Digital Health News

Calls For Compulsory Flu Jabs For NHS Staff

2009-03-03T11:00:00.000+02:00

The Royal College of General Practitioners has called for hospital doctors, GPs, nurses, carers and other staff to have compulsory flu jabs. It is reported that Department of Health figures show fewer than one in seven frontline NHS staff had a flu jab last year! Such low levels of vaccination among staff were identified by the Health Protection Agency as a significant factor in the flu outbreak which affected a number of hospitals at the end of last year.

Dr George Kassianos of the Royal College of General Practitioners said: "The only way to boost the effectiveness of the flu vaccine is to immunise the people who are delivering the care. You are placing patients' at risk if you give them the flu."

Protecting yourself and those you care for

This is a most concerning state of affairs - particularly for older people more likely to be receiving medical treatment or attending appointments. Quite clearly, it's wise to take precautions to protect yourself or those you are caring for from the risk of flu infection - and the potentially dangerous consequences that might follow.

It's comforting, therefore, to know that, in addition to a flu jab, many self-help measures can be taken - to avoid infection, to build up natural immunity and to obtain effective natural relief. Care Directions presents a comprehensive guide to Colds & Flu Protection.

Read it now

here.

http://www.caredirections.co.uk

Pitt Study Finds Children Of Bipolar Parents Have Increased Risk Of Psychiatric Disorders

2009-03-02T22:00:00.000+02:00

Children and teens of parents with bipolar disorder have an increased risk of early-onset bipolar disorder, mood disorders and anxiety disorders, according to a study by University of Pittsburgh School of Medicine researchers published in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

An estimated one in 100 children and teens worldwide has bipolar disorder. Identifying the condition early may improve long-term outcomes, potentially preventing high psychosocial and medical costs. Researchers from the Pittsburgh Bipolar Offspring Study suggest that having family members with bipolar disorder is the best predictor of whether their children will go on to develop the condition.

"A bipolar diagnosis at a young age deprives children of the opportunity to experience normal emotional, cognitive and social development, and this is why there is an urgent need to identify, diagnose and treat these patients early on," said Boris Birmaher, M.D., director of the Child and Adolescent Anxiety Program and co-director of the Child and Adolescent Bipolar Services at Western Psychiatric Institute and Clinic of UPMC, endowed chair in Early Onset Bipolar Disease and professor of psychiatry at the University of Pittsburgh School of Medicine.

Compared with the offspring of control parents, children with bipolar parents had a 14-fold increased risk of having a bipolar spectrum disorder, as well as a two-to three-fold increase of having a mood or anxiety disorder. Children in families where both parents had bipolar disorders also were more likely to develop the condition than those in families containing one parent with bipolar disorder. However, their risk for other psychiatric disorders was the same as children who had one bipolar parent.

Bipolar disorder, commonly called manic-depression, often emerges in adolescence, and is characterized by intense swings between depression, mania and periods with mixed symptoms. Bipolar spectrum disorders consist of three sub-types. Bipolar I (BP-I) is characterized by episodes of full-blown mania and major depression; bipolar II (BP-II) involves episodes of less severe mania, called hypomania, and major depression; and the third sub-type is called Bipolar Not Otherwise Specified (BP-NOS), which involves symptoms consistent with elated or irritable moods that are disruptive to daily living, plus two to three other symptoms of bipolar disorder.

In this blind study, researchers compared 388 children and teens, ages 6 to 18, of 233 parents with BP-I and BP-II to 251 offspring of 143 demographically matched control parents. Parents were assessed for psychiatric disorders, family mental health history, family environment, exposure to negative life events, and also were interviewed about their children. Children were assessed directly for bipolar disorder and other psychiatric disorders by researchers who did not know their parents' diagnoses.

"Consistent with prior research, most parents with bipolar disorder recalled that their illness started before age 20 and about 20 percent had illness that started before age 13," said Dr. Birmaher. "In contrast, most of their children developed their first bipolar disorder episode before age 12, suggesting the possibility that parents were more perceptive of their children's symptoms early in life or perhaps that bipolar disorder appears earlier in new generations."

The researchers note that these findings have important clinical implications. "Clinicians who treat adults with bipolar disorder should question them about their children's psychopathology to offer prompt identification and early interventions for any psychiatric problems that may be affecting the children's functioning, particularly early-onset bipolar disorder," said Dr. Birmaher. "Further studies are needed to help determine the clinical, biological and genetic risk factors that may be modified to prevent the development of psychiatric disorders in the children of those with bipolar disorder."

Co-authors of the Pittsburgh Bipolar Offspring Study include David Axelson, M.D., Kelly Monk, R.N., Catherine Kalas, R.N., Benjamin Goldstein, M.D., Mary Beth Hickey, B.A., Mihaela Obreja, M.S., Mary Ehmann, M.A., Satish Iyengar, Ph.D., Warl Shamseddeen, M.D., David Kupfer, M.D., and David Brent, M.D., all from WPIC and the University of Pittsburgh Department of Psychiatry.

The Pittsburgh Bipolar Offspring Study was supported in part by funding provided by the National Institute of Mental Health.

Western Psychiatric Institute and Clinic (WPIC) is considered to be one of the nation's foremost university-based psychiatric care facilities and one of the world's leading centers for research and treatment of mental health disorders. WPIC houses the Department of Psychiatry of the University of Pittsburgh School of Medicine and is the flagship of UPMC Behavioral Health, the psychiatric specialty division of the University of Pittsburgh Medical Center.

University of Pittsburgh Medical Center, U.S. Steel Tower, 600 Grant St., 57th Floor, Pittsburgh, PA 15213 United States

http://www.upmc.com

GP Practices Losing Patients And Staff To Local Polyclinic, Bradford, England

2009-03-02T11:00:00.000+02:00

The first GP-led health centre in the United Kingdom to open is already taking not only patients but also staff from nearby practices, according to the medical journal Pulse.

Even though the polyclinic is situated in an under-doctored area of Bradford, nearly half of those registered there come from neighbouring practices. One local GP practice has already lost two practice nurses who were offered a 'significant pay rise' by the polyclinic.

Fear has grown among General Practitioners (GPs) that the new centres will undermine practices after a recent report by the Health Services Management centre warned they would have to take up approximately 20% of GPs' patients to avoid becoming white elephants.

The Hillside Bridge Healthcare Centre in Bradford registered 198 new patients in its first sixty days of operation - 86 of them came from other local practices, 77 came from practices slightly further away, while 35 were previously unregistered patients.

According to Sarah Rhodes, Practice Manager, Avicenna Medical Practice, and chair of the local practice managers association, two nurse practitioners and approximately 20 patients had defected to the new centre since it opened. "The main impact is staff moving down there because they pay more than the general practices do. We've lost both of our nurse practitioners. We're having to advertise and we're currently having to use locums."

The centre, which also provides out-of-hours services in the area, is run by non-profit organisation Local Care Direct. Alan Whitaker, Communications & Community Relations Manager, Local Care Direct, said "Local Care Direct is not aggressively seeking to register patients already with other local practices. Patients are at liberty to register wherever they like to find the service which best suits their needs. We have advertised externally for nursing staff at different levels to fulfill different roles at different locations and do not actively seek to influence staff to leave other practices."

Click here to view the full article online in Pulse.

About PulseToday

PulseToday is the GP's website in the UK providing general practice news, clinical education and practice information to GPs and primary care staff.

You can register on this site to get access to further information by visiting:

www.pulsetoday.co.uk/subscribemenu.asp

Written by - Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Young Ex-servicemen At Increased Risk Of Suicide

2009-02-28T11:00:00.000+02:00

Young men who have served in the British Armed Forces are up to three times more likely to take their own lives than their civilian counterparts, research published today (March 3) has found.

Researchers at The University of Manchester's Centre for Suicide Prevention linked UK military discharge data between 1996 and 2005 with details of suicides collected by the National Confidential Inquiry into Suicides and Homicides.

The study, published in the journal Public Library of Science (PLoS) Medicine, revealed that ex-servicemen under 24 years old were at greatest risk of suicide, with those in lower ranks and shorter military careers proving most vulnerable.

The report's authors, Professor Nav Kapur and colleagues, were unable to prove why younger ex-military personnel had higher rates of suicide than men of the same age in the general population but suggest three possibilities.

"One explanation for the higher suicide risk among young ex-military personnel is that those entering military service at a young age are already vulnerable to suicide, which would explain why those serving for a relatively short period of time before being discharged were most likely to take their own lives," said Kapur, lead author and professor of psychiatry and population health at Manchester University.

"A second explanation is the difficulty a minority of individuals experience making the transition to civilian life.

