Wednesday, August 16, 2006
Low-risk prostate cancer patients face overtreatment
Many low-risk prostate cancer patients are being overtreated and might fare better if doctors monitored the cancer until treatment was necessary, a new study reports in the August 16 issue of the Journal of the National Cancer Institute.
Past recommendations for early-stage prostate cancer patients involved prostate removal rather than monitoring the cancer's progress until treatment is necessary. But more recently, cancers are being detected at earlier stages, and reports that low-risk patients are being treated aggressively have made researchers suggest such treatment may not be the best solution. New studies suggest that aggressive treatment does not improve survival benefits and may harm patients' health.
John T. Wei, M.D., of the University of Michigan in Ann Arbor, and colleagues identified 71,602 men over age 70 diagnosed with prostate cancer between 2000 and 2002. They determined how many men were treated with various therapies, including surgery and radiation, and how many times the "wait and see" approach was used.
The authors identified 24,825 men with lower-risk prostate cancers, 13,537 of whom underwent immediate treatment with radiation or prostate removal. Assuming waiting for treatment would have been the best approach for these cancers, the authors found that 10% of patients were overtreated with prostate removal and 44% with radiation therapy. Wei and colleagues suggest waiting until treatment is necessary may reduce overtreatment for patients with low risk prostate cancer.
They write, "Efforts to reduce overtreatment should be a clinical and public health priority."
Past recommendations for early-stage prostate cancer patients involved prostate removal rather than monitoring the cancer's progress until treatment is necessary. But more recently, cancers are being detected at earlier stages, and reports that low-risk patients are being treated aggressively have made researchers suggest such treatment may not be the best solution. New studies suggest that aggressive treatment does not improve survival benefits and may harm patients' health.
John T. Wei, M.D., of the University of Michigan in Ann Arbor, and colleagues identified 71,602 men over age 70 diagnosed with prostate cancer between 2000 and 2002. They determined how many men were treated with various therapies, including surgery and radiation, and how many times the "wait and see" approach was used.
The authors identified 24,825 men with lower-risk prostate cancers, 13,537 of whom underwent immediate treatment with radiation or prostate removal. Assuming waiting for treatment would have been the best approach for these cancers, the authors found that 10% of patients were overtreated with prostate removal and 44% with radiation therapy. Wei and colleagues suggest waiting until treatment is necessary may reduce overtreatment for patients with low risk prostate cancer.
They write, "Efforts to reduce overtreatment should be a clinical and public health priority."
Monday, August 14, 2006
Disabled travellers badly treated by airlines
Responding to the Department of Transport’s decision to continue with the exclusion of air travel from the provisions of the Disability Discrimination Act (DDA), the Disability Rights Commission said that evidence from callers to its own helpline was proof enough that a voluntary code was not working.
Will Bee, Director of Transport policy at the Commission, said:
“Over a third of all transport calls to our helpline relate to bad treatment of disabled travellers by airline operators and the nature of the complaints chimes in exactly with those cited in the Government’s report. Disabled air travellers run the risk of poor service and mistreatment whenever they contemplate air travel. And this is likely to continue when similar treatment on buses and trains will ruled out under the DDA this December. ’
Will Bee continued:
“We’re disappointed that the Government has ignored the evidence of its own report and continued to support a voluntary approach which is clearly is not working.”
A new EU regulation coming partly into force in July 2007 (and fully a year later) will establish for the first time protection for disabled people when making European flights. The regulations will also confirm the shared responsibility that airline companies and airports have to meet the costs of reasonable adjustments for disabled travellers. But the regulations, the DRC says, have weaknesses in key areas.
“The definition of disability under the EU regulations is more restrictive than the DDA and it will not prohibit charging for some adjustments needed on board a plane. Although they are an important step in the right direction, we believe that the Government has to make clear that, unless airlines ensure that disabled people can fly with confidence, they will extend the DDA to airlines to close the remaining gaps in the legislation.’
Will Bee, Director of Transport policy at the Commission, said:
“Over a third of all transport calls to our helpline relate to bad treatment of disabled travellers by airline operators and the nature of the complaints chimes in exactly with those cited in the Government’s report. Disabled air travellers run the risk of poor service and mistreatment whenever they contemplate air travel. And this is likely to continue when similar treatment on buses and trains will ruled out under the DDA this December. ’
Will Bee continued:
“We’re disappointed that the Government has ignored the evidence of its own report and continued to support a voluntary approach which is clearly is not working.”
A new EU regulation coming partly into force in July 2007 (and fully a year later) will establish for the first time protection for disabled people when making European flights. The regulations will also confirm the shared responsibility that airline companies and airports have to meet the costs of reasonable adjustments for disabled travellers. But the regulations, the DRC says, have weaknesses in key areas.
“The definition of disability under the EU regulations is more restrictive than the DDA and it will not prohibit charging for some adjustments needed on board a plane. Although they are an important step in the right direction, we believe that the Government has to make clear that, unless airlines ensure that disabled people can fly with confidence, they will extend the DDA to airlines to close the remaining gaps in the legislation.’
Ancient war paint in fight against breast cancer
A plant that gave ancient Britons and Celts their blue war paint, has been found to be a rich source of the anti-cancer compound, glucobrassicin, traditionally associated with broccoli. Glucobrassicin has been found to be effective against breast cancer. The war paint, a blue dye, is obtained from Woad, a member of the Brassicaceae family.
Stefania Galletti and her team at the University of Bologna, Italy, found that the plant contains twenty times more cancer fighting chemical glucobrassicin than its relative, broccoli, which they enhanced to nearly 65 times using various treatments (Journal of the Science of Agriculture DOI: 10.1002/jsfa.2571). This compound plays a defensive role in plants, and the researchers found that wounding the leaves can increase levels by 30%. When leaves are damaged, for example, by insects, glucobrassicin is released as a defence mechanism. Its derivatives can kill some plant pests, and also appear to have anti-tumoral properties, and are particularly effective against breast cancer.
