Health Technology Research Synopsis
114th Issue Date 21OCT2011
Compiled By Ralph Turchiano
Editors Top Five:
1. New buzzwords ‘reduce medicine to economics’
2. Teachers, children mistake candy for medicine in study
3. Industry conflicts of interest are pervasive among medical guideline panel members
4. Human Norovirus In Groundwater Remains Infective After Two Months
5. Are acid-suppressing drugs prescribed too often in infants?
In This Issue:
1. Exercise just as good as drugs at preventing migraines
2. Ginger root supplement reduced colon inflammation markers
3. Common antibiotic can have serious adverse reactions
4. Link shown between environmental toxicants and atherosclerosis
5. Folic acid in early pregnancy associated with reduced risk of severe language delay in children
6. Eating your greens can change the effect of your genes on heart disease, say researchers
7. Melatonin delays onset, reduces deaths in mouse model of Huntington’s disease
8. Mushroom compound appears to improve effectiveness of cancer drugs
9. Industry conflicts of interest are pervasive among medical guideline panel members
10. Scientists find vitamin D crucial in human immune response to TB
11. New buzzwords ‘reduce medicine to economics’
12. Folic acid supplements in early pregnancy may reduce the risk of severe language delay in children
13. Eating green veggies improves immune defenses
14. Teachers, children mistake candy for medicine in study
15. Broccoli-based compound beats drug resistance in lung disease
16. High rate of false-positives with annual mammogram
17. Omega-3 fatty acids shown to prevent or slow progression of osteoarthritis
18. Shift work in teens linked to increased multiple sclerosis risk
19. Researchers Discover Why Steroid Treatment for COPD Is Ineffective
20. Brain scans support findings that IQ can rise or fall significantly during adolescence
21. Could a probiotic be used to treat inflammatory bowel disease?
22. Study links pollutants to a 450 percent increase in risk of birth defects
23. Are acid-suppressing drugs prescribed too often in infants?
24. Study proves new technology kills bacteria
25. Women do not get enough vitamin D during the menopause
26. Early mortality risk reduced up to 40 percent through increased physical activity and sports
27. Human Norovirus In Groundwater Remains Infective After Two Months
28. When do consumers try to increase social standing by eating too much?
Public release date: 10-Oct-2011
Exercise just as good as drugs at preventing migraines
Although exercise is often prescribed as a treatment for migraine, there has not previously been sufficient scientific evidence that it really works. However, research from the Sahlgrenska Academy at the University of Gothenburg, Sweden, has now shown that exercise is just as good as drugs at preventing migraines.
Doctors use a variety of different methods to prevent migraines these days: on the pharmaceutical side a drug based on the substance topiramate has proved effective, while non-medical treatments with well-documented effects include relaxation exercises.
No previous evidence
Exercise is also frequently recommended as a treatment, though there has not been sufficient scientific evidence that it really has any effect on migraine patients. In a randomized controlled study researchers from the University of Gothenburg’s Sahlgrenska Academy have now analysed how well exercise works as a preventative treatment for migraines relative to relaxation exercises and topiramate.
40 minutes of exercise
Published in the journal Cephalalgia, the study involved 91 migraine patients, a third of whom were asked to exercise for 40 minutes three times a week under the supervision of a physiotherapist, with another third doing relaxation exercises, and the final third given topiramate. The study lasted for a total of three months, during which the patients’ migraine status, quality of life, aerobic capacity and level of phyical activity were evaluated before, during and after their treatment. Follow-ups were then carried out after three and six months.
Exercise just as effective
The results show that the number of migraines fell in all three groups. Interestingly, there was no difference in the preventative effect between the three treatments.
-Our conclusion is that exercise can act as an alternative to relaxations and topiramate when it comes to preventing migraines, and is particularly appropriate for patients who are unwilling or unable to take preventative medicines, says Emma Varkey, the physiotherapist and doctoral student at the Sahlgrenska Academy who carried out the study.
Public release date: 11-Oct-2011
Ginger root supplement reduced colon inflammation markers
PHILADELPHIA — Ginger supplements reduced markers of colon inflammation in a select group of patients, suggesting that this supplement may have potential as a colon cancer prevention agent, according to a study published in Cancer Prevention Research, a journal of the American Association for Cancer Research.
Suzanna M. Zick, N.D., M.P.H., a research assistant professor at the University of Michigan Medical School, and colleagues enrolled 30 patients and randomly assigned them to two grams of ginger root supplements per day or placebo for 28 days.
After 28 days, the researchers measured standard levels of colon inflammation and found statistically significant reductions in most of these markers, and trends toward significant reductions in others.
Inflammation has been implicated in prior studies as a precursor to colon cancer, but another trial would be needed to see how ginger root affects that risk, Zick said.
“We need to apply the same rigor to the sorts of questions about the effect of ginger root that we apply to other clinical trial research,” she said. “Interest in this is only going to increase as people look for ways to prevent cancer that are nontoxic, and improve their quality of life in a cost-effective way.”
Zick is a naturopathic doctor (N.D.), which is a four-year degree that supplements a traditional medical education with instruction on the proper use of natural therapies, diet, nutrition and other alternative treatments. Her program is one of eight in the country, compared with about 135 traditional medical schools.
Public release date: 11-Oct-2011
Common antibiotic can have serious adverse reactions
A commonly prescribed antimicrobial – trimethoprim-sulfamethoxazole – that has been used since 1968 can cause serious adverse reactions and physicians need to be aware of these in prescribing, states a review in CMAJ (Canadian Medical Association Journal) (pre-embargo link only)http://www.cmaj.ca/site/embargo/cmaj111152.pdf.
Trimethoprim–sulfamethoxazole is the most commonly prescribed antibiotic for urinary tract infections in Canada, and is used to treat community-acquired methicillin-resistant Staphylococcus aureus (MRSA) and other bacterial infections. The drug, which is low-cost and effective, is used by hundreds of thousands of Canadians each year, with about 4000 prescriptions each week in Ontario alone.
However, it can cause adverse reactions, some that can be life-threatening, as well as kidney effects (hyperkalemia) and hypoglycemia, which are common results of drug interactions.
“Although trimethoprim-sulfamethoxazole has numerous benefits, particularly in the care of patients with HIV and methicillin-resistant S. aureus, it is associated with multiple toxicities,” write the authors. “However, all drugs carry adverse effects. When considering other antimicrobials, clinicians should remember that areas of uncertainty remain, particularly with newer agents.”
To help physicians to remember the various possible toxic reactions, the authors propose the NOT RISKY acronym as an aid. They also suggest ways to reduce the risk of trimethoprim–sulfamethoxazole, such as using an alternative antibiotic, especially in pregnant women, and monitoring for kidney issues and hypoglycemia in patients on the drug.
“Clinicians should be cognizant of the potential consequences of prescribing trimethoprim–sulfamethoxazole, monitor patients for adverse events during therapy or use an alternate antibiotic when appropriate,” the authors conclude.
Public release date: 11-Oct-2011
Link shown between environmental toxicants and atherosclerosis
Environmental toxicants such as dioxins, PCBs, and pesticides can pose a risk for cardiovascular disease. For the first time a link has been demonstrated between atherosclerosis and levels of long-lived organic environmental toxicants in the blood. The study, carried out by researchers at Uppsala University, is being published online this week in ahead of print in the prestigious journal Environmental Health Perspectives.
Cardiovascular diseases, including heart attacks and strokes, are the most common cause of death in industrialized countries, and the most important underlying cause of these diseases is atherosclerosis. Unbalanced blood fats, diabetes, smoking, and high blood pressure are traditionally recognized risk factors for atherosclerosis.
Previous studies have also reported possible links between cardiovascular disease and high levels of persistent (long-lived and hard-to-degrade) organic environmental toxicants, such as dioxins, PCBs, and pesticides. These compounds are fat-soluble and can therefore accumulate in vessel walls. However, no earlier studies have investigated possible links between exposure to these compounds and atherosclerosis.
The current study measured the circulating levels of the above group of compounds in about 1,000 Swedes living in Uppsala. Atherosclerosis in the carotid artery was also measured using ultrasound.
The findings show a clear connection between increasing levels of environmental toxicants and atherosclerosis, even after taking into consideration the traditional risk factors. There was also a link to tangible signs of fat accumulation in vessel walls.
“These findings indicate that long-lived organic environmental toxicants may be involved in the occurrence of atherosclerosis and thereby lead to future death from cardiovascular diseases,” says Lars Lind, professor at the Department of Medical Sciences, Uppsala University.
“In Sweden, and in many countries in the world, many of these substances are forbidden today, but since they are so long-lived they’re still out there in our environment. We ingest these environmental toxicants with the food we eat, and since they are stored in our bodies, the levels grow higher the older we get,” says Monica Lind, Associate Professor in Environmental Medicine at Occupational and Environmental Medicine
These researchers are now going on to study how these compounds affect atherosclerosis in experimental models. They are also going to monitor the individuals included in their study to determine whether a direct connection exists between exposure to these substances and the occurrence of heart attacks and strokes in humans.
Public release date: 11-Oct-2011
Folic acid in early pregnancy associated with reduced risk of severe language delay in children
CHICAGO — Use of folic acid supplements by women in Norway in the period 4 weeks before to 8 weeks after conception was associated with a reduced risk of the child having severe language delay at age 3 years, according to a study in the October 12 issue of JAMA.