"However, a third possibility that we could not explore in this study is that exposure to adverse experiences during military service or active deployment played a role in the two to three-fold increase in suicide among young veterans, although many of those most at risk had not completed basic training and therefore had not deployed overseas."

The study, funded by the Veterans Policy Unit in the UK Ministry of Defence, also found that the suicide risk was highest among young men leaving the Armed Forces within the first two years of discharge.

The risk of suicide was also higher in young women aged under 20 years compared with the general population, but the overall numbers were small.

The overall suicide risk was no greater for ex-military personnel than for civilians when all age groups were considered 16 to 49 years. Men aged 30-49 years had a lower rate of suicide than the general population.

During the study period 233,803 individuals left the Armed Forces, of which 224 took their own lives. Worryingly, the research also found that veterans had a low rate of contact with mental health professionals in the year before death just 14% for those under 20 years of age and 20% for those under 24 years.

"Whatever the explanation for our findings, these individuals may benefit from some form of intervention," said Professor Kapur. "Initial pre-recruitment interview, medical examination and training are important in ensuring military health but it should be recognised that those discharged at any of these stages may be at higher risk of suicide."

The University of Manchester

http://www.manchester.ac.uk

Effective Mentoring Critical To HIV/AIDS Research Efforts

2009-02-27T11:00:00.000+02:00

An innovative mentoring program at the UCSF-Gladstone Institute for Virology and Immunology Center for AIDS Research is providing vital support for the development of the next generation of HIV/AIDS researchers and clinician scientists.

Described in an article published in the American Journal for Public Health February 26 in the First Look section of the AJPH website, the program focuses on overcoming challenges faced by early-career investigators through several novel mechanisms.

"One key innovation adopted in our program is 'trans' mentoring. In this model, a mentee is paired with a mentor from a research discipline different from the mentee's. For instance, a mentee working in basic science is paired with a mentor who is doing either clinical or behavioral research. One advantage is to lessen potential conflicts of interest between mentee and mentor. Additionally, an important benefit in that it strongly encourages multidisciplinary research," said the article's co-author James S. Kahn, MD, UCSF professor of clinical medicine and co-director of the UCSF-GIVI CFAR's mentoring program.

One of the goals of the CFAR mentoring program is to support and create pathways for multidisciplinary HIV research. The three broad categories that mentors and mentees are divided into are basic research, clinical or translational research, and population or behavioral research.

Another significant innovation in the CFAR program lies in considering the role of the mentor.

"In the past, senior investigators mentored junior researchers without really considering what was necessary for successful mentoring. Our concept is that mentoring is a teachable skill. We focus on and help develop the specific skill set needed by a mentor to best assist an early-career investigator," said Kahn.

Open mentoring is an innovation that the CFAR mentoring program uses to support its goal of retaining early-career investigators and optimizing their productivity. Open mentoring is a strategy that provides mentoring to persons desiring mentoring and is contrasted with elite mentoring in which mentoring is provided to those investigators who have achieved early success.

"Deciding to reserve mentoring for the top strata of early-career researchers does not broaden the pool of investigators. By making mentoring open to any investigator doing HIV research, we find that we are providing career support to a more diverse group of individuals from a more diverse set of research disciplines," said the article's co-author, Ruth M. Greenblatt, MD, UCSF professor of clinical medicine and co-director of the CFAR mentoring program.

The authors note other goals of the mentoring program, including retaining early-career investigators and optimizing their productivity and assisting them with transitions as their careers progress.

"The National Institutes of Health is limiting grant resubmissions due to funding constraints. Our mentors assist in optimizing grant submissions and ensuring mentees have a strong career strategy with appropriate expectations. Moreover, mentoring can be extremely helpful in assisting early-career investigators with the complicated but essential balancing of personal time with career advancement," said Greenblatt.

Greenblatt observed that the NIH has placed particular emphasis on the challenges faced by clinician scientists and noted that the country risks losing an entire generation of these essential investigators.

"We hear similar concerns from clinician scientists. They mention lack of access to funding, lack of caring for them as individuals and lack of a collegial atmosphere. Our mentoring serves as an intervention to specifically address these problems," said Greenblatt.

----------------------------

Article adapted by Medical News Today from original press release.

----------------------------

Funding for the UCSF-GIVI CFAR is provided by the National Institutes of Health.

UCSF-Gladstone Institute for Virology and Immunology CFAR is a multi-disciplinary, multi-campus program focused on translational HIV/AIDS research. CFAR's mission is to support a multidisciplinary environment that promotes basic, clinical, epidemiologic, behavioral and translational research in the prevention, detection and treatment of HIV infection and AIDS, while expanding the intersections of research between those scientific disciplines.

The J. David Gladstone Institutes, an independent, non-profit biomedical research organization affiliated with the University of California, San Francisco (UCSF), are dedicated to the health and welfare of humankind through research into the causes and prevention of some of the world's most devastating diseases. Gladstone is comprised of the Gladstone Institute of Cardiovascular Disease, the Gladstone Institute of Virology and Immunology and the Gladstone Institute of Neurological Disease.

UCSF-GIVI CFAR is affiliated with the AIDS Research Institute (ARI) at UCSF. UCSF ARI houses hundreds of scientists and dozens of programs throughout UCSF and affiliated labs and institutions, making ARI one of the largest AIDS research entities in the world.

UCSF is a leading university dedicated to defining health worldwide through advanced biomedical research, graduate level education in the life sciences and health professions, and excellence in patient care.

Source: Jeff Sheehy

University of California - San Francisco

Government Of Canada Works With Manitoba To Help Prevent Drug Use Among Province's Youth

2009-02-26T17:00:00.000+02:00

Merv Tweed, Member of Parliament for Brandon-Souris, Manitoba, announced today on behalf of Leona Aglukkaq, Minister of Health, that the Government of Canada is supporting projects under the Drug Strategy Community Initiatives Fund that will strengthen drug prevention among youth in Manitoba.

"The Government of Canada is proud to be working with provinces and communities across the country to help prevent illicit drug use among youth," said Minister Aglukkaq. "This project will provide Manitoban communities with tools they need to educate young people about such issues."

The Brandon Community Alcohol & Drug Education Coalition Drug Prevention Mobilization Plan project will help community partners in the Brandon-Souris region to develop, implement and promote educational and other activities aimed at preventing drug use among young people.

"It is truly inspiring to see how residents and businesses in Brandon-Souris are pulling together to address this issue," said Mr. Tweed. "I look forward to seeing the benefits of these efforts in the months and years ahead."

Initiatives such as this one are another step in implementing the Government of Canada's National Anti-Drug Strategy which was announced by Prime Minister Stephen Harper in October 2007.

The federal Drug Strategy Community Initiatives Fund provides financial support for health promotion and prevention projects at the national, provincial and local levels. It addresses a wide range of illicit drug use issues, especially among vulnerable populations such as youth. The Brandon School Division #40 will receive up to $148,500 in financial support for this important project.

Please visit the National Anti-Drug Strategy website for more information.

Health Canada

Shelf-Life Of Malaria Drugs Could Be Extended

2009-02-26T11:00:00.000+02:00

The most important malaria drug passed basic quality tests well beyond its sell-by date, indicating a potential shelf-life extension that could save many lives in the developing world, concludes a new study published today in the Malaria Journal. Artemether-lumefantrine is one of the dominant forms of artemisinin-based combination therapy (ACT) - the current standard of care for malaria. Artemisinin, a plant extract, has a 14-month production cycle from planting to extraction of the active ingredient and when used in combination therapy, has a shelf-life of only two-years. In countries where malaria is most prevalent, limited health care infrastructure complicates efforts to accurately predict demand, as well as procure, distribute, and administer medicines during their approved shelf-life. This typically results in purchasers procuring too little medicine, causing stock-outs and excess mortality, or purchasing too much medicine, causing overstock and drugs expiring on the shelf. Pharmaceutical companies face logistical challenges in managing the supply of raw materials and finished product, and suffer significant financial loses if they are forced to destroy product as a result of inaccurate forecasting.

"Our study suggests, based on the limited evidence we present, that a re-evaluation of the two-year shelf-life of artemether-lumefantrine is warranted," said Dr. Roger Bate, Legatum Fellow at the American Enterprise Institute and lead author on the study. "Our hope is that the publication of this paper will motivate the relevant companies and authorities to prioritize undertaking more detailed and thorough analyses, which would be necessary for such a change in shelf-life."

97% (68 of 70 samples) of fixed dose combination artemether-lumefantrine, between one and 58 months post-expiry, passed thin-layer chromatography, disintegration testing, and near infrared Raman spectrometry testing. These field techniques, validated as 'silver standard', are primarily used for product identification, particularly assessing counterfeit drugs, but provide enough information to indicate probable product stability. The spectrometry data provide useful measurements of apparent product degradation over time, which could be useful for future field surveys. The study's findings argue for further research using more advanced analytical techniques, the 'gold standard', before a longer shelf-life would be firmly established.

