OMAHA, Neb. - Doctors and nurses on the go often skip soap and water in favor of an alcohol-based hand gel, thinking the quick-acting goo will kill bacteria on their hands and curb the spread of infection. It turns out that's not enough.
In a Nebraska hospital, medical workers nearly doubled their use of the alcohol-based gel, but their generally cleaner hands had no bearing on the rate of infections among patients.
The doctor who studied the problem pointed to many villains: Rings and fingernails that are too long and hard to clean, poor handling of catheters and treatment areas that aren't sanitized.
"Hand hygiene is still important, but it's not a panacea," said Dr. Mark Rupp, an infectious disease specialist at the University of Nebraska Medical Center. He led the study at the adjoining Nebraska Medical Center.
The results of his study appear to contradict hospital guidelines from the Centers for Disease Control and Prevention that say better hand hygiene — through frequent washing or use of hand gels — has been shown to cut the spread of hospital infections.
The spread of infection-causing germs in U.S. hospitals is a huge health problem, accounting for an estimated 1.7 million infections and 99,000 deaths each year, according to the CDC. These include drug-resistant staph, urinary tract infections and ventilator-associated pneumonia, among others.
"There are many factors that influence the development of hospital-acquired infections. It would be naive to think that a single, simple intervention would fix this problem," Rupp said.
His study appears in the January issue of Infection Control and Hospital Epidemiology.
Research has shown alcohol-based hand gels are more effective, faster and easier to use than soap and water. The findings of the new study were based on 300 hours of hand hygiene observations of nurses and doctors in two comparable intensive care units over a two-year period.
More gel dispensers were put in the units, and usage rose from 37 percent to 68 percent in one unit and from 38 percent to 69 percent in the other. Compliance for hand washing of any kind in most hospitals is estimated to be about 40 percent, according to experts, although some hospitals do better.
Every two months, bacteria samples were taken from health workers' hands, which were found to be cleaner when using the alcohol gel.
The infection rates in both ICUs were "relatively low," the study said. And researchers found "no significant relationship" between rates of hand gel use and infections among patients. In fact, in one unit the infection rate rose when the hand gel was widely available and its use promoted.
Rupp found the results surprising. However, he said hospital-borne infections cannot be stopped by better hand hygiene alone because infections aren't limited to person-to-person contact.
He suggested hand gels be combined with other measures, such as better cleaning of hospital units, proper insertion and maintenance of catheters, and doctors prescribing antibiotics only when necessary so more drug-resistant bacteria don't pop up.
He also said hospital workers shouldn't wear rings and should trim their fingernails even more than the CDC recommendation of no longer than a quarter of an inch. Rupp said bacteria showed up when nails extended just beyond the fingertip.
Mike Bell, who deals with infection control at the CDC, said that while he didn't agree that hand gels do little to reduce infection, Rupp was right to say they were just one part of the solution.
"If they don't do everything else right, having clean hands is not enough," he said.
Both Bell and Dr. David Hooper of Massachusetts General Hospital in Boston suggested that Rupp's study would have shown a reduction in infections if it was conducted over a longer period.
Hooper said the compliance rate for hand hygiene at Massachusetts General has been about 90 percent for the past several years. The number of drug-resistant staph cases was cut in half and continues to decline, he said.
___
On the Net:
University of Nebraska Medical Center: http://www.unmc.edu/
Centers for Disease Control and Prevention: http://www.cdc.gov/
Massachusetts General Hospital: http://www.massgeneral.org/
Tuesday, January 29, 2008
Wednesday, January 23, 2008
Obesity surgery seen as diabetes cure
CHICAGO - A new study gives the strongest evidence yet that obesity surgery can cure diabetes.
Patients who had surgery to reduce the size of their stomachs were five times more likely to see their diabetes disappear over the next two years than were patients who had standard diabetes care, according to Australian researchers.
Most of the surgery patients were able to stop taking diabetes drugs and achieve normal blood tests.
"It's the best therapy for diabetes that we have today, and it's very low risk," said the study's lead author, Dr. John Dixon of Monash University Medical School in Melbourne, Australia.
The patients had stomach band surgery, a procedure more common in Australia than in the United States, where gastric bypass surgery, or stomach stapling, predominates.
Gastric bypass is even more effective against diabetes, achieving remission in a matter of days or a month, said Dr. David Cummings, who wrote an accompanying editorial in the journal but was not involved in the study.
"We have traditionally considered diabetes to be a chronic, progressive disease," said Cummings of the University of Washington in Seattle. "But these operations really do represent a realistic hope for curing most patients."
Diabetes experts who read the study said surgery should be considered for some obese patients, but more research is needed to see how long results last and which patients benefit most. Surgery risks should be weighed against diabetes drug side effects and the long-term risks of diabetes itself, they said.
Experts generally agree that weight-loss surgery would never be appropriate for diabetics who are not obese, and current federal guidelines restrict the surgery to obese people.
