Researchers note differences between people and animals on calorie restriction
St. Louis, 25 sept 2008 — Calorie restriction, a diet that is low in calories and high in nutrition, may not be as effective at extending life in people as it is in rodents, according to scientists at Washington University School of Medicine in St. Louis.
Previous research had shown that laboratory animals given 30 percent to 50 percent less food can live up to 50 percent longer. Because of those findings, some people have adopted calorie restriction in the hope that they can lengthen their lives. But the new research suggests the diet may not have the desired effect unless people on calorie restriction also pay attention to their protein intake.
In an article published online this month in the journal Aging Cell, investigators point to a discrepancy between humans and animals on calorie restriction. In the majority of the animal models of longevity, extended lifespan involves pathways related to a growth factor called IGF-1 (insulin-like growth factor-1), which is produced primarily in the liver. Production is stimulated by growth hormone and can be reduced by fasting or by insensitivity to growth hormone. In calorie-restricted animals, levels of circulating IGF-1 decline between 30 percent and 40 percent.
"We looked at IGF-1 in humans doing calorie restriction," says first author Luigi Fontana, M.D., Ph.D., assistant professor of medicine at Washington University and an investigator at the Istituto Superiore di Sanità in Rome, Italy. "For years, we have been following a cohort of people from the CR Society who have been on long-term calorie restriction. We found no difference in IGF-1 levels between people on calorie restriction and those who are not."
The CR Society members, who call themselves CRONies (Calorie Restriction with Optimal Nutrition), had been on a calorie-restriction diet for an average of seven years when Fontana did the measurements, but their IGF-1 levels were virtually identical to sedentary people who ate a standard, Western diet.
Because calorie restriction is linked to extraordinary increases in maximal lifespan in rats and mice, Fontana and colleagues at Washington University, including principal investigator John O. Holloszy, M.D., professor of medicine, have been involved in a scientific study that compares calorie restriction to exercise and measures many biological factors linked to longevity and health. Called the CALERIE study (Comprehensive Assessment of the Long term Effects of Reducing Intake of Energy), the project randomly divided 48 people into three groups: Eighteen cut their caloric intake by 25 percent for one year. Another 18 started exercising to increase their energy expenditure by 25 percent for a year. A third group of 10 people didn't change anything.
At the end of that year, the investigators measured IGF-1 levels in all three groups. Again they found no reductions in the group on calorie restriction.
"That was puzzling because it was the first time we hadn't seen agreement between mice and rats on calorie restriction and humans on calorie restriction," Fontana explains. "But we know there are two major influences on IGF-1 levels: calorie intake and protein intake. So we decided to look at the influence of protein."
Again, Fontana had a ready-made study group. His team has been following a population of strict vegans for several years. They tend to eat less protein than the CRONies from the CR Society, so he compared IGF-1 levels between the two groups.
"The vegans had significantly less circulating IGF-1, even if they were heavier and had more body fat than CRONies," he says. "Protein in the diet seemed to correlate with the lower levels of IGF-1. The strict vegans took in about 10 percent of their total calories from protein, whereas those on calorie restriction tended to get about 23 or 24 percent of calories from protein."
The investigators wanted to take one more look at the relationship between dietary protein and IGF-1, so Fontana asked a group of CRONies to eat less protein for a few weeks. He says it was not easy to cut protein because those on calorie restriction have to do a lot of calculating and juggling to ensure they take in very few calories and still get adequate nutrition. Increasing dietary protein is one way many CRONies guard against becoming malnourished.
"But six of them agreed to lower their protein intake," Fontana explains, "and after three weeks their circulating IGF-1 declined dramatically."
Previous research from Fontana's group had found that a diet lower in protein might protect against some cancers. These more recent findings suggest lowering protein also might be important to longevity. Fontana admits his evidence is preliminary, but the findings suggest that when people adjust their diets to improve health and lengthen life, they should control not only calories and fat but also keep an eye on protein.
Fontana isn't proposing radical low-protein diets. Instead, he is suggesting the current recommended daily allowance (RDA) for protein, which is 0.82 grams of protein per kilogram of body weight, or about 56 grams of protein for an average, adult man and 46 grams for an average, adult woman. Most people, including CRONies, consume much more protein than the RDA recommendation.
"It's much easier to restrict protein than to restrict calories," he says. "If our research is on the right track, maybe humans don't need to be so calorie restricted. Limiting protein intake to .7 or .8 grams per kilogram per day might be more effective. That's just a hypothesis. We have to confirm it in future studies."
Until then, Fontana suggests people might want to look at protein consumption and tailor it to RDA recommendations. Traditionally, he says, nutritionists have not worried about people eating too much protein, but these findings suggest perhaps they should.
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Fontana L, Weiss EP, Villarreal DT, Klein S, Holloszy JO. Long-term effects of calorie or protein restriction on serum IGF-1 and IGFBP-3 concentration in humans. Aging Cell vol. 7 (5); Doi: 10.1111/j.1474-9726.2008.00417.x
Thursday, September 25, 2008
Sinusitis patients have pain similar to the elderly and people with arthritis
When medicines don't work, researchers say endoscopic surgery can offer relief
CHICAGO, 25 sept 2008 –A new analysis led by researchers at Georgetown University Medical Center suggests many patients with sinusitis have aches and pains similar in severity to people in their 80s and those with arthritis or depression. The study also finds that endoscopic sinus surgery to clear clogged sinuses can bring significant pain relief.
About 14 percent of Americans suffer from sinusitis, an illness that can be chronic and sometimes difficult to treat.
"Bodily pain is not listed as a symptom of chronic sinusitis in general medical texts or journals and as a result, patients are sometimes diagnosed with unrelated conditions such as arthritis, depression, fibromyalgia or chronic fatigue syndrome," says the study's author Alexander C. Chester, M.D., an internist and clinical professor at Georgetown University Medical Center. "Unfortunately, this leaves too many people unaware of treatments for sinusitis that can improve their overall condition."
The purpose of the study, presented today at the 2008 annual meeting of the American Academy of Otolaryngology--Head and Neck Surgery Foundation in Chicago was to determine if elevated levels of bodily pain were associated with sinusitis and to examine whether bodily pain improved following endoscopic sinus surgery.
In the first known review of its kind, Chester and his colleagues performed a meta-analysis of 11 studies which included a general, health-related quality-of-life survey with a separate assessment of bodily pain before and after endoscopic sinus surgery on a scale of 0 (most bodily pain) to 100 (least bodily pain).
"We found that the daily experience of bodily pain was much more common in patients with sinusitis than in the overall population," explains Chester. "Confirmation that aches and pains occur with sinus disease is a relief to many patients who thought they had two separate illnesses."
In addition to their findings about the pervasiveness of pain, a majority of the studies analyzed showed that following endoscopic sinus surgery, postoperative bodily pain scores improved to values similar to that in the general population.
"Having data showing that pain will improve after sinus surgery is particularly helpful when considering the merits of undergoing surgery when medications fail," explains Chester. He says more than 200,000 endoscopic sinus surgeries are done annually in the United States using a technique considered less invasive and much safer than older methods.
"This study highlights an important point: Chronic sinusitis should not be considered as a minor localized disease condition rather, as this study emphasizes, sinusitis can cause serious clinical levels of discomfort in many patients," says Neil Bhattacharyya, MD, otolaryngologist and sinus surgeon at Brigham and Women's Hospital and Harvard Medical School, the study's senior author.
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In addition to Chester and Bhattacharyya, other authors include Raj Sindwani, MD, FRCS, of St. Louis University School of Medicine; and Timothy L. Smith, MD, MPH of Oregon Health and Science University. The authors report no financial disclosures.
When medicines don't work, researchers say endoscopic surgery can offer relief
CHICAGO, 25 sept 2008 –A new analysis led by researchers at Georgetown University Medical Center suggests many patients with sinusitis have aches and pains similar in severity to people in their 80s and those with arthritis or depression. The study also finds that endoscopic sinus surgery to clear clogged sinuses can bring significant pain relief.
About 14 percent of Americans suffer from sinusitis, an illness that can be chronic and sometimes difficult to treat.
"Bodily pain is not listed as a symptom of chronic sinusitis in general medical texts or journals and as a result, patients are sometimes diagnosed with unrelated conditions such as arthritis, depression, fibromyalgia or chronic fatigue syndrome," says the study's author Alexander C. Chester, M.D., an internist and clinical professor at Georgetown University Medical Center. "Unfortunately, this leaves too many people unaware of treatments for sinusitis that can improve their overall condition."
The purpose of the study, presented today at the 2008 annual meeting of the American Academy of Otolaryngology--Head and Neck Surgery Foundation in Chicago was to determine if elevated levels of bodily pain were associated with sinusitis and to examine whether bodily pain improved following endoscopic sinus surgery.
In the first known review of its kind, Chester and his colleagues performed a meta-analysis of 11 studies which included a general, health-related quality-of-life survey with a separate assessment of bodily pain before and after endoscopic sinus surgery on a scale of 0 (most bodily pain) to 100 (least bodily pain).
"We found that the daily experience of bodily pain was much more common in patients with sinusitis than in the overall population," explains Chester. "Confirmation that aches and pains occur with sinus disease is a relief to many patients who thought they had two separate illnesses."
In addition to their findings about the pervasiveness of pain, a majority of the studies analyzed showed that following endoscopic sinus surgery, postoperative bodily pain scores improved to values similar to that in the general population.
"Having data showing that pain will improve after sinus surgery is particularly helpful when considering the merits of undergoing surgery when medications fail," explains Chester. He says more than 200,000 endoscopic sinus surgeries are done annually in the United States using a technique considered less invasive and much safer than older methods.
"This study highlights an important point: Chronic sinusitis should not be considered as a minor localized disease condition rather, as this study emphasizes, sinusitis can cause serious clinical levels of discomfort in many patients," says Neil Bhattacharyya, MD, otolaryngologist and sinus surgeon at Brigham and Women's Hospital and Harvard Medical School, the study's senior author.
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In addition to Chester and Bhattacharyya, other authors include Raj Sindwani, MD, FRCS, of St. Louis University School of Medicine; and Timothy L. Smith, MD, MPH of Oregon Health and Science University. The authors report no financial disclosures.
Acupuncture reduces side effects of breast cancer treatment as much as conventional drug therapy
Therapy shown to increase energy and overall well-being for breast cancer patients
Boston, 25 sept 2008 – Acupuncture is as effective and longer-lasting in managing the common debilitating side effects of hot flashes, night sweats, and excessive sweating (vasomotor symptoms) associated with breast cancer treatment and has no treatment side effects compared to conventional drug therapy, according to a first-of-its-kind study presented September 24, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.
Findings also show there were additional benefits to acupuncture treatment for breast cancer patients, such as an increased sense of well being, more energy, and in some cases, a higher sex drive, that were not experienced in those patients who underwent drug treatment for their hot flashes.
"Our study shows that physicians and patients have an additional therapy for something that affects the majority of breast cancer survivors and actually has benefits, as opposed to more side effects. The effect is more durable than a drug commonly used to treat these vasomotor symptoms and, ultimately, is more cost-effective for insurance companies," Eleanor Walker, M.D., lead author of the study and a radiation oncologist at the Henry Ford Hospital Department of Radiation Oncology in Detroit, said.
The reduction in hot flashes lasted longer for those breast cancer patients after completing their acupuncture treatment, compared to patients after stopping their drug therapy plan.