"That artemether-lumefantrine has a shelf-life of only two years poses unique logistical challenges and contributes to serious disruptions in treatment availability," said Richard Tren, Director of Africa Fighting Malaria, a non-profit advocacy group. "If the shelf-life were extended this would simplify the logistics of ACT delivery and potentially reduce the cost."

The study also found evidence that health ministry supply chains in some African countries are corrupted, whereby batches of artemether-lumefantrine, which had been sold into the public sector at concessional pricing, were illegally diverted to the private sector where they were sold for profit.

Africa Fighting Malaria is a non-profit health research and advocacy group based in South Africa and Washington DC. The research reported in this study is part of the March of Washingtons project, a campaign to assess anti-malarial drug quality and procure high-quality drugs for malarial countries in Africa.

Samples of artemether-lumefantrine were procured from pharmacies in seven malarial countries in Africa and from the researchers' own stocks. The expired medicines were tested according to protocols established in the scientific literature. The results of this study indicate that further laboratory testing using more sophisticated methodology such as high performance liquid chromatography is warranted with a view to extending the shelf-life of the products. The authors do not advocate for a shelf-life extension at this stage. The research was funded by a grant made to Africa Fighting Malaria by the Ohrstrom Foundation and by the Legatum Institute.

Article title: "Physical and chemical stability of expired fixed dose combination artemether-lumefantrine in uncontrolled tropical conditions"

Authors: Roger Bate, Richard Tren, Kimberly Hess and Amir Attaran

Journal: Malaria Journal

Available at: http://www.malariajournal.com/content/8/1/33

http://www.fightingmalaria.org

Impact Of Nursing Shortage Crisis On Escalating Alzheimer Population

2009-02-25T17:00:00.000+02:00

In just two short years, the first wave of baby boomers will begin to turn age 65 - the age of greatest risk for developing Alzheimer's disease. There are an estimated 5.2 million Americans living with this fatal, degenerative disease that today has no cure. With an aging baby boomer population, as many as 16 million people may have the disease by 2050. As the prevalence of Alzheimer's increases, so does the need for qualified nurses. We applaud the creation of the Champion Nursing Coalition, a broad spectrum of stakeholders who have come together to shed light on the grave threat the nursing shortage poses to the nation and the health care system.

Nurses serve as the bedrock of support for Alzheimer families throughout all stages of the disease. The need for more qualified nurses that can also meet the unique challenges of people living with dementia will become increasingly important with an aging society more at risk for cognitive impairment. Addressing the diminishing nursing workforce is absolutely essential to addressing the needs of this escalating Alzheimer population.

Approximately 70 percent of nursing home residents have some degree of cognitive impairment and 27 percent of older adults living in the community with severe disabilities are cognitively impaired. There is a consistent need for qualified, trained nurses to coordinate their care today - which will grow exponentially in the near future.

By 2010, there will be nearly a half million new cases of Alzheimer's develop each year and nurses will continue to play a crucial role in the lives of Alzheimer families. The Alzheimer's Association, the leading voluntary health organization in Alzheimer care, support and research, looks forward to working with the partners in the Champion Nursing Coalition to spotlight the vital role nurses play in providing quality health care and enhancing care coordination. The Alzheimer's Association urges lawmakers to enhance the recruitment, education and training of nursing professionals to meet future demands.

The Alzheimer's Association

The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's.

Alzheimer's Association

Regular Light Alcohol Drinking Raises Cancer Risk For Women

2009-02-25T11:00:00.000+02:00

Women who regularly consume one or two alcoholic drinks each day have a notably higher chance of developing cancers compared to women who do not drink regularly, says a new report from Cancer Research UK.

The risk increases significantly for breast, liver and rectum cancers, says the report. A woman smoker who regularly consumes one or two alcohol drinks per day also has a significantly higher chance of developing mouth and throat cancers compared to a female smoker who does not drink regularly. The report did not compare mouth and throat cancer risks between female smokers and non-smokers.

According to the researchers, British women who drink alcohol consume an average of one alcoholic drink per day - this consumption is similar to that found among alcohol-consuming women in other developed nations. Approximately 118 of these cancers are diagnosed for every 1,000 women up to that age of 75 in industrialized countries. The researchers say that there would be 15 extra cancer cases per 1,000 women up to 75 years of age for every additional regularly consumed alcoholic drink.

13% of cancers of the breast, liver, rectum, mouth and throat are caused by alcohol consumption, say the authors of the report.

Approximately 11% of breast cancer cases in the UK can be attributed to women's consumption of alcohol, say the researchers (5,000 out of 45,000 each year).

Cancer Research UK researchers at the University of Oxford's cancer epidemiology unit studied data from more than a million middle-aged women from the Million Women Study.

Dr Naomi Allen, lead study author, said: "These findings suggest that even relatively low levels of drinking - about one or two alcoholic drinks every day - increase a woman's risk of developing cancer of the breast, liver and rectum, and in smokers, cancers of the mouth and throat."

The researchers stressed that the raised cancer risk did not depend on what kind of alcohol was drunk - only the amount. For example, women who drank wine exclusively had a similar risk of developing cancer as those who drank other alcoholic beverages or a mixture of drinks.

Among the women studied, fewer than 2% regularly drank more than three drinks per day. The study included 68,775 cases of cancer, registered over 7.2 years of follow-up.

Sara Hiom, director of health information at Cancer Research UK, said: "We know that too much alcohol increases the risk of a number of cancers. This latest study shows that even relatively low levels of drinking increase a woman's risk. It is important that women are as well informed as possible so they can take responsible decisions over how much alcohol they drink. Cancer Research UK recommends that the more you cut down on alcohol, the more you reduce your cancer risk. The more you drink the greater the risk."

Source - Cancer Research UK

Written by - Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Managing Your Anger Could Save Your Life

2009-02-24T11:00:00.000+02:00

A new US study suggests that learning to manage your anger might save your life: they found that anger-induced electrical changes can predict future heart arrhythmias in patients with implantable cardioverter-defibrillators (ICDs).

The study is the work of researchers at Yale University School of Medicine in New Haven, and the Veterans Affairs Connecticut Healthcare System in West Haven, Connecticut, and at PinMed Inc. and University of Pittsburgh, Cardiovascular Institute, Pittsburgh, Pennsylvania, and is published in the March 3rd issue of the Journal of the American College of Cardiology.

Lead author Dr Rachel Lampert, associate professor at Yale University School of Medicine told the press that the study was important because:

"We are beginning to understand how anger and other types of mental stress can trigger potentially lethal ventricular arrhythmias, especially among patients with structural heart abnormalities."

"We know strong emotion increases sympathetic arousal," explained Lampert.

"In this study, we found patients with higher levels of anger-induced TWA [a measure of the heart's electrical stability] were more likely to experience arrhythmias requiring ICD termination," she added.

Findings from other studies show that at times of great stress in the population, such as when there is an earthquake or war, there are more sudden cardiac deaths.

This study is the first to show that changes brought on by anger and other strong emotions can anticipate arrthymias and link mental stress to sudden cardiac arrest.

Sudden cardiac arrest is when the heart unexpectedly suddenly stops beating, causing blood to stop flowing to the brain and other vital organs.

According to the National Heart, Lung and Blood Instititue (NHLBI), every year between 250,000 and 450,000 Americans have sudden cardiac arrest. It occurs most often in people in their mid-thirties to mid-forties and appears to affect men twice as often as women.

For this study, Lampert and colleagues examined 62 patients fitted with ICDs because they either had coronary artery diseae or dilated cardiomyopathy, a condition where the heart muscle is enlarged. They were all recruited from the Yale Electrophysiology practice.

They monitored the patients as they underwent a mental stress test in the laboratory about 3 months after being implanted with the ICD. During the test patients were asked to remember a recent situation that made them feel angry or aggravated. While the patients recalled their anger incident, the researchers monitored their T-wave alternans (TWA), a measure of their heart's electrical stability.

After this the patients were followed for an average of 37 months to see which of them had arrthymias that had to be stopped by their implanted ICDs.

The results showed that 16 per cent of the patients had ICD-terminated arrhythmias during follow up, and these also had higher TWA induced by anger than those patients who did not have arrhythmias during follow up.

Even when they took other clinical factors into account that might predispose patients to higher levels of TWA or higher levels of heart events (eg heart failure or history of arrhythmia), the researchers found that anger-induced TWA remained a significant predictor of arrhythmia during follow up. The risk was ten times that of other patients.

