 17.

“The progress made in reducing tobacco use over the last 50 years should in no way temper our commitment to further reductions. Nor should that progress be interpreted to mean tobacco use is less toxic or that tobacco companies are now on the ropes. But, if appropriate steps are taken, a tobacco-free nation can be achieved within a few decades,” Fiore says.

Past success has been born of:

• Tobacco tax increases.
• Enactment of clean-indoor air laws.
• Tobacco industry advertising restrictions.
• Tobacco product-labeling requirements.
• Policies that restrict youth access to tobacco products.
• Mass media campaigns.

Increased availability and effectiveness of treatments to help current smokers quit.
In their article, Baker and Fiore called for FDA regulation of tobacco products to spur progress. That bill was signed into law on June 22, along with provisions that would further restrict tobacco industry targeting of kids, strengthen health warnings on tobacco packaging, require disclosure about what’s in tobacco products and ban terms like “light” and “mild” to describe cigarettes.

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On The Net:

University of Wisconsin-Madison

Researchers at The University of Texas School of Public Health have developed a game for HIV-positive youth, +CLICK, designed to reduce secondary transmission of the virus.

+CLICK was developed by Christine Markham, Ph.D., and Ross Shegog, Ph.D., assistant professors of behavioral sciences. The game’s usability and credibility were assessed by HIV-positive (HIV+) youth at a Texas Children’s Hospital clinic. Results from the study were published in the May issue of AIDS Care.

According to the World Health Organization, adolescents and young adults ages 13-24 account for 40 percent of new HIV infections worldwide and almost half of all HIV infections in the United States. Many HIV+ youth engage in risky sexual behaviors, according to Markham.

“We wanted to create +CLICK so that we could help educate youth on the importance of making proper, healthy decisions to protect their relationships and themselves as well as help to reduce transmission of the HIV virus,” said Markham, lead investigator of the study.
The game was developed as an adjunct to the youths’ traditional clinic-based self-management education.

The small sample size of 32 study participants included 62.5 percent females and 37.5 percent males. Of those participants, 56.2 percent contracted the virus through birth and 43.8 percent became infected through sexual contact.

Markham and Shegog worked with Mary Paul, M.D., associate professor of pediatrics at Baylor College of Medicine, and Amy Leonard, M.P.H., research coordinator at Baylor College of Medicine, to develop the material presented in the interactive lessons.

Replicating a shopping mall, study participants travel through lessons on abstinence, condoms and contraception, and also watch video clips from experts and peers who are also HIV+. +CLICK is designed to target four behaviors: choosing not to have sex; disclosing HIV status to a potential partner; using condoms correctly and consistently; and using an effective method of birth control along with condoms.

Participants were able to play several of the game’s lessons in approximately 15 minutes during their regularly scheduled clinic visits.

“Participants were very receptive and enthusiastic about playing the game,” said Leonard. “They also liked that they were able to ask the clinicians questions about what they learned on the lessons.” Credibility of the game was trusted by 93.8 percent of the participants and 84.4 percent of users found the game to be very easy to use and would tell others about +CLICK, according to the study.

A prototype of the game was used for the study. The game, which is in the last stages of development, is tentatively scheduled to be available to the public in approximately six months. In addition, the research team is working to create a similar web-based game that will focus on medication adherence for HIV+ youth.

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On The Net:

University Of Texas

The National Institutes of Health (www.nih.gov) today announced expanded funding for Baylor College of Medicine’s (www.bcm.edu) Human Genome Sequencing Center for its involvement in the Human Microbiome Project, which seeks to understand how the trillions of microscopic organisms that live in or on the human body affect human health and lives.

Also announced was that BCM’s Dr. James Versalovic (http://www.bcm.edu/cmb/?pmid=2446) will lead one of 15 pilot clinical demonstration projects.

The Human Genome Sequencing Center at BCM was one of the centers that took part in the initial phase of the project. This new $3.7 million four-year expansion grant will enable it along with the other original designated centers ““ Washington University Genome Sequencing Center in St. Louis, Mo., and the J. Craig Venter Institute in Rockville, Md. ““ to sequence the genomes of 400 microbes to add to the 500 whose sequences are already complete or nearing completion.