Eighty percent of women treated for breast cancer suffer from hot flashes after being treated with chemotherapy and/or anti-estrogen hormones, such as Tamoxifen and Arimidex. Although hormone replacement therapy is typically used to relieve these symptoms, breast cancer patients cannot use this therapy because it may increase the risk of the cancer coming back. As a treatment alternative, patients are generally treated with steroids and/or antidepressant drugs. These drugs, however, have additional side effects, such as weight gain, nausea, constipation and fatigue. The antidepressant, venlafaxine (Effexor), a selective serotonin reuptake inhibitor, is one of the most common drugs used to treat these hot flashes. However, many women decide against this treatment choice because of potential side effects, including decreased libido, insomnia, dizziness and nausea, or because they simply do not want to take any more medications.
The randomized clinical trial compared acupuncture treatment to venlafixine for 12 weeks to find out if acupuncture reduced vasomotor symptoms in breast cancer patients receiving hormonal therapy and produced fewer side effects than venlafaxine. The study involved 47 breast cancer patients who received either Tamoxifen or Arimidex and had at least 14 hot flashes per week. Results show that acupuncture reduces hot flashes as effectively as venlafaxine, with no side effects, and also provides additional health benefits to patients.
Therapy shown to increase energy and overall well-being for breast cancer patients
Boston, 25 sept 2008 – Acupuncture is as effective and longer-lasting in managing the common debilitating side effects of hot flashes, night sweats, and excessive sweating (vasomotor symptoms) associated with breast cancer treatment and has no treatment side effects compared to conventional drug therapy, according to a first-of-its-kind study presented September 24, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.
Findings also show there were additional benefits to acupuncture treatment for breast cancer patients, such as an increased sense of well being, more energy, and in some cases, a higher sex drive, that were not experienced in those patients who underwent drug treatment for their hot flashes.
"Our study shows that physicians and patients have an additional therapy for something that affects the majority of breast cancer survivors and actually has benefits, as opposed to more side effects. The effect is more durable than a drug commonly used to treat these vasomotor symptoms and, ultimately, is more cost-effective for insurance companies," Eleanor Walker, M.D., lead author of the study and a radiation oncologist at the Henry Ford Hospital Department of Radiation Oncology in Detroit, said.
The reduction in hot flashes lasted longer for those breast cancer patients after completing their acupuncture treatment, compared to patients after stopping their drug therapy plan.
Eighty percent of women treated for breast cancer suffer from hot flashes after being treated with chemotherapy and/or anti-estrogen hormones, such as Tamoxifen and Arimidex. Although hormone replacement therapy is typically used to relieve these symptoms, breast cancer patients cannot use this therapy because it may increase the risk of the cancer coming back. As a treatment alternative, patients are generally treated with steroids and/or antidepressant drugs. These drugs, however, have additional side effects, such as weight gain, nausea, constipation and fatigue. The antidepressant, venlafaxine (Effexor), a selective serotonin reuptake inhibitor, is one of the most common drugs used to treat these hot flashes. However, many women decide against this treatment choice because of potential side effects, including decreased libido, insomnia, dizziness and nausea, or because they simply do not want to take any more medications.
The randomized clinical trial compared acupuncture treatment to venlafixine for 12 weeks to find out if acupuncture reduced vasomotor symptoms in breast cancer patients receiving hormonal therapy and produced fewer side effects than venlafaxine. The study involved 47 breast cancer patients who received either Tamoxifen or Arimidex and had at least 14 hot flashes per week. Results show that acupuncture reduces hot flashes as effectively as venlafaxine, with no side effects, and also provides additional health benefits to patients.
1-week radiation effective breast cancer treatment
Boston, 25 sept 2008 – Accelerated partial breast irradiation (APBI) using a type of radiation seed implants called balloon brachytherapy, a newer type of radiation treatment that offers more convenience to early-stage breast cancer patients by shortening radiation therapy from the standard six to seven weeks of treatment to only one week, is as effective in keeping breast cancer from coming back as the standard external beam radiation treatment, according to a study presented September 22, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.
"Not only does it make radiation treatment much more convenient, it may actually increase the rate of breast conservation, since some women choose mastectomy because they live too far from a radiation center and cannot afford the time and expense of six to seven weeks of living or traveling to the center," Peter Beitsch, M.D., lead author of the study and a surgical oncologist at Medical City Dallas Hospital in Dallas, said. "Also, there are many women who for a host of reasons don't receive the necessary postoperative radiation and the shortened course should hopefully allow more women to receive the therapy that they need."
Many women with breast cancer are able to undergo breast conserving therapy to keep their breast after treatment. Typically, this means they first have surgery to remove the cancer (a lumpectomy) followed by a course of radiation therapy to kill any cancer cells that may remain. The standard radiation therapy treatment takes a few minutes, every day, Monday through Friday, for six to seven weeks.
Brachytherapy is one of several methods of APBI, which treats only the area surrounding the tumor, instead of the whole breast. During this type of breast brachytherapy, after the tumor has been removed from the breast, the doctor inserts a small balloon into the cavity. That balloon is then attached to a catheter that delivers high doses of radiation via tiny radioactive seeds into the lumpectomy cavity.
The American Society of Breast Surgeons (ASBS) MammoSite RTS Registry Trial evaluated data from more than 1,400 women with early stage breast cancer who were treated with balloon brachytherapy using the MammoSite Radiation Therapy System, one type of breast brachytherapy. In this study, 400 women were followed for nearly four years and results show that women with early-stage breast cancer who are treated with APBI using this type of balloon brachytherapy had the same chance of the cancer returning as those who had the standard radiation treatment.
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For more information on radiation therapy for breast cancer, visit www.rtanswers.org.
Boston, 25 sept 2008 – Accelerated partial breast irradiation (APBI) using a type of radiation seed implants called balloon brachytherapy, a newer type of radiation treatment that offers more convenience to early-stage breast cancer patients by shortening radiation therapy from the standard six to seven weeks of treatment to only one week, is as effective in keeping breast cancer from coming back as the standard external beam radiation treatment, according to a study presented September 22, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.
"Not only does it make radiation treatment much more convenient, it may actually increase the rate of breast conservation, since some women choose mastectomy because they live too far from a radiation center and cannot afford the time and expense of six to seven weeks of living or traveling to the center," Peter Beitsch, M.D., lead author of the study and a surgical oncologist at Medical City Dallas Hospital in Dallas, said. "Also, there are many women who for a host of reasons don't receive the necessary postoperative radiation and the shortened course should hopefully allow more women to receive the therapy that they need."
Many women with breast cancer are able to undergo breast conserving therapy to keep their breast after treatment. Typically, this means they first have surgery to remove the cancer (a lumpectomy) followed by a course of radiation therapy to kill any cancer cells that may remain. The standard radiation therapy treatment takes a few minutes, every day, Monday through Friday, for six to seven weeks.
Brachytherapy is one of several methods of APBI, which treats only the area surrounding the tumor, instead of the whole breast. During this type of breast brachytherapy, after the tumor has been removed from the breast, the doctor inserts a small balloon into the cavity. That balloon is then attached to a catheter that delivers high doses of radiation via tiny radioactive seeds into the lumpectomy cavity.
The American Society of Breast Surgeons (ASBS) MammoSite RTS Registry Trial evaluated data from more than 1,400 women with early stage breast cancer who were treated with balloon brachytherapy using the MammoSite Radiation Therapy System, one type of breast brachytherapy. In this study, 400 women were followed for nearly four years and results show that women with early-stage breast cancer who are treated with APBI using this type of balloon brachytherapy had the same chance of the cancer returning as those who had the standard radiation treatment.
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For more information on radiation therapy for breast cancer, visit www.rtanswers.org.
Wednesday, September 24, 2008
Study confirms benefit of combination therapy for Alzheimer's disease
First long-term study finds that treatment slows symptom progression, benefits last for years
24 sept 2008--Extended treatment with Alzheimer's disease drugs can significantly slow the rate at which the disorder advances, and combination therapy with two different classes of drugs is even better at helping patients maintain their ability to perform daily activities. Results from the first long-term study of the real-world use of Alzheimer's drugs, published by researchers from Massachusetts General Hospital in the July/September issue of Alzheimer Disease and Associated Disorders, support a level of effectiveness that may not be immediately apparent to patients or their family members.
"There has been the impression that these drugs only work for some patients and for a limited amount of time," says Alireza Atri, MD, PhD, of the MGH Department of Neurology, lead author of the current study. "One of the problems in judging these drugs has been that patients naturally continue to decline, which can make them think the drugs have stopped working. But our study, which has some unique strengths, indicates that treatment does have long-term benefit."
Two types of medications have received FDA approval for Alzheimer's treatment. Cholinesterase inhibitors have been available since the mid-1990s and act by inhibiting the breakdown of the neurotransmitter acetylcholine. The drug memantine, which received FDA approval in 2003, is the first of a second class of agents that modulate the actions of the amino acid glutamate and is often used in combination with cholinesterase inhibitors (CIs).
"Clinical trials that drug companies conduct for FDA approval only last six months and enroll patients according to very specific criteria," Atri explains. "Only large-population studies can really tell us how these drugs work for the full range of patients in real-life situations." The researchers were able to conduct such a study by analyzing data on patients treated at the MGH Memory Disorders Unit since 1990, including 144 who did not receive any pharmaceutical treatment, 122 treated with a CI alone and 116 who received both a CI and memantine. As part of their regular treatment, every six months patients received standardized assessments of both cognitive abilities and how well they carried out daily activities.
The results showed significant differences in the rate of symptom progression among all three groups – with the smallest level of decline in those receiving combination therapy. While there was an average of two and a half years' worth of data on the study participants, the researchers analyzed the information with a statistical model that predicted probable outcomes for up to four years. Although the model's projection of future benefits is conservative, it predicted that the longer patients kept receiving combination therapy, the smaller their rate of decline would become, suggesting that treatment might even protect brain cells from further damage, a possibility needing further investigation.
"Finding something that could actually modify the course of the disease is the Holy Grail of Alzheimer's treatment, but we really don't know if that is happening or what the mechanism behind these effects might be," Atri explains. "What we can say now is that providers should help patients understand that the benefits of these drugs are long term and may not be apparent in the first months of treatment. Even if a patient's symptoms get worse, that doesn't mean the drug isn't working, since the decline probably would have been much greater without therapy." Atri is an instructor in Neurology at Harvard Medical School (HMS) and associate director of the Center for Translational Cognitive Neuroscience at the Veterans Administration Hospital in Bedford, Mass.
John Growdon, MD – director of the MGH Memory Disorders Unit, professor of Neurology at HMS, and senior author of the paper – explains, "The results of this study should change the way we treat patients with Alzheimer's disease. Cholinesterase inhibitors are approved for use in mild to moderate dementia, while memantine has been approved for advanced dementia. But it looks like there is an advantage in prescribing both drugs as initial treatment."
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The study was entirely supported by grants from the National Institute on Aging and the Massachusetts Alzheimer's Disease Research Center; there was no involvement or support from the pharmaceutical industry. Additional co-authors of the report are Lynn Shaughnessy, Massachusetts School of Professional Psychology, and Joseph Locascio, PhD, MGH Neurology.
Behavior: As People Age, the Thrill Is (Almost) Gone
By ERIC NAGOURNEY
24 sept 2008--If opening presents seems less exciting at age 60 than it did at age 10, the explanation may lie in the brain.
A study has found that as people age, their brains respond less strongly to rewards. The main difference is in the response of the brain to dopamine, a naturally occurring chemical messenger that plays a central role in the reward system.
Dr. Karen Faith Berman of the National Institutes of Health, an author of the study, said the shifts in brain response might be reflected in the shifts in attitude that accompanied aging.
“It may explain anecdotal evidence that people are mellower,” she said, “that they may not get the same highs from certain experiences, but they may not get the same lows, either.”