Glucobrassicin has shown an active role in flushing out cancer-causing chemicals including derivatives of estrogen. Women with higher levels of this hormone are at an increased risk of developing breast cancer.
There have been many reports on the health benefits of broccoli and other commonly consumed vegetables from the same family. However, it has been difficult to extract enough of the broccoli compound to carry out extensive tests. Galletti's team hope that by using this cheap, rich source, in depth research can be carried out to study how this compound acts in the body.
More on breast cancer here
Stefania Galletti and her team at the University of Bologna, Italy, found that the plant contains twenty times more cancer fighting chemical glucobrassicin than its relative, broccoli, which they enhanced to nearly 65 times using various treatments (Journal of the Science of Agriculture DOI: 10.1002/jsfa.2571). This compound plays a defensive role in plants, and the researchers found that wounding the leaves can increase levels by 30%. When leaves are damaged, for example, by insects, glucobrassicin is released as a defence mechanism. Its derivatives can kill some plant pests, and also appear to have anti-tumoral properties, and are particularly effective against breast cancer.
Glucobrassicin has shown an active role in flushing out cancer-causing chemicals including derivatives of estrogen. Women with higher levels of this hormone are at an increased risk of developing breast cancer.
There have been many reports on the health benefits of broccoli and other commonly consumed vegetables from the same family. However, it has been difficult to extract enough of the broccoli compound to carry out extensive tests. Galletti's team hope that by using this cheap, rich source, in depth research can be carried out to study how this compound acts in the body.
More on breast cancer here
Clinical trial evaluates first-line approaches for treating HIV
In the first head-to-head comparison between two commonly used HIV treatments, researchers found one triple-drug therapy was significantly more effective at reducing HIV viral load in the blood when used as a first-line treatment. Results of the clinical trial, which sought to determine from among three different therapies the optimal approach for patients beginning HIV treatment for the first time, will be reported at the XVI International AIDS Conference (AIDS 2006).
Of the two triple-drug approaches evaluated in the randomized trial, the therapy consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) with efavirenz, a non-nucleoside reverse transcriptase inhibitor (NNRTI), suppressed the virus to undetectable levels in more participants than the three-drug combination of two NRTIs and a protease inhibitor called lopinavir/ritonavir. Moreover, a third regimen, efavirenz and lopinavir/ritonavir, performed nearly as well as the three-drug cocktail with efavirenz, suggesting initial therapy need not include NRTIs, a class of drugs that can produce intolerable side effects in some patients.
"Our findings suggest that the efavirenz plus two-NRTI regimen was the best of the three approaches as initial therapy, even in patients with relatively advanced HIV disease," said Sharon Riddler, M.D., M.P.H., assistant professor of medicine in the division of infectious diseases at the University of Pittsburgh School of Medicine, who will present the findings at AIDS 2006.
"Also, we found that the NRTI-sparing two-drug combination of efavirenz and lopinavir had a similar level of effectiveness to the efavirenz plus two-NRTI regimen. When we started this study, we heard from physicians with concerns about using efavirenz in the absence of NRTIs. Now that we've completed the trial, there should be little doubt that patients can benefit from this 'nuke'-sparing treatment regimen when NRTI side effects are a problem," she added.
The NRTI-sparing combination of lopinavir/ritonavir and efavirenz had never before been studied as first-line therapy in a large randomized clinical trial, in part because a general belief that combining an NNRTI with a protease inhibitor could result in resistance to two important classes of drugs. But earlier studies with other drug combinations suggested the approach would be safe. Thus, in designing the trial, Dr. Riddler and her national co-chair, Richard Haubrich, M.D., at the University of California, San Diego (UCSD) School of Medicine, felt it important to include this less conventional regimen so it could be evaluated under the rigors of a clinical trial.
The study included 753 participants at 55 centers and was conducted under the auspices of the AIDS Clinical Trials Group (ACTG), considered the world's largest HIV clinical trials organization. ACTG receives its funding from the National Institute of Allergy and Infectious Diseases.
At the start of the study, just more than half of the participants had viral loads greater than 100,000 copies of HIV RNA per milliliter of blood. The median CD4+ T cell count was just 182 cells per cubic milliliter. Each participant was randomly assigned to one of the three treatment arms: 250 were selected to receive the efavirenz-based triple drug therapy, 253 the lopinavir/ritonavir-based triple drug therapy, and 250 were assigned to the group receiving the NRTI-sparing regimen of efavirenz and lopinavir/ritonavir. Participants in the triple-drug therapy groups each received two NRTIs: lamivudine, plus their choice of stavudine, zidovudine or tenofovir disoproxil fumarate.
The researchers found all three of the treatment regimens were potent, producing substantial increases in CD4+ T cell counts and decreases in HIV viral load. After 96 weeks of treatment, 89 percent of the participants randomized to the efavirenz arm had "undetectable" levels of HIV, meaning viral load was less than 50 copies per milliliter; 77 percent of the lopinavir/ritonavir arm participants and 83 percent of the participants on the NRTI-sparing regimen had low viral loads. Interestingly, the CD4+ T cell count increase was greater in the two study arms containing lopinavir/ritonavir as compared to the efavirenz regimen. At week 96, the CD4+ T cells increased from baseline to 285 cells in the lopinavir/ritonavir group, 268 cells in the nucleoside-sparing group and 241 cells for the efavirenz regimen.