The authors recommended screening based on accurate non-invasive risk tests to identify patients at greatest risk for life-threatening arrhythmia, since these findings suggest that mental stress, and anger in particular, may be another route that provokes arrhythmia.

Commenting in an accompanying editorial, Dr Eric J. Rashba, professor of Medicine at Stony Brook University Medical Center, Long Island, New York, wrote:

"What remains unclear is how this new T-wave alternans test relates to traditional exercise TWA testing."

"It may be that combining exercise TWA tests with newer mental stress TWA tests may help clinicians better select patients likely to have arrhythmia and, in turn, benefit from a defibrillator; however, more study is needed," he added.

Lampert said that unlike exercise, mental stress doesn't raise heart rate significantly, which suggests that mental stress may affect heart tissue directly via adrenaline. Thus mental stress tests could be an alternative to atrial pacing for patients who can't exercise, she added, stressing that:

"More research is needed, but these data suggest that therapies focused on helping patients deal with anger and other negative emotions may help reduce arrhythmias and, therefore, sudden cardiac death in certain patients."

"Anger-Induced T-Wave Alternans Predicts Future Ventricular Arrhythmias in Patients With Implantable Cardioverter- Defibrillators."

Lampert, Rachel, Shusterman, Vladimir, Burg, Matthew, McPherson, Craig, Batsford, William, Goldberg, Anna, Soufer, Robert.

J Am Coll Cardiol 2009; 53:774-778.

doi:10.1016/j.jacc.2008.10.053

Click here for Abstract.

Sources: Journal abstract, American College of Cardiology press statement, NHLBI.

Written by: Catharine Paddock, PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Calculating Gene And Protein Connections In A Parkinson's Disease Model

2009-02-23T11:00:00.000+02:00

A novel approach to analyzing cellular data is yielding new understanding of Parkinson's disease's destructive pathways.

Whitehead Institute and Massachusetts Institute of Technology (MIT) scientists have employed this new computational technique to analyze alpha-synuclein, a mysterious protein that is associated with Parkinson's disease.

Cells are constantly adapting to various stimuli, including changes in their environment and mutations, through an intricate web of molecular interactions. Knowledge of these changes is crucial for developing new treatments for diseases. To decipher how a cell responds to various stimuli, laboratories worldwide have been turning to new technologies that produce vast amounts of data. Such data typically exists in two major forms: genetic screen data (the results from deleting a gene from a cell's genome and seeing what observable traits appear in the cell) and information on the cellular levels of messenger RNA (mRNA, which is the template for proteins).

Historically, these two types of data have largely been analyzed independently of each other, revealing only glimpses of the cell's internal workings. Each type of data is actually biased toward identifying different aspects of cellular response, something that researchers had not realized until now. However, the new algorithm, known as ResponseNet, exploits these biases and allows for combined analysis.

In this combined analysis, both data types are integrated with molecular interactions data into a diagram that connects the experimentally identified proteins and genes. While this typically results in an extraordinarily complicated diagram, sometimes jokingly referred to as a "hairball", ResponseNet is designed to whittle the hairball down to the most probable pathways connecting various genes and proteins.

Esti Yeger-Lotem, a postdoctoral researcher in the laboratories of Whitehead Member Susan Lindquist and of Ernest Fraenkel at MIT's Biological Engineering department and co-author of the Nature Genetics article, says that by analyzing those probable pathways, a systems view of the cellular response emerges. "This allows for a more complete understanding of cellular response and can reveal hidden components of the response that may be targeted by drugs," she says.

According to Laura Riva, a postdoctoral researcher in MIT's biological engineering department and one of the designers of the algorithm, ResponseNet is potentially very useful for researchers.

"It is a powerful approach for interpreting experimental data because it can efficiently analyze tens of thousands of nodes and interactions," says Riva, who is also a co-author on the article. "The output of ResponseNet is a sparse network connecting some of the genetic data to some of the transcriptional data via intermediate proteins. Biologists can look at the network and understand which pathways are perturbed, and they can use it to generate testable hypotheses."

To demonstrate ResponseNet's capabilities, Yeger-Lotem entered the data from screens of 5,500 yeast strains (Saccharomyces cerevisiae). These strains are based on a yeast model that creates large amounts of the protein alpha-synuclein, thereby mimicking the toxic effects of alpha-synuclein accumulation in Parkinson's disease patients' brain cells.

Ernest Fraenkel, Assistant Professor of Biological Engineering at MIT, says that the alpha-synuclein data are an excellent test case for the algorithm, which has lead to new insights from existing data.

"The connection between alpha-synuclein and Parkinson's disease is enigmatic," says Fraenkel. "We have wonderful data from the yeast model, but despite this richness of data, so little is known about what alpha-synuclein really does in the cell."

Using these data, ResponseNet identified several links between alpha-synuclein toxicity and basic cell processes, including those used to recycle proteins and to usher the cell through its normal life cycle.

Surprisingly, ResponseNet also tied alpha-synuclein toxicity to a highly-conserved pathway targeted by cholesterol-lowering statin drugs and another pathway targeted by the immunosuppressing drug rapamycin.

To confirm ResponseNet's links and to test how these two pathways could affect alpha-synuclein toxicity, researchers added either rapamycin or the statin lovastatin to yeast model cultures. When the researchers added a low dose of rapamycin to the yeast model, the drug was toxic to the yeast. When lovastatin was added, the yeast reduced their growth rate, an indicator that the yeast had gotten sicker. However, when researchers added the molecule ubiquinone (also known as coenzyme Q10 or CoQ10), which is farther downstream in the statin network and possibly undersynthesized in alpha-synuclein-containing yeast, ubiquinone modestly suppressed alpha-synuclein toxicity.

All of these results validated the hypotheses based on ResponseNet's network.

"ResponseNet provides a wealth of new information," says Lindquist, who is also a Howard Hughes Medical Institute investigator and a professor of biology at MIT. "Some of the things we have found offer a promise to speed the development of new therapeutic strategies for Parkinson's disease. For the sake of the patients involved, let's hope they hold true in a human brain."

----------------------------

Article adapted by Medical News Today from original press release.

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Written by Nicole Giese

Ernest Fraenkel is the Eugene Bell Assistant Professor of biological engineering at Massachusetts Institute of Technology. Susan Lindquist's primary affiliation is with Whitehead Institute for Biomedical Research, where her laboratory is located and all her research is conducted. She is also a Howard Hughes Medical Institute investigator and a professor of biology at Massachusetts Institute of Technology.

Full Citation: "Bridging high-throughput genetic and transcriptional data reveals cellular responses to alpha-synuclein toxicity"

Nature Genetics, online February 22, 2009

Esti Yeger-Lotem (1,2,8), Laura Riva (1,8), Linhui Julie Su (2) Aaron D Gitler (2,7), Anil G. Cashikar (2,7), Oliver D King (2,7), Pavan K Auluck (2,3), Melissa L Geddie (2), Julie S Valastyan (2,4), David R Karger (5), Susan Lindquist (2,6) & Ernest Fraenkel (1,5)

Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
Whitehead Institute for Biomedical Research, Cambridge, Massachusetts 02142, USA.
Departments of Pathology and Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, and Harvard Medical School, Boston, Massachusetts 02115, USA.
Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
Howard Hughes Medical Institute, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
Present addresses: Department of Cell and Developmental Biology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA (A.D.G.), Medical College of Georgia, Augusta, Georgia, USA (A.G.C.) and Boston Biomedical Research Institute, Watertown, Massachusetts, USA (O.D.K.).
These authors contributed equally to this work.

Source: Nicole Giese

Whitehead Institute for Biomedical Research

For The First Time, Doctors Can Predict Which Hepatitis B Patients Have The Highest Chance To Achieve Treatment Success With Pegasys

2009-02-21T11:00:00.000+02:00

Immune-boosting effect of Pegasys provides patients with the chance for a clinical cure

New data presented showed that, for the first time, doctors can predict which hepatitis B patients treated with Pegasys (peginterferon alfa-2a) have the highest chance to achieve a positive treatment outcome and even a clinical cure1,2. The study results represent an important step forward, as some patients will now be able to feel confident during their Pegasys treatment about the likelihood of beating the disease.

Several studies at the major Asia-Pacific liver disease meeting (APASL) focused on measuring the decline in levels of a viral protein called surface or 's'-antigen, to provide insight into the likelihood of treatment success for patients treated with Pegasys. S-antigen clearance, considered a clinical cure, is associated with greatly reduced liver cancer, cirrhosis and an improved life expectancy3,4,5.

