September 7, 2010, 7:39 AM CT

Antibiotic-resistant infections slowing

The United States must focus on conserving the use of antibacterial drugs, or face a public health crisis from rapidly rising rates of antibiotic-resistant infections, as per an analysis out today.

Evidence indicates that our nation's supply of antibiotics is being depleted by resistance, which occurs when infection-causing microbes mutate or change so that they no longer respond to widely-used therapys. Most proposals to solve this problem focus on giving pharmaceutical companies financial incentives to develop new drugs that could replace those that are no longer working.

But a new report published recently in the recent issue of Health Affairs suggests that approach won't work for long. New drugs will face microbial foes that figure out how to evade therapy, say two medical policy experts.

"This is a war we cannot win unless we adopt a two-pronged strategy: one that would boost the supply of new drugs and at the same time preserve the ones we have left," says Aaron Kesselheim, M.D., J.D., M.P.H., one of the paper's co-authors. He conducted the analysis of antibacterial drugs and their impact on public health through a grant from Public Health Law Research (PHLR), a national program of the Robert Wood Johnson Foundation (RWJF).

The current pharmaceutical reimbursement system gives companies an incentive to oversell antibiotics, says Kesselheim, who is also an instructor in medicine in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and Harvard Medical School in Boston. Companies that have spent large sums of money on research and development for a new drug often seek to turn a profit on that product as quickly as possiblebefore resistance sets in, he says......... Posted by: Mark      Read more         Source

September 7, 2010, 7:38 AM CT

Many hospital emergency department visits

About 17 percent of all visits to hospital emergency departments across the United States could be treated at retail medical clinics or urgent care centers, potentially saving $4.4 billion annually in health care costs, as per a new RAND Corporation study.

Conditions that could be treated safely outside hospitals include minor infections, strains, fractures and lacerations, as per findings reported in the September edition of the journal Health Affairs

"Patient traffic to hospital emergency departments has been growing, but a significant proportion of patients could be safely treated in these alternative settings," said Robin Weinick, the study's main author and a senior social scientist at RAND, a nonprofit research organization. "Diverting these patients to alternatives such as retail clinics and urgent care centers could shorten their waiting times and save money".

More Americans are using hospital emergency departments because they face long waits for appointments with their doctor and limited after-hours options. A number of studies have observed the cost of treating of nonemergent conditions in the emergency department is significantly higher than in other settings, which can increase patients' out-of-pocket costs and add avoidable spending to the nation's health care bill......... Posted by: Janet      Read more         Source

September 7, 2010, 7:37 AM CT

Universal screening of newborns for congenital adrenal hyperplasia

The Endocrine Society released a new clinical practice guideline on the diagnosis and therapy of congenital adrenal hyperplasia (CAH). The guideline features a series of evidence-based clinical recommendations developed by an expert task force.

The guideline, reported in the September 2010 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society, is endorsed by the American Academy of Pediatrics, Pediatric Endocrine Society, the European Society for Paediatric Endocrinology, the European Society of Endocrinology, the Society for Pediatric Urology, the Androgen Excess and PCOS Society, and the CARES Foundation.

CAH is a genetic disorder of the adrenal glands that affects about one in 10,000 to 20,000 newborns, both male and female. The adrenal glands make the steroid hormones cortisol, aldosterone and androgens. In individuals with CAH, the adrenal glands produce an imbalance of these hormones which can result in ambiguous genitalia in newborn females, infertility and the development of masculine features such as development of pubic hair, rapid growth in both girls and boys before the expected age of puberty.

"If CAH is not recognized and treated, both girls and boys undergo rapid postnatal growth and early sexual development or, in more severe cases, neonatal salt loss and death," said Phyllis Speiser, MD, of Cohen Children's Medical Center of New York and Hofstra University School of Medicine, and chair of the task force that developed the guideline. "We recommend that every newborn be screened for CAH and that positive results be followed up with confirmatory tests"......... Posted by: JoAnn      Read more         Source

September 1, 2010, 7:13 AM CT

High-fat diet during puberty linked to breast cancer

Girls eating a high-fat diet during puberty, even those who do not become overweight or obese, appears to be at a greater risk of developing breast cancer during the later part of life, as per Michigan State University researchers.

The implications - that a high-fat diet may have detrimental effects independent of its effect to cause obesity - could drive new cancer prevention efforts.