More participants in the lopinavir/ritonavir group experienced virologic failure – a rebound in the HIV virus load to detectable levels – during the study compared to the efavirenz group. After 96 weeks of treatment, 33 percent of participants in the lopinavir/ritonavir group had virologic failure compared to 24 percent of the participants receiving the efavirenz-based therapy and 27 percent of those in the NRTI-sparing group.
It was no mistake that the two particular triple-drug therapies were selected for the study. Both are listed as "preferred" options in the U.S. Department of Health and Human Service's treatment guidelines for HIV infection.
"We were surprised that the lopinavir plus two-NRTI regimen did not perform as well as the efavirenz-based treatment because lopinavir/ritonavir is considered one of the most potent drugs that we have available for HIV treatment at this time. It may be that the lopinavir/ritonavir regimen, which was dosed twice daily using the soft gel capsule form, was less convenient or less well tolerated by patients. We will continue to evaluate our study data to try to assess the reasons for these findings," noted Dr. Haubrich, professor of medicine in the division of infectious diseases at UCSD School of Medicine.
All of the drugs used in the clinical trial are approved for the treatment of HIV. Nucleoside reverse transcriptase inhibitors, or NRTIs, prevent healthy T cells from being infected by blocking a process called reverse transcription that HIV uses to convert its RNA into DNA. By inserting faulty building blocks, HIV can't copy its DNA. NNRTIs, the non-nucleoside reverse transcriptase inhibitors, target the same mechanism but block the reverse transcriptase enzyme by attaching to a different site than NRTIs. The class of drugs known as protease inhibitors blocks the maturation of proteins that HIV needs to assemble itself into an infectious virus.
More on HIV/Aids here
Of the two triple-drug approaches evaluated in the randomized trial, the therapy consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) with efavirenz, a non-nucleoside reverse transcriptase inhibitor (NNRTI), suppressed the virus to undetectable levels in more participants than the three-drug combination of two NRTIs and a protease inhibitor called lopinavir/ritonavir. Moreover, a third regimen, efavirenz and lopinavir/ritonavir, performed nearly as well as the three-drug cocktail with efavirenz, suggesting initial therapy need not include NRTIs, a class of drugs that can produce intolerable side effects in some patients.
"Our findings suggest that the efavirenz plus two-NRTI regimen was the best of the three approaches as initial therapy, even in patients with relatively advanced HIV disease," said Sharon Riddler, M.D., M.P.H., assistant professor of medicine in the division of infectious diseases at the University of Pittsburgh School of Medicine, who will present the findings at AIDS 2006.
"Also, we found that the NRTI-sparing two-drug combination of efavirenz and lopinavir had a similar level of effectiveness to the efavirenz plus two-NRTI regimen. When we started this study, we heard from physicians with concerns about using efavirenz in the absence of NRTIs. Now that we've completed the trial, there should be little doubt that patients can benefit from this 'nuke'-sparing treatment regimen when NRTI side effects are a problem," she added.
The NRTI-sparing combination of lopinavir/ritonavir and efavirenz had never before been studied as first-line therapy in a large randomized clinical trial, in part because a general belief that combining an NNRTI with a protease inhibitor could result in resistance to two important classes of drugs. But earlier studies with other drug combinations suggested the approach would be safe. Thus, in designing the trial, Dr. Riddler and her national co-chair, Richard Haubrich, M.D., at the University of California, San Diego (UCSD) School of Medicine, felt it important to include this less conventional regimen so it could be evaluated under the rigors of a clinical trial.
The study included 753 participants at 55 centers and was conducted under the auspices of the AIDS Clinical Trials Group (ACTG), considered the world's largest HIV clinical trials organization. ACTG receives its funding from the National Institute of Allergy and Infectious Diseases.
At the start of the study, just more than half of the participants had viral loads greater than 100,000 copies of HIV RNA per milliliter of blood. The median CD4+ T cell count was just 182 cells per cubic milliliter. Each participant was randomly assigned to one of the three treatment arms: 250 were selected to receive the efavirenz-based triple drug therapy, 253 the lopinavir/ritonavir-based triple drug therapy, and 250 were assigned to the group receiving the NRTI-sparing regimen of efavirenz and lopinavir/ritonavir. Participants in the triple-drug therapy groups each received two NRTIs: lamivudine, plus their choice of stavudine, zidovudine or tenofovir disoproxil fumarate.
The researchers found all three of the treatment regimens were potent, producing substantial increases in CD4+ T cell counts and decreases in HIV viral load. After 96 weeks of treatment, 89 percent of the participants randomized to the efavirenz arm had "undetectable" levels of HIV, meaning viral load was less than 50 copies per milliliter; 77 percent of the lopinavir/ritonavir arm participants and 83 percent of the participants on the NRTI-sparing regimen had low viral loads. Interestingly, the CD4+ T cell count increase was greater in the two study arms containing lopinavir/ritonavir as compared to the efavirenz regimen. At week 96, the CD4+ T cells increased from baseline to 285 cells in the lopinavir/ritonavir group, 268 cells in the nucleoside-sparing group and 241 cells for the efavirenz regimen.
More participants in the lopinavir/ritonavir group experienced virologic failure – a rebound in the HIV virus load to detectable levels – during the study compared to the efavirenz group. After 96 weeks of treatment, 33 percent of participants in the lopinavir/ritonavir group had virologic failure compared to 24 percent of the participants receiving the efavirenz-based therapy and 27 percent of those in the NRTI-sparing group.
It was no mistake that the two particular triple-drug therapies were selected for the study. Both are listed as "preferred" options in the U.S. Department of Health and Human Service's treatment guidelines for HIV infection.