'In treating hepatitis B, we need to change mindsets and raise expectations so that patients and physicians are focused on achieving the best possible outcome clearance of the s-antigen. These new data show that measuring s-antigen decline throughout treatment can help determine success in the long-term. Doctors can now therefore make a strong case to certain patients that Pegasys treatment may provide treatment success or even a clinical cure,' said Dr Patrick Marcellin, Professor of Hepatology at the University of Paris and Head of the Viral Hepatitis Research Unit in Hôpital Beaujon, Clichy, France.

'Unlike anti-viral tablets for hepatitis B, which just reduce the number of viral copies, Pegasys also boosts the body's immune system and mobilises it to fight the disease,' commented William M. Burns, CEO Roche Pharmaceuticals Division. 'Due to these immune-stimulating effects, the number of patients treated with Pegasys who achieve a clinical cure has been shown to continue increasing for years after the end of treatment. This supports its use as a first-line therapy for hepatitis B.' Measuring success with Pegasys in the two types of hepatitis B

There are two types of patients with hepatitis B: those with early disease who still have the envelope or 'e'-antigen in their blood, and those who do not (called 'e-positive' and 'e-negative' disease, respectively). Although some of the treatment endpoints are different, s-antigen clearance is the ultimate goal of therapy in both types of hepatitis B.

All patients start off with e-positive disease. For e-positive patients, loss of the e-antigen after treatment, or 'e-seroconversion', signifies that therapy has worked well, and is a first important indicator of treatment success. In a new study looking at e-positive patients, the results showed that 50% of patients whose s-antigen levels dropped significantly 24 weeks after starting Pegasys treatment were able to achieve 'e-seroconversion', an important treatment endpoint for these patients. Furthermore, approximately 20% of the patients with e-seroconversion went on to achieve s-antigen clearance, a so-called 'clinical cure', six months after treatment had ended.2

In some patients, after many years of infection, the virus mutates and no longer produces the e-antigen; these patients are considered e-negative. In this form of the disease, the virus evades the body's immune system so that the infection and liver damage return.

According to another new study presented at APASL, the number of e-negative hepatitis B patients who achieved a clinical cure continued to increase, even after the end of treatment with Pegasys.1 At year five, 12.2% of Pegasys-treated patients had cleared s-antigen, compared with just 3.5% of lamivudine-treated patients. Whilst modest, the number of patients who achieve s-antigen clearance on Pegasys therapy is a breakthrough because such high rates of s-clearance have never been shown with an oral anti-viral.1 Furthermore, researchers observed that s-antigen decline during treatment was associated with the achievement of a clinical cure.1

The ability of a finite 48-week course of Pegasys to induce a long-term response with increasing s-antigen clearance rates in some patients makes it a cost-effective option compared with oral anti-virals, which may need to be taken for life.6

Measuring patients' response to therapy

New data were also presented at APASL on Roche's surface antigen test, Elecsys HBsAg II assay.7,8,9 In line with Roche's commitment to tailor treatment according to each patient's needs, growing scientific evidence is showing that this test application for quantitative detection of the s-antigen currently available on a research-only basis - represents a simple and reliable means of testing s-antigen levels, allowing doctors to accurately assess a patient's response to therapy and then to determine the most appropriate treatment approach.

About chronic hepatitis B

Chronic hepatitis B is a serious global healthcare problem that affects more than 350 million people worldwide. It is one of the principal causes of chronic liver disease, cirrhosis, and primary liver cancer. Approximately one million people die from chronic hepatitis B annually, making it the tenth leading cause of death worldwide. The ultimate objective of treatment in chronic hepatitis B is to induce s-antigen clearance, which is associated with complete and sustained remission of the liver disease, and improved life expectancy and is generally equated to clinical cure.

Pegasys in hepatitis B

Pegasys is approved for the treatment of chronic hepatitis B in over 60 countries. It is approved in the EU, the US and the People's Republic of China, among others.

About Roche

Headquartered in Basel, Switzerland, Roche is one of the world's leading research-focused healthcare groups in the fields of pharmaceuticals and diagnostics. As the world's biggest biotech company and an innovator of products and services for the early detection, prevention, diagnosis and treatment of diseases, the Group contributes on a broad range of fronts to improving people's health and quality of life. Roche is the world leader in in-vitro diagnostics and drugs for cancer and transplantation, and is a market leader in virology. It is also active in other major therapeutic areas such as autoimmune diseases, inflammatory and metabolic disorders and diseases of the central nervous system. In 2008 sales by the Pharmaceuticals Division totalled 36.0 billion Swiss francs, and the Diagnostics Division posted sales of 9.7 billion francs. Roche has R&D agreements and strategic alliances with numerous partners, including majority ownership interests in Genentech and Chugai, and invested nearly 9 billion Swiss francs in R&D in 2008. Worldwide, the Group employs about 80,000 people. Additional information is available on the Internet at http://www.roche.com.

All trademarks used or mentioned in this release are protected by law.

References

1) Marcellin P et al. HBsAg clearance continues to increase after the end of treatment with PEGASYS ± lamivudine: 5-year follow-up study in patients with HBeAg-negative disease. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

2) Lau GKK et al. HBsAg decline in patients treated with PEGASYS and its association with post-treatment response in HBeAg positive chronic hepatitis B. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

3) Marcellin P et al. Virological and biochemical response in patients with HBeAg-negative chronic hepatitis B treated with peginterferon alfa-2a (40KD) with or without lamivudine: results of 4-year follow-up. Presented at: 43rd Annual Meeting of the European Association for the Study of the Liver (EASL); April 23-27, 2008; Milan, Italy.

4) Fattovich G et al. Delayed clearance of serum HBsAg in compensated cirrhosis B: relation to interferon alpha therapy and disease prognosis. Am J Gastroenterol. 1998;93(6):896-900.

5) Perrillo RP. Therapy of hepatitis B viral suppression or eradication? Hepatology. 2006;43(2 suppl 1):S182-S193.

6) Hoofnagle JH et al. Management if hepatitis B: summary of a clinical research group. Hepatology. 2007;45(4):1056-1075.

7) Ferruccio B et al. Use of the Elecsys® HBsAg II assay for simple and accurate quantification of HBsAg levels in sera of patients infected with HBV. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

8) Jidong J et al. Comparison of the sensitivity and specificity of the Elecsys® HBsAg II assay with other available assays in China for detection of HBsAg. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

9) Louisirirotchanakul S et al. Multiple sites for evaluation of the performance of the Elecsys® HBsAg II assay. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

Roche

http://www.roche.com

Rare, Nearly Fatal Illness Brings Shattered Family Back Together

2009-02-20T11:00:00.000+02:00

Judy and Scott Lorenz had been through one of the most difficult periods of their lives.

Their marriage of 30 years broke up, leaving them bickering and at odds over a host of difficult emotional issues. Their son, 30-year-old Scott, and daughter, Chris, 25, were having equally difficult times struggling with their own feelings of blame and resentment about the dissolution of their parents' marriage.

But then a near-fatal illness forced them to set aside all their differences and come back together as one. In August 2008, Judy Lorenz was diagnosed with primary veno-occlusive disease, an extremely rare form of pulmonary hypertension. Her heart and lungs had begun to lose function. Without a double-lung transplant, she would die within a year.

"Sometimes in life it takes something like this to bring people together. You hear it all the time, but it's true," said Lorenz as ex-husband Scott looked on during a checkup at Loyola University Medical Center where she received her lifesaving transplant on Dec. 13, 2008. "As much as the entire family went through, that was all forgotten."

Scott agreed and added that though they are both dating other people now, he, Judy and their children have never been closer.

"It's kind of funny because while she was in the hospital bed, me and her boyfriend were in the room together eating pizza and keeping her company. My daughter walks in, sees us and says, 'Oh, my God " I need to be in therapy now,'" Scott Lorenz said. "We all laughed. Strangely enough, this gave us a second chance."

That second chance would have not have been possible without the skills of Loyola's transplant team and the surgeon who performed Judy's surgery, Dr. Robert Love, professor and vice chair of thoracic and cardiovascular surgery and surgical director, lung transplant, Loyola University Chicago Stritch School of Medicine, Maywood, Ill.

"Dr. Love and his team did a great job. They've been very much an advocate for me and I think they do a great job for every patient," Scott Lorenz said. "Without Dr. Love's influence to get this transplant to go, it probably never would have happened because she was a very high-risk patient."