The study appears online in The Proceedings of the National Academy of Sciences. The researchers performed brain scans on two groups of volunteers, one in their 60s and the other in their 20s, as they played a computer game resembling a slot machine.
The researchers found differences between the groups both when they anticipated winning money in the game and when they actually did so. It was not just a matter of how much dopamine was produced, but also which parts of the brain responded to it and how much, the study said.
When a reward was anticipated, the researchers said, three parts of a reward center in the brain lighted up in the younger group, but only one in the older group.
By ERIC NAGOURNEY
24 sept 2008--If opening presents seems less exciting at age 60 than it did at age 10, the explanation may lie in the brain.
A study has found that as people age, their brains respond less strongly to rewards. The main difference is in the response of the brain to dopamine, a naturally occurring chemical messenger that plays a central role in the reward system.
Dr. Karen Faith Berman of the National Institutes of Health, an author of the study, said the shifts in brain response might be reflected in the shifts in attitude that accompanied aging.
“It may explain anecdotal evidence that people are mellower,” she said, “that they may not get the same highs from certain experiences, but they may not get the same lows, either.”
The study appears online in The Proceedings of the National Academy of Sciences. The researchers performed brain scans on two groups of volunteers, one in their 60s and the other in their 20s, as they played a computer game resembling a slot machine.
The researchers found differences between the groups both when they anticipated winning money in the game and when they actually did so. It was not just a matter of how much dopamine was produced, but also which parts of the brain responded to it and how much, the study said.
When a reward was anticipated, the researchers said, three parts of a reward center in the brain lighted up in the younger group, but only one in the older group.
Revisions Sharply Cut Estimates on Malaria
By DONALD G. MCNEIL JR
24 sept 2008--The world has many fewer cases of malaria than previously thought, the World Health Organization is reporting. But the agency says the apparent drop is not a result of mosquito nets, miracle drugs and DDT spraying — just better statistical techniques.
The war on the disease still needs to be prosecuted with vigor, the health organization said last week, because malaria is as bad as ever in its rural African epicenter. And although experts agree that the new estimates are probably closer to the truth, they are still not very accurate.
Issuing its annual malaria report, the W.H.O. said there were about 250 million cases of malaria in the world each year, and about 880,000 deaths. Previous official estimates were 350 million to 500 million cases and more than a million deaths.
“Almost all the drop is in the methodology,” said Dr. Mac W. Otten Jr., a W.H.O. epidemiologist. Cases in Africa, where 91 percent of malaria deaths occur, remained nearly steady. Virtually the entire drop was in India, Indonesia, Pakistan and other Asian countries, where many cases are a less deadly strain of malaria called vivax.
Cases in Asia were overestimated because those figures relied on population and vegetation maps dating to the 1960s.
Since then, millions of Asians have migrated to cities, and millions of acres have been deforested, reducing mosquito habitat. Also, as countries like India have grown richer, they have gotten better at health care and mosquito control.
But the new estimate revealed a simple truth about malaria: all global estimates are imprecise guesses. The change comes on the heels of last year’s downward revision by Unaids, the United Nations’ AIDS-fighting agency, of its estimates of the global AIDS burden: 33.2 million cases, down from 39.5 million. In that case, too, most of the drop was due to an earlier assumption that India’s caseload was worse than it really was.
Malaria cases may be even harder to count than AIDS cases, experts say. Most poor people with fevers that might be from the parasites never see a doctor or get a malaria test. They simply buy whatever malaria pills are on sale in local shops. No record is kept and no case reported to a national health service — if the country even has one capable of collecting such records.
In fact, doctors say, most fevers are not malaria. In some Asian studies, as few as 10 percent of those seeking malaria treatment actually had malaria. And whether patients recover or die may have little to do with pill purchases; in some Southeast Asian countries, tests on over-the-counter drugs found that more than half were fake.
Given these limitations, Dr. Christopher J. L. Murray, director of the University of Washington’s new Institute for Health Metrics and Evaluation, said he found the W.H.O. report “a pretty impressive improvement in the rigor and quality of the surveillance work.”
But Amir Attaran, a health policy expert at the University of Ottawa and a frequent critic of various participants in the war on malaria, was dismissive.
“It’s better fudging, not better reporting,” he said. “It’s still assumption built on assumption built on assumption.”
And Bob Snow, a University of Oxford epidemiologist working in Kenya, with whom the health agency consulted before issuing its report, said, “Improving on what the W.H.O. did for their 2005 report does not equate to getting it right.”
He noted that the new estimate, like old ones, counted case reports from people who went to clinics in countries with broken-down health care systems and then tried to make statistical adjustments for those who never sought care in those countries.
Dr. Snow called that practice “ludicrous” and added that “even a back-of-the-envelope calculation” would come up with higher caseloads through most of Africa, as well as in Indonesia, which is the fourth-most-populous country and has not recently been cooperative at sharing data with the W.H.O.
Eline L. Korenromp, an epidemiologist at the Global Fund to Fight AIDS, Tuberculosis and Malaria who was a chief author of the 2005 report, agreed that its estimates were “quite uncertain,” particularly since so few cases were recorded by doctors. For example, she said, she believed that 75 percent of all cases in Myanmar were never recorded.
Inside Africa, a big change in the way caseloads are estimated is the use of satellite imagery, Dr. Otten said. Satellites can track vegetation, temperature and humidity, improving estimates of how many people are at risk of mosquito bites. That is combined with spot studies of selected rural villages to estimate how many villagers are infected and how many die.
Outside Africa, where malaria is focused in patches, national health records and general health surveys of thousands of households — many of which are new, and paid for by the United States — are used to estimate how many of the sick sought treatment and whether they died.
Dr. Otten said the new estimates were almost entirely unaffected by the recent surge in donations of long-lasting insecticide-treated nets, spraying of houses with DDT, and purchases of medicines that include the new malaria drug artemisinin.
Most of the data was gathered in or before 2006, when only 25 percent of people needing mosquito nets and only 3 percent of those needing the new drugs were getting them.
Big improvements will be needed before precise data can be gathered in Africa, Dr. Otten said. For example, hundreds of millions of rapid diagnostic kits that can detect malaria in a finger-stick drop of blood will have to be distributed.
Right now, most diagnosis is done by a technician looking through a microscope. “Microscopy is hard,” Dr. Otten said. “You have to look at the slide carefully and for a long time.”
There are some bright spots in malaria control in the W.H.O. report. São Tomé and Principe, Rwanda and Eritrea cut their caseloads by more than half, and Zambia, Madagascar and the Tanzanian island of Zanzibar also did well. But those regions have so few people that they are a mere blip in the global figures.
By DONALD G. MCNEIL JR
24 sept 2008--The world has many fewer cases of malaria than previously thought, the World Health Organization is reporting. But the agency says the apparent drop is not a result of mosquito nets, miracle drugs and DDT spraying — just better statistical techniques.
The war on the disease still needs to be prosecuted with vigor, the health organization said last week, because malaria is as bad as ever in its rural African epicenter. And although experts agree that the new estimates are probably closer to the truth, they are still not very accurate.
Issuing its annual malaria report, the W.H.O. said there were about 250 million cases of malaria in the world each year, and about 880,000 deaths. Previous official estimates were 350 million to 500 million cases and more than a million deaths.
“Almost all the drop is in the methodology,” said Dr. Mac W. Otten Jr., a W.H.O. epidemiologist. Cases in Africa, where 91 percent of malaria deaths occur, remained nearly steady. Virtually the entire drop was in India, Indonesia, Pakistan and other Asian countries, where many cases are a less deadly strain of malaria called vivax.
Cases in Asia were overestimated because those figures relied on population and vegetation maps dating to the 1960s.
Since then, millions of Asians have migrated to cities, and millions of acres have been deforested, reducing mosquito habitat. Also, as countries like India have grown richer, they have gotten better at health care and mosquito control.
But the new estimate revealed a simple truth about malaria: all global estimates are imprecise guesses. The change comes on the heels of last year’s downward revision by Unaids, the United Nations’ AIDS-fighting agency, of its estimates of the global AIDS burden: 33.2 million cases, down from 39.5 million. In that case, too, most of the drop was due to an earlier assumption that India’s caseload was worse than it really was.
Malaria cases may be even harder to count than AIDS cases, experts say. Most poor people with fevers that might be from the parasites never see a doctor or get a malaria test. They simply buy whatever malaria pills are on sale in local shops. No record is kept and no case reported to a national health service — if the country even has one capable of collecting such records.
In fact, doctors say, most fevers are not malaria. In some Asian studies, as few as 10 percent of those seeking malaria treatment actually had malaria. And whether patients recover or die may have little to do with pill purchases; in some Southeast Asian countries, tests on over-the-counter drugs found that more than half were fake.
Given these limitations, Dr. Christopher J. L. Murray, director of the University of Washington’s new Institute for Health Metrics and Evaluation, said he found the W.H.O. report “a pretty impressive improvement in the rigor and quality of the surveillance work.”
But Amir Attaran, a health policy expert at the University of Ottawa and a frequent critic of various participants in the war on malaria, was dismissive.
“It’s better fudging, not better reporting,” he said. “It’s still assumption built on assumption built on assumption.”
And Bob Snow, a University of Oxford epidemiologist working in Kenya, with whom the health agency consulted before issuing its report, said, “Improving on what the W.H.O. did for their 2005 report does not equate to getting it right.”
He noted that the new estimate, like old ones, counted case reports from people who went to clinics in countries with broken-down health care systems and then tried to make statistical adjustments for those who never sought care in those countries.
Dr. Snow called that practice “ludicrous” and added that “even a back-of-the-envelope calculation” would come up with higher caseloads through most of Africa, as well as in Indonesia, which is the fourth-most-populous country and has not recently been cooperative at sharing data with the W.H.O.
Eline L. Korenromp, an epidemiologist at the Global Fund to Fight AIDS, Tuberculosis and Malaria who was a chief author of the 2005 report, agreed that its estimates were “quite uncertain,” particularly since so few cases were recorded by doctors. For example, she said, she believed that 75 percent of all cases in Myanmar were never recorded.
Inside Africa, a big change in the way caseloads are estimated is the use of satellite imagery, Dr. Otten said. Satellites can track vegetation, temperature and humidity, improving estimates of how many people are at risk of mosquito bites. That is combined with spot studies of selected rural villages to estimate how many villagers are infected and how many die.
Outside Africa, where malaria is focused in patches, national health records and general health surveys of thousands of households — many of which are new, and paid for by the United States — are used to estimate how many of the sick sought treatment and whether they died.
Dr. Otten said the new estimates were almost entirely unaffected by the recent surge in donations of long-lasting insecticide-treated nets, spraying of houses with DDT, and purchases of medicines that include the new malaria drug artemisinin.
Most of the data was gathered in or before 2006, when only 25 percent of people needing mosquito nets and only 3 percent of those needing the new drugs were getting them.
Big improvements will be needed before precise data can be gathered in Africa, Dr. Otten said. For example, hundreds of millions of rapid diagnostic kits that can detect malaria in a finger-stick drop of blood will have to be distributed.
Right now, most diagnosis is done by a technician looking through a microscope. “Microscopy is hard,” Dr. Otten said. “You have to look at the slide carefully and for a long time.”
There are some bright spots in malaria control in the W.H.O. report. São Tomé and Principe, Rwanda and Eritrea cut their caseloads by more than half, and Zambia, Madagascar and the Tanzanian island of Zanzibar also did well. But those regions have so few people that they are a mere blip in the global figures.
Blacks at Higher Risk of Colon Polyps, Study Says
CHICAGO, 24 sept 2008- Blacks are more likely than whites to have large colon polyps, and their tumors tend to be located higher in the colon where they are harder to detect, U.S. researchers said Tuesday.