"We were surprised that the lopinavir plus two-NRTI regimen did not perform as well as the efavirenz-based treatment because lopinavir/ritonavir is considered one of the most potent drugs that we have available for HIV treatment at this time. It may be that the lopinavir/ritonavir regimen, which was dosed twice daily using the soft gel capsule form, was less convenient or less well tolerated by patients. We will continue to evaluate our study data to try to assess the reasons for these findings," noted Dr. Haubrich, professor of medicine in the division of infectious diseases at UCSD School of Medicine.
All of the drugs used in the clinical trial are approved for the treatment of HIV. Nucleoside reverse transcriptase inhibitors, or NRTIs, prevent healthy T cells from being infected by blocking a process called reverse transcription that HIV uses to convert its RNA into DNA. By inserting faulty building blocks, HIV can't copy its DNA. NNRTIs, the non-nucleoside reverse transcriptase inhibitors, target the same mechanism but block the reverse transcriptase enzyme by attaching to a different site than NRTIs. The class of drugs known as protease inhibitors blocks the maturation of proteins that HIV needs to assemble itself into an infectious virus.
More on HIV/Aids here
DoH publishes NHS financial performance
The Department of Health has published the NHS financial performance for the first quarter of 2006-07.
The data shows that:
* the NHS as a whole is forecasting a small surplus for the year - £18m - after application of a £350 million contingency created by the Strategic Health Authorities;
* forecast gross deficits for the year total £883 million compared with £1,227 million in 2005-06;
* 120 organisations are forecasting deficits compared with 174 that returned deficits in 2005-06.
Health Minister Lord Warner said:
"By publishing NHS financial data on a quarterly basis, we are being more open and transparent about NHS accounts than ever before. The Audit Commission recently confirmed that our transparent approach was exposing financial risks that were previously hidden and it was therefore helping the NHS to spot problems earlier and take steps to address them.
"These figures are encouraging news. They show that the NHS is on track to achieve our aim of a net financial balance by the end of the year. Good progress has been made to bring the NHS into balance, and this has been done whilst continuing to maintain good patient care.
"However, there is no room for complacency. It should be recognised that at this point in the year there remains considerable financial risk in some Trusts to be managed to ensure delivery in line with forecast positions. That is why a minority of Trusts are having to take tough decisions about how to bring their financial situation into balance. Even with these tough decisions there is little evidence of a damaging effect on patient services or of significant redundancies.
"There should be no trade-off between improving the quality of patient care and actions to improve financial management. The NHS is consistently delivering better services for patients. Waiting times for operations remain at record lows, accident and emergency departments are faster despite recent increases in demand, and health outcomes for patients across the service are improving.
"We have agreed with the NHS that Strategic Health Authorities can enter into loan agreements with Primary Care Trusts in order to bring the regional health economy into balance. We have been clear that any loans will have to be repaid with interest, and that priority for early repayment will be areas with the greatest health need."
The data shows that:
* the NHS as a whole is forecasting a small surplus for the year - £18m - after application of a £350 million contingency created by the Strategic Health Authorities;
* forecast gross deficits for the year total £883 million compared with £1,227 million in 2005-06;
* 120 organisations are forecasting deficits compared with 174 that returned deficits in 2005-06.
Health Minister Lord Warner said:
"By publishing NHS financial data on a quarterly basis, we are being more open and transparent about NHS accounts than ever before. The Audit Commission recently confirmed that our transparent approach was exposing financial risks that were previously hidden and it was therefore helping the NHS to spot problems earlier and take steps to address them.
"These figures are encouraging news. They show that the NHS is on track to achieve our aim of a net financial balance by the end of the year. Good progress has been made to bring the NHS into balance, and this has been done whilst continuing to maintain good patient care.
"However, there is no room for complacency. It should be recognised that at this point in the year there remains considerable financial risk in some Trusts to be managed to ensure delivery in line with forecast positions. That is why a minority of Trusts are having to take tough decisions about how to bring their financial situation into balance. Even with these tough decisions there is little evidence of a damaging effect on patient services or of significant redundancies.
"There should be no trade-off between improving the quality of patient care and actions to improve financial management. The NHS is consistently delivering better services for patients. Waiting times for operations remain at record lows, accident and emergency departments are faster despite recent increases in demand, and health outcomes for patients across the service are improving.
"We have agreed with the NHS that Strategic Health Authorities can enter into loan agreements with Primary Care Trusts in order to bring the regional health economy into balance. We have been clear that any loans will have to be repaid with interest, and that priority for early repayment will be areas with the greatest health need."
Tuesday, August 08, 2006
Hayfever linked to Parkinson's
Researchers from Mayo Clinic have discovered that allergic rhinitis is associated with the development of Parkinson’s disease later in life. Findings will be published in the Aug. 8 issue of the journal Neurology.
“The association with Parkinson’s disease is increased to almost three times that of someone who does not have allergic rhinitis,” says James Bower, M.D., Mayo Clinic neurologist and lead study investigator. “That’s actually a pretty high elevation.”
Previous studies had shown that people who regularly take nonsteroidal anti-inflammatory drugs, such as ibuprofen, are less likely to develop Parkinson’s disease. These results prompted the Mayo Clinic investigators to look further into the links between diseases characterized by inflammation and Parkinson’s. They studied 196 people who developed Parkinson’s disease, matched with people of similar age and gender who did not develop Parkinson’s. The study was conducted in Olmsted County, Minn., home of Mayo Clinic, over a 20-year period.