What made Judy Lorenz's operation risky was her physical condition. Her illness, primary veno-occlusive disease, left her almost completely incapacitated. High blood pressure in the arteries that supply the lungs is called pulmonary hypertension. In Lorenz's case, the hypertension involved the pulmonary veins that returned oxygenated blood to her lungs. The right side of her heart struggled to expel blood into her lungs. The cause is unknown. "When the veins inside the lungs get blocked, the heart on the right side gradually ends up doing more work than it's built to do," Love said, who has performed more than 600 lung transplants but only two that involved the disease the led to Judy Lorenz's operation. "It's an incredibly rare disease." The prognosis for patients with primary veno-occlusive disease is grim. Eventually, their heart and lungs fail as a package, said Love, who oversees a program that is days away from performing its 600th transplant, which will place it among only five transplant centers in the United States that have achieved that feat. "That's why patients like Judy become so debilitated that they can hardly move. They have no cardiac reserve, no heart reserve, no lung reserve," Love said. "They can't deliver blood into their body with oxygen in it because they can't push it through the lungs."

By the time of her transplant Judy Lorenz was on eight liters of oxygen a day and was so ill that she could barely lift herself from bed. The first decision the Loyola transplant team had to make was if a transplant was even possible.

"The complexity of her illness along with her poor physical condition made her a high risk for not making it to and surviving transplantation," Love said.

For various reasons, a heart-lung transplant was out of the question in Judy Lorenz's case, Dr. Love said. But the transplant team concluded that her heart wasn't damaged to the point that it wouldn't recover if a double-lung transplant was performed.

"She was referred to Loyola largely because of our expertise in treating the most difficulty of cases, such as one involving end-stage heart and lung failure as in Judy's case," Love said. "We're one of the few hospitals in the Midwest that has the expertise to transplant a patient in Judy's condition."

Today, Judy Lorenz is looking forward to returning to a normal life. She can't wait to hit the gym to start working out again, plans to return to her favorite activity, dancing, and is thrilled to be slowing regaining her independence.

"Before my transplant, I couldn't do anything. It was tough relying on everyone to stand me up, to get me to the bathroom, to wheel me around. Every little move I made I could feel my breathing," she said. "After the operation when they took the ventilator out, I was like, 'Whoa. I think I'm breathing without help.' Then I thought, 'This is great' because I hadn't had that in three months."

Loyola University Health System

2160 S First Ave.

Maywood

IL 60153

United States

http://www.luhs.org

New Test To Identify Illegal Steroids In Cattle

2009-02-19T11:00:00.000+02:00

In an effort to curb the illegal use of steroids in the European beef industry, scientists in the United Kingdom are reporting the development of a new test that can identify steroids with higher accuracy, more convenience, and less cost than conventional doping tests. Their report is in the current issue of Analytical Chemistry, a semi-monthly journal.

In the new study, Rodat Cunningham and colleagues note that the European Union banned use of growth-promoting agents in cattle. However, widespread abuse of steroids continues and remains difficult to detect, they say. The standard methods for detecting steroid abuse --mass spectrometry and gas chromatography - involve directly measuring these substances in cattle. But the tests are expensive and can't detect some of the newer steroid hormones.

The scientists describe a new test that measures steroids indirectly based on chemical changes associated with growth and muscle development in steroid-treated cattle. Using a commercial blood analyzer commonly found in hospitals, the researchers measured 20 chemical markers, including proteins and cholesterol, in cattle treated with and without commonly used steroids over a 42-day study period. The new test detected the steroids with accuracy between 91 and 96 percent. The study opens the door to on-site steroid testing with portable instrumentation, the researchers say.

"Feasibility of a Clinical Chemical Analysis Approach To Predict Misuse of Growth Promoting Hormones in Cattle"

DOWNLOAD FULL TEXT ARTICLE

American Chemical Society

The world's largest scientific society.

http://www.acs.org

Staying Mentally Active But Not Prolonged TV Viewing Linked To Lower Memory Loss

2009-02-18T17:00:00.000+02:00

A study to be presented at a conference in the US in late spring suggests that staying mentally active as in reading magazines, or pursuing a craft or hobby like knitting, pottery, and even playing computer games, in later life may delay or prevent memory loss: however watching too much TV does not.

The study will be presented at the American Academy of Neurology's 61st Annual Meeting, which this year takes place from 25 April to 2 May in Seattle, Washington.

The researchers studied 197 people aged 70 to 89 who had been diagnosed with mild cognitive impairment or memory loss, and compared them to 1,124 people of the same age group who had no such symptoms.

They questioned both groups about their daily activities in middle age (when they were 50 to 65 years old) and within the past year.

The results showed that:

Participants whose daily activity in later life included reading books, playing games, using the computer, and doing crafts like pottery and quilting, had a 30 to 50 per cent lower risk of developing memory loss compared to participants who did none of these things.

Participants who spent less than seven hours a day in their later years watching TV were 50 per cent less likely to develop memory loss compared to those who spent more than 7 hours a day in front of the TV.

And participants who had socialized and read magazines during middle age were about 40 per cent less likely to develop memory loss later in life than those who had not.

One of the authors, Dr Yonas Geda, a neuropsychiatrist at the Mayo Clinic in Rochester, Maine, and a member of the American Academy of Neurology, said in a press statement that:

"This study is exciting because it demonstrates that aging does not need to be a passive process."

"By simply engaging in cognitive exercise, you can protect against future memory loss," Geda explained, while cautiously adding that:

"Of course, the challenge with this type of research is that we are relying on past memories of the participants, therefore, we need to confirm these findings with additional research."

Mild cognitive impairment is a stage between normal aging and the more serious problems of dementia and Alzheimer's. It often includes the memory loss problems associated with with Alzheimer's, but it doesn't have many of the other symptoms of full blown dementia.

Many people who have mild cognitive impairment (MCI) do go on to develop Alzheimer's, but some do not, so a diagnosis of MCI does not mean you will develop Alzheimer's.

Scientists at the Mayo Clinic are testing a simple way to help people with MCI to hang on to their independence. The system relies on monthly pocket calendars that are small enough to fit in a man's pocket or a woman's purse. Each day on the calendar shows planned events and things to do, plus miscellaneous notes like the weather forecast or something useful like what the latest bargain is at the local supermarket.

This type of memory tool has been tested and found successful with people who have suffered memory problems after brain injury, so the Mayo Clinic scientists are testing it on people with mild cognitive impairment to see if it serves them too. So far it appears that it does.

More information on the pocket calendar tool and trial can be found at http://www.mayoclinic.com/health/memory-loss/HA00001.

Abstracts for the American Academy of Neurology's 61st Annual Meeting will be available to view online from 25 February on this webpage http://www.aan.com/go/science/abstracts.

Sources: American Academy of Neurology, Mayo Clinic website.

Written by: Catharine Paddock, PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Researchers Explore New Driver Of Transplant Rejection: Platelets

2009-02-18T11:00:00.000+02:00

Platelets, tiny and relatively uncharted tenants of the bloodstream known mostly for their role in blood clotting, turn out to also rally sustained immune system inflammatory responses that play a critical role in organ transplant rejection, according to a new report from Johns Hopkins scientists.

"Platelets potentially hold sway over many aspects of transplant biology," says Craig Morrell, D.V.M., Ph.D., an assistant professor of molecular and comparative pathobiology at the Johns Hopkins University School of Medicine. "Our data, as well as others', show a surprising interplay of platelets and the immune system, so it's time for the transplant world at large to have platelets on its radar."

A self-described "platelet guy" transfixed by the unexplored biology of these circulating bodies, Morrell collaborated with clinicians in the fields of transplant to write a comprehensive review of platelets and transplant biology, published in the January issue of the American Journal of Transplantation.

"It all began with the observation that when transplant tissue is rejected, platelets line up in the interior of blood vessels feeding the tissue," Morrell says. "It turns out they are not just bystanders, but have a role in driving that rejection."

As one of the most abundant cell types in the blood second only to the oxygen-carrying red variety platelets are ubiquitous but relatively unexplored, Morrell says. "It's crazy how many potentially active molecules are jam-packed in these small cells and that we're only just beginning to appreciate their pro-inflammatory qualities."

In fact, mounting evidence from Morrell and others shows that platelets are part of a sustained and general immune response that can trigger or exacerbate organ rejection. Not only do they rush to the scene of a wound and adhere to local blood vessels, preventing fatal bleeding, they also dump out granules that "talk to" immune system white blood cells, Morrell says, recruiting them from far and wide to stave off potential infections.

These are on the whole very good things for platelets to do, Morrell says, but in the context of organ transplants, their pro-inflammatory function gets out of control, and they do more bad than good after contributing to initial wound healing.

Strategies using drugs or other means to keep platelets quiet and non-inflammatory might benefit transplant patients in the long run because chronic rejection as contrasted with acute or immediate organ rejection is a major complication for which there is little current treatment, according to Hamid Rabb, M.D., medical director of kidney transplantation and a professor of medicine at the Johns Hopkins University School of Medicine.

In prior research using mice with skin transplants, Morrell and his team noted that increased platelet interactions led to increased and prolonged white cell interactions with the inner lining of the blood vessels and worsened transplant vessel damage.