Blacks are already known to have higher rates of colon cancer than whites and up to 43 percent higher death rates from the disease, which kills 52,000 Americans annually.
Researchers said several factors may account for the racial disparity in colon cancer rates, including genetic differences that account for about a third of all cases of the disease. But blacks also have poorer access to health care and lower rates of participation when screening is offered.
Since 1985, colon cancer has risen among black men and is unchanged among black women, while declining by as much as 25 percent among whites, the report in the Journal of the American Medical Association said.
Early detection of colon cancer is considered a key to successful treatment.
In a study of nearly 5,500 blacks and more than 80,000 whites who had colonoscopies, researchers at Portland VA Medical Center found nearly 8 percent of blacks had one or more polyps sized more than 9 millimeters in diameter compared to slightly more than 6 percent of whites.
The tumors detected in blacks were more likely to be in the upper part of the colon where a sigmoidoscopy -- a procedure that looks only at the lower half of the colon -- would be unlikely to find it.
The incidence of large polyps was noticeably high among black women younger than age 50, the age when adults are recommended to begin getting regular colonoscopies.
"If this finding is confirmed in other studies, consideration should be given to initiation of screening before age 50 years in black women," wrote David Lieberman, who led the team performing the study.
"These data strongly emphasize the importance of timely screening in black women and men," he added.
CHICAGO, 24 sept 2008- Blacks are more likely than whites to have large colon polyps, and their tumors tend to be located higher in the colon where they are harder to detect, U.S. researchers said Tuesday.
Blacks are already known to have higher rates of colon cancer than whites and up to 43 percent higher death rates from the disease, which kills 52,000 Americans annually.
Researchers said several factors may account for the racial disparity in colon cancer rates, including genetic differences that account for about a third of all cases of the disease. But blacks also have poorer access to health care and lower rates of participation when screening is offered.
Since 1985, colon cancer has risen among black men and is unchanged among black women, while declining by as much as 25 percent among whites, the report in the Journal of the American Medical Association said.
Early detection of colon cancer is considered a key to successful treatment.
In a study of nearly 5,500 blacks and more than 80,000 whites who had colonoscopies, researchers at Portland VA Medical Center found nearly 8 percent of blacks had one or more polyps sized more than 9 millimeters in diameter compared to slightly more than 6 percent of whites.
The tumors detected in blacks were more likely to be in the upper part of the colon where a sigmoidoscopy -- a procedure that looks only at the lower half of the colon -- would be unlikely to find it.
The incidence of large polyps was noticeably high among black women younger than age 50, the age when adults are recommended to begin getting regular colonoscopies.
"If this finding is confirmed in other studies, consideration should be given to initiation of screening before age 50 years in black women," wrote David Lieberman, who led the team performing the study.
"These data strongly emphasize the importance of timely screening in black women and men," he added.
Inhaler lung drugs tied to heart problems, deaths
By LINDSEY TANNER
24 sept 2008--Inhaler drugs used by millions of people with emphysema and bronchitis may slightly raise the risk for heart attacks and even death, a study suggests.
The results aren't conclusive and inhalers provide significant relief for these patients struggling to breathe. But the study authors urged doctors to closely monitor patients who use the inhalers.
Most affected patients have both emphysema and chronic bronchitis. The condition's formal name, chronic obstructive pulmonary disease, COPD, is the nation's fourth leading cause of death.
The study's increased risks were small, and the drugs' marketer said both medicines are safe. Outside experts called the study compelling but said it has limitations that make it hard to know if the drugs or something else was at fault.
The drugs are tiotropium, sold as Spiriva Handihaler by Boehringer Ingelheim Pharmaceuticals, Inc., and ipratropium, available generically and also sold by Boehringer under the brand name Atrovent.
Spiriva, approved in 2004, and the decade-old Atrovent are used once or more daily to relax muscles and open lung airways. They've been used by 8 million patients worldwide.
A Veterans Affairs study published last week linked ipratropium with an increased risk for heart-related deaths in men.
The new study appears in Wednesday's Journal of the American Medical Association.
The company told the Food and Drug Administration earlier this year that its own data had linked Spiriva with a possible increased risk for strokes. But Boehringer and Pfizer Inc., which jointly market Spiriva, said Tuesday that they had recently given the FDA a new analysis of that data plus new long-term data, which they said shows initial concerns about strokes were unfounded.
"We strongly disagree with the conclusion" in the new study, the companies said in a statement.
COPD affects as many as 24 million Americans and kills more than 100,000 each year. It involves thickened and narrowed lung airways and excess mucous. Symptoms include persistent coughing and severe shortness of breath; smoking is a leading cause.
Patients describe COPD breathing problems as feeling like they're "living the entire day under water, unable to come to the surface," said Dr. Aaron Milstone of Vanderbilt University medical school.
The new study pooled results from 17 randomized studies comparing mostly older patients on either of the drugs with those on different medicine or dummy drugs. Randomized studies are the most rigorous kind of medical research, but Milstone said drawing conclusions from a pooled analysis can be problematic because of differences in patients' characteristics.
It found that using either drug for more than one month appeared to increase chances for fatal and nonfatal heart problems including heart attacks by more than 50 percent.
Among about 7,400 patients on either inhaled drug, 1.8 percent or 135 people developed fatal or nonfatal heart problems over a period of several weeks to several years. By contrast, among about 7,300 patients on other drugs or dummy medicine, 1.2 percent or 86 had those problems.
In absolute terms, out of 40 patients using either drug for one year, there would be one extra drug-linked death, said study author Dr. Sonal Singh of Wake Forest University's medical school.
Other drugs are used for COPD, but they also can have serious side effects, Singh said. This puts patients in "a very tough spot," he acknowledged.
He said before starting drugs, patients should try to reduce heart risks by quitting smoking, keeping blood pressure and cholesterol under control, and using oxygen.
Dr. Mark Rosen, former president of the American College of Chest Physicians and a lung specialist on New York's Long Island, said the data "are very compelling but they're not conclusive."
He said it's unclear what caused the apparent increased risks since the drugs aren't known to affect the heart. The authors said that damaging proteins involved in inflammation are thought to play a role in both COPD and heart disease.
Rosen noted that the analyzed studies weren't designed to look for heart problems, and said it's possible patients on the drugs had more heart problems to begin with.
Still, Rosen said the study "is an excellent reason to do more research to figure out why this is true, if it is true and not a statistical fluke."
By LINDSEY TANNER
24 sept 2008--Inhaler drugs used by millions of people with emphysema and bronchitis may slightly raise the risk for heart attacks and even death, a study suggests.
The results aren't conclusive and inhalers provide significant relief for these patients struggling to breathe. But the study authors urged doctors to closely monitor patients who use the inhalers.
Most affected patients have both emphysema and chronic bronchitis. The condition's formal name, chronic obstructive pulmonary disease, COPD, is the nation's fourth leading cause of death.
The study's increased risks were small, and the drugs' marketer said both medicines are safe. Outside experts called the study compelling but said it has limitations that make it hard to know if the drugs or something else was at fault.
The drugs are tiotropium, sold as Spiriva Handihaler by Boehringer Ingelheim Pharmaceuticals, Inc., and ipratropium, available generically and also sold by Boehringer under the brand name Atrovent.
Spiriva, approved in 2004, and the decade-old Atrovent are used once or more daily to relax muscles and open lung airways. They've been used by 8 million patients worldwide.
A Veterans Affairs study published last week linked ipratropium with an increased risk for heart-related deaths in men.
The new study appears in Wednesday's Journal of the American Medical Association.
The company told the Food and Drug Administration earlier this year that its own data had linked Spiriva with a possible increased risk for strokes. But Boehringer and Pfizer Inc., which jointly market Spiriva, said Tuesday that they had recently given the FDA a new analysis of that data plus new long-term data, which they said shows initial concerns about strokes were unfounded.
"We strongly disagree with the conclusion" in the new study, the companies said in a statement.
COPD affects as many as 24 million Americans and kills more than 100,000 each year. It involves thickened and narrowed lung airways and excess mucous. Symptoms include persistent coughing and severe shortness of breath; smoking is a leading cause.
Patients describe COPD breathing problems as feeling like they're "living the entire day under water, unable to come to the surface," said Dr. Aaron Milstone of Vanderbilt University medical school.
The new study pooled results from 17 randomized studies comparing mostly older patients on either of the drugs with those on different medicine or dummy drugs. Randomized studies are the most rigorous kind of medical research, but Milstone said drawing conclusions from a pooled analysis can be problematic because of differences in patients' characteristics.
It found that using either drug for more than one month appeared to increase chances for fatal and nonfatal heart problems including heart attacks by more than 50 percent.
Among about 7,400 patients on either inhaled drug, 1.8 percent or 135 people developed fatal or nonfatal heart problems over a period of several weeks to several years. By contrast, among about 7,300 patients on other drugs or dummy medicine, 1.2 percent or 86 had those problems.
In absolute terms, out of 40 patients using either drug for one year, there would be one extra drug-linked death, said study author Dr. Sonal Singh of Wake Forest University's medical school.
Other drugs are used for COPD, but they also can have serious side effects, Singh said. This puts patients in "a very tough spot," he acknowledged.
He said before starting drugs, patients should try to reduce heart risks by quitting smoking, keeping blood pressure and cholesterol under control, and using oxygen.
Dr. Mark Rosen, former president of the American College of Chest Physicians and a lung specialist on New York's Long Island, said the data "are very compelling but they're not conclusive."
He said it's unclear what caused the apparent increased risks since the drugs aren't known to affect the heart. The authors said that damaging proteins involved in inflammation are thought to play a role in both COPD and heart disease.
Rosen noted that the analyzed studies weren't designed to look for heart problems, and said it's possible patients on the drugs had more heart problems to begin with.
Still, Rosen said the study "is an excellent reason to do more research to figure out why this is true, if it is true and not a statistical fluke."
U.S. doctors offer patients scant empathy in study
By Will Dunham
24 sept 2008--During an appointment with his doctor, a man diagnosed with lung cancer sounded dispirited when talking about what cigarettes had done to him.
"I was always told I had a good strong heart and lungs. But the lungs couldn't withstand all (those) cigarettes ... asbestos and pollution and second-hand smoke and all these other things, I guess," the man told his doctor.
"Do you have glaucoma?" the doctor responded, abruptly changing the subject.
U.S. researchers who assessed interactions between a small group of people with lung cancer and their doctors found physicians provided little emotional support even when patients seemed to be searching for it.
When patients made comments on topics like the personal impact of cancer, their diagnosis and treatment and struggles with the health care system, doctors responded with words of empathy only 10 percent of the time, the researchers said.
This was a small study -- appointments between doctors and 10 patients at a Veterans Affairs hospital in Houston were audiotaped and analyzed for whether the physicians provided empathy for the plight of these people with a deadly illness.
But Dr. Diane Morse of the University of Rochester Medical Center in Rochester, New York said the findings reinforce other research showing doctors fall short in the simple act of acknowledging the emotional difficulties of their patients' predicament.
"When doctors do provide empathy, it doesn't make the interaction take longer. All that we're asking physicians to think about doing is to acknowledge what they hear," Morse, whose findings appear in the journal Archives of Internal Medicine, said in a telephone interview.
She said words of empathy can be succinct and spoken early in an appointment. In answering how long a patient has left to live, a doctor might say "that's a really scary question" and acknowledge the patient's misfortune.
Few studies have involved a word-by-word analysis of doctor-patient meetings to assess how doctors respond to patients' worries about their own mortality, possible mistrust of medical care and the emotions arising from a deadly diagnosis.