“Randomized controlled trials and other studies have demonstrated that periconceptional [the period from before conception to early pregnancy] folic acid supplements reduce the risk of neural tube defects. To our knowledge, none of the trials have followed up their sample to investigate whether these supplements have effects on neurodevelopment that are only manifest after birth,” the authors write.
Christine Roth, M.Sc., Clin.Psy.D., of the Norwegian Institute of Public Health, Oslo, and colleagues conducted a study to investigate whether maternal use of folic acid supplements was associated with a reduced risk of severe language delay among offspring at age 3 years. “Unlike the United States, Norway does not fortify foods with folic acid, increasing the contrast in relative folate status between women who do and do not take folic acid supplements,” the researchers write. Pregnant women were recruited for the study beginning in 1999, and data were included on children born before 2008 whose mothers returned the 3-year follow-up questionnaire by June 16, 2010. Maternal use of folic acid supplements within the interval from 4 weeks before to 8 weeks after conception was the exposure. The primary outcome measured for the study was children’s language competency at age 3 years as gauged by maternal report on a 6-point ordinal language grammar scale. Children with minimal expressive language (only 1-word or unintelligible utterances) were rated as having severe language delay.
The main analysis for the study included 38,954 children (19,956 boys and 18,998 girls). Of these children, 204 (0.5 percent) were rated as having severe language delay (159 [0.8 percent] boys and 45 [0.2 percent) girls). Children whose mothers took no dietary supplements in the specified exposure interval were the reference group (n = 9,052 [24.0 percent], with severe language delay in 81 children [0.9 percent]). Data for 3 patterns of exposure to maternal dietary supplements were: other supplements, but no folic acid (n = 2,480 [6.6 percent], with severe language delay in 22 children [0.9 percent]); folic acid only (n = 7,127 [18.9 percent], with severe language delay in 28 children [0.4 percent]); and folic acid in combination with other supplements (n = 19,005 [50.5 percent], with severe language delay in 73 children [0.4 percent]).
The researchers write that maternal use of supplements containing folic acid within the period from 4 weeks before to 8 weeks after conception was associated with a substantially reduced risk of severe language delay in children at age 3 years. “We found no association, however, between maternal use of folic acid supplements and significant delay in gross motor skills at age 3 years. The specificity provides some reassurance that there is not confounding by an unmeasured factor. Such a factor might be expected to relate to both language and motor delay.”
The authors add that to their knowledge, no previous prospective observational study has examined the relation of prenatal folic acid supplements to severe language delay in children.
“If in future research this relationship were shown to be causal, it would have important implications for understanding the biological processes underlying disrupted neurodevelopment, for the prevention of neurodevelopmental disorders, and for policies of folic acid supplementation for women of reproductive age.”
Public release date: 11-Oct-2011
Eating your greens can change the effect of your genes on heart disease, say researchers
Hamilton, ON — A long-held mantra suggests that you can’t change your family, the genes they pass on, or the effect of these genes. Now, an international team of scientists, led by researchers at McMaster and McGill universities, is attacking that belief.
The researchers discovered the gene that is the strongest marker for heart disease can actually be modified by generous amounts of fruit and raw vegetables. The results of their study are published in the current issue of the journal PLoS Medicine.
“We know that 9p21 genetic variants increase the risk of heart disease for those that carry it,” said Dr. Jamie Engert, joint principal investigator of the study, who is a researcher in cardiovascular diseases at the Research Institute of the McGill University Health Centre (RI-MUHC) and associate member in the Department of Human Genetics at McGill University. “But it was a surprise to find that a healthy diet could significantly weaken its effect.”
The research, which represents one of the largest gene-diet interaction studies ever conducted on cardiovascular disease, involved the analysis of more than 27,000 individuals from five ethnicities — European, South Asian, Chinese, Latin American and Arab — and the affect that their diets had on the effect of the 9p21 gene. The results suggest that individuals with the high risk genotype who consumed a prudent diet, composed mainly of raw vegetables, fruits and berries, had a similar risk of heart attack to those with the low risk genotype.
“We observed that the effect of a high-risk genotype can be mitigated by consuming a diet high in fruits and vegetables,” said Sonia Anand, joint principal investigator of the study, and a researcher at the Population Health Research Institute and a professor of medicine and epidemiology at the Michael G. DeGroote School of Medicine at McMaster University. “Our results support the public health recommendation to consume more than five servings of fruits or vegetables as a way to promote good health.”
“Our research suggests there may be an important interplay between genes and diet in cardiovascular disease,” says the study’s lead author Dr. Ron Do, who conducted this research as part of his PhD at McGill and is now based at the Center for Human Genetics Research at the Massachusetts General Hospital, Boston, Massachusetts. “Future research is necessary to understand the mechanism of this interaction, which will shed light on the underlying metabolic processes that the 9p21 gene is involved in.”
Public release date: 11-Oct-2011
Melatonin delays onset, reduces deaths in mouse model of Huntington’s disease
PITTSBURGH, Oct. 11 — Melatonin, best known for its role in sleep regulation, delayed the onset of symptoms and reduced mortality in a mouse model of Huntington’s disease, say researchers at the University of Pittsburgh School of Medicine and Harvard Medical School. Their findings, published today in theJournal of Neuroscience, show for the first time that certain receptors for the hormone reside in the mitochondria, and that there are fewer of them both in affected mice and human brains.
Huntington’s disease (HD) is an inherited, lethal disorder of involuntary movement, progressive loss of intellectual function and emotional problems, explained senior investigator Robert M. Friedlander, M.D., chair, Department of Neurological Surgery and UPMC Endowed Professor of neurosurgery and neurobiology. A mutant protein, called huntingtin, kills neurons in the brain’s striatum and then the cortex.
“In earlier work, we screened more than 1,000 FDA-approved drugs to see which ones could block the release of a small protein called cytochrome c from the mitochondria to interrupt a key step in a chain reaction known as apoptosis, or programmed cell death,” he said. “Melatonin, which we know to be a potent antioxidant, was one of the agents that could do this in the test tube, but we needed to determine if it would also be neuroprotective in a transgenic animal model of HD.”
For the study, the researchers injected HD mice daily with either melatonin or a placebo, evaluated them weekly for signs of the disease, and examined their brain tissue after death. They found that melatonin treatment delayed the onset of disease by 19 percent, slowed disease progression and prolonged life span by 18 percent.
The researchers determined also that type 1 melatonin (MT1) receptors are found on mitochondria, which supplies energy for the cell, and that they were depleted in both HD-affected human and mice brain tissue samples. In lab experiments, administration of an agent that prevents melatonin from binding to the MT1 receptor encouraged cell death, while gene-engineering to increase the number of receptors led to greater neuroprotection, even when melatonin levels were normal.
“Extra melatonin might help fill all the available MT1 receptors, allowing the hormone to counter the programmed cell death cascade and thus protect neurons,” Dr. Friedlander said. “This suggests that melatonin or similar agents that influence the MT1 receptor have potential as an HD treatment, which we’ve never had before.”
Low levels of circulating melatonin have been seen in other neurodegenerative diseases, including Alzheimer’s disease and Parkinson’s disease. The research team is continuing to explore what might cause the loss of MT1 receptors and to assess other drugs that block cytochrome c and cell death.
“Perhaps the best approach will be to develop a cocktail of drugs that target different molecular pathways that are responsible for creating HD,” Dr. Friedlander said. “We plan to see if combining different agents leads to a greater impact on disease progression and mortality.”
Public release date: 11-Oct-2011
Mushroom compound appears to improve effectiveness of cancer drugs
AUGUSTA, Ga. – A compound isolated from a wild, poisonous mushroom growing in a Southwest China forest appears to help a cancer killing drug fulfill its promise, researchers report.
The compound, verticillin A, sensitizes cancer cells to TRAIL, a drug which induces cancer cells to self destruct, said Dr. Kebin Liu, cancer immunologist at the Georgia Health Sciences University Cancer Center and corresponding author of the study in the journal Cancer Research.
The compound appears to keep cancer cells from developing resistance to TRAIL, short for tumor necrosis factor-related apoptosis inducing ligand. Drug resistance, intrinsic or acquired, is a major problem for cancer patients, accounting for greater than 90 percent of treatment failures in patients with metastatic disease.
“If we can make drugs work again, more people will survive,” Liu said.
Patient experience has shown cancer’s skill at desensitizing itself to the TRAIL. “It looks as though most cancer cells have found a way to become resistant and evade its action,” said Dr. Wendy Bollag, cell physiologist at GHSU and a study co-author. Tenacious cancer cells also are naturally resistant to cell suicide, which is how TRAIL works.
In mice, they found verticillin A alone was adequate to kill cancer cells, but the required dose made the mice sick, a common problem with many cancer therapies. However, when a lower dose was paired with TRAIL, it became a powerful, more tolerable recipe that killed previously resistant cells.
They also found that the compound improved the efficacy of commonly used cancer drugs etoposide and cisplatin, which also work by promoting cancer cell death but are less targeted than TRAIL. “We believe this could be a good companion drug for a lot of cancer therapies,” Liu said.