The data will help researchers characterize the microbial communities found in samples from five areas of the body: digestive tract, mouth, skin, nose and vagina.

Federal officials said they expect that the Broad Institute of MIT/Harvard in Cambridge Mass., which was part of the initial phase, will take part in this phase of the project as well.

“This is an exciting phase of this transformative project,” said Dr. Richard Gibbs, director of BCM’s Human Genome Sequencing Center and principal investigator of the Human Microbiome Project study center at BCM. “The Human Genome Sequencing Center (at BCM) will be participating in the first deep understanding of the role of complex microbial communities in human biology.”

In addition, Versalovic, professor of pathology, pediatrics, molecular and human genetics, and molecular virology and microbiology at BCM, head of the department of pathology at Texas Children’s Hospital (www.texaschildrens.org), and a co-investigator in the College’s microbiome project, has received one of 15 pilot clinical demonstration projects awarded nationally. Dr. Robert Shulman, professor of pediatrics at BCM, will co-lead the project with Versalovic.

His project on pediatric irritable bowel syndrome was funded at $750,000 for one year after which it will be reviewed for renewal.

“These pilot studies represent the first grants in this project connecting the human microbiome with health and disease,” said Versalovic, also director of the Texas Children’s Microbiome Center “The award enables us to gain an inside track on more translational microbiome-related projects in the future.”

Other researchers involved in the BCM part of the project include Dr. Wendy Keitel, associate professor of molecular virology and microbiology, Dr. Sarah Highlander, associate professor of molecular virology and microbiology, and Dr. Joseph Petrosino, assistant professor of molecular virology and microbiology.

For more information about the Human Microbiome Project, visit www.nihroadmap.nih.gov/hmp/ and www.hmpdacc.org.

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On The Net:

BCM

Eating disorders are frequently seen as psychological or societal diseases, but do they have an underlying biological cause? A new study shows that the levels of a brain protein differ between healthy and anorexic women.

Anorexia is a serious and occasionally fatal eating disorder most commonly affecting women. Scientists do not yet understand the physical causes of anorexia, though some studies suggest a link to low levels of a brain protein called BDNF. Now, a study recommended by Cynthia Bulik, a member of Faculty of 1000 Medicine and leading expert in the field of psychiatry and eating disorders, shows that BDNF levels are higher in women who have recovered from anorexia. This suggests that low BDNF levels may be reversible.

Researchers at Chiba University in Japan found that anorexic women had lower levels of BDNF in their blood than healthy women or those who had recovered from anorexia. Women with low BDNF also had the lowest self-image, suffered from anxiety and depression, and performed poorly on certain tests of cognitive ability.

Further study is needed to determine what role BDNF plays in anorexia, and if it can be used to predict the risk of developing it, but Bulik forecasts that “…BDNF may emerge as a useful biomarker of [anorexia] and of recovery from [anorexia].”

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On The Net:

Faculty of 1000: Biology and Medicine

Dr. Janet D. Latner, an Associate Professor of Psychology at the University of Hawai’i at Manoa, has co-authored an article in the July 2009 edition of the Journal of Sex & Marital Therapy on “Weight Stigma in Existing Relationships.”

The research””conducted jointly by Professor Latner and New Zealand clinical psychologist Dr. Alice D. Boyes (www.aliceboyes.com)””addresses body image, weight, romantic relationships, and differences between men and women.

Associations between body mass index (BMI) and relationship quality and other partner/relationship perceptions were investigated in 57 couples in New Zealand. Heavier women had lower quality relationships, which they predicted were more likely to end. They partnered with less desirable men and thought their partners would rate them as less warm/trustworthy.

The male partners of heavier women judged the women’s bodies less positively and men rated heavier women as poorer matches to their ideal partners for attractiveness/vitality. In contrast, men’s BMIs were generally not associated with relationship functioning. These findings point to the potential mechanisms that may contribute to heavier women’s relationship difficulties.

“Prejudice and discrimination are commonly directed at overweight individuals. However, few previous studies have examined whether weight stigma occurs within established romantic relationships. Our results suggest it does,” said Dr. Latner.