The researchers examined these groups to determine if those who developed Parkinson’s disease had more inflammatory diseases. They found that those with allergic rhinitis were 2.9 times more likely to develop Parkinson’s. They did not find a similar association between inflammatory diseases such as lupus, rheumatoid arthritis, pernicious anemia or vitiligo and Parkinson’s disease. The researchers hypothesize that they may not have found significant links between these diseases and Parkinson’s disease due to the relatively small number of those in the population who have these diseases, and thus the small number with these diseases in their population sample study. They also did not find the same association with Parkinson’s disease in patients with asthma that they discovered in those with allergic rhinitis.
Dr. Bower says that this study did not examine patients’ types of allergies or when they developed allergies.
The investigators theorize that a tendency toward inflammation is the key link between the diseases.
“People with allergic rhinitis mount an immune response with their allergies, so they may be more likely to mount an immune response in the brain as well, which would produce inflammation,” Dr. Bower says. “The inflammation produced may release certain chemicals in the brain and inadvertently kill brain cells, as we see in Parkinson’s.”
Dr. Bower explains that this study does not prove that allergies cause Parkinson’s disease; instead, it points to an association between the two diseases. He advises that allergy patients can do little to reduce the potential risk for Parkinson’s.
“I wouldn’t worry if you have allergies,” he says. “Treat the allergy symptoms you have to alleviate them at the time. At this point, we have no good evidence that this treatment will protect you from possibly developing Parkinson’s disease later.”
Dr. Bower and colleagues hope, however, that the clues in this study may give scientists a strong hint about inflammation’s role in Parkinson’s.
“This is exciting, because we may be able to develop medications to block the inflammation,” he says.
Parkinson’s is a complex disease, says Dr. Bower, because many factors can contribute to its development and its causes can differ. The complexity can be compared to heart attacks, which can be caused by hypertension, high cholesterol or smoking, among other factors. Thus, allergic rhinitis would now be considered one among many possible risk factors for development of Parkinson’s disease.
Parkinson’s disease affects nerve cells (neurons) in the part of the brain that controls muscle movement. People with Parkinson’s disease often experience trembling, muscle rigidity, difficulty walking, and problems with balance and coordination. These symptoms generally develop after age 50, although the disease also affects a small percentage of younger people. The normal lifetime risk to develop Parkinson’s disease for men and women combined is 1.7 percent.
More on Allergenic Rhinitis here and more on Parkinson's here
“The association with Parkinson’s disease is increased to almost three times that of someone who does not have allergic rhinitis,” says James Bower, M.D., Mayo Clinic neurologist and lead study investigator. “That’s actually a pretty high elevation.”
Previous studies had shown that people who regularly take nonsteroidal anti-inflammatory drugs, such as ibuprofen, are less likely to develop Parkinson’s disease. These results prompted the Mayo Clinic investigators to look further into the links between diseases characterized by inflammation and Parkinson’s. They studied 196 people who developed Parkinson’s disease, matched with people of similar age and gender who did not develop Parkinson’s. The study was conducted in Olmsted County, Minn., home of Mayo Clinic, over a 20-year period.
The researchers examined these groups to determine if those who developed Parkinson’s disease had more inflammatory diseases. They found that those with allergic rhinitis were 2.9 times more likely to develop Parkinson’s. They did not find a similar association between inflammatory diseases such as lupus, rheumatoid arthritis, pernicious anemia or vitiligo and Parkinson’s disease. The researchers hypothesize that they may not have found significant links between these diseases and Parkinson’s disease due to the relatively small number of those in the population who have these diseases, and thus the small number with these diseases in their population sample study. They also did not find the same association with Parkinson’s disease in patients with asthma that they discovered in those with allergic rhinitis.
Dr. Bower says that this study did not examine patients’ types of allergies or when they developed allergies.
The investigators theorize that a tendency toward inflammation is the key link between the diseases.
“People with allergic rhinitis mount an immune response with their allergies, so they may be more likely to mount an immune response in the brain as well, which would produce inflammation,” Dr. Bower says. “The inflammation produced may release certain chemicals in the brain and inadvertently kill brain cells, as we see in Parkinson’s.”
Dr. Bower explains that this study does not prove that allergies cause Parkinson’s disease; instead, it points to an association between the two diseases. He advises that allergy patients can do little to reduce the potential risk for Parkinson’s.
“I wouldn’t worry if you have allergies,” he says. “Treat the allergy symptoms you have to alleviate them at the time. At this point, we have no good evidence that this treatment will protect you from possibly developing Parkinson’s disease later.”
Dr. Bower and colleagues hope, however, that the clues in this study may give scientists a strong hint about inflammation’s role in Parkinson’s.
“This is exciting, because we may be able to develop medications to block the inflammation,” he says.
Parkinson’s is a complex disease, says Dr. Bower, because many factors can contribute to its development and its causes can differ. The complexity can be compared to heart attacks, which can be caused by hypertension, high cholesterol or smoking, among other factors. Thus, allergic rhinitis would now be considered one among many possible risk factors for development of Parkinson’s disease.
Parkinson’s disease affects nerve cells (neurons) in the part of the brain that controls muscle movement. People with Parkinson’s disease often experience trembling, muscle rigidity, difficulty walking, and problems with balance and coordination. These symptoms generally develop after age 50, although the disease also affects a small percentage of younger people. The normal lifetime risk to develop Parkinson’s disease for men and women combined is 1.7 percent.
More on Allergenic Rhinitis here and more on Parkinson's here
Monday, August 07, 2006
Stroke Association comments on audit
The Stroke Association has responded to the Royal College of Physicians Sentinel Stroke Audit 2006
Joe Korner, Director of Communications for The Stroke Association, said:"Despite welcome increases in the number of stroke units, lives are still being lost because of huge gaps in emergency and acute care for stroke.
Last year only 218 stroke patients got the potentially life saving clot-busting treatment they needed, but as many as 12,000 people lost out. With the right treatment in specialist stroke units we could be saving hundreds of lives every year and reducing the personal and financial costs of severe disability.