One way verticillin A appears to work is by upregulating BN1P3, a gene that promotes cell death, the researchers said. Cancer cells work to silence BN1P3 through a process called DNA methylation; verticillin A appears to modify the same process to turn the gene on.
All cells use DNA methylation but cancer cells use it differently, said Dr. Keith Robertson, cancer epigeneticist and Georgia Cancer Coalition Scholar. “Verticillin A may be working by altering methylation in a way that makes the cancer cells sensitive to TRAIL,” Robertson said.
Their studies were of metastatic human colon cancer cells, which are highly resistant to treatment, including TRAIL, both in culture as well as transplanted into mice. They did similar studies on sarcoma, lung adenocarcinoma and breast cancer.
Additional toxicity studies are needed before moving forward with clinical trials, Bollag said. The researchers also want to pursue the compound’s potential in melanoma and pancreatic cancer.
Verticillin A was isolated from mushrooms in Dr. Ping Wu’s laboratory at the Research Centre of Siyuan Natural Pharmacy and Biotoxicology at China’s Zhejiang University and brought to GHSU by former postdoctoral fellow, Dr. Feiyan Liu, the study’s first author, who studied with Kebin Liu in Augusta for two years. The Chinese university is involved in extensive studies to isolate active compounds from plants to explore their therapeutic potential and both Dr. Lius liked verticillin A’s aggressive response against cancer.
Public release date: 11-Oct-2011
Industry conflicts of interest are pervasive among medical guideline panel members
Researchers at Mount Sinai School of Medicine have found that conflicts of interest (COI) are prevalent and potentially underreported among individuals participating in the development of clinical practice guidelines, which inform standards of patient care. The findings provide further evidence of the potential influence of industry on medical practice recommendations. The study is published online Oct. 12 in BMJ: The British Medical Journal.
To assess COI, the Mount Sinai team reviewed the panel members involved in the development of clinical practice guidelines for two highly prevalent conditions— diabetes and high cholesterol—from major organizations in the United States and Canada, such as the American Diabetes Association (ADA), the American Heart Association (AHA), and government-sponsored organizations, such as the U.S. Preventive Services Task Force (USPSTF).
Of the 288 total panel members evaluated, 150 (52 percent) had COI. In addition, they found that panel members developing government-sponsored guidelines had significantly fewer conflicts than those from the non-government sponsored guideline panels. Lastly, they revealed that one out of nine panelists who formally declared no COI did in fact have COI.
“Guidelines inform evidence-based practice and ultimately protect patients, so safeguarding against potential sources of bias is important,” said the study’s lead author Jennifer Neuman, MD, Instructor of Preventive Medicine at Mount Sinai School of Medicine.
“The majority of guideline panel members and half of guideline panel chairs in our study received some sort of compensation from industry, indicating a risk of industry influence on guideline recommendations,” said Dr. Neuman “But, we found that government agencies were able to effectively staff their guideline panels with individuals with few conflicts of interest, therefore it is possible to convene panels with minimal COI.”
The authors support the efforts by the Institute of Medicine and other prominent medical organizations around the world to increase transparency and decrease potential industry bias on guideline development panels. “Conflict-free guideline panels are feasible and would help to improve the quality of the guideline development process,” they concluded.
Public release date: 12-Oct-2011
Scientists find vitamin D crucial in human immune response to TB
Necessary for both innate and adaptive immune reactions; May lead to new treatment pathway
Not just important for building strong bones, an international team of scientists has found that vitamin D also plays an essential role in the body’s fight against infections such as tuberculosis.
A potentially fatal lung disease, tuberculosis is estimated to cause 1.8 million deaths annually and especially impacts those with reduced immunity such as HIV-infected individuals, according to the World Health Organization.
In an interesting twist, people with darker skin traditionally have had a higher susceptibility to tuberculosis and areas of Africa lead the world with the highest infection rates. Scientists believe this may be partly due to the skin pigment melanin, which is more abundant in darker skin that shields the body from absorbing ultraviolet rays, but also reduces vitamin D production.
Vitamin D — a natural hormone, rather than a vitamin– is known to be instrumental in bone development, but also may protect against cancer and autoimmune diseases, as well as fight infections.
Published online Oct. 12 in the peer-reviewed journal, Science Translational Medicine, researchers examined the mechanisms that govern the immune system’s ability to kill or inhibit the growth of pathogens such as M. tuberculosis, the bacteria causing tuberculosis.
The team found that T-cells, which are white blood cells that play a central role in immunity, release a protein called interferon-g that triggers communication between cells and directs the infected immune cells to attack the invading tuberculosis bacteria. However, this activation requires sufficient levels of vitamin D to be effective.
Researchers next tested serum taken from blood samples in healthy humans with and without sufficient vitamin D and found that the immune response was not triggered in serum with lower vitamin D levels, such as those found in African Americans. But, when adequate vitamin D was added to deficient serum, the immune response was effectively activated.
Scientists found that there was an 85 percent reduction of colony-forming tuberculosis bacteria in human macrophage cells that were effectively treated with interferon-g in the presence of sufficient vitamin D.
“Over the centuries, vitamin D has intrinsically been used to treat tuberculosis. Sanatoriums dedicated to tuberculosis patients were traditionally placed in sunny locations that seemed to help patients — but no one knew why this worked,” said first study author Dr. Mario Fabri, who conducted the research at UCLA and is currently at the Department of Dermatology at the University of Cologne, Germany. “Our findings suggest that increasing vitamin D levels through supplementation may improve the immune response to infections such as tuberculosis.”
The team notes that vitamin D may help both innate and adaptive immunity, two systems that work synergistically together to fight infections.
Previous research by the team found that vitamin D played a key role in the production of a molecule called cathelicidin, which helps the innate immune system kill the tuberculosis bacteria. Humans are born with innate immunity, which is the preprogrammed part of the immune system.
The current research findings demonstrate that vitamin D is also critical for the action of T-cells, key players in adaptive immunity, a highly specialized system that humans acquire over time as they encounter different pathogens.
“The findings of our previous research with innate immunity provided us with a new opportunity to take a look at the effects and role of Vitamin D with acquired immunity, both critical systems of human defense,” said senior investigator Dr. Robert Modlin, Klein Professor of Dermatology and Distinguished Professor of Medicine and Microbiology, Immunology and Molecular Genetics, Chief of Dermatology, Vice Chair for Cutaneous Medicine and Dermatological Research, Department of Medicine, David Geffen School of Medicine at UCLA.
Surprisingly, researchers found that although both the innate and acquired immune systems start out by using different receptors to trigger a complex chain reaction in infected cells to kill the tuberculosis bacteria, both converge early on to follow the same pathway that utilizes vitamin D.
Specifically, in the current study, researchers discovered that T-cells released interferon, which not only activated the infected cells called macrophages to generate cathelicidin and other proteins to kill tuberculosis, but also ensured that these proteins, like a honing device, are delivered to the compartment of the cell where the bacteria resides. The cells then gobble-up the infectious areas containing bacteria.
“These current findings provide the first credible mechanistic explanation for how vitamin D critically contributes to acquired T-cell immunity that protects us from infections, particularly tuberculosis,” said Modlin.
Researchers also note that this is the first study to demonstrate that the protein interferon activates cells to kill the tuberculosis bacteria.
“The role of interferon has been speculated for years in numerous studies, but previous research didn’t take into account that sufficient vitamin D was needed to help interferon-g trigger an effective immune response,” said study author Dr. John Adams, professor of orthopaedic surgery, Geffen School of Medicine. “Now we understand better how this chain reaction works.”
According to the team, the findings are also important because they show that this unique pathway to fight tuberculosis cannot be studied in a mouse model. These nocturnal animals are not exposed to the sun to absorb vitamin D and as a result, use an entirely different pathway than humans to kill tuberculosis.
Fabri notes that most people with tuberculosis are asymptomatic, perhaps due to successful immunological control and sufficient vitamin D to keep the infection from developing into active disease.
“At a time when drug-resistant forms of tuberculosis are emerging, understanding how to enhance natural innate and acquired immunity through vitamin D may be very helpful,” said co-author Barry Bloom, former dean of the faculty at the Harvard School of Public Health, Distinguished University Service Professor, Jack and Joan Jacobson Professor of Public Health, Harvard School of Public Health, Department of Immunology and Infectious Diseases and Department of Global Health and Population.
According to researchers, the next step is to initiate clinical trials to learn whether vitamin D supplementation augments resistance to host resistance to tuberculosis and other infections.
Public release date: 12-Oct-2011
New buzzwords ‘reduce medicine to economics’
BIDMC physicians lament the devaluation of clinical judgment in today’s health care world
BOSTON – Physicians who once only grappled with learning the language of medicine must now also cope with a health care world that has turned hospitals into factories and reduced clinical encounters to economic transactions, two Beth Israel Deaconess Medical Center physicians lament.
“Patients are no longer patients, but rather ‘customers’ or ‘consumers’. Doctors and nurses have transmuted into ‘providers,’ Pamela Hartzband, MD and Jerome Groopman MD, write in the Oct. 13 edition of the New England Journal of Medicine.
“We are in the midst of an economic crisis and efforts to reform the health care system have centered on controlling spiraling costs. To that end, many economists and policy makers have proposed that patient care should be industrialized and standardized. Hospitals and clinics should be run like modern factories and archaic terms like doctor, nurse and patient must therefore be replaced with terminology that fits this new order.”