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On The Net:

University of Hawaii at Manoa

Appendicitis is the most common childhood surgical emergency, but the diagnosis can be challenging, especially in children, often leading to either unnecessary surgery in children without appendicitis, or a ruptured appendix and serious complications when the condition is missed. Now, emergency medicine physicians and scientists at the Proteomics Center at Children’s Hospital Boston demonstrate that a protein detectable in urine might serve as a “biomarker” for appendicitis. Their report was published online June 23 by the Annals of Emergency Medicine.

Despite improvement in imaging technologies, recent figures indicate that 3 to 30 percent of children have unnecessary appendectomies, while 30 to 45 percent of those diagnosed with appendicitis already have a ruptured appendix. Laboratory biomarkers have been identified, but none have proved reliable enough to be clinically useful. Researchers led by Richard Bachur, MD, acting chief of emergency medicine at Children’s Hospital Boston, Hanno Steen, PhD, director of the Proteomics Center, and clinical fellow Alex Kentsis, MD, PhD, decided to take a systematic approach, performing a proteomics study using state-of-the are mass spectrometry (a technique that detects and quantifies proteins in a sample). Their two-part study has identified the most accurate biomarker for acute appendicitis known to date.

In the first phase, they examined 12 urine specimens ““ 6 from patients with appendicitis, taken before and after appendectomy, and 6 from patients without appendicitis ““and identified 32 candidate biomarkers, including many proteins associated with immune response and inflammation. To these 32 they added other candidates found through gene expression studies and other means, yielding a total of 57 potential biomarkers. They then sought to validate these markers in 67 children seen at the hospital for suspected appendicitis over an 18-month period, 25 of whom ultimately had proven appendicitis. The laboratory investigators testing for the markers were not told the patients’ clinical status, to ensure unbiased assessment of the test performance.

Seven promising urine biomarkers were identified. The best of them was leucine-rich alpha-2-glycoprotein (LRG), which appears to be a specific marker of local inflammation. It had an “area under the curve” value of 0.97, indicating near-perfect sensitivity (with almost no false-negatives) and near-perfect specificity (almost no false-positives). LRG was strongly elevated in diseased appendices, even when those appendices appeared normal on imaging, and the amount of LRG correlated with the severity of the appendicitis as judged by histologic review of the appendix specimens.

Although mass spectrometry isn’t widely available clinically, urine LRG elevations were detected by immunoblotting, suggesting that a rapid clinical test, such as a urine dipstick, could be developed through further research.

Bachur, Steen and Kentsis now seek to develop quantitative LRG urine assays and further validate their findings. “Recent diagnostic advances have focused on advanced radiologic procedures, such as computed tomography and ultrasound, but these resources are not universally available and can delay diagnosis,” says Bachur. “Although these advances have improved the diagnosis and decreased complications from appendicitis, CT scans also expose children to radiation that may increase the lifetime risk of cancer.”

The researchers note that since their study was limited to children, and that patterns of biomarkers likely vary in older patients, LRG testing would need to be studied in other clinical settings.

Steen, director of the Proteomics Center at Children’s, predicts that proteomics will play a major role in discovering diagnostic markers for a variety of pediatric diseases in the future. The hospital made a significant financial investment five years ago to launch the Center.

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On The Net:

Children’s Hospital Boston

For years, vitamin D and fish oil have been two of the most popular over-the-counter dietary supplements in U.S.  Now, an extensive, government-funded study will test the benefits of both in the prevention of cancer, heart disease and strokes to determine whether they will get the official thumbs up.

What’s more, the study is one of but a small handful of health experiments to ever look into the ethnic-specific effects of nutrients on the human body.

In humans and most other mammals vitamin D is synthesized naturally when UVB rays from the sun penetrate the skin and stimulate its production in the basal levels of the epidermis.  In dark-skinned people however””particularly those of African descent””large quantities of the pigment melanin in the upper layers of skin serve as a filter, blocking most of the UVB light and significantly reducing the amount of vitamin D that the body is able to produce.

A number of scientists have hypothesized that this lower production of vitamin D may be an important piece of the puzzle in understanding why African Americans, for example, suffer from such high rates of cancer, stroke and heart disease.

“If something as simple as taking a vitamin D pill could help lower these risks and eliminate these health disparities, that would be extraordinarily exciting,” said Dr. JoAnn Manson of Harvard-affiliated Brigham and Women’s Hospital in Boston, who, along with Dr. Julie Buring, will be co-leader of the research project.