In this study, the doctors and patients knew the sessions were being recorded. They were not identified by name.
Researchers identified 384 times during these appointments when patients mentioned such concerns or emotions. Doctors responded with empathy in just 39 of these instances, they said.
By Will Dunham
24 sept 2008--During an appointment with his doctor, a man diagnosed with lung cancer sounded dispirited when talking about what cigarettes had done to him.
"I was always told I had a good strong heart and lungs. But the lungs couldn't withstand all (those) cigarettes ... asbestos and pollution and second-hand smoke and all these other things, I guess," the man told his doctor.
"Do you have glaucoma?" the doctor responded, abruptly changing the subject.
U.S. researchers who assessed interactions between a small group of people with lung cancer and their doctors found physicians provided little emotional support even when patients seemed to be searching for it.
When patients made comments on topics like the personal impact of cancer, their diagnosis and treatment and struggles with the health care system, doctors responded with words of empathy only 10 percent of the time, the researchers said.
This was a small study -- appointments between doctors and 10 patients at a Veterans Affairs hospital in Houston were audiotaped and analyzed for whether the physicians provided empathy for the plight of these people with a deadly illness.
But Dr. Diane Morse of the University of Rochester Medical Center in Rochester, New York said the findings reinforce other research showing doctors fall short in the simple act of acknowledging the emotional difficulties of their patients' predicament.
"When doctors do provide empathy, it doesn't make the interaction take longer. All that we're asking physicians to think about doing is to acknowledge what they hear," Morse, whose findings appear in the journal Archives of Internal Medicine, said in a telephone interview.
She said words of empathy can be succinct and spoken early in an appointment. In answering how long a patient has left to live, a doctor might say "that's a really scary question" and acknowledge the patient's misfortune.
Few studies have involved a word-by-word analysis of doctor-patient meetings to assess how doctors respond to patients' worries about their own mortality, possible mistrust of medical care and the emotions arising from a deadly diagnosis.
In this study, the doctors and patients knew the sessions were being recorded. They were not identified by name.
Researchers identified 384 times during these appointments when patients mentioned such concerns or emotions. Doctors responded with empathy in just 39 of these instances, they said.
Tuesday, September 23, 2008
Caregivers Face Multiple Strains Tending Older Parents
23 sept 2008-- Middle-aged adults who regularly help their elderly parents get by experience a drop in health and well-being in their own lives, a new study shows.
The study, published earlier this year in the Journal of Gerontology: Social Sciences, found these adult children were often juggling multiple roles each day, sometimes causing conflicts in roles or feeling overloaded.
"The accumulation of small and large daily stressors such as work deadlines, PTA meetings, supporting family and friends as well as providing routine assistance to a parent living outside one's house can build up," study leader Jyoti Savla, assistant professor of human development and gerontology at Virginia Tech, said in a university news release. "Sooner or later, they can spill over into other areas of life with negative mental and physical consequences. Days when help is provided to parents are more stressful than days when it is not," Savla said.
Salva's team studied diaries of the individuals who provided help to parents, more than half of which did so on two or more days each week. They found several factors, such as having a spouse and higher education, could decrease the conflict and demands on time. Also, those who believed in personal growth, mastery and self-acceptance experienced fewer negative consequences from helping their parents.
"By building on an understanding of individual's experiences, this approach could make daily life easier for older adults and the individuals who support them and prevent the depletion of care resources," Savla said.
More information
The AARP has more about managing caregiver stress.
Combining advanced medical and information technologies offers pathway to lower health care costs
New Zealand, 23 sept 2008--sponsored panel presents global opportunities, challenges for introducing new medical technologies at Advamed 2008
Washington D.C. (September 22, 2008): Integrating sophisticated medical technologies for patient monitoring with advanced information systems and clinical expertise has the potential to significantly improve medical care while lowering treatment costs. This is especially true for patients with chronic illnesses like diabetes, today said an international panel of experts, including New Zealand medical device developer, Zephyr Technology (http://www.zephyrtech.co.nz). The panelists discussed the critical role of technology in improving medical care and reducing treatment costs, as well as U.S. and global challenges surrounding the adoption and reimbursement of such advanced technologies as part of the AdvaMed 2008 MedTech Conference, being held September 21 – 24 in Washington, D.C.
Health care costs have been rising globally, causing concerns about the sustainability of providing high quality care to populations on an equitable basis. The financial burden to payers is substantial, making the short-term cost of advances increasingly prominent in the introduction of new technologies. Yet many of these new medical technologies are positioned to provide better, earlier diagnosis and treatment of diseases, with fewer side effects and better outcomes than alternative treatment regimens – leading to lower health care costs over the course of a patient's illness. This is particularly true in the area of chronic illnesses, like diabetes, where early detection and treatment of potentially costly complications can provide significant savings and new real-time, remote monitoring technology can better enable patients to receive care at home, thus avoiding costly hospital stays.
For example, New Zealand's Zephyr has developed "Smart Fabric" technology for real-time patient monitoring that uses various off the shelf textiles that are integrated with small unobtrusive electronic modules integrated with garments or straps. Comfortable to wear and designed to work in ambulatory environments, these sensors detect key metabolic functions (i.e. breathing rate, activity, posture, temperature and heart rate) then determine alarm status using multiple sensors and communicate with local and internet based health monitoring applications via standard wireless technologies such as Bluetooth. This provides the patient with total freedom without compromising data integrity or patient safety.
Brian Russell, Zephyr Chief Executive Officer, told Advamed audiences that U.S. payers were becoming more accepting of the importance of preventive care, making it easier to gain reimbursement for products like the company's diabetic shoe inner soles, which detect conditions leading to foot ulceration, thus significantly reducing the risk of ulceration, infection and amputation in diabetic patients.
The clinical benefit and potential cost savings offered by such technologies was underscored by Dr. David G. Armstrong, DPM, PhD, Professor of Surgery, University of Arizona College of Medicine and Director of the Southern Arizona Limb Salvage Alliance (SALSA), a noted expert on diabetes care, who said that the current expenditures for caring for the feet of people with diabetes exceeded the annual revenues of the U.S. cell phone industry.
Unfortunately, with third-party payers still seeing technology costs as a significant contributor to the rise in overall healthcare expenses, barriers to adoption of new medical technologies are increasing in North America, noted Dr. Liesl Cooper, Vice President - Health Economics, Policy and Reimbursement, Covidien. "For example, appropriate third-party payment categories do not yet exist for many medical technologies, which is limiting their development and successful introduction. As a result, important strategic considerations, including the need for realistic timeframes for technology adoption, must be taken into account in preparing new technologies for a successful launch within this market."
At the same time, many medical device companies are increasing their efforts to expand throughout Asia in response to a fast rising demand for advanced medical technologies. "Within Asian markets, shifting policy and market access barriers continue to make countries like Japan, China and India difficult to navigate," commented Chris Miller, Vice President, Government and Industry Affairs, Medtronic Asia Pacific. "As a result, companies need to identify and consider the key policy and reimbursement elements affecting medical technology with each market as they look to expand their global reach."
The AdvaMed 2008 panel, held on September 22 from 9 – 10:30 am ET, was sponsored and organized by New Zealand Trade and Enterprise (http://www.nzte.govt.nz/).
New Zealand, 23 sept 2008--sponsored panel presents global opportunities, challenges for introducing new medical technologies at Advamed 2008
Washington D.C. (September 22, 2008): Integrating sophisticated medical technologies for patient monitoring with advanced information systems and clinical expertise has the potential to significantly improve medical care while lowering treatment costs. This is especially true for patients with chronic illnesses like diabetes, today said an international panel of experts, including New Zealand medical device developer, Zephyr Technology (http://www.zephyrtech.co.nz). The panelists discussed the critical role of technology in improving medical care and reducing treatment costs, as well as U.S. and global challenges surrounding the adoption and reimbursement of such advanced technologies as part of the AdvaMed 2008 MedTech Conference, being held September 21 – 24 in Washington, D.C.
Health care costs have been rising globally, causing concerns about the sustainability of providing high quality care to populations on an equitable basis. The financial burden to payers is substantial, making the short-term cost of advances increasingly prominent in the introduction of new technologies. Yet many of these new medical technologies are positioned to provide better, earlier diagnosis and treatment of diseases, with fewer side effects and better outcomes than alternative treatment regimens – leading to lower health care costs over the course of a patient's illness. This is particularly true in the area of chronic illnesses, like diabetes, where early detection and treatment of potentially costly complications can provide significant savings and new real-time, remote monitoring technology can better enable patients to receive care at home, thus avoiding costly hospital stays.
For example, New Zealand's Zephyr has developed "Smart Fabric" technology for real-time patient monitoring that uses various off the shelf textiles that are integrated with small unobtrusive electronic modules integrated with garments or straps. Comfortable to wear and designed to work in ambulatory environments, these sensors detect key metabolic functions (i.e. breathing rate, activity, posture, temperature and heart rate) then determine alarm status using multiple sensors and communicate with local and internet based health monitoring applications via standard wireless technologies such as Bluetooth. This provides the patient with total freedom without compromising data integrity or patient safety.
Brian Russell, Zephyr Chief Executive Officer, told Advamed audiences that U.S. payers were becoming more accepting of the importance of preventive care, making it easier to gain reimbursement for products like the company's diabetic shoe inner soles, which detect conditions leading to foot ulceration, thus significantly reducing the risk of ulceration, infection and amputation in diabetic patients.
The clinical benefit and potential cost savings offered by such technologies was underscored by Dr. David G. Armstrong, DPM, PhD, Professor of Surgery, University of Arizona College of Medicine and Director of the Southern Arizona Limb Salvage Alliance (SALSA), a noted expert on diabetes care, who said that the current expenditures for caring for the feet of people with diabetes exceeded the annual revenues of the U.S. cell phone industry.
Unfortunately, with third-party payers still seeing technology costs as a significant contributor to the rise in overall healthcare expenses, barriers to adoption of new medical technologies are increasing in North America, noted Dr. Liesl Cooper, Vice President - Health Economics, Policy and Reimbursement, Covidien. "For example, appropriate third-party payment categories do not yet exist for many medical technologies, which is limiting their development and successful introduction. As a result, important strategic considerations, including the need for realistic timeframes for technology adoption, must be taken into account in preparing new technologies for a successful launch within this market."
At the same time, many medical device companies are increasing their efforts to expand throughout Asia in response to a fast rising demand for advanced medical technologies. "Within Asian markets, shifting policy and market access barriers continue to make countries like Japan, China and India difficult to navigate," commented Chris Miller, Vice President, Government and Industry Affairs, Medtronic Asia Pacific. "As a result, companies need to identify and consider the key policy and reimbursement elements affecting medical technology with each market as they look to expand their global reach."
The AdvaMed 2008 panel, held on September 22 from 9 – 10:30 am ET, was sponsored and organized by New Zealand Trade and Enterprise (http://www.nzte.govt.nz/).
New research could lead to a vaccine for pneumococcus disease
23 sept 2008--New research has shown how the immune system detects and destroys the bug, pneumococcus, which could help in the development of a new vaccine against the disease.
Pneumococcus is a bacterium which causes a lot of illness and disease in the very young and the elderly, including pneumonia and meningitis. Large numbers of pneumonia deaths occur in children every year especially in poor countries. Existing vaccines are not ideal for use in such countries and are also much too expensive.
Carriage of pneumococcus in the nose is a necessary first step for most infections. As children age, they carry pneumococcus for shorter periods of time and their risk of disease decreases also. The mechanisms underlying this age-related decrease of carriage are not well understood.