The problem, Hartzband and Groopman, note, is that the special knowledge that doctors and nurses possess and use to help patients understand the reason for and remedies to their illness get lost in a system that values prepackaged, off-the-shelf solutions that substitute “evidence-based practice” for “clinical judgment.”
“Reducing medicine to economics makes a mockery of the bond between the healer and the sick,” they write. “For centuries doctors who were mercenary were publicly and appropriately castigated … Such doctors betrayed their calling. Should we now be celebrating the doctor whose practice, like a successful business, maximizes profits from ‘customers’”?
Hartzband and Groopman say the new emphasis on “evidence-based practice” is not really a new phenomenon at all. “Evidence” was routinely presented on daily rounds or clinical conferences where doctors debated numerous research studies.
“But the exercise of clinical judgment, which permitted the assessment of those data and the application of study results to an individual patient, was seen as the acme of professional practice. Now some prominent health policy planners and even physicians contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints, written by experts.”
They note the subjective core of the concept is proven by the fact that working with the same data, different groups of experts often write different guidelines for conditions as common as hypertension and elevated cholesterol levels or for the use of screening tests for prostate and breast cancer.
“The specific cutoffs for treatment or no treatment … all necessarily reflect the values and preferences of the experts who write the recommendations. And these values and preferences are subjective, not scientific.”
Even more troubling, the authors suggest, is the impact of the new vocabulary on future doctors, nurses, therapists and social workers who care for patients.
“Recasting their roles as providers who merely implement prefabricated practices diminishes their professionalism. Reconfiguring medicine in economic and industrial terms is unlikely to attract creative and independent thinkers with not only expertise in science and biology but also an authentic focus on humanism and caring.
“When we ourselves are ill, we want someone to care about us as people, not paying customers and to individualize our treatment according to our values. Despite the lip service paid to ‘patient-centered care’ by the forces promulgating the new language of medicine, their discourse shifts the focus from the good of the individual to the exigencies of the system and its costs.
“We believe doctors, nurses and others engaged in care should eschew the use of such terms that demean patients and professionals alike and dangerously neglect the essence of medicine.”
Public release date: 12-Oct-2011
Folic acid supplements in early pregnancy may reduce the risk of severe language delay in children
October 12, 2011– Research has established that taking folic acid supplements during pregnancy reduces the risk of bearing a child with neural tube defects, but little is known about the relationship between prenatal folic acid and neurodevelopment after birth. A collaborative study between investigators at the Norwegian Institute of Public Health and Columbia University’s Mailman School of Public Health has now reported that mothers who took folic acid supplements from 4 weeks before to 8 weeks after conception reported a significantly lower prevalence of severe language delay in their children at age 3. The study was based in a unique Norwegian pregnancy cohort often referred to as “MoBa”.
The full study findings are published online in the October 12 issue of JAMA.
The current analysis included 19,956 boys and 18,998 girls. Of these children, 204 (0.5%) were rated as having severe language delay, defined as minimal expressive language, only 1-word or unintelligible utterances. Among women who took folic acid supplements in early pregnancy, the reported prevalence of such delay was 0.4%, but among the approximately 9,000 children whose mothers took no folic acid, the delay was more than twice as common: 0.9% (81 children).
Across the entire sample, severe language delays were four times more common in boys than girls, as is typically the case.
“Unlike the United States, Norway does not fortify foods with folic acid—a fact that increases the contrast between women who do and do not take folic acid supplements and makes Norway a good place to study this effect,” noted lead author Christine Roth, Clin.Psy.D., MSc, of the Division of Mental Health at the Norwegian Institute of Public Health, Oslo and a visiting researcher at the Mailman School. “If in future research this relationship were shown to be causal, it would have important implications for understanding the biological processes underlying disrupted neurodevelopment, for the prevention of neurodevelopmental disorders, and for policies of folic acid supplementation for women of reproductive age,” said senior author Dr. Susser, director of the Imprints Center for Genetic and Environmental Life Course Studies, of the Mailman School of Public Health and the New York State Psychiatric Institute.
Pregnant women were recruited for the study beginning in 1999, and data were included on children born before 2008 whose mothers returned the 3-year follow-up questionnaire by June 2010. The primary outcome measured for the study was children’s language competency at age 3 years as gauged by maternal report on a 6-point ordinal language grammar scale.
Researchers also looked at gross motor skills at age 3 and found no relationship between significant motor delays and prenatal folic acid. “This provides some reassurance that there is not confounding by an unmeasured factor,” the authors observed. “Such a factor might be expected to relate to both language and motor delay.”
The study, if corroborated by further research, could help further scientific understanding of the biology of language development. The researchers plan to pursue this question further with stringent tests of whether the relationship is causal, studies of the hypothesized mechanisms, and detailed follow-ups of the children at age 5.
Public release date: 13-Oct-2011
Eating green veggies improves immune defenses
Researchers reporting online in the journal Cell, a Cell Press publication, on October 13th have found another good reason to eat your green vegetables, although it may or may not win any arguments with kids at the dinner table.
It turns out that green vegetables — from bok choy to broccoli — are the source of a chemical signal that is important to a fully functioning immune system. They do this by ensuring that immune cells in the gut and the skin known as intra-epithelial lymphocytes (IELs) function properly.
“It is still surprising to me,” said Marc Veldhoen of The Babraham Institute in Cambridge. “I would have expected cells at the surface would play some role in the interaction with the outside world, but such a clear cut interaction with the diet was unexpected. After feeding otherwise healthy mice a vegetable-poor diet for two to three weeks, I was amazed to see 70 to 80 percent of these protective cells disappeared.”
Those protective IELs exist as a network beneath the barrier of epithelial cells covering inner and outer body surfaces, where they are important as a first line of defense and in wound repair. Veldhoen’s team now finds that the numbers of IELs depend on levels of a cell-surface protein called the aryl hydrocarbon receptor (AhR), which can be regulated by dietary ingredients found primarily in cruciferous vegetables. Mice lacking this receptor lose control over the microbes living on the intestinal surface, both in terms of their numbers and composition.
Earlier studies suggested that breakdown of cruciferous vegetables can yield a compound that can be converted into a molecule that triggers AhRs. The new work finds that mice fed a synthetic diet lacking this key compound experience a significant reduction in AhR activity and lose IELs. With reduced numbers of these key immune cells, animals showed lower levels of antimicrobial proteins, heightened immune activation and greater susceptibility to injury. When the researchers intentionally damaged the intestinal surface in animals that didn’t have normal AhR activity, the mice were not as “quick to repair” that damage.
As an immunologist, Veldhoen says he hopes the findings will generate interest in the medical community, noting that some of the characteristics observed in the mice are consistent with those seen in patients with inflammatory bowel disease.
“It’s tempting to extrapolate to humans,” he said. “But there are many other factors that might play a role.”
For the rest of us, he says, “it’s already a good idea to eat your greens.” Still, the results offer a molecular basis for the importance of cruciferous vegetable-derived phyto-nutrients as part of a healthy diet.
Public release date: 17-Oct-2011
Teachers, children mistake candy for medicine in study
BOSTON — More than one in four kindergarten children, and one in five teachers, had difficulty distinguishing between medicine and candy in new research conducted by two, now seventh-grade students, who presented their findings on Monday, Oct. 17, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston.
Casey Gittelman and Eleanor Bishop conducted their study, “Candy or Medicine: Can Children Tell the Difference?” earlier this year at Ayer Elementary School in suburban Cincinnati, Ohio.
The girls obtained a medicine cabinet from The Drug and Poison Information Center at Cincinnati Children’s Hospital Medical Center with a mixture of 20 candies and medicines. They then randomly selected 30 teachers and 30 kindergarten students and asked them which items in the cabinet were candies, taking into consideration that many of the younger children were unable to read. In addition, participants were surveyed on how they stored medicine at home and their daily medicine usage.
Students correctly distinguished candy from medicine at a rate of 71 percent, while teachers did so at a rate of 78 percent. Students who couldn’t read did significantly worse at distinguishing between candy and medicine compared to students who could read. The most common mistakes among teachers and students were M&Ms being mistaken for Coricidin (43 percent), SweeTARTS for Mylanta (53 percent), Reese’s Pieces for Sine-off (50 percent), and SweeTARTS for Tums (53 percent).
“(The candy) most frequently mistaken were circular objects, those similar in color and shine, and those with no distinguishable markings,” said Bishop. In addition, 78 percent of the 60 students and teachers in the study said medicines in their homes were not locked and out-of-reach.
“We found that neither teachers nor students store their medicines appropriately at home,” said Gittelman. “Interventions to educate families about safe storage of medicines, and manufacturing medicines to have distinguishable appearances may help to reduce unintentional ingestions of medications.”
The study authors recommend interventions to educate families about safe storage practices for medication, and the development of medications with distinguishable appearances to reduce unintentional ingestions.