“But we should be cautious before jumping on the bandwagon to take mega-doses of these supplements,” she cautioned. “We know from history that many of these nutrients that looked promising in observational studies didn’t pan out.”

For a time, a there was a tremendous buzz in the medical community over the tremendous potential of Vitamins C, E, beta carotene, folic acid and others to lower the risk of a number of chronic health problems.  After rigorous testing, however, mega-doses of these supplements were shown to carry just as many health risks as benefits.

Others have simply proven ineffective. In October of 2008, federal funding for a major long-term study examining the role of vitamin E in preventing certain forms of cancer was abandoned after researchers failed to produce results that even remotely hinted at statistically significant benefits of the supplement.

Vitamin D is one of the last well-known nutrients to be put through the scientific ringer.

Scientists and nutritionists have known for some time that a large number of people have vitamin D deficiencies.  In addition to blacks, health experts have also detected higher rates of cancer in people inhabiting northern regions, where longer winters and reduced exposure to sunlight means that their bodies have less opportunity to produce sufficient quantities of the “sunshine vitamin.”

Further complicating the problem for both northerners and those with dark skin is the fact that vitamin D is not as readily available in dietary sources as a number of other vitamins.  Nutritionists say that it’s difficult to eat enough dairy and fish products to compensate for a lack of naturally-produced vitamin D.

While scientists are already quite certain about several of the health benefits of the vitamin D””such as its role as a regulator of calcium and phosphorous levels in the blood””they are also eager to take a more in depth look at some of the less-understood physiological effects of the fat-soluble compound.

“Vitamin D and omega-3s have powerful anti-inflammatory effects that may be key factors in preventing many diseases. They may also work through other pathways that influence cancer and cardiovascular risk,” explained an optimistic Manson.

The expansive new study will include some 20,000 subjects over the age of 60 who have no history of heart disease or stroke.  Because of difficulties that the body often has utilizing vitamins from a pill, some of the participants will be randomly assigned to take vitamin D pills, while others will take natural fish oil supplements, both nutrients or placebo pills.

For a five year period, the patients will receive 2,000 international units of vitamin D-3 a day.  Also known to researchers by its scientific name, cholecalciferol, this version is known to be the most active form of the nutrient. 

The subjects receiving fish oil will get about one gram a day””roughly 10 times more than what the average American consumes.

“We’re hoping to see a result during the trial, that we won’t have to wait five years,” said Manson.

Besides the vitamin’s potential effect on heart disease, stroke and cancer, the researchers will also be looking for possible benefits in reducing memory loss, depression, diabetes, osteoporosis and other problems, explained Buring.

National Cancer Institute,  in collaboration with the National Heart, Lung and Blood Institute and other federal agencies will be funding the $20 million project. Pharmavite LLC of Northridge, Calif., is providing the vitamin D pills, and Ocean Nutrition Canada Ltd. of Dartmouth, Nova Scotia, is providing the omega-3 fish oil capsules.

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On the Net:

• Brigham and Women’s Hospital

 The percentage of patients lowering their elevated “bad” cholesterol to within target levels nearly doubled in the last decade, according to a multi-national survey reported in Circulation: Journal of the American Heart Association.

In the Lipid Treatment Assessment Project (L-TAP) 2 “” a survey of nearly 10,000 patients (average age 62) from nine countries undergoing cholesterol-lowering and management efforts “” researchers found that:

The number of patients successfully reaching their respective low-density lipoprotein (LDL) levels rose from 38 percent to 73 percent over the last 10 years.
Among high-risk patients, 67 percent reached established goal levels.
Only 30 percent of very high risk patients “” those with existing coronary artery disease and two or more other risk factors such as obesity, diabetes and smoking “” successfully reached their LDL target of 70 milligrams per deciliter (mg/dL) or less.
LDL is known as “bad” cholesterol because it’s associated with increased cardiovascular risk.
“Although there is room for improvement, particularly in very high-risk patients, these results indicate that lipid-lowering therapy is being applied much more successfully than it was a decade ago,” said David D. Waters, M.D., lead author of the study and Emeritus Professor, University of California, San Francisco.