As part of a continuing collaboration between labs at the universities of Bristol and Harvard, researchers have shed new light on how the immune system detects and destroys the bug when it colonises the nose. The study is published in PLoS Pathogens.
American researchers led by Drs Richard Malley and Marc Lipsitch have produced evidence for a key role for the recently described cytokine interleukin 17 in a mouse model of the infection. The Bristol group led by Professor Adam Finn have shown that immune cells from children's tonsils, removed at surgery, also produce IL17 when stimulated with pneumococci.
The researchers have identified the immune cells that are responsible for this process, so-called TH17 cells, which release a factor that enables human blood cells to kill pneumococcus more efficiently. They have shown that these TH17 cells exist in adults and children, but not in newborn babies, which suggests that they may arise as a consequence of humans being exposed to pneumococcus.
Professor Finn said: "Understanding how children build up immunity to pneumococcus will help the development of effective affordable vaccines for use where they are most needed."
In the past, immunity to pneumococcus was thought to be due entirely to antibodies. This new research suggests that other mechanisms may be very important too.
23 sept 2008--New research has shown how the immune system detects and destroys the bug, pneumococcus, which could help in the development of a new vaccine against the disease.
Pneumococcus is a bacterium which causes a lot of illness and disease in the very young and the elderly, including pneumonia and meningitis. Large numbers of pneumonia deaths occur in children every year especially in poor countries. Existing vaccines are not ideal for use in such countries and are also much too expensive.
Carriage of pneumococcus in the nose is a necessary first step for most infections. As children age, they carry pneumococcus for shorter periods of time and their risk of disease decreases also. The mechanisms underlying this age-related decrease of carriage are not well understood.
As part of a continuing collaboration between labs at the universities of Bristol and Harvard, researchers have shed new light on how the immune system detects and destroys the bug when it colonises the nose. The study is published in PLoS Pathogens.
American researchers led by Drs Richard Malley and Marc Lipsitch have produced evidence for a key role for the recently described cytokine interleukin 17 in a mouse model of the infection. The Bristol group led by Professor Adam Finn have shown that immune cells from children's tonsils, removed at surgery, also produce IL17 when stimulated with pneumococci.
The researchers have identified the immune cells that are responsible for this process, so-called TH17 cells, which release a factor that enables human blood cells to kill pneumococcus more efficiently. They have shown that these TH17 cells exist in adults and children, but not in newborn babies, which suggests that they may arise as a consequence of humans being exposed to pneumococcus.
Professor Finn said: "Understanding how children build up immunity to pneumococcus will help the development of effective affordable vaccines for use where they are most needed."
In the past, immunity to pneumococcus was thought to be due entirely to antibodies. This new research suggests that other mechanisms may be very important too.
Variant of vitamin D receptor gene linked to melanoma risk
23 sept 2008--A new analysis indicates an association between a gene involved in vitamin D metabolism and skin cancer. Published in the November 1, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study suggests that individuals with certain variants in a vitamin D-related gene, called BsmI, may be at an increased risk of developing melanoma.
Research has shown that vitamin D in the body has significant protective effects against the development of cancer because it regulates cell growth, cell differentiation and cell death. This is supported by evidence that sun exposure, which helps in the production of vitamin D, can have anticancer effects.
Vitamin D exerts its effects by binding to a receptor located within cells. Because there are genetic differences in this vitamin D receptor among individuals, investigators suspect that different people have different levels of vitamin D activity within their bodies. Therefore, some individuals may naturally be able to achieve more vitamin D-related protection against cancer than others. However, study results on this topic have been conflicting, and no review of the available data has been performed to date.
To address this issue, Dr. Simone Mocellin and Dr. Donato Nitti of the University of Padova in Italy examined the existing research investigating the association between common variants in the vitamin D receptor and the risk of melanoma. The analysis revealed a significant association between melanoma risk and the BsmI gene.
The researchers note that additional research is needed to validate this link, and called for well-designed, population-based, large, multi-institutional studies to test whether any vitamin D receptor variant is independently associated with melanoma risk.
"These findings prompt further investigation on this subject and indirectly support the hypothesis that sun exposure might have an anti-melanoma effect through activation of the vitamin D system," the authors wrote.
###
Article: "Vitamin D Receptor Polymorphisms and the Risk of Cutaneous Melanoma: A Systematic Review and Meta-Analysis." Simone Mocellin and Donato Nitti. CANCER; Published Online: September 22, 2008 (DOI: 10.1002/cncr.23867); Print Issue Date: November 1, 2008.
23 sept 2008--A new analysis indicates an association between a gene involved in vitamin D metabolism and skin cancer. Published in the November 1, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study suggests that individuals with certain variants in a vitamin D-related gene, called BsmI, may be at an increased risk of developing melanoma.
Research has shown that vitamin D in the body has significant protective effects against the development of cancer because it regulates cell growth, cell differentiation and cell death. This is supported by evidence that sun exposure, which helps in the production of vitamin D, can have anticancer effects.
Vitamin D exerts its effects by binding to a receptor located within cells. Because there are genetic differences in this vitamin D receptor among individuals, investigators suspect that different people have different levels of vitamin D activity within their bodies. Therefore, some individuals may naturally be able to achieve more vitamin D-related protection against cancer than others. However, study results on this topic have been conflicting, and no review of the available data has been performed to date.
To address this issue, Dr. Simone Mocellin and Dr. Donato Nitti of the University of Padova in Italy examined the existing research investigating the association between common variants in the vitamin D receptor and the risk of melanoma. The analysis revealed a significant association between melanoma risk and the BsmI gene.
The researchers note that additional research is needed to validate this link, and called for well-designed, population-based, large, multi-institutional studies to test whether any vitamin D receptor variant is independently associated with melanoma risk.
"These findings prompt further investigation on this subject and indirectly support the hypothesis that sun exposure might have an anti-melanoma effect through activation of the vitamin D system," the authors wrote.
###
Article: "Vitamin D Receptor Polymorphisms and the Risk of Cutaneous Melanoma: A Systematic Review and Meta-Analysis." Simone Mocellin and Donato Nitti. CANCER; Published Online: September 22, 2008 (DOI: 10.1002/cncr.23867); Print Issue Date: November 1, 2008.
Is the salad bar safe? Produce concerns linger after summer scares
COLUMBIA, Mo, 23 sept 2008 – Widespread reports had most people afraid to eat tomatoes this summer and when tomatoes were vindicated, eating peppers became a fear. A University of Missouri food safety expert says there is only so much that can be done to assure produce is safe to eat.
"We basically want perfect food, but produce is not sterile," said Andrew Clarke, associate professor of food science in the MU College of Agriculture, Food and Natural Resources. "We all have a risk of consuming something that doesn't agree with us. There is no way to keep everything we eat 100 percent risk-free. Some people, who might be more susceptible, may get sick."
Any food could potentially contain bacteria, according to Clarke, who also is an MU Extension state specialist. His best advice is to keep produce cold, wash hands before handling, and wash all surfaces to eliminate cross-contamination. Another alternative is to cook all produce.
"We like our fresh produce, and we don't want to cook or can everything," Clarke said. "Contamination could happen 1,000 miles away because someone didn't wash his or her hands. A home isn't a sterile environment either, so something can happen to contaminate produce in your own home. Hopefully, if you are healthy whatever contamination that might be present will not harm you."
According to the U.S. Department of Agriculture, 76 million cases of food-borne illness occur each year. More than 325,000 people are hospitalized, and 5,000 die from food-borne illness.
The advice for cooking items, such as meat, is more clear-cut. Washing and rinsing may sound too simple to be effective, but Clarke says it is the best defense against bacteria on produce. Washing with water will not eliminate everything; however, he does not recommend using soap or rinsing with hot water.
"Unless you use scalding hot water, you don't effectively kill the bacteria when rinsing produce," Clarke said. "I don't think using soap is a good idea because you don't want to start consuming traces of soap. Anytime you wash the surface of produce, you can still miss bacteria that are microscopically embedded because it isn't always on the surface. It's like a pothole in the road. Someone could scrub the street with soap and water and rinse, but the material that fills the pothole is still there."
Clarke advises using common sense when deciding if a food has gone bad or is still good enough to eat.
"If it looks bad, smells bad, tastes bad, don't eat it! It's not worth giving to the dog either unless you want to end up taking the dog to the vet," Clarke said.
COLUMBIA, Mo, 23 sept 2008 – Widespread reports had most people afraid to eat tomatoes this summer and when tomatoes were vindicated, eating peppers became a fear. A University of Missouri food safety expert says there is only so much that can be done to assure produce is safe to eat.
"We basically want perfect food, but produce is not sterile," said Andrew Clarke, associate professor of food science in the MU College of Agriculture, Food and Natural Resources. "We all have a risk of consuming something that doesn't agree with us. There is no way to keep everything we eat 100 percent risk-free. Some people, who might be more susceptible, may get sick."
Any food could potentially contain bacteria, according to Clarke, who also is an MU Extension state specialist. His best advice is to keep produce cold, wash hands before handling, and wash all surfaces to eliminate cross-contamination. Another alternative is to cook all produce.
"We like our fresh produce, and we don't want to cook or can everything," Clarke said. "Contamination could happen 1,000 miles away because someone didn't wash his or her hands. A home isn't a sterile environment either, so something can happen to contaminate produce in your own home. Hopefully, if you are healthy whatever contamination that might be present will not harm you."
According to the U.S. Department of Agriculture, 76 million cases of food-borne illness occur each year. More than 325,000 people are hospitalized, and 5,000 die from food-borne illness.
The advice for cooking items, such as meat, is more clear-cut. Washing and rinsing may sound too simple to be effective, but Clarke says it is the best defense against bacteria on produce. Washing with water will not eliminate everything; however, he does not recommend using soap or rinsing with hot water.
"Unless you use scalding hot water, you don't effectively kill the bacteria when rinsing produce," Clarke said. "I don't think using soap is a good idea because you don't want to start consuming traces of soap. Anytime you wash the surface of produce, you can still miss bacteria that are microscopically embedded because it isn't always on the surface. It's like a pothole in the road. Someone could scrub the street with soap and water and rinse, but the material that fills the pothole is still there."
Clarke advises using common sense when deciding if a food has gone bad or is still good enough to eat.
"If it looks bad, smells bad, tastes bad, don't eat it! It's not worth giving to the dog either unless you want to end up taking the dog to the vet," Clarke said.
Whole brain radiation increases risk of learning and memory problems in cancer patients
Nearly half of patients experience impaired neurocognitive function, prompts possible change to standard practice
Eric L. Chang
BOSTON, 23 sept 2008 - Cancer patients who receive stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) for the treatment of metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone, according to new research from The University of Texas M. D. Anderson Cancer Center.
The findings of the phase III randomized trial were presented at today's 50th annual meeting of the American Society for Therapeutic Radiology and Oncology.
Led by Eric L. Chang, M.D., associate professor in the Department of Radiation Oncology at M. D. Anderson, the study offers greater context to the ongoing debate among oncologists about how best to manage the treatment of cancer patients with one to three brain metastases.
The American Cancer Society estimates approximately 170,000 cancer patients will experience metastases to the brain from common primary cancers such as breast, colorectal, kidney and lung in 2008. More than 80,000 of those patients will have between one and three brain metastases.
Over the last decade, SRS, which uses high-doses of targeted x-rays, has gained acceptance as an initial treatment for tumors that have spread to the brain. SRS is also commonly used in combination with WBRT, radiation of the entire brain, to treat tumors that are visible and those that may not be detected by diagnostic imaging.