"The audit also shows we have a long way to go to improve rehabilitation services in the community. The right support when people leave hospital (and for their carers) is absolutely vital, if they are to continue to recover and regain independence."
More about Strokes
Joe Korner, Director of Communications for The Stroke Association, said:"Despite welcome increases in the number of stroke units, lives are still being lost because of huge gaps in emergency and acute care for stroke.
Last year only 218 stroke patients got the potentially life saving clot-busting treatment they needed, but as many as 12,000 people lost out. With the right treatment in specialist stroke units we could be saving hundreds of lives every year and reducing the personal and financial costs of severe disability.
"The audit also shows we have a long way to go to improve rehabilitation services in the community. The right support when people leave hospital (and for their carers) is absolutely vital, if they are to continue to recover and regain independence."
More about Strokes
Launch of self assessment pilots
People with long term health and social care needs are being given the option to self assess their need for home care and equipment, as part of a series of pilot schemes launched today.
Until now patients have been assessed by local social services Until now patients have been assessed by local social services on their eligibility for equipment, fittings and home care.
The 11 pilot projects will help determine whether self assessment schemes are a feasible option for patients with long term health and social care needs.
A number of the pilots will also focus on groups in the community whose needs can be difficult to meet, such as minority ethnic groups and people living in rural areas.
Putting people in control of their own care was one of the main commitments in the recent White Paper, Our health, our care, our say.
Until now patients have been assessed by local social services Until now patients have been assessed by local social services on their eligibility for equipment, fittings and home care.
The 11 pilot projects will help determine whether self assessment schemes are a feasible option for patients with long term health and social care needs.
A number of the pilots will also focus on groups in the community whose needs can be difficult to meet, such as minority ethnic groups and people living in rural areas.
Putting people in control of their own care was one of the main commitments in the recent White Paper, Our health, our care, our say.
Deadly latex evading lax food labelling laws
Food packaging containing latex should be labeled to avoid the possibility of sensitive individuals being exposed to potentially deadly levels of the allergen, experts told C&I. A recent UK study revealed that one third of food packaging tested was contaminated with latex. The latex was transferred to food in some cases. In one unnamed chocolate biscuit, the amount of latex found was 20 times the level that instigates a reaction.
A group of experts from the UK Latex Allergy Support Group (LASG) Advisory Panel said that these results were significant. 'For a few people, natural rubber latex is a very potent allergen and for these individuals, there is no safe level of exposure,' says LASG representative Graham Lowe. 'We would welcome an approach to the EU to consider this evidence and the issue of labelling,' he said. Lowe added that latex transfer to food could account for some currently inexplicable reactions.
There is no agreement on a safe level of latex, but it has been reported that a billionth of a gram (1ng/ml) can be enough to cause a reaction. Currently manufacturers are not required to label food packaging as containing latex.
Scientists at Leatherhead Food International measured the presence of four major latex allergens in 21 types of food packaging for confectionary, fruit and vegetable produce, meat, pastry and dairy products. A third of the materials tested gave positive results for the presence of latex and in some cases this was transferred onto the food (Journal of the Science of Food and Agriculture DOI 10/1002/jsfa.2580).
The highest levels of latex allergens were found in a chocolate biscuit containing nearly 20ng/ml. The wrapper contained 85ng/ml of latex. The highest levels in packaging was detected in ice cream wrappers, with over 370ng/ml found in one sample. The ice cream itself contained around 14ng/ml. One company admitted spraying whole wrappers with latex adhesive, so that they could be sealed with minimum wastage.
A spokesperson for the Food Standards Agency, which funded this study, said food-labelling guidelines were designed to avoid restriction of choice due to excess use of warning labels. 'Advisory labeling should only be used when, following a thorough risk assessment, there is a real risk of allergic reactions,' they said.
The Leatherhead study is the first attempt to quantify the latex allergens present in food contact materials and also in foods.
Between 1-6% of the British population suffer from latex allergies. Latex is used in many food packaging materials, including rubber bands, meat netting, stickers found on some fruit and vegetables and the adhesive used for cold sealing of confectionary.
A group of experts from the UK Latex Allergy Support Group (LASG) Advisory Panel said that these results were significant. 'For a few people, natural rubber latex is a very potent allergen and for these individuals, there is no safe level of exposure,' says LASG representative Graham Lowe. 'We would welcome an approach to the EU to consider this evidence and the issue of labelling,' he said. Lowe added that latex transfer to food could account for some currently inexplicable reactions.
There is no agreement on a safe level of latex, but it has been reported that a billionth of a gram (1ng/ml) can be enough to cause a reaction. Currently manufacturers are not required to label food packaging as containing latex.
Scientists at Leatherhead Food International measured the presence of four major latex allergens in 21 types of food packaging for confectionary, fruit and vegetable produce, meat, pastry and dairy products. A third of the materials tested gave positive results for the presence of latex and in some cases this was transferred onto the food (Journal of the Science of Food and Agriculture DOI 10/1002/jsfa.2580).
The highest levels of latex allergens were found in a chocolate biscuit containing nearly 20ng/ml. The wrapper contained 85ng/ml of latex. The highest levels in packaging was detected in ice cream wrappers, with over 370ng/ml found in one sample. The ice cream itself contained around 14ng/ml. One company admitted spraying whole wrappers with latex adhesive, so that they could be sealed with minimum wastage.
A spokesperson for the Food Standards Agency, which funded this study, said food-labelling guidelines were designed to avoid restriction of choice due to excess use of warning labels. 'Advisory labeling should only be used when, following a thorough risk assessment, there is a real risk of allergic reactions,' they said.