Public release date: 17-Oct-2011
Broccoli-based compound beats drug resistance in lung disease
Chronic obstructive pulmonary disease (COPD) is a common lung disease that gets progressively worse over time, making it harder and harder to breathe. It is caused primarily by cigarette smoking, which leads to persistent inflammation in the airways and the subsequent destruction of the lung tissue. Given the central role of inflammation in COPD, it is surprising that patients derive little benefit from treatment with potent anti-inflammatory drugs known as corticosteroids. Working with cells from individuals with COPD, a team of researchers led by Shyam Biswal and Rajesh Thimmulappa, at Johns Hopkins University, Baltimore, has identified a candidate therapeutic that could potentially be used to augment the anti-inflammatory effects of corticosteroids in individuals with COPD — sulforaphane, a compound obtained from cruciferous vegetables such as broccoli, Brussels sprouts, and cabbages.
Public release date: 17-Oct-2011
Omega-3 fatty acids shown to prevent or slow progression of osteoarthritis
New research has shown for the first time that omega-3 in fish oil could “substantially and significantly” reduce the signs and symptoms of osteoarthritis.
According to the University of Bristol study, funded by Arthritis Research UK and published in the journal Osteoarthritis and Cartilage, omega-3-rich diets fed to guinea pigs, which naturally develop osteoarthritis, reduced disease by 50 per cent compared to a standard diet.
The research is a major step forward in showing that omega-3 fatty acids, either sourced from fish oil or flax oil, may help to slow down the progression of osteoarthritis, or even prevent it occurring, confirming anecdotal reports and “old wives’ tales” about the benefits of fish oil for joint health.
Lead researcher Dr John Tarlton, from the Matrix Biology Research group at the University of Bristol’s School of Veterinary Sciences, said classic early signs of the condition, such as the degradation of collagen in cartilage and the loss of molecules that give it shock-absorbing properties, were both reduced with omega-3.
“Furthermore, there was strong evidence that omega-3 influences the biochemistry of the disease, and therefore not only helps prevent disease, but also slows its progression, potentially controlling established osteoarthritis,” he said.
Dr Tarlton added: “The only way of being certain that the effects of omega-3 are as applicable to humans as demonstrated in guinea pigs is to apply omega-3 to humans. However, osteoarthritis in guinea pigs is perhaps the most appropriate model for spontaneous, naturally occurring osteoarthritis, and all of the evidence supports the use of omega-3 in human disease.”
Medical research director of Arthritis Research UK, Professor Alan Silman, said: “The possibility that omega-3 fatty acids could prevent osteoarthritis from developing has been a tantalising one. Some limited, previous research in dogs has suggested that we were a long way away from understanding the potential use in humans. However, this current research in guinea pigs is exciting as it brings us closer to understanding how omega-3 might fundamentally interfere with the osteoarthritis process, and that it could potentially be taken as a treatment.”
On the back of the results of his study, Dr Tarlton said that following government guidelines on dietary intake of omega-3 fatty acids could be effective in reducing the burden of osteoarthritis. Fish oil is far more effective than the flax oil based supplement, but for vegetarians flax oil remains a viable alternative.
“Most diets in the developed world are lacking in omega-3, with modern diets having up to 30 times too much omega-6 and too little omega-3. Taking omega-3 will help redress this imbalance and may positively contribute to a range of other health problems such as heart disease and colitis.”
Further studies are needed to determine the influence of omega-3 fatty acids on established disease in guinea pigs, and to confirm the effects in human osteoarthritis, said Dr Tarlton.
Osteoarthritis affects around eight million people in the UK, and is caused when the cartilage at the ends of bones wears away and the underlying bone thickens, leading to stiff, painful joints. Currently, there is no effective treatment to slow down disease progression, and treatment is limited to pain relief and ultimately joint replacement.
Public release date: 17-Oct-2011
High rate of false-positives with annual mammogram
During a decade of receiving mammograms, more than half of cancer-free women will be among those summoned back for more testing because of false-positive results, and about one in 12 will be referred for a biopsy.
Simply shifting screening to every other year lowers a woman’s probability of having one of these false-positive episodes by about a third – from 61 percent to 42 percent – over the course of a decade.
A new study delving into false-positives in mammography looked at nearly 170,000 women between the ages of 40 and 59 from seven regions around the United States, and almost 4,500 women with invasive breast cancer. Because of the added decade of testing alone, it found, women who start mammograms at 40 instead of 50 are more likely to have false-positive results that lead to more testing.
“This study provides accurate estimates of the risk of a false-positive mammography and breast biopsy for women undergoing repeat mammography in community practice, and so provides important information about the potential harms of undergoing regular mammography,” said co-author Karla Kerlikowske, a professor of medicine at the UCSF School of Medicine.
The study will be published in Annals of Internal Medicine. The research was led by Group Health Research Institute of Seattle for the Breast Cancer Surveillance Consortium.
“Recalls” for a second mammogram for what turn out to be non-cancer results, known as false positives, may cause inconvenience and anxiety. Recommendations for fine-needle aspiration or surgical biopsy are less common, but can lead to unnecessary pain and scarring. The additional testing also contributes to rising medical costs.
Kerlikowske is the lead author of an additional report – to be published in the same issue of Annals – that for the first time in the United States examines the accuracy of film mammography against digital, which has increasingly replaced older film screening.
That study looked at nearly 330,000 women between the ages of 40 and 79. The data was pooled from the Breast Cancer Surveillance Consortium, a collaborative network of mammography registries in the United States.
The researchers found that overall cancer detection rates were similar for both methods. However, digital screening may be better for women between the ages of 40 and 49 who are more likely to have extremely dense breasts associated with lower cancer detection. The study also found new evidence that digital mammography is better at detecting estrogen receptor-negative tumors, particularly in women aged 40 to 49 years.
Breast cancer may not be detected, the researchers caution, if a radiologist fails to identify a visible breast lesion or if a tumor is obscured by normal breast tissue. Additionally, an imperceptible tumor may grow quickly and be discovered through a clinical exam prior to the next mammogram.
Digital mammography was developed in part to improve the detection of breast cancer in dense breasts by improving the ability to distinguish normal dense breast tissue from isodense invasive cancer.
The authors note that for every 10,000 women 40 to 49 who are given digital mammograms, two more cases of cancer will be identified for every 170 additional false-positive examinations.
Healthy women will undergo 12 screening mammograms in their lifetimes if they follow U.S. Preventive Services Task Force guidelines that recommend biennial screening starting at age 50 and continuing until age 74. This is controversial, with many practitioners recommending annual mammograms.
If women start biennial screening at 40, they will undergo 17 exams; those who start annual screenings at age 40 will undergo 34 exams.
For the false-positive study, the researchers found that after a decade of annual screening, a majority of women will receive at least one false-positive result, and 7 to 9 percent will receive a false-positive biopsy recommendation.
“We conducted this study to help women know what to expect when they get regular screening mammograms over the course of many years,” said study leader Rebecca Hubbard, PhD, an assistant investigator at Group Health Research Institute. “We hope that if women know what to expect with screening, they’ll feel less anxiety if – or when – they are called back for more testing. In the vast majority of cases, this does not mean they have cancer.”
The researchers say that screening every other year would likely lessen the probability of false-positive results “but could also delay cancer diagnosis.” However, for those diagnosed with cancer, the authors found women screened every two years were not significantly more likely to be diagnosed with late-stage cancer compared to those screened at one-year intervals.
The study stresses the importance of radiologists being able to review a patient’s previous mammograms because it “may halve the odds of a false-positive recall.”
Public release date: 18-Oct-2011
Shift work in teens linked to increased multiple sclerosis risk
Circadian disruption and sleep restriction contributing factors
Researchers from Sweden have uncovered an association between shift work and increased risk of multiple sclerosis (MS). Those who engage in off-hour employment before the age of 20 may be at risk for MS due to a disruption in their circadian rhythm and sleep pattern. Findings of this novel study appear today in Annals of Neurology, a journal published by Wiley-Blackwell on behalf of the American Neurological Association and Child Neurology Society.
Previous research has determined that shift work—working during the night or rotating working hours—increases the risk of cardiovascular disease, thyroid disorders, and cancer. Circadian disruption and sleep restriction are associated with working night shifts; these factors are believed to disturb melatonin secretion and increase inflammatory responses, promoting disease states. MS is a central nervous system autoimmune inflammatory disorder that has an important environmental component, thus investigating lifestyle risk factors, such as sleep loss related to shift work, is an important objective and the focus of the current study.
Dr. Anna Karin Hedström and colleagues from the Karolinska Institutet in Stockholm analyzed data from two population-based studies—one with 1343 incident cases of MS and 2900 controls and another with 5129 prevalent MS cases and 4509 controls. The team compared the occurrence of MS among study subjects exposed to shift work at various ages against those who had never been exposed. All study subjects resided in Sweden and were between the ages of 16 and 70. Shift work was defined as permanent or alternating working hours between 9 p.m. and 7 a.m.
“Our analysis revealed a significant association between working shift at a young age and occurrence of MS,” explains Dr. Hedström. “Given the association was observed in two independent studies strongly supports a true relationship between shift work and disease risk.” Results showed that those in the incident MS cohort who had worked off-hour shifts for three years or longer before age 20 had a 2 fold-risk of developing MS compared with those who never worked shifts. Similarly, subjects in the prevalent cohort who engaged in shift work as teens had slightly more than a 2-fold risk of MS than subjects who never worked shifts.