"Determining how to optimize outcomes with the smallest cost to the quality of life is a treatment decision every radiation oncologist faces," said Chang. "While both approaches are in practice and both are equally acceptable, data from this trial suggest that oncologists should offer SRS alone as the upfront, initial therapy for patients with up to three brain metastases."
The seven year study observed 58 patients presenting with one to three newly diagnosed brain metastases who were randomized to receive SRS followed by WBRT or SRS alone. Approximately four months after treatment, 49 percent of patients who received WBRT experienced a decline in learning and memory function compared to 23 percent in those patients who received SRS alone.
An independent data monitoring committee halted the trial after interim results showed the high statistical probability (96.4 percent) that patients randomized to SRS alone would continue to perform better.
M. D. Anderson researchers measured participants' neurocognitive function using a short battery of neuropsychological tests, with the primary endpoint being memory function as tested by the Hopkins Verbal Learning Test Revised. Patient performance that decreased more than a predefined criteria relative to their baseline were considered to exhibit a marked decline.
"This is a case where the risks of learning dysfunction outweigh the benefits of freedom from progression and tip the scales in favor of using SRS alone. Patients are spared from the side effects of whole brain radiation and we are able to preserve their memory and learning function to a higher degree" said Chang. "Here the research suggests patients who receive SRS as their initial treatment and then are monitored closely for any recurrence will fare better."
The study builds on previous research by senior author Christina A. Meyers, Ph.D., M. D. Anderson's chief of the Section Neuropsychology in the Department of Neuro-Oncology, examining neurocognitive function in patients with brain metastases treated with whole-brain radiation. "Unlike past studies comparing the two treatment strategies which did not use sensitive cognitive tests or closely follow patients after being treated with SRS, radiation oncologists in this trial were able to identify new lesions early and treat them with either radiosurgery, surgery, whole brain radiation or less commonly, chemotherapy," Meyers said. "We believe doctors and patients alike will favor this method over upfront whole brain radiation."
###
M. D. Anderson is a leader in the application of SRS to cancers of the spine and head and neck, as well as research determining the effects toxic cancer treatment, like radiation therapy, has on brain function. Based on these results, future research studies are planned to determine if there are expanded indications of using SRS alone for patients with more than three brain metastases.
In addition to Chang and Meyers, M. D. Anderson researchers contributing to the study include Jeffrey S. Wefel, Ph.D., Department of Neuro-Oncology; Kenneth R. Hess, Ph.D., Division of Quantitative Sciences; Fredrick F. Lang, M.D., Department of Neurosurgery and Pamela K. Allen, Ph.D., David Kornguth, M.D., Anita Mahajan, M.D., Moshe Maor, M.D., Christopher Pelloski, M.D. and Shiao Y. Woo, M.D., all of the Department of Radiation Oncology.
Nearly half of patients experience impaired neurocognitive function, prompts possible change to standard practice
Eric L. Chang
BOSTON, 23 sept 2008 - Cancer patients who receive stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) for the treatment of metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone, according to new research from The University of Texas M. D. Anderson Cancer Center.
The findings of the phase III randomized trial were presented at today's 50th annual meeting of the American Society for Therapeutic Radiology and Oncology.
Led by Eric L. Chang, M.D., associate professor in the Department of Radiation Oncology at M. D. Anderson, the study offers greater context to the ongoing debate among oncologists about how best to manage the treatment of cancer patients with one to three brain metastases.
The American Cancer Society estimates approximately 170,000 cancer patients will experience metastases to the brain from common primary cancers such as breast, colorectal, kidney and lung in 2008. More than 80,000 of those patients will have between one and three brain metastases.
Over the last decade, SRS, which uses high-doses of targeted x-rays, has gained acceptance as an initial treatment for tumors that have spread to the brain. SRS is also commonly used in combination with WBRT, radiation of the entire brain, to treat tumors that are visible and those that may not be detected by diagnostic imaging.
"Determining how to optimize outcomes with the smallest cost to the quality of life is a treatment decision every radiation oncologist faces," said Chang. "While both approaches are in practice and both are equally acceptable, data from this trial suggest that oncologists should offer SRS alone as the upfront, initial therapy for patients with up to three brain metastases."
The seven year study observed 58 patients presenting with one to three newly diagnosed brain metastases who were randomized to receive SRS followed by WBRT or SRS alone. Approximately four months after treatment, 49 percent of patients who received WBRT experienced a decline in learning and memory function compared to 23 percent in those patients who received SRS alone.
An independent data monitoring committee halted the trial after interim results showed the high statistical probability (96.4 percent) that patients randomized to SRS alone would continue to perform better.
M. D. Anderson researchers measured participants' neurocognitive function using a short battery of neuropsychological tests, with the primary endpoint being memory function as tested by the Hopkins Verbal Learning Test Revised. Patient performance that decreased more than a predefined criteria relative to their baseline were considered to exhibit a marked decline.
"This is a case where the risks of learning dysfunction outweigh the benefits of freedom from progression and tip the scales in favor of using SRS alone. Patients are spared from the side effects of whole brain radiation and we are able to preserve their memory and learning function to a higher degree" said Chang. "Here the research suggests patients who receive SRS as their initial treatment and then are monitored closely for any recurrence will fare better."
The study builds on previous research by senior author Christina A. Meyers, Ph.D., M. D. Anderson's chief of the Section Neuropsychology in the Department of Neuro-Oncology, examining neurocognitive function in patients with brain metastases treated with whole-brain radiation. "Unlike past studies comparing the two treatment strategies which did not use sensitive cognitive tests or closely follow patients after being treated with SRS, radiation oncologists in this trial were able to identify new lesions early and treat them with either radiosurgery, surgery, whole brain radiation or less commonly, chemotherapy," Meyers said. "We believe doctors and patients alike will favor this method over upfront whole brain radiation."
###
M. D. Anderson is a leader in the application of SRS to cancers of the spine and head and neck, as well as research determining the effects toxic cancer treatment, like radiation therapy, has on brain function. Based on these results, future research studies are planned to determine if there are expanded indications of using SRS alone for patients with more than three brain metastases.
In addition to Chang and Meyers, M. D. Anderson researchers contributing to the study include Jeffrey S. Wefel, Ph.D., Department of Neuro-Oncology; Kenneth R. Hess, Ph.D., Division of Quantitative Sciences; Fredrick F. Lang, M.D., Department of Neurosurgery and Pamela K. Allen, Ph.D., David Kornguth, M.D., Anita Mahajan, M.D., Moshe Maor, M.D., Christopher Pelloski, M.D. and Shiao Y. Woo, M.D., all of the Department of Radiation Oncology.
Monday, September 22, 2008
ENT/sleep apnea patients experience higher levels of depression
New research released at world's largest ENT meeting
Chicago, IL, 22 sept 2008 – Patients who experience a range of ear, nose, and throat-related health problems exhibited a greater prevalence of depression than is observed in the general population, says new research presented at the 2008 American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO in Chicago, IL.
In any given one-year period, approximately 9.5 percent of the population, or about 18.8 million American adults suffer from a depressive illness. The new study, which analyzed the health of 12,516 distinct otolaryngology patients, found that 30 percent of these patients either had been diagnosed with depressive illness or took antidepressants.
The study further broke down different otolaryngologic diagnoses to determine which conditions had the highest co-morbidity with depression. Researchers found that patients diagnosed with sleep apnea had the highest levels of depression and use of antidepressant medications (21 percent and 46 percent).
Findings from this study could help clinicians diagnose and treat co-morbid depressive and otolaryngolic symptoms in patients.
###
Title: Prevalence of Depression in Otolaryngology Patients Presenters: Victoria A. Epstein MD; Andrew J. Fishman, MD; Rakesh K. Chandra, MD Date: September 21, 2008, 9:00 am
Breast cancer survivors have high quality of life up to 15 years after lumpectomy/radiation
BOSTON, 22 sept 2008 -- Women with breast cancer who are treated with lumpectomy and radiation report a high level of overall quality of life several years after treatment that is comparable to a general sampling of the adult women U.S. population according to a survey conducted by physicians at Fox Chase Cancer Center.
"Treatments for breast cancer may decrease quality of life temporarily, but this is evidence that survivors on average will return to a normal quality of life," said Gary Freedman, M.D., an attending physician in the department of radiation oncology at Fox Chase Cancer Center who led the survey. Freedman's research was presented today at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology.
The study included women with early stage breast cancer treated with breast-conserving surgery and radiation with or without chemotherapy and hormone therapy. During routine follow-up visits with their oncologist, the women were asked to complete a brief questionnaire. Of the 1,050 women surveyed, 32 percent submitted 1 survey, 29 percent submitted 2, 21 percent submitted 3 and 18 percent submitted 4 or more surveys. The women were at various points in their follow-up -- from 3 months to 15 years after treatment. The mean follow-up time between treatment and the survey (midway between the two extremes) was 3 years.
The survey tool used is called EQ-5D, a standardized and validated instrument for measuring health outcomes. There are 5 general questions about health including questions about mobility, self-care, anxiety/depression, pain/discomfort, and ability to perform usual activities. The survey allows for three possible levels of response (1 = no problems, 2 = some problems, or 3 = extreme problems). The answers are combined to determine a health state for each woman at the time of the survey. Considering the 5 questions and 3 possible answers for each, there were 243 possible health states. An index number between 0 and 1 was assigned to each health state. The index scores gathered in this survey were compared to a survey of the general U.S. adult population (Luo et al Med Care 2005; 43:1078-86).
There were no significant differences in health states between patients by age. The mean index score 5 years after treatment was 0.95 for women ages 18󈞘, 0.90 for women ages 45󈞬, and 0.88 for women older than 64. The mean index score 10 years after treatment was 0.96 for women ages 18󈞘, 0.93 for women ages 45󈞬, and 0.76 for women older than 64.
By comparison, the reported mean index scores for the general U.S. female population by age is 0.91 for ages 18-44, 0.84 for ages 45-64, and 0.81 for women over 64.
"These data appear to show breast cancer survivors have a very high quality of life when compared to the general population," said Freedman.
He added that in four of the five questions, a statistically significant trend was observed with the women moving between none or some problems over the years following treatment. For the question regarding self care, the patients trend up, moving from "no problems" to "some problems." For 3 of the questions—anxiety, pain and ability to do usual activities-- patients reported improved health states from "some problems" to "no problems."
There were very few women (less than 5 percent) reporting extreme problems with pain, usual activity or self care.
"The brevity of this survey with its 5 questions and 3 possible responses for each, allows us to conduct it quickly in the clinical setting with more patients," Freedman explained. "However, the survey is a general measure of quality of life and does not include information on all possible side effects, such as lymphedema or if the women are happy with their breast appearance."
###
In addition to Freedman, other authors include Penny Anderson, Tianyu Li, Nicos Nicolaou and Andre Konski of Fox Chase Cancer Center. The authors report no disclosures.
BOSTON, 22 sept 2008 -- Women with breast cancer who are treated with lumpectomy and radiation report a high level of overall quality of life several years after treatment that is comparable to a general sampling of the adult women U.S. population according to a survey conducted by physicians at Fox Chase Cancer Center.
"Treatments for breast cancer may decrease quality of life temporarily, but this is evidence that survivors on average will return to a normal quality of life," said Gary Freedman, M.D., an attending physician in the department of radiation oncology at Fox Chase Cancer Center who led the survey. Freedman's research was presented today at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology.
The study included women with early stage breast cancer treated with breast-conserving surgery and radiation with or without chemotherapy and hormone therapy. During routine follow-up visits with their oncologist, the women were asked to complete a brief questionnaire. Of the 1,050 women surveyed, 32 percent submitted 1 survey, 29 percent submitted 2, 21 percent submitted 3 and 18 percent submitted 4 or more surveys. The women were at various points in their follow-up -- from 3 months to 15 years after treatment. The mean follow-up time between treatment and the survey (midway between the two extremes) was 3 years.