The Leatherhead study is the first attempt to quantify the latex allergens present in food contact materials and also in foods.
Between 1-6% of the British population suffer from latex allergies. Latex is used in many food packaging materials, including rubber bands, meat netting, stickers found on some fruit and vegetables and the adhesive used for cold sealing of confectionary.
Speed promotes HIV spread
Researchers at the University at Buffalo have presented the first evidence that the addictive drug methamphetamine, or meth, also commonly known as "speed" or "crystal," increases production of a docking protein that promotes the spread of the HIV-1 virus in infected users.
The investigators found that meth increases expression of a receptor called DC-SIGN, a "virus-attachment factor," allowing more of the virus to invade the immune system.
"This finding shows that using meth is doubly dangerous," said Madhavan P.N. Nair, Ph.D., first author on the study, published in the online version of the Journal of Neuroimmune Pharmacology. The study will appear in print in the September issue of the journal.
"Meth reduces inhibitions, thus increasing the likelihood of risky sexual behavior and the potential to introduce the virus into the body, and at the same time allows more virus to get into the cell," said Nair, professor of medicine and a specialist in immunology in the UB School of Medicine and Biomedical Sciences.
His research centers on dendritic cells, which serve as the first line of defense again pathogens, and two receptors on these cells -- HIV binding/attachment receptors (DC-SIGN) and the meth-specific dopamine receptor. Dendritic cells overloaded with virus due to the action of methamphetamine can overwhelm the T cells, the major target of HIV, and disrupt the immune response, promoting HIV infection.
"Now that we have identified the target receptor, we can develop ways to block that receptor and decrease the viral spread," said Nair. "We have to approach this disease from as many different perspectives as possible.
"If we could prevent the upregulation of the meth-specific dopamine receptor by blocking it, we may be able to prevent the interaction of meth with its specific receptors, thereby inhibiting the virus attachment receptor," said Nair.
"Right now, we don't know how the virus-attachment receptor and meth-specific receptors interact with each other, leading to the progression of HIV disease in meth-using HIV-infected subjects. That is the next question we want to answer.
"Since meth mediates its effects through interacting with dopamine receptors present on the cells, and meth increases DC-SIGN, which are the HIV attachment receptors, use of dopamine receptor blockers during HIV infection in meth users could be beneficial therapeutically to reduce HIV infection in these high-risk populations," Nair said.
More on HIV here and more on drugs here
The investigators found that meth increases expression of a receptor called DC-SIGN, a "virus-attachment factor," allowing more of the virus to invade the immune system.
"This finding shows that using meth is doubly dangerous," said Madhavan P.N. Nair, Ph.D., first author on the study, published in the online version of the Journal of Neuroimmune Pharmacology. The study will appear in print in the September issue of the journal.
"Meth reduces inhibitions, thus increasing the likelihood of risky sexual behavior and the potential to introduce the virus into the body, and at the same time allows more virus to get into the cell," said Nair, professor of medicine and a specialist in immunology in the UB School of Medicine and Biomedical Sciences.
His research centers on dendritic cells, which serve as the first line of defense again pathogens, and two receptors on these cells -- HIV binding/attachment receptors (DC-SIGN) and the meth-specific dopamine receptor. Dendritic cells overloaded with virus due to the action of methamphetamine can overwhelm the T cells, the major target of HIV, and disrupt the immune response, promoting HIV infection.
"Now that we have identified the target receptor, we can develop ways to block that receptor and decrease the viral spread," said Nair. "We have to approach this disease from as many different perspectives as possible.
"If we could prevent the upregulation of the meth-specific dopamine receptor by blocking it, we may be able to prevent the interaction of meth with its specific receptors, thereby inhibiting the virus attachment receptor," said Nair.
"Right now, we don't know how the virus-attachment receptor and meth-specific receptors interact with each other, leading to the progression of HIV disease in meth-using HIV-infected subjects. That is the next question we want to answer.
"Since meth mediates its effects through interacting with dopamine receptors present on the cells, and meth increases DC-SIGN, which are the HIV attachment receptors, use of dopamine receptor blockers during HIV infection in meth users could be beneficial therapeutically to reduce HIV infection in these high-risk populations," Nair said.
More on HIV here and more on drugs here
Anti-smoking campaigner has lung cancer
Allen Carr, one of the world's best known anti-smoking campaigners who smoked 100 cigarettes a day before giving up, has been diagnosed with lung cancer.
Credited with helping millions of people stop smoking, Carr gave up accountancy in 1983 to open his first anti-smoking clinic.
He has since gone on to open cessation clinics around the world and has written a number of best selling books advising people on how to quit.
Mr Carr said that he was in good spirits and that he viewed the diagnosis as an opportunity to reach more people.
"Since I stopped smoking more than 23 years ago I have been the happiest man in the world - I still feel the same way," he said.
A spokesman for Mr Carr's company said that it was impossible to tell whether the disease was linked to Mr Carr's previous tobacco use.
"Allen has spent many years in smoke-filled rooms since he quit, whilst treating smokers for their addiction," the spokesman said.
"He is certain that, had he not quit, he would have been dead 20 years ago."
Credited with helping millions of people stop smoking, Carr gave up accountancy in 1983 to open his first anti-smoking clinic.
He has since gone on to open cessation clinics around the world and has written a number of best selling books advising people on how to quit.
Mr Carr said that he was in good spirits and that he viewed the diagnosis as an opportunity to reach more people.
"Since I stopped smoking more than 23 years ago I have been the happiest man in the world - I still feel the same way," he said.
A spokesman for Mr Carr's company said that it was impossible to tell whether the disease was linked to Mr Carr's previous tobacco use.