The authors suggest that disruption of circadian rhythm and sleep loss may play a role in the development of MS; however the exact mechanisms behind this increased risk remain unclear and further study is needed.
Public release date: 18-Oct-2011
Researchers Discover Why Steroid Treatment for COPD Is Ineffective
Findings Offer Potential New Drug Target for COPD Therapy
Chronic obstructive pulmonary disease (COPD) leads to persistent inflammation of the airways and is typically managed with corticosteroids, a class of anti-inflammatory medication. However, corticosteroids do not improve survival nor alter the progression of COPD and may reduce lung symptoms as little as 20 percent. A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health, found why corticosteroids do not work well for COPD patients and how additional treatment with sulforaphane—an ingredient of broccoli and other vegetables—can improve the effectiveness of corticosteroids. The study was published online October 17, 2011, in advance of print in the Journal of Clinical Investigation.
COPD is a major public health problem for both the developed and the developing world, and is most often caused by cigarette smoking or exposure to pollutants from combustion. Characterized by chronic bronchitis and emphysema, COPD is the third leading cause of death in the U.S. and affects 24 million Americans and 210 million people worldwide.
Histone deacetylase 2 (HDAC2) is critical component in a chain of reactions that enable corticosteroids to reduce inflammation. However, HDAC2 is substantially reduced in the lung tissue of individuals with COPD. In the study, Johns Hopkins researchers found that S-nitrosylation causes HDAC2 dysfunction and leads to corticosteroid insensitivity in the alveolar macrophages of the lungs of individuals with COPD. S-nitrosylation of HDAC2 occurs from exposure to cigarette smoke, a primary cause of COPD.
“This study provides the mechanism of exaggerated inflammation observed in COPD patients during exacerbations, which has been a barrier to developing effective therapy,” said Rajesh Thimmulappa, PhD, co-author of the study and an assistant scientist in the Bloomberg School’s Department of Environmental Health Sciences.
Furthermore, the research team found that treatment with sulforaphane restored HDAC2 activity and corticosteroid sensitivity. Previous studies by the research team showed sulforaphane activates the Nrf2 pathway (nuclear factor erythroid 2–related factor 2) and it is being tested in clinical trial for patients with COPD.
“Restoring corticosteroid sensitivity in patients with COPD by targeting the Nrf2 pathway holds promise for effectively treating exacerbations,” saidShyam Biswal, PhD, senior author of the study and professor in the Bloomberg School’s Department of Environmental Health Sciences and Division of Pulmonary and Critical Care Medicine at the Johns Hopkins School of Medicine.
Public release date: 19-Oct-2011
Brain scans support findings that IQ can rise or fall significantly during adolescence
IQ, the standard measure of intelligence, can increase or fall significantly during our teenage years, according to research funded by the Wellcome Trust, and these changes are associated with changes to the structure of our brains. The findings may have implications for testing and streaming of children during their school years.
Across our lifetime, our intellectual ability is considered to be stable, with Intelligence Quotient (IQ) scores taken at one point in time used to predict educational achievement and employment prospects later in life. However, in a study published today in the journal Nature, researchers at the Wellcome Trust Centre for Neuroimaging at UCL (University College London) and the Centre for Educational Neuroscience show for the first time that in fact our IQ is not constant.
The researchers, led by Professor Cathy Price, tested thirty-three healthy adolescents in 2004 when they were between the ages of 12 and 16 years. They then repeated the tests four years later when the same subjects were between 15 and 20 years old. On both occasions, the researchers took structural brains scans of the subjects using magnetic resonance imaging (MRI).
Professor Price and colleagues found significant changes in the IQ scores measured in 2008 compared to the 2004 scores. Some subjects had improved their performance relative to people of a similar age by as much as 20 points on the standardised IQ scale; in other cases, however, performance had fallen by a similar amount. In order to test whether these changes were meaningful, the researchers analysed the MRI scans to see if there was a correlation with changes in the structure of the subjects’ brains.
“We found a considerable amount of change in how our subjects performed on the IQ tests in 2008 compared to four years earlier,” explains Sue Ramsden, first author of the study. “Some subjects performed markedly better but some performed considerably worse. We found a clear correlation between this change in performance and changes in the structure of their brains and so can say with some certainty that these changes in IQ are real.”
The researchers measured each subject’s verbal IQ, which includes measurements of language, arithmetic, general knowledge and memory, and their non-verbal IQ, such as identifying the missing elements of a picture or solving visual puzzles. They found a clear correlation with particular regions of the brain. An increase in verbal IQ score correlated with an increase in the density of grey matter – the nerve cells where the processing takes place – in an area of the left motor cortex of the brain that is activated when articulating speech. Similarly, an increase in non-verbal IQ score correlated with an increase in the density of grey matter in the anterior cerebellum, which is associated with movements of the hand. However, an increase in verbal IQ did not necessarily go hand-in-hand with an increase in non-verbal IQ.
According to Professor Price, a Wellcome Trust Senior Research Fellow, it is not clear why IQ should have changed so much and why some people’s performance improved whilst others’ decline. It is possible that the differences are due to some of the subjects being early or late developers, but it is equally possible that education played a role in changing IQ, and this has implications for how schoolchildren are assessed.
“We have a tendency to assess children and determine their course of education relatively early in life, but here we have shown that their intelligence is likely to be still developing,” says Professor Price. “We have to be careful not to write off poorer performers at an early stage when in fact their IQ may improve significantly given a few more years.
“It’s analogous to fitness. A teenager who is athletically fit at 14 could be less fit at 18 if they stopped exercising. Conversely, an unfit teenager can become much fitter with exercise. “
Other studies from the Wellcome Trust Centre for Neuroimaging and other research groups have provided strong evidence that the structure of the brain remains ‘plastic’ even throughout adult life. For example, Professor Price showed recently that guerrillas in Columbia who had learned to read as adults had a higher density of grey matter in several areas of the left hemisphere of the brain than those who had not learned to read. Professor Eleanor Maguire, also from the Wellcome Trust Centre, showed that part of a brain structure called the hippocampus, which plays an important role in memory and navigation, has greater volume in licensed London taxi drivers.
“The question is, if our brain structure can change throughout our adult lives, can our IQ also change?” adds Professor Price. “My guess is yes. There is plenty of evidence to suggest that our brains can adapt and their structure changes, even in adulthood.”
‘Understanding the brain’ is one of the Wellcome Trust’s key strategic challenges. It funds a significant portfolio of neuroscience and mental health research, ranging from studies of molecular and cellular components to work on cognition and higher systems. At the Wellcome Trust Centre for Neuroimaging, clinicians and scientists study higher cognitive function to understand how thought and perception arise from brain activity, and how such processes break down in neurological and psychiatric disease.
“This interesting study highlights how ‘plastic’ the human brain is,” said Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust. “It will be interesting to see whether structural changes as we grow and develop extend beyond IQ to other cognitive functions. This study challenges us to think about these observations and how they may be applied to gain insight into what might happen when individuals succumb to mental health disorders.”
Public release date: 19-Oct-2011
Could a probiotic be used to treat inflammatory bowel disease?
Scientists have been unclear for some time about how most probiotics work. A new study has found a scientific ‘design’ for a probiotic that could be used to treat inflammatory bowel disease (IBD), such as Crohn’s disease.
The research by academics at the University of Bristol’s School of Veterinary Sciences and the School of Clinical Medicine is published online in the journalPLoS ONE.
Most probiotics on the market, such as Lactobacillus and Bifidobacterium, are lactic acid bacteria. Although probiotics have been shown to successfully maintain remission in IBD, evidence of their effectiveness in active disease is rare. The researchers have found that this is because an increase in iron levels, which happens during active IBD, inhibits the growth of probiotic bacteria, including Lactobacillus.
Iron levels increase in the intestine during inflammation, bleeding, during stress and when people are taking iron supplements. Iron is critically important to the growth of most species of bacteria, including pathogens, and its availability is what restricts their growth. It is well known that pathogens increase growth rate by up to 8,000 times when exposed to increased levels of iron. Lactic acid bacteria are unusual as they have evolved not to require iron, and so do not increase growth rate when exposed to it.
Dr Tristan Cogan, Research Fellow in the School of Veterinary Sciences, said: “When we started our study we considered the properties that a probiotic would need to treat IBD. Most importantly, it would need to be able to survive and grow in the presence of high levels of iron and to reduce inflammation. We then worked out how to test bacteria to see whether it had these properties.
“The difficult step was finding a bacterium that had all of the properties that we wanted. Now we have found something that looks like it should work, our next step will be to test the probiotic in clinical trials.”
The researchers found that a range of probiotic strains of lactic acid bacteria cannot respond to increased iron levels. The study then identified a strain, which the academics have patented, that can and showed that it has probiotic and immunomodulatory properties, and can reduce pro-inflammatory responses to pathogens associated with IBD.
The researchers suggest that iron response is the factor that prevents probiotics from being useful in treating disease, and that their bacterium could be a novel probiotic treatment for active intestinal disease.
Public release date: 19-Oct-2011
Study links pollutants to a 450 percent increase in risk of birth defects
Many other congenital conditions, including autism, may one day prove to be related to environmental pollutants
AUSTIN, Texas — Pesticides and pollutants are related to an alarming 450 percent increase in the risk of spina bifida and anencephaly in rural China, according to scientists at The University of Texas at Austin and Peking University.