The findings come from research at MSU's Breast Cancer and the Environment Research Center, established in 2003 and funded through 2010 by the National Institute of Environmental Health Sciences and the National Cancer Institute.

Physiology professor Sandra Haslam, director of the center, and Richard Schwartz, microbiology professor and associate dean in the College of Natural Science, are now expanding that research with a new, five-year, $2.3 million federal grant. They will use that funding to continue their work studying the impact of prenatal-to-adult environmental exposures that predispose women to breast cancer as part of the extended nationwide Breast Cancer and the Environment Research Program.

"The pubertal time period is crucial, as this is when the basic framework is created for mammary gland development," Haslam said. "What we are seeing from preliminary research in animals is that a high-fat diet during puberty can lead to the production of inflammatory products in the mammary glands of adults, which can promote cancer growth"......... Posted by: Janet      Read more         Source

September 1, 2010, 7:05 AM CT

Individualized chemotherapy in lung cancer

Chemotherapy is the best broad defense against cancer recurrence after surgical resection. However, it is difficult to predict which patients will benefit from which regimen of anticancer drugs, if at all. Building on existing knowledge, a study reported in the September edition of the Journal of Thoracic Oncology (JTO), analyzed the usefulness of adjuvant chemotherapy for non-small cell lung cancer (NSCLC) based on the histoculture drug response assay (HDRA). After seven years of study, scientists concluded that the use of adjuvant (post-operative) chemotherapy based on results of the in vitro HDRA improved the survival and prognosis of patients with NSCLC who had undergone surgery and whose results of the HDRA assay showed chemosensitivity to the specific drugs used for therapy.

The patients' chemosensitivity to cisplatin, carboplatin, paclitaxel, docetaxel, gemcitabine and irinotecan were examined by the HDRA assay. The patients in the study were then split into two groups: (1) those whose tumors were sensitive to at least two of the HDRA drugs and received two HDRA positive drugs per chemotherapy session (31 patients) and (2) those whose tumors were sensitive to one or none of the HDRA drugs and were treated with a combination of one HDRA positive drug and one HDRA negative or two HDRA negative drugs per chemotherapy session (34 patients)......... Posted by: Scott      Read more         Source

September 1, 2010, 7:03 AM CT

Insomnia and a short sleep duration

A study in the Sept. 1 issue of the journal SLEEP found an elevated risk of death in men with a complaint of chronic insomnia and an objectively measured short sleep duration. The results suggest that public health policy should emphasize the diagnosis and appropriate therapy of chronic insomnia.

In comparison to men without insomnia who slept for six hours or more, men with chronic insomnia who slept for less than six hours were four times more likely to die during the 14-year follow-up period (odds ratio = 4.33). Results were adjusted for potential confounders such as body mass index, smoking status, alcohol use, depression and obstructive sleep apnea. Further adjustments for high blood pressure and diabetes had little effect on the elevated mortality risk (OR = 4.00). No significant mortality risk was found in women with insomnia and a short sleep duration of less than six hours (OR = 0.36).

"The primary finding of our study is that insomnia, the most common sleep disorder, is linked to significant mortality in men," said principal investigator Alexandros N. Vgontzas, MD, professor of psychiatry in the Department of Psychiatry at Penn State College of Medicine and Hershey Medical Center in Hershey, Pa. "Until now no study has demonstrated that insomnia is linked to mortality. Our different results are based on our novel approach to define insomnia both on a subjective complaint and the objective physiological marker of short sleep duration measured in the sleep lab"......... Posted by: Daniel      Read more         Source

September 1, 2010, 6:55 AM CT

Heavy Drinkers Outlive Nondrinkers

One of the most contentious issues in the vast literature about alcohol consumption has been the consistent finding that those who don't drink actually tend to die sooner than those who do. The standard Alcoholics Anonymous explanation for this finding is that a number of of those who show up as abstainers in such research are actually former hard-core drunks who had already incurred health problems linked to drinking.

But a new paper in the journal Alcoholism: Clinical and Experimental Research suggests that - for reasons that aren't entirely clear - abstaining from alcohol does actually tend to increase one's risk of dying even when you exclude former drinkers. The most shocking part? Abstainers' mortality rates are higher than those of heavy drinkers. (See pictures of booze under a microscope.).