"We watched platelets flowing through the blood vessels of transplanted skin in mice with and without platelets and determined tissue-platelet interactions by comparing the speeds of those flows," says Morrell, whose team ultimately demonstrated that antibodies made in reaction to the transplanted tissue sparked platelet activation and white cell recruitment.

Studies on tissue from platelet-depleted mice helped confirm the importance of platelets in white cell activation and recruitment, strongly suggesting that limiting the inflammatory response might improve transplanted tissue survival.

Mounting evidence suggesting that platelets are activated not only post-transplant, but also during organ harvest, presents new opportunities for attacking organ injury and rejection head-on, says Rabb. The traditional target of current anti-rejection medicine is the so-called T lymphocyte a white blood cell believed to be the major orchestrator of the immune response against any foreign tissues, including transplants.

"The thought was that if we hit the general that initiates acute rejection, it would put the troops in disarray," says Rabb. "Traditional therapies therefore inhibit or deplete T lymphocytes and other white blood cell components of the immune system. The newest kid on the block is the platelet and it represents an opportunity to target the effectors of organ injury rather than only the general."

The authors of the review, who were supported by National Institutes of Health grants, are A.D. Kirk, Emory Transplant Center, Emory University; W.M. Baldwin III, formerly of Johns Hopkins and now at the Lerner Research Institute; and Morrell, of Johns Hopkins.

Johns Hopkins Medicine

901 S Bond St., Ste. 550

Baltimore

MD 21231

United States

http:// www.hopkinsmedicine.org

Personal Private Medical Insurance Launched By NPA Insurance

2009-02-17T17:00:00.000+02:00

NPA Insurance is launching Private Medical Insurance designed for pharmacists and their families. The NPA's medical insurance offers comprehensive benefits such as out-patient, inpatient and day-treatment. Complementary therapies and medicines are also included as standard along with helpful advice lines and a claims service with experienced and friendly staff.

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- A comprehensive product covering complementary medicines and therapies - these could include physiotherapy, chiropractic, osteopathy, acupuncture or homeopathy

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- Easy arrangement of treatment over the phone

- Optional cover for long term health conditions such as heart and cancer treatment

- Easy transfer from existing private health insurer

- A range of helpful advice lines and a 24 hour counselling service.

A bespoke group health scheme can be arranged for larger groups.

Paul Coleman, NPA Insurance Director, explains some of the particular advantages of taking out medical insurance from NPA Insurance: "Our research showed that many NPA members already have some form of health insurance but that there is a need for a more comprehensive offering. We believe our policy will fulfil this need.

"We have made transferring from an existing provider easier and we offer the same rates to customers switching from their existing health provider as we offer to first time customers. Making a claim is even easier. In most circumstances, our customers will simply need to call the Claims Helpline and treatment will be arranged and approved over the telephone - no forms will have to be completed. This makes things so much simpler, and is likely to be especially helpful at a time when you could be under particular stress."

Notes

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Diagnostic tests - Core benefit

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Our dedicated UK based call centre will be happy to supply more detailed information and can give an immediate quotation over the phone. Please call 0800 496 0426 between 08.30 a.m. - 5.30 p.m. Monday - Friday.

Further information can also be obtained from http://www.npainsurance.co.uk.

NPA Insurance

Watchdog Calls On NHS To Get Responses To Complaints 'Right First Time' And Learn Lessons From Them, UK

2009-02-17T11:00:00.000+02:00

Report highlights that patients remain concerned about how trusts deal with their complaints, as well as the same basic aspects of healthcare

Some NHS trusts are still not responding to complaints effectively or learning lessons from them, says the Healthcare Commission in its report published yesterday.

The way trusts handle complaints is still the number one issue raised by complainants, accounting for 19% of cases reviewed, up from 16% last year.

In almost half of complaints reviewed, the Commission either upheld the complaint or sent it back to the trust for further work because the trust's initial response to the complainant was not good enough.

Patients and the public also continue to raise issues about the same basic aspects of healthcare such as: poor communication (12% of cases, down from 17% in 2006/07), standard of treatment (11% up from 6% in 2006/07), delay or failure to diagnosis a condition (9%), and delays in accessing care (8% up from 4% in 2006/07).

Each year the NHS delivers 380 million treatments and receives around 135,000 complaints. The Commission reviews cases where the patient is unhappy with the response from the trust. The report, the third of its kind, covers the 8,949 complaints reviewed in the year to 31 July 2008.

The Commission upheld 30% of the cases reviewed in this period, up from almost 20% last year. In a further 17% of cases (down from 26% in 2006/07), the Commission found the trust's response to the complainant was not sufficient and it was sent back to the trust for further work. This means almost half of complaints reviewed required further work by the trust.

Twenty-seven percent were out of the Commission's jurisdiction, mostly because the complainant had not raised their concerns locally first. This is up from 24% last year, suggesting that some trusts are not making the complaints procedure clear enough for patients and the public or that people do not have faith in the independence of the local procedure.

Eighteen percent of cases were found in favour of the trust as it was found that the NHS had handled them appropriately. Most of the remaining cases were either withdrawn by the complainant or referred on to the Parliamentary and Health Service Ombudsman.

The report shows there were an equal number of complaints reviewed by the Commission about both primary and hospital care (both 43%). The remainder were about mental health trusts (10%), strategic health authorities (1%), ambulance trusts (0.9%), prisons (0.8%) and other trusts (2%).

Anna Walker, the Commission's Chief Executive, said: "Considering that millions of treatments are delivered by the NHS each year it is perhaps encouraging that we only receive around 8,000 complaints a year. However, it is concerning that around half of complainants received an inadequate response from the trust when they first complained and we required further work to be done on the complaint.

"It is also concerning that complaints raised with us continue to be about the same basic aspects of healthcare such as poor communication, inadequate treatment and failure to diagnose conditions.

"It is clear from our wider work on complaints that trusts are not always systematically learning from them and improving their services for the future as a result. They clearly need to do so.

"It is very important that people feel that they can complain about their NHS trust if they need to and that the trust will respond positively to their complaint and learn general lessons from it.

"We have made 12 key recommendations to all trusts to improve the way they handle complaints. These are basics which patients should be entitled to.

"Things are sometimes bound to go wrong given the amount of care the NHS provides. But we will have a stronger NHS if it can embrace complaints where justified and really learn from them rather than adopt a defensive approach."

Analysis of the complaints reviewed by the Commission reveals the following themes:

- Hospitals (43% of total)

The majority of complaints about hospitals were concerning nursing care. Of these, 43.5% were about general care, highlighting issues such as nutrition, falls and observation of patients.

- GP practices (11% of total)

Complaints about GPs were the most common type of complaint about the primary care sector. Twenty-five percent of complaints about GPs were in relation to a delay or failure to diagnose a condition or illness.

- Dental surgeries (4% of total)

The majority of complaints about dental services related to treatment (36%). This included issues such as delays in accessing services and incorrect or unsuccessful treatment.

- Accident and emergency care (3% of total)

The main issues complained about were related to treatment (24%). There were concerns about ambulance response times and incorrect treatment.

- Maternity services (2% of total)

Thirty-one percent of complaints about maternity services were about treatment. These include complainants' concerns about the standard and timeliness of treatment they received.

- Mental health services (5% of total)

The main concerns were in relation to general care (47%), such as the appropriateness of treatment, care review meetings and the use of control and restraint.

- Learning disabilities (0.3% of total)

These were not primarily complaints made about learning disability services, but healthcare services for those with learning disabilities. Recommendations to the trust were made in over half of cases.

The Commission has made 12 key recommendations to all NHS trusts to improve the way they resolve complaints in preparation for the new system.

It recommends trusts should: acknowledge the person's right to complain, take statements and interview staff involved in events leading to the complaint, ensure any letters to the person are clearly written and free from complex clinical terminology, ensure that the person is kept informed of progress, offer an unequivocal apology where appropriate and ensure that general learning is taken from specific complaints and is embedded into the system.

From 1 April 2009, a new two-tier complaints handling system will replace the current three-tier procedure. If a person complains to a trust and they are unhappy with the trust's response they will be able to request a review from the Parliamentary and Health Service Ombudsman. The new system will put more emphasis on trusts resolving complaints at a local level. It is therefore even more important that they improve their initial handling of complaints to make sure patients are not disadvantaged.

The Commission emphasises that trusts need to learn from this report.

Spotlight on complaints 2009: A report on second-stage complaints about the NHS in England

Complaints procedure

The current procedure for complaints is a three-tier process. If someone is unhappy with the treatment or service they have received from the NHS, they are entitled to make a complaint and receive a response from the trust. If the complainant is still not happy with the response, they can refer it to the Healthcare Commission to request an independent review. If, following a review, the complainant is still unhappy they may refer it to the Parliamentary and Health Service Ombudsman.