"Allen has spent many years in smoke-filled rooms since he quit, whilst treating smokers for their addiction," the spokesman said.
"He is certain that, had he not quit, he would have been dead 20 years ago."
Hearts Flutter for over 50s
Hearts fluttering, spontaneous romance and love at first sight might sound like the pages of Mills and Boon or at least teenage fantasy, but hearts are racing a plenty amongst the over 50s too - according to a study by Saga and the British Heart Foundation.
36% of over 50s consider themselves more spontaneous now than they were in their 20s and 30s and the numbers of over 50s claiming to live life to the full actually increases the further over 50 they get.
This certainly applies to over 50s’ love lives as over one in four proclaim to feel more romantic the older they get and over half believe in love at first sight, 6% more than cynical under 50s.
69% of over 50s consider themselves romantic; a sentiment put into practice when, as part of the study, the majority lovingly picked their husband, wife or partner as a dream date even when they could have picked celebrities such as George Clooney and Jennifer Aniston.
Ideal celebrity dates vary slightly among age groups, younger ladies prefer Johnny Depp (29%) or Robbie Williams (22%) whereas those over 50 would rather romance Sean Connery (20%) or Mel Gibson (16%), only one man featured in the top 3 of both age groups – the ever popular George Clooney.
Kylie Minogue (20%) and Angelina Jolie (19%) are most likely to set young mens’ hearts fluttering, whereas the older romantics opted for Jennifer Aniston (18%), followed closely by Julia Roberts (17%) and proving that a way to a man’s heart truly is through his stomach, 16% chose Nigella Lawson.
These over 50s Casanovas were discovered by Saga and BHF as they investigated what makes hearts flutter, as part of the launch of a new fundraising partnership between Britain’s leading services provider to today’s over 50s and the nation’s heart charity
As part of the partnership Saga will be publicising the work of the BHF to Saga customers and jointly promoting fundraising activities. Saga aims to raise hundreds of thousands of pounds over the course of the partnership.
Professor Andrew Steptoe, BHF Chair of Psychology at University College London said: "There is a serious side to thinking about love and affection as we grow older. Clinical research has shown that people who enjoy high levels of emotional support and who have lots of social connections are at reduced risk for developing coronary heart disease.
"On the other hand, family discord and conflict between partners may raise risk. There are direct links between these emotional states and our biological responses in everyday life. With research funding from the British Heart Foundation, we are trying to understand these processes in detail, so that we can work out exactly how our emotional lives affect the heart.
Andrew Goodsell, Chief Executive, Saga Group said: "It is good to know that today’s over 50s are making the most of love and romance and better still, that this is good for our hearts. We are proud to be working with the British Heart Foundation and I am confident that working together we will raise money and awareness of why the nation’s over 50s should keep fit, healthy and active."
Douglas Rouse, Head of Corporate Partnerships at the British Heart Foundation said: “The money raised through our fundraising partnership with Saga, will help us in our fight against heart disease, which remains the UK’s biggest killer. Through this partnership, we will highlight the importance of maintaining a healthy heart, so romance can continue to blossom for the over 50s.”
More on the heart here
36% of over 50s consider themselves more spontaneous now than they were in their 20s and 30s and the numbers of over 50s claiming to live life to the full actually increases the further over 50 they get.
This certainly applies to over 50s’ love lives as over one in four proclaim to feel more romantic the older they get and over half believe in love at first sight, 6% more than cynical under 50s.
69% of over 50s consider themselves romantic; a sentiment put into practice when, as part of the study, the majority lovingly picked their husband, wife or partner as a dream date even when they could have picked celebrities such as George Clooney and Jennifer Aniston.
Ideal celebrity dates vary slightly among age groups, younger ladies prefer Johnny Depp (29%) or Robbie Williams (22%) whereas those over 50 would rather romance Sean Connery (20%) or Mel Gibson (16%), only one man featured in the top 3 of both age groups – the ever popular George Clooney.
Kylie Minogue (20%) and Angelina Jolie (19%) are most likely to set young mens’ hearts fluttering, whereas the older romantics opted for Jennifer Aniston (18%), followed closely by Julia Roberts (17%) and proving that a way to a man’s heart truly is through his stomach, 16% chose Nigella Lawson.
These over 50s Casanovas were discovered by Saga and BHF as they investigated what makes hearts flutter, as part of the launch of a new fundraising partnership between Britain’s leading services provider to today’s over 50s and the nation’s heart charity
As part of the partnership Saga will be publicising the work of the BHF to Saga customers and jointly promoting fundraising activities. Saga aims to raise hundreds of thousands of pounds over the course of the partnership.
Professor Andrew Steptoe, BHF Chair of Psychology at University College London said: "There is a serious side to thinking about love and affection as we grow older. Clinical research has shown that people who enjoy high levels of emotional support and who have lots of social connections are at reduced risk for developing coronary heart disease.
"On the other hand, family discord and conflict between partners may raise risk. There are direct links between these emotional states and our biological responses in everyday life. With research funding from the British Heart Foundation, we are trying to understand these processes in detail, so that we can work out exactly how our emotional lives affect the heart.
Andrew Goodsell, Chief Executive, Saga Group said: "It is good to know that today’s over 50s are making the most of love and romance and better still, that this is good for our hearts. We are proud to be working with the British Heart Foundation and I am confident that working together we will raise money and awareness of why the nation’s over 50s should keep fit, healthy and active."
Douglas Rouse, Head of Corporate Partnerships at the British Heart Foundation said: “The money raised through our fundraising partnership with Saga, will help us in our fight against heart disease, which remains the UK’s biggest killer. Through this partnership, we will highlight the importance of maintaining a healthy heart, so romance can continue to blossom for the over 50s.”
More on the heart here