Researchers examined compliance with LDL goals outlined in the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III, the 2003 Joint European Societies, or the 2003 Canadian Working Group. Countries in the study were the United States, Canada, Mexico, the Netherlands, Spain, France, Brazil, South Korea and Taiwan.

LDL cholesterol goals in the United States depend on how many risk factors are present, according to NCEP ATP III guidelines:

For people without coronary heart disease, diabetes or cardiovascular risk factors, the goal is less than 160 mg/dL.
For people without coronary heart disease or diabetes, but who have two or more cardiovascular risk factors, the goal is less than 130 mg/dL.
For patients with coronary heart disease or diabetes, the goal is less than 100 mg/dL. But when risk is very high, a goal of less than 70 mg/dL is a therapeutic option.
Researchers found that 75 percent of the patients surveyed were taking a statin drug (atorvastatin, simvastatin, rosuvastatin or pravastatin). The median duration of therapy was two years. Others were treated with fibrates, ezetimbe or lifestyle changes such as diet and exercise alone.

In 1996″“97, only 38 percent of patients in the United States were achieving recommended cholesterol goals and just 18 percent of those with coronary heart disease were at goal. The new study found the success rate was 86 percent in low-risk patients, 74 percent in those at moderate risk and 67 percent in high-risk patients.

In the survey, average LDL levels were 119 mg/dL in the low-risk group, 109 mg/dL among those at moderate risk and 91 mg/dL in high-risk groups.

The researchers also reviewed high-density lipoprotein (HDL), or “good” cholesterol levels. In the entire group, HDL cholesterol was optimal “” about 60 mg/dL in 26 percent of patients and below 40 mg/dL in 19 percent. The average HDL cholesterol levels were 62 mg/dL for low-risk patients, 49 mg/dL for moderate-risk and 50 mg/dL for high-risk patients.

The proportion of patients achieving LDL goals according to relevant national guidelines ranged from 47 percent in Spain to 84 percent in South Korea. Researchers couldn’t explain the variation among countries.

In an accompanying editorial, Antonio M. Gotto, Jr., M.D., D.Phil, notes that these results
indicate there is still a considerable gap in the treatment of patients at highest risk for cardiovascular events.

“Rates of obesity and diabetes have worsened over the past decade, and cardioprotective drugs can only do so much to remedy the metabolic complications that often result from poor lifestyle choices,” writes Gotto, professor of medicine at Weill Cornell Medical College in New York. “Effectively addressing global cardiovascular risk requires an increased focus on lifestyle, as well as lipids.”

Co-authors of the study are Carlos Brotons, M.D.; Cheng-Wen Chiang, M.D.; Jean Ferrires, M.D.; JoAnne Foody, M.D.; J. Wouter Jukema, M.D.; Raul D. Santos, M.D.; Juan Verdejo, M.D.; Michael Messig, Ph.D; Ruth McPherson, M.D.; Ki-Bae Seung, M.D.; and Lisa Tarasenko, Pharm.D.; on behalf of the L-TAP 2 Investigators. Individual author disclosures can be found on the manuscript.

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On The Net:

AHA

Melatonin can slow down the effects of aging. A team at laboratoire Arago in Banyuls sur Mer (CNRS / Universit© Pierre et Marie Curie) has found that a treatment based on melatonin can delay the first signs of aging in a small mammal. These results appeared in the journal PLoS ONE on 15 June 2009.

Better known as the “Ëœtime-keeping’ hormone, melatonin is naturally secreted by the body during the night. It is therefore a kind of biological signal for nightfall, allowing an organism to synchronize itself with the day/night rhythm.

At Laboratoire Arago, Elodie Magnanou and her co-workers studied the long-term effects of melatonin on the Greater White-toothed shrew, a small nocturnal insectivorous mammal. Under normal conditions, this animal shows the first signs of aging after reaching 12 months, mainly through the loss of circadian rhythm in its activities. By continuously administering melatonin, starting a little before 12 months, the appearance of these first signs was delayed by at least 3 months, which is a considerable period in relation to the lifespan of this shrew(1).

Melatonin is now known to play several beneficial roles. These include being an antioxidant, an anti-depressant, and helping to remediate sleep problems. The next step will be to understand the mode of action of the hormone on aging, so we can perhaps envisage its use on humans.

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On The Net:

AlphaGalileo