A new two-tier system will replace the current procedure from 1 April 2009. If a complainant is unhappy with a trust's response they may refer it directly to the Parliamentary and Health Service Ombudsman to request a review.

When the Commission first took over responsibility for reviewing complaints in 2004, it faced a much higher than expected demand for its service that led to a build up of 5,000 open cases. The Commission cleared these cases and it now resolves 95% of complaints within six months, each taking two months on average. It has reviewed over 30,000 complaints and made 16,500 recommendations to trusts to resolve complaints and improve services for patients

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

From 1 April 2009, the Care Quality Commission will bring together the work of the Commission for Social Care Inspection, the Healthcare Commission, and the Mental Health Act Commission. The new commission will regulate the quality of care in health and adult social care and look after the interests of people detained under the Mental Heath Act. This is the first time that independent regulation of health, mental heath and social care has been brought together in this way.

Healthcare Commission

Doctors Can Now Predict Which Hepatitis B Patients Have The Highest Chance To Achieve Treatment Success With Pegasys(R)

2009-02-16T17:00:00.000+02:00

New data presented howed that, for the first time, doctors can predict which hepatitis B patients treated with Pegasys® (peginterferon alfa-2a) have the highest chance to achieve a positive treatment outcome-and even a clinical cure.[i],[ii] The study results represent an important step forward, as some patients will now be able to feel confident during their Pegasys treatment about the likelihood of beating the disease.

Several studies at the major Asia-Pacific liver disease meeting (APASL) focused on measuring the decline in levels of a viral protein called surface or 's'-antigen, to provide insight into the likelihood of treatment success for patients treated with Pegasys. S-antigen clearance, considered a clinical cure, is associated with greatly reduced liver cancer, cirrhosis and an improved life expectancy.[iii],[iv],[v]

'In treating hepatitis B, we need to change mindsets and raise expectations so that patients and physicians are focused on achieving the best possible outcome-clearance of the s-antigen. These new data show that measuring s-antigen decline throughout treatment can help determine success in the long-term. Doctors can now therefore make a strong case to certain patients that Pegasys treatment may provide treatment success or even a clinical cure,' said Dr Patrick Marcellin, Professor of Hepatology at the University of Paris and Head of the Viral Hepatitis Research Unit in Hôpital Beaujon, Clichy, France.

'Unlike anti-viral tablets for hepatitis B, which just reduce the number of viral copies, Pegasys also boosts the body's immune system and mobilises it to fight the disease,' commented William M. Burns, CEO Roche Pharmaceuticals Division. 'Due to these immune-stimulating effects, the number of patients treated with Pegasys who achieve a clinical cure has been shown to continue increasing for years after the end of treatment. This supports its use as a first-line therapy for hepatitis B.'

Measuring success with Pegasys in the two types of hepatitis B

There are two types of patients with hepatitis B: those with early disease who still have the envelope or 'e'-antigen in their blood, and those who do not (called 'e-positive' and 'e-negative' disease, respectively). Although some of the treatment endpoints are different, s-antigen clearance is the ultimate goal of therapy in both types of hepatitis B.

All patients start off with e-positive disease. For e-positive patients, loss of the e-antigen after treatment, or 'e-seroconversion', signifies that therapy has worked well, and is a first important indicator of treatment success. In a new study looking at e-positive patients, the results showed that 50% of patients whose s-antigen levels dropped significantly 24 weeks after starting Pegasys treatment were able to achieve 'e-seroconversion', an important treatment endpoint for these patients. Furthermore, approximately 20% of the patients with e-seroconversion went on to achieve s-antigen clearance, a so-called 'clinical cure', six months after treatment had ended.ii

In some patients, after many years of infection, the virus mutates and no longer produces the e-antigen; these patients are considered e-negative. In this form of the disease, the virus evades the body's immune system so that the infection and liver damage return.

According to another new study presented at APASL, the number of e-negative hepatitis B patients who achieved a clinical cure continued to increase, even after the end of treatment with Pegasys.i At year five, 12.2% of Pegasys-treated patients had cleared s-antigen, compared with just 3.5% of lamivudine-treated patients. Whilst modest, the number of patients who achieve s-antigen clearance on Pegasys therapy is a breakthrough because such high rates of s-clearance have never been shown with an oral anti-viral. i Furthermore, researchers observed that s-antigen decline during treatment was associated with the achievement of a clinical cure.i

The ability of a finite 48-week course of Pegasys to induce a long-term response with increasing s-antigen clearance rates in some patients makes it a cost-effective option compared with oral anti-virals, which may need to be taken for life.[vi]

Measuring patients' response to therapy

New data were also presented at APASL on Roche's surface antigen test, Elecsys HBsAg II assay.[vii],[viii],[ix] In line with Roche's commitment to tailor treatment according to each patient's needs, growing scientific evidence is showing that this test application for quantitative detection of the s-antigen - currently available on a research-only basis - represents a simple and reliable means of testing s-antigen levels, allowing doctors to accurately assess a patient's response to therapy and then to determine the most appropriate treatment approach.

About chronic hepatitis B

Chronic hepatitis B is a serious global healthcare problem that affects more than 350 million people worldwide. It is one of the principal causes of chronic liver disease, cirrhosis, and primary liver cancer. Approximately one million people die from chronic hepatitis B annually, making it the tenth leading cause of death worldwide. The ultimate objective of treatment in chronic hepatitis B is to induce s-antigen clearance, which is associated with complete and sustained remission of the liver disease, and improved life expectancy and is generally equated to clinical cure.

Pegasys in hepatitis B

Pegasys is approved for the treatment of chronic hepatitis B in over 60 countries. It is approved in the EU, the US and the People's Republic of China, among others.

About Roche

Headquartered in Basel, Switzerland, Roche is one of the world's leading research-focused healthcare groups in the fields of pharmaceuticals and diagnostics. As the world's biggest biotech company and an innovator of products and services for the early detection, prevention, diagnosis and treatment of diseases, the Group contributes on a broad range of fronts to improving people's health and quality of life. Roche is the world leader in in-vitro diagnostics and drugs for cancer and transplantation, and is a market leader in virology. It is also active in other major therapeutic areas such as autoimmune diseases, inflammatory and metabolic disorders and diseases of the central nervous system. In 2008 sales by the Pharmaceuticals Division totalled 36.0 billion Swiss francs, and the Diagnostics Division posted sales of 9.7 billion francs. Roche has R&D agreements and strategic alliances with numerous partners, including majority ownership interests in Genentech and Chugai, and invested nearly 9 billion Swiss francs in R&D in 2008. Worldwide, the Group employs about 80,000 people. Additional information is available on the Internet at http://www.roche.com.

All trademarks used or mentioned in this release are protected by law.

Additional information

-About Hepatitis, Roche Health Kiosk

-About Pegasys and Hepatitis

References

[i] Marcellin P et al. HBsAg clearance continues to increase after the end of treatment with PEGASYS ± lamivudine: 5-year follow-up study in patients with HBeAg-negative disease. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

[ii] Lau GKK et al. HBsAg decline in patients treated with PEGASYS and its association with post-treatment response in HBeAg positive chronic hepatitis B. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

[iii] Marcellin P et al. Virological and biochemical response in patients with HBeAg-negative chronic hepatitis B treated with peginterferon alfa-2a (40KD) with or without lamivudine: results of 4-year follow-up. Presented at: 43rd Annual Meeting of the European Association for the Study of the Liver (EASL); April 23-27, 2008; Milan, Italy.

[iv] Fattovich G et al. Delayed clearance of serum HBsAg in compensated cirrhosis B: relation to interferon alpha therapy and disease prognosis. Am J Gastroenterol. 1998;93(6):896-900.

[v] Perrillo RP. Therapy of hepatitis B-viral suppression or eradication? Hepatology. 2006;43(2 suppl 1):S182-S193.

[vi] Hoofnagle JH et al. Management of hepatitis B: summary of a clinical research group. Hepatology. 2007;45(4):1056-1075.

[vii] Ferruccio B et al. Use of the Elecsys® HBsAg II assay for simple and accurate quantification of HBsAg levels in sera of patients infected with HBV. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

[viii] Jidong J et al. Comparison of the sensitivity and specificity of the Elecsys® HBsAg II assay with other available assays in China for detection of HBsAg. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

[ix] Louisirirotchanakul S et al. Multiple sites for evaluation of the performance of the Elecsys® HBsAg II assay. Presented at: Asian Pacific Association for the Study of the Liver (APASL); February 13-16, 2009; Hong Kong, China.

Roche