Moderate drinking, which is defined as one to three drinks per day, is linked to the lowest mortality rates in alcohol studies. Moderate alcohol use (particularly when the beverage of choice is red wine) is thought to improve heart health, circulation and sociability, which can be important because people who are isolated don't have as a number of family members and friends who can notice and help treat health problems.

But why would abstaining from alcohol lead to a shorter life? It's true that those who abstain from alcohol tend to be from lower socioeconomic classes, since drinking can be expensive. And people of lower socioeconomic status have more life stressors - job and child-care worries that might not only keep them from the bottle but also cause stress-related illnesses over long periods. (They also don't get the stress-reducing benefits of a drink or two after work.)......... Posted by: Janet      Read more         Source

August 31, 2010, 7:15 AM CT

Decongestant Use and Lower Risk of Preterm Birth

A newly released study led by Boston University School of Public Health (BUSPH) epidemiologists has observed that women who took over-the-counter decongestants during their pregnancies are less likely to give birth prematurely.

Preterm birth -- deliveries at less than 37 weeks' gestation- -- is the leading cause of infant morbidity and mortality in developed countries, but its causes remain largely unknown, said Rohini Hernandez, the study's main author and a doctoral candidate in epidemiology at BUSPH. In the United States, the rate of preterm delivery has increased from 9.5 percent in 1981 to 12.3 percent in 2008.

"Maybe this can provide some clues as to how to prevent preterm delivery," Hernandez said. "The more we can learn about what could potentially cause preterm birth would help our understanding in how to stop it".

The study, published online ahead of print in the journal Birth Defects Research Part A: Clinical and Molecular Teratology, observed that women who took decongestants in their second or third trimesters had a roughly 58 percent reduced risk of preterm delivery in comparison to women who didn't use decongestants during their pregnancy. (The finding was observed only for women without preeclampsia.) The authors cautioned, however, that the findings do not necessarily imply a cause and effect relationship......... Posted by: Emily      Read more         Source

August 31, 2010, 7:13 AM CT

Improved Tool for Cycling Fitness

For competitive bicyclists with goals - whether competing in the Tour de France or aiming for the podium at a local race - faster cycling comes from training regimens based on various zones of exercise intensity. New research from exercise researchers at the University of New Hampshire has observed that effective training regimens, which generally are created after expensive, time-consuming laboratory tests, can be developed from a relatively simple, do-it-yourself test.

Using two tools most competitive cyclists already own -- a power meter, an increasingly common training device that mounts on a bicycle's rear wheel, and a stationary bicycle trainer - UNH graduate student Jay Francis '09 modified a three-minute all-out cycling test and observed that it is as effective as more lab-intensive measurements for determining exercise intensity. The study, which was Francis's master's thesis, is reported in the September 2010 issue of Medicine & Science in Sports and Exercise, the premier journal in the field.

"Power is a very unbiased way of measuring your exercise ability, in comparison to speed, heart rate, or perceived exertion," says Francis. "A power meter measures how much power you are getting from your body to the road," independent of external conditions like hills, wind, or even what you had for lunch, he adds......... Posted by: JoAnn      Read more         Source

August 31, 2010, 7:11 AM CT

Destination amnesia

Elderly adults are more likely to have destination memory failures forgetting who they've shared or not shared information with, as per a newly released study led by Baycrest's Rotman Research Institute.

It's the kind of memory faux pas that can lead to awkward or embarrassing social situations and even miscommunication in the doctor's office. Ironically, after making these memory errors elderly adults remain highly confident in their false beliefs.

The study appears online, ahead of print publication, in the Online First Section of Psychology and Aging

"What we've found is that elderly adults tend to experience more destination amnesia than younger adults," said lead investigator and cognitive scientist Dr. Nigel Gopie, who led the study with internationally-renowned experts in memory and attention, Drs. Fergus Craik and Lynn Hasher.

Typically "destination amnesia is characterized by falsely believing you've told someone something, such as believing you've told your daughter about needing a ride to an appointment, when you actually had told a neighbour".

Why are elderly adults more prone to destination memory failures? The ability to focus and pay attention declines with age, so elderly adults use up most of their attentional resources on the telling of information and don't properly encode the context (ie. who they are speaking to) for later recall......... Posted by: JoAnn      Read more         Source