The survey tool used is called EQ-5D, a standardized and validated instrument for measuring health outcomes. There are 5 general questions about health including questions about mobility, self-care, anxiety/depression, pain/discomfort, and ability to perform usual activities. The survey allows for three possible levels of response (1 = no problems, 2 = some problems, or 3 = extreme problems). The answers are combined to determine a health state for each woman at the time of the survey. Considering the 5 questions and 3 possible answers for each, there were 243 possible health states. An index number between 0 and 1 was assigned to each health state. The index scores gathered in this survey were compared to a survey of the general U.S. adult population (Luo et al Med Care 2005; 43:1078-86).
There were no significant differences in health states between patients by age. The mean index score 5 years after treatment was 0.95 for women ages 18󈞘, 0.90 for women ages 45󈞬, and 0.88 for women older than 64. The mean index score 10 years after treatment was 0.96 for women ages 18󈞘, 0.93 for women ages 45󈞬, and 0.76 for women older than 64.
By comparison, the reported mean index scores for the general U.S. female population by age is 0.91 for ages 18-44, 0.84 for ages 45-64, and 0.81 for women over 64.
"These data appear to show breast cancer survivors have a very high quality of life when compared to the general population," said Freedman.
He added that in four of the five questions, a statistically significant trend was observed with the women moving between none or some problems over the years following treatment. For the question regarding self care, the patients trend up, moving from "no problems" to "some problems." For 3 of the questions—anxiety, pain and ability to do usual activities-- patients reported improved health states from "some problems" to "no problems."
There were very few women (less than 5 percent) reporting extreme problems with pain, usual activity or self care.
"The brevity of this survey with its 5 questions and 3 possible responses for each, allows us to conduct it quickly in the clinical setting with more patients," Freedman explained. "However, the survey is a general measure of quality of life and does not include information on all possible side effects, such as lymphedema or if the women are happy with their breast appearance."
###
In addition to Freedman, other authors include Penny Anderson, Tianyu Li, Nicos Nicolaou and Andre Konski of Fox Chase Cancer Center. The authors report no disclosures.
New options when an old enemy returns
22 sept 2008--In review study, researchers say CyberKnife is a safe treatment option for recurrent pancreatic cancer in some patients and can be delivered in only a week's time
BOSTON -- Pancreatic cancer is one of the most challenging malignancies to treat, and recurrence is common, even after initial treatment with surgery and radiation. When the cancer does return, treatment options are often limited to chemotherapy, but researchers at Georgetown's Lombardi Comprehensive Cancer Center are utilizing the precision allowed by CyberKnife® to see if radiosurgery is a viable treatment option in select patients.
"When treating recurrent pancreatic tumors, there are a number of factors to evaluate before we can consider radiosurgery as an additional treatment option," explains Christopher Lominska, M.D., lead author of the study and a resident in radiation medicine at Georgetown's Lombardi Comprehensive Cancer Center. "First, treatment must be safe, which is demonstrated in this study. We also designed a treatment that can be delivered in a short period of time -- a critically important quality-of-life factor in this patient population." The results of the study were presented today at the 50th annual meeting of the American Society for Therapeutic and Radiology Oncology (ASTRO) in Boston.
For the study, Lominska and his colleagues evaluated the safety of radiosurgery using CyberKnife® by reviewing the records of patients treated for pancreatic cancer at Georgetown from June 2002 through July 2007. Twenty-eight patients were treated for locally recurrent disease, 20 of whom had had prior chemotherapy and conventional radiation, and eight of whom had had prior surgery as well as radiation and chemotherapy. Disease recurrence was visualized with CT or PET/CT imaging.
The median age of the patients was 63 years old. Follow-up was available on 24 of 28 patients (patients lost to follow-up were assumed deceased). Median survival from the date of radiosurgery treatment was 5.3 months (range 1-27 months). Seven (7) patients (25 percent) lived more than 8 months after treatment.
"We found an acceptable safety profile for those receiving radiosurgery," says Lominska. "These patients had received full doses of conventional radiation therapy prior to their radiation treatment, so this speaks to the very high level of precision of the CyberKnife® -- that we were able to give them more radiation safely. It's also worth noting that treatment was delivered in only a week allowing patients to resume systemic chemotherapy with minimal interruption."
Lominska says only two patients experienced serious GI toxicity (one peripancreatic abscess, one bowel obstruction) after being treated with three sessions of radiosurgery. (Five sessions of daily treatment are now commonly given with the belief that this is better tolerated.) Review of radiographic studies revealed local control in 6 patients, local control with distant progression in 6 patients, and local and distant progression in two patients with no follow-up imaging available on the remaining patients. As of March 2008, 26/28 patients have died. The two surviving patients remain locally controlled without evidence of distant disease on follow-up of three and 8 months.
Lominska says the preliminary survival trends look good, but are not conclusive until more studies are designed to evaluate if radiosurgery with CyberKnife can extend survival when compared with usual care.
###
In addition to Lominska, other study authors include Nadim Nasr M.D., Natalie Silver M.S., and Gregory Gagnon M.D., all of Georgetown. The authors report the following disclosures: Gagnon occasionally serves as a paid consultant and receives speaking fees from Accuray, the manufacturer of the CyberKnife. There was no external funding for this study.
22 sept 2008--In review study, researchers say CyberKnife is a safe treatment option for recurrent pancreatic cancer in some patients and can be delivered in only a week's time
BOSTON -- Pancreatic cancer is one of the most challenging malignancies to treat, and recurrence is common, even after initial treatment with surgery and radiation. When the cancer does return, treatment options are often limited to chemotherapy, but researchers at Georgetown's Lombardi Comprehensive Cancer Center are utilizing the precision allowed by CyberKnife® to see if radiosurgery is a viable treatment option in select patients.
"When treating recurrent pancreatic tumors, there are a number of factors to evaluate before we can consider radiosurgery as an additional treatment option," explains Christopher Lominska, M.D., lead author of the study and a resident in radiation medicine at Georgetown's Lombardi Comprehensive Cancer Center. "First, treatment must be safe, which is demonstrated in this study. We also designed a treatment that can be delivered in a short period of time -- a critically important quality-of-life factor in this patient population." The results of the study were presented today at the 50th annual meeting of the American Society for Therapeutic and Radiology Oncology (ASTRO) in Boston.
For the study, Lominska and his colleagues evaluated the safety of radiosurgery using CyberKnife® by reviewing the records of patients treated for pancreatic cancer at Georgetown from June 2002 through July 2007. Twenty-eight patients were treated for locally recurrent disease, 20 of whom had had prior chemotherapy and conventional radiation, and eight of whom had had prior surgery as well as radiation and chemotherapy. Disease recurrence was visualized with CT or PET/CT imaging.
The median age of the patients was 63 years old. Follow-up was available on 24 of 28 patients (patients lost to follow-up were assumed deceased). Median survival from the date of radiosurgery treatment was 5.3 months (range 1-27 months). Seven (7) patients (25 percent) lived more than 8 months after treatment.
"We found an acceptable safety profile for those receiving radiosurgery," says Lominska. "These patients had received full doses of conventional radiation therapy prior to their radiation treatment, so this speaks to the very high level of precision of the CyberKnife® -- that we were able to give them more radiation safely. It's also worth noting that treatment was delivered in only a week allowing patients to resume systemic chemotherapy with minimal interruption."
Lominska says only two patients experienced serious GI toxicity (one peripancreatic abscess, one bowel obstruction) after being treated with three sessions of radiosurgery. (Five sessions of daily treatment are now commonly given with the belief that this is better tolerated.) Review of radiographic studies revealed local control in 6 patients, local control with distant progression in 6 patients, and local and distant progression in two patients with no follow-up imaging available on the remaining patients. As of March 2008, 26/28 patients have died. The two surviving patients remain locally controlled without evidence of distant disease on follow-up of three and 8 months.
Lominska says the preliminary survival trends look good, but are not conclusive until more studies are designed to evaluate if radiosurgery with CyberKnife can extend survival when compared with usual care.
###
In addition to Lominska, other study authors include Nadim Nasr M.D., Natalie Silver M.S., and Gregory Gagnon M.D., all of Georgetown. The authors report the following disclosures: Gagnon occasionally serves as a paid consultant and receives speaking fees from Accuray, the manufacturer of the CyberKnife. There was no external funding for this study.
Olfactory stimuli may influence dreams
New research released at world's largest ENT meeting
Chicago, IL, 22 sept 2008 – What you smell as you sleep has the power to influence your dreams, says new research presented at the 2008 American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO in Chicago, IL.
German researchers used specific volatile odorants with a negative or a positive smell ("rotten eggs" versus "roses") to simulate subjects during sleep. They then recorded the subjects' impressions when they were awakened. When using the unpleasant odorant, the emotional coloration of the dream was predominantly negative, while under stimulation with the pleasant stimulus, nearly all dreams had a positive coloration.
Researchers note that only recently information on olfactory function during sleep has become available, and that this is the first valid study that documents the impact of olfactory function on dreams. This study may also open a potential field of therapeutic intervention with nocturnal olfactory stimulation.
###
Title: The Impact of Olfactory Stimulation on Dreams Presenters: Boris A. Stuck, MD; Desislava Atanasova; Kathrin Frauke Grupp; Michael Schredl, PhD Date: September 21, 2008, 10:30 am - 12:00 pm (all times CDT)
Information for the Media:
The AAO-HNSF Annual Meeting & OTO EXPO newsroom will be located in Room 265, Lakeside Level 2, McCormick Place Convention Center. Hours of operation: Saturday, September 20, 12 pm to 5 pm; Sunday - Tuesday, September 21 - 23, 7:30 am to 5 pm; and Wednesday, September 24, 7:30 am to 2 pm. The newsroom serves as a work space for credentialed members of the media and credentialed public relations staff. The newsroom is managed and staffed by the AAO-HNS Communications Unit. Please see the AAO-HNS website for media credentialing requirements for the event.
New research released at world's largest ENT meeting
Chicago, IL, 22 sept 2008 – What you smell as you sleep has the power to influence your dreams, says new research presented at the 2008 American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO in Chicago, IL.
German researchers used specific volatile odorants with a negative or a positive smell ("rotten eggs" versus "roses") to simulate subjects during sleep. They then recorded the subjects' impressions when they were awakened. When using the unpleasant odorant, the emotional coloration of the dream was predominantly negative, while under stimulation with the pleasant stimulus, nearly all dreams had a positive coloration.
Researchers note that only recently information on olfactory function during sleep has become available, and that this is the first valid study that documents the impact of olfactory function on dreams. This study may also open a potential field of therapeutic intervention with nocturnal olfactory stimulation.
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Title: The Impact of Olfactory Stimulation on Dreams Presenters: Boris A. Stuck, MD; Desislava Atanasova; Kathrin Frauke Grupp; Michael Schredl, PhD Date: September 21, 2008, 10:30 am - 12:00 pm (all times CDT)
Information for the Media:
The AAO-HNSF Annual Meeting & OTO EXPO newsroom will be located in Room 265, Lakeside Level 2, McCormick Place Convention Center. Hours of operation: Saturday, September 20, 12 pm to 5 pm; Sunday - Tuesday, September 21 - 23, 7:30 am to 5 pm; and Wednesday, September 24, 7:30 am to 2 pm. The newsroom serves as a work space for credentialed members of the media and credentialed public relations staff. The newsroom is managed and staffed by the AAO-HNS Communications Unit. Please see the AAO-HNS website for media credentialing requirements for the event.
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