Two of the pesticides found in high concentrations in the placentas of affected newborns and stillborn fetuses were endosulfan and lindane. Endosulfan is only now being phased out in the United States for treatment of cotton, potatoes, tomatoes and apples. Lindane was only recently banned in the United States for treatment of barley, corn, oats, rye, sorghum and wheat seeds.
Strong associations were also found between spina bifida and anencephaly and high concentrations of polycyclic aromatic hydrocarbons (PAHs), which are byproducts of burning fossil fuels such as oil and coal. Spina bifida is a defect in which the backbone and spinal canal do not close before birth. Anencephaly is the absence of a large part of the brain and skull.
“Our advanced industrialized societies have unleashed upon us a lot of pollutants,” says Richard Finnell, professor of nutritional sciences and director of genomic research at the Dell Children’s Medical Center of Central Texas. “We’ve suspected for a while that some of these pollutants are related to an increase in birth defects, but we haven’t always had the evidence to show it. Here we quite clearly showed that the concentration of compounds from pesticides and coal-burning are much higher in the placentas of cases with neural tube defects than in controls.”
The study, which was published in August in the Proceedings of the National Academy of Sciences, is the result of a more than decadelong collaboration between Finnell and a team of researchers in Shanxi, a province in northern China.
Finnell sought collaborators in China because the prevalence of neural tube defects is much greater there than it is in the United States. Also, because of its population policies, China is good at tracking births.
“It’s an extraordinary natural experiment,” says Finnell, who was recently recruited to the university to help anchor the Dell Pediatric Research Institute. “It would be much harder to do this study in the United States, where neural tube defects are more rare. It’s also an opportunity to assist the Chinese government in their efforts to lower their birth defect rates.”
Working with public health officials in four rural counties in Shanxi, researchers collected placentas from 80 newborn or stillborn fetuses that suffered from spina bifida or anencephaly. Once a fetus or a newborn with such defects was identified as a case, the placenta of a healthy newborn with no congenital malformations born in the same hospital was selected as a control.
Finnell and his colleagues screened these placentas for the presence of a class of substances known as persistent organic pollutants (POPs). Common POPs include agricultural pesticides, industrial solvents and the byproducts of burning fuels such as oil and coal.
They found strong associations between the birth defects and high levels of a number of compounds present in commonly used pesticides. They also found elevated placental concentrations of PAHs.
“This is a region where they mine and burn a lot of coal,” says Finnell. “Many people cook with coal in their homes. The air is often black. You don’t need to be a rocket scientist to say that maybe there’s something in there that isn’t good for babies.”
Finnell says although the environmental conditions in Shanxi are dramatically worse than they are in most areas of the United States, they are comparable to what the United States was like a century ago, and the neural tube defects are not solely a Chinese problem.
Every year approximately 3,000 pregnancies in the United States are complicated by neural tube defects. Many other congenital conditions, including autism, may one day prove to be related to environmental pollutants.
“Ultimately you need enough cells to make a proper, healthy baby,” says Finnell, “and these are the types of compounds that cause cell death. At the most basic level, we’re learning that environmental things kill cells, and if that occurs in a critical progenitor population at a crucial time, you’re going to have problems.”
Public release date: 20-Oct-2011
Are acid-suppressing drugs prescribed too often in infants?
Cincinnati, OH, October 20, 2011 – Frequent spitting up, irritability, and unexplained crying in infants can be very distressing to parents. Pediatricians often prescribe acid-suppressing drugs for these symptoms in an effort to treat infants for gastroesophageal reflux disease (GERD); however, GERD is an uncommon cause of these symptoms in otherwise thriving infants. In a soon to be published Commentary in The Journal of Pediatrics, Eric Hassall, MBChB, FRCPC, FACG, cautions against the over-diagnosis of GERD and over-prescription of acid-suppressing drugs in infants.
Dr. Hassall is affiliated with the Department of Pediatrics at the University of British Columbia, Vancouver, Canada, is currently Staff Gastroenterologist at Sutter Pacific Medical Foundation in San Francisco, California, and is an advisor to the U.S. Food and Drug Administration (FDA). Although the FDA has only approved the use of acid-suppressing drugs, such as proton pump inhibitors (PPIs), in children over the age of one year, the use of PPIs in infants less than 12 months old has greatly increased in the last decade.
Dr. Hassall notes that most “reflux” in infants is not acidic because stomach contents have been buffered by frequent feedings. “However, in the absence of better information and physician guidance and fed by advertising and misinformation on the Internet, distressed parents take their concerns to doctors, who very frequently comply and prescribe acid-suppressing medications for symptoms and signs that, in most cases, are not GERD,” he states.
Studies have shown that PPIs are no better than placebo for most infants with symptoms of spitting up, irritability, or unexplained crying, which may be because the medications are frequently prescribed for symptoms that are not GERD. Dr. Hassall emphasizes that spitting up in otherwise healthy infants is normal and resolves with time. Irritability or unexplained crying, with or without spitting up, is often a normal developmental phenomenon, especially in infants 2-5 months old. Although some infants are unable to self-calm, this also improves with maturation and age.
“We are medicalizing normality,” Dr. Hassall asserts, “In most infants, these symptoms are ‘life,’ not a disease, and do not warrant treatment with drugs, which can have significant adverse effects.” He explains that gastric acid is an early line of defense against infection and is important for nutrition; by prescribing acid-suppressing medications to infants without GERD, pediatricians are putting their patients at a higher risk for infections like pneumonia and gastroenteritis. The use of PPIs in infants can also lead to abnormalities in the levels of essential minerals and vitamins, such as magnesium, calcium, and vitamin B12.
Dr. Hassall encourages his fellow pediatricians to initially explore nonpharmacological approaches, such as changes in maternal diet of breastfeeding mothers or hypoallergenic formulas for bottle-fed infants. However, if these approaches fail or if an infant has severe symptoms and is suspected of having actual GERD, Dr. Hassall suggests beginning treatment with an acid-suppressing medication for a time-limited period of 2 weeks. However, as Dr. Hassall notes, “In most cases, it is not the spitting up that should be treated. The real issue is the unexplained crying, which causes real and considerable distress and concern for parents.” He goes on to say, “It is important for pediatricians to acknowledge their concerns, explain the spectrum of normal infant behavior, discuss the range of measures available, start implementation, and be available for follow-up.”
Public release date: 20-Oct-2011
Study proves new technology kills bacteria
BOSTON, MA (October 20, 2011) – Results from a comprehensive multi-site clinical trial demonstrated that the use of antimicrobial copper surfaces in intensive care unit rooms reduced the amount of bacteria in the rooms by 97 percent and resulted in a 41 percent reduction in the hospital acquired infection rate. According to researchers, this study is one of the first to demonstrate the value of a passive infection control intervention, one that does not rely on staff or patients remembering to take action. The results will be presented on Friday, October 21 at the 2011 Annual Meeting of the Infectious Diseases Society of America in Boston.
Objects in hospital patient rooms are a potential breeding ground for bacteria that cause infections. According to Dr. Michael Schmidt, Vice Chairman of Microbiology and Immunology at the Medical University of South Carolina, and a researcher on this study, bacteria on ICU room surfaces are responsible for up to 80 percent of patient infections. The results of this study demonstrate that reducing the amount of bacteria in the patient’s environment significantly lowers the risk of infection.
Hospital patients have a 1:20 chance of developing an infection, and of those who do become ill, 1:20 have chance of dying. The CDC estimates that in the U.S., hospital acquired infections kill 100,000 people and cost $45 billion annually.
The study was funded by the U.S. Department of Defense and took place at Memorial Sloan Kettering Cancer Center in New York, the Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, both in Charleston. As part of the study, common objects such as bed rails, overbed tray tables, nurse call buttons and IV poles, were replaced with antimicrobial copper versions.
Independent laboratory testing has demonstrated that when cleaned regularly, antimicrobial copper products kill greater than 99.9% of the following bacteria within two hours of exposure: MRSA, VRE, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli O157:H7. For a complete listing of approved EPA public health claims for antimicrobial copper, please visit www.antimicrobialcopper.com. Study results are to be submitted to the U.S. Environmental Protection Agency for review and approval. Because many factors contribute to the risk of infection, individual results may vary.
Public release date: 20-Oct-2011
Women do not get enough vitamin D during the menopause
A healthy diet is especially important during the menopause – a period in which the risk of suffering from health problems increases. Various studies analyse the diet of peri- and postmenopausal women in Spain alongside the troubles that come with this transition. The results show that all of those groups studied have a deficient intake of vitamin D.
Marina Pollán, researcher at the Carlos III Institute of Health and one of the authors of the study explains that “biological and physiological changes in women caused by the menopause come with a greater risk of developing health problems in which diet plays an important role. These include diabetes, osteoporosis, cardiovascular disease and certain types of cancer.”
Therefore, the analysis of dietary patterns during and after the menopause is of particular interest because of its health implications. However, in Spain there have been very few studies that have assessed the diet of peri- and postmenopausal women.
In order to study these dietary habits, the authors of the study analysed 3574 women from the age of 45 to 68 from October 2007 to July 2008. Each programme contained a minimum of 500 women from seven Spanish cities (La Coruña, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia and Zaragoza) and involved a food frequency questionnaire validated by the Spanish population.
The results show that obesity rates stand at 29% whereas 42% of subjects are overweight. Average calorie intake was 2053 kilocalories (with 43% of energy intake coming from carbohydrates, 36% from fats and 20% from proteins). Researchers highlight that practically all of the women received the recommended intake of all the vitamins, apart from D and E.
The case of vitamin D is striking given that none of the groups reached 50% of their RDA (Recommended Daily Allowance). The average total intake was 2.14 micrograms per day, which constitutes just 39% of the RDA for women of this age group.
“A diet with less fat and protein that is high in vegetables, nuts, and carbohydrate-rich foods will even out the energy balance and corrects levels of vitamin D and E,”according to the researchers. “This is especially important in places that are far away from the Mediterranean Sea where women have a greater tendency to fall short of the current recommendations.”
Public release date: 20-Oct-2011
Early mortality risk reduced up to 40 percent through increased physical activity and sports
Even though previous studies have been shown the link between regular exercises and improved health the exact dose-response relation remains unclear. Guenther Samitz, researcher in physical activity and public health at the Centre for Sports Sciences and University Sports of the University of Vienna has investigated this relationship with a meta-study representing more than 1.3 million participants. The research project was carried out in collaboration with public health scientists and epidemiologists of the Universities of Bern, Switzerland and Bristol, UK. The results of the study have been published in International Journal of Epidemiology.
One week is 10.080 minutes, already 150 minutes of moderate-intensity physical activity per week protect against chronic diseases and premature death according to the recommendations of the World Health Organisation (WHO). A research group around Guenther Samitz of the Centre for Sports Sciences and University Sports at the University of Vienna investigated that link between increased levels of physical activity of different domains (occupation, daily living, transportation, and leisure) and all-cause mortality. The investigators also assessed to what extent current WHO recommendations for physical activity decrease the risk of premature death in adult populations.
80 studies with 1.3 million study participants
The study was conducted as a systematic review including multiple meta-analyses. Meta-analyses combine the results of individual studies that address a set of predefined research questions. In Public Health and Medicine the evidence from meta-analyses is often used to update or revise recommendations and guidelines for prevention and therapy.
The researchers identified about 7,000 potentially relevant reports, of which a total of 80 cohort studies with more than 1.3 million study participants from Europe, Canada, United States, and Asia fulfilled the strict inclusion criteria. At study onset participants had to be free of cardiovascular disease, cancer and other chronic conditions. Study participants were followed up by a median of 11 years. ‘The results of the included studies were combined and controlled for other potential influential factors, e.g. cigarette smoking, alcohol uptake, body mass index, blood pressure, nutrition, education and social factors,’ explained Guenther Samitz.
Women benefit more than men
In Europe only about one third of the adult population meets the minimum WHO recommendation for physical activity. Higher levels of physical activity were associated with reduced all-cause mortality, regardless whether in job, daily living, leisure or active transportation. However, the association was higher for leisure time physical activity and activities of daily living, and mortality reductions were more pronounced in women when compared with men. Women and older persons even had a survival benefit when engaging in regular light- to moderate-intensity activities of daily living, e.g. domestic work, gardening, walking or bicycling to the shopping mall. It is unclear why the survival benefit from physical activity across all domains was consistently higher for women. The study authors suspect that changes in female hormone levels, in oestrogen metabolism and body fat distribution could partly be responsible for this difference.
Some physical activity is good, more is better
In a second step the investigators quantified the mortality benefit in dependence upon the physical activity dose per week. For light- to moderate intensity activities of daily living, e.g. housework, gardening, stair climbing, walking and bicycling for transportation, an increase of one hour per week compared to no physical activity was associated with a reduction in mortality of four percent. Dr. Samitz said that with moderate-intensity leisure activities (e.g. Nordic walking, hiking, social dance) the risk reduction increased to six percent, and with vigorous-intensity aerobic activity or sports (e.g. jogging, bicycling (>10 miles per hour), tennis, ball sport), the reduction in all-cause mortality was even nine percent per one hour increment per week.
Meeting the WHO´s recommended level of 150 minutes per week of moderate physical activity of daily life or during leisure was associated with a reduction in mortality risk by ten percent. For vigorous exercise and sports the reduction in mortality risk was more than twofold higher (22 %).
300 minutes (five hours) per week, this activity level is recommended for extended health benefits, were associated with a reduction in mortality risk by 19% and 39% for moderate-intensity activities of daily living, and vigorous-intensity aerobic activity and sports, respectively. But even for lower levels than recommended by the WHO the researchers observed a significant survival benefit.
‘Any physical activity is better than none and even activities of daily life are associated with a survival benefit, but more and vigorous-intensity physical activity are associated with a larger reduction in all-cause mortality’, summarizes Samitz and he recommends: ‘Nonetheless, sedentary adults should start with moderate-intensity physical activities and slowly increase weekly dose and intensity, because in sedentary adults vigorous-intensity physical activity is associated with increased risk of musculoskeletal injuries and adverse cardiac events.’
Public release date: 20-Oct-2011
Human Norovirus In Groundwater Remains Infective After Two Months
Researchers from Emory University have discovered that norovirus in groundwater can remain infectious for at least 61 days. The research is published in the October Applied and Environmental Microbiology.
Human norovirus is the most common cause of acute gastroenteritis. The disease it causes tends to be one of the more unpleasant of those that leave healthy people unscathed in the long run, with diarrhea and vomiting that typically last for 48 hours. Norovirus sickens one in 15 Americans annually, causing 70,000 hospitalizations, and more than 500 deaths annually, according to the Centers for Disease Control and Prevention.
The results answer a question of great importance to public health, which had driven researcher Christine Moe and her colleagues to conduct this research: If well water becomes contaminated with noroviruses–perhaps from leaking sewer lines or a septic tank—how long do these noroviruses survive in water, and when would it be safe to drink from that well?
To answer that question, they prepared a safety-tested virus stock solution. They then put a known amount of this solution into a container of groundwater from an Atlanta well, which had met Environmental Protection Agency drinking water standards.
The researchers then tested the virus infectivity at days naught, 4, 14, 21, 27, and 61, by having volunteers drink the water on those days. The durability of the virus’ infectivity was unexpected, says Moe. Most of the 13 volunteers became infected at various time points, exhibiting among them the complete range of norovirus symptoms, which endured for as long as five days post challenge. “We were surprised to observe that even the volunteers that drank the water 61 days after we had added the virus still got infected with the norovirus,” says Moe.
Norovirus may remain infective far longer than 61 days. The researchers stored the groundwater at room temperature in the dark, using reverse transcription polymerase chain reaction to determine how much viral RNA remained after 622 days, and again after 1,266 days. They found no reduction after the first interval, and very little at the end of the second interval.Unfortunately, funding was insufficient to test infectivity in human volunteers beyond day 61.
“This study provides further evidence of the need to treat groundwater used for drinking water,” says Moe, adding that the Environmental Protection Agency and other decision-makers who regulate drinking water need to take these findings into account, particularly since roughly half the US population relies upon groundwater for drinking.
To ensure that the volunteers’ health would not be compromised, the investigators conducted the study in a special research unit of Emory University Hospital, while taking a variety of other precautionary measures.
Anticipating a question about who would volunteer to participate in a study with such potentially unpleasant consequences, Moe says that some volunteers have said that “they want to see how good their immune system is, and whether they will actually get sick.” Three of the 13 volunteers did not become sick. One volunteer was the local librarian “who came to the research unit with a huge bag of books that she wanted to read while she was in the study,” says Moe.
Public release date: 21-Oct-2011
When do consumers try to increase social standing by eating too much?
Consumers who feel powerless will choose larger size food portions in an attempt to gain status, according to a new study in the Journal of Consumer Research. But there is hope for convincing them that a Big Gulp won’t translate to higher ranking.
“An ongoing trend in food consumption is consumers’ tendency to eat more and more,” write authors David Dubois (HEC Paris), Derek D. Rucker, and Adam D. Galinsky (both Northwestern University). “Even more worrisome, the increase in food consumption is particularly prevalent among vulnerable populations such as lower socioeconomic status consumers.”
Many cultural norms associate larger products with greater status—for instance, the size of a vehicle, house, or TV. The authors tested whether or not consumers used the size of food products to express their status. “Because vulnerable consumers are prone to express their status in order to compensate for their undesirable position and respond to daily threats, this research further proposes that the tendency to use the size of food options within an assortment will be particularly strong among those consumers who feel powerless,” the authors write.
In one of the authors’ experiments, they confirmed that consumers equate larger sizes of food options with greater status. For example, participants perceived that consumers who chose a large coffee had more status than someone who chose medium or small, even when the price was the same.
In other experiments, powerless consumers chose larger pieces of bagels than baseline participants. And the authors found that participants chose larger smoothies when they were at a social event than when they were alone.
But there is hope for our expanding waistlines, according to the authors. When powerless participants in one study were told that smaller hors d’oeuvres were served at prestigious events, they chose smaller items that had fewer calories.
“Understanding and monitoring the size-to-status relationship of food options within an assortment is an important tool at the disposal of policy makers to effectively fight against overconsumption,” the authors conclude.