The diabetes benefits of weight-loss surgery were known, but the Australian study in Wednesday's Journal of the American Medical Association is the first of its kind to compare diabetes in patients randomly assigned to surgery or standard care. Scientists consider randomized studies to yield the highest-quality evidence.
The study involved 55 patients, so experts will be looking for results of larger experiments under way.
"Few studies really qualify as being a landmark study. This one is," said Dr. Philip Schauer, who was not involved in the Australian research but leads a Cleveland Clinic study that is recruiting 150 obese people with diabetes to compare two types of surgery and standard medical care.
"This opens an entirely new way of thinking about diabetes."
Obesity is a major risk factor for diabetes, and researchers are furiously pursuing reasons for the link as rates for both climb. What's known is that excess fat can cause the body's normal response to insulin to go haywire. Researchers are investigating insulin-regulating hormones released by fat and the role of fatty acids in the blood.
In the Australian study, all the patients were obese and had been diagnosed with type 2 diabetes during the past two years. Their average age was 47. Half the patients underwent a type of surgery called laparoscopic gastric banding, where an adjustable silicone cuff is installed around the upper stomach, limiting how much a person can eat.
Both groups lost weight over two years; the surgery patients lost 46 pounds on average, while the standard-care patients lost an average of 3 pounds.
Blood tests showed diabetes remission in 22 of the 29 surgery patients after two years. In the standard-care group, only four of the 26 patients achieved that goal. The patients who lost the most weight were the most likely to eliminate their diabetes.
Both patient groups learned about low-fat, high-fiber diets and were encouraged to exercise. Both groups could meet with a health professional every six weeks for two years.
The death rate for stomach band surgery, which can cost $17,000 to $20,000, is about 1 in 1,000. There were only minor complications in the study. Stomach stapling has a 2 percent death rate and costs $20,000 to $30,000.
In the United States, surgeons perform more than 100,000 obesity surgeries each year.
The American Diabetes Association is interested in the findings. The group revises its recommendations each fall, taking new research into account.
"There is a growing body of evidence that bariatric surgery is an effective tool for managing diabetes," said Dr. John Buse of the University of North Carolina School of Medicine in Chapel Hill, the association's president for medicine and science.
"It's just a question of how effective is it, for what spectrum of patients, over what period of time and at what cost? Not all those questions have been answered yet."
Medical devices used in the study were provided by the manufacturers, but the companies had no say over the study's design or its findings, Dixon said.
Patients who had surgery to reduce the size of their stomachs were five times more likely to see their diabetes disappear over the next two years than were patients who had standard diabetes care, according to Australian researchers.
Most of the surgery patients were able to stop taking diabetes drugs and achieve normal blood tests.
"It's the best therapy for diabetes that we have today, and it's very low risk," said the study's lead author, Dr. John Dixon of Monash University Medical School in Melbourne, Australia.
The patients had stomach band surgery, a procedure more common in Australia than in the United States, where gastric bypass surgery, or stomach stapling, predominates.
Gastric bypass is even more effective against diabetes, achieving remission in a matter of days or a month, said Dr. David Cummings, who wrote an accompanying editorial in the journal but was not involved in the study.
"We have traditionally considered diabetes to be a chronic, progressive disease," said Cummings of the University of Washington in Seattle. "But these operations really do represent a realistic hope for curing most patients."
Diabetes experts who read the study said surgery should be considered for some obese patients, but more research is needed to see how long results last and which patients benefit most. Surgery risks should be weighed against diabetes drug side effects and the long-term risks of diabetes itself, they said.
Experts generally agree that weight-loss surgery would never be appropriate for diabetics who are not obese, and current federal guidelines restrict the surgery to obese people.
The diabetes benefits of weight-loss surgery were known, but the Australian study in Wednesday's Journal of the American Medical Association is the first of its kind to compare diabetes in patients randomly assigned to surgery or standard care. Scientists consider randomized studies to yield the highest-quality evidence.
The study involved 55 patients, so experts will be looking for results of larger experiments under way.
"Few studies really qualify as being a landmark study. This one is," said Dr. Philip Schauer, who was not involved in the Australian research but leads a Cleveland Clinic study that is recruiting 150 obese people with diabetes to compare two types of surgery and standard medical care.
"This opens an entirely new way of thinking about diabetes."
Obesity is a major risk factor for diabetes, and researchers are furiously pursuing reasons for the link as rates for both climb. What's known is that excess fat can cause the body's normal response to insulin to go haywire. Researchers are investigating insulin-regulating hormones released by fat and the role of fatty acids in the blood.
In the Australian study, all the patients were obese and had been diagnosed with type 2 diabetes during the past two years. Their average age was 47. Half the patients underwent a type of surgery called laparoscopic gastric banding, where an adjustable silicone cuff is installed around the upper stomach, limiting how much a person can eat.
Both groups lost weight over two years; the surgery patients lost 46 pounds on average, while the standard-care patients lost an average of 3 pounds.
Blood tests showed diabetes remission in 22 of the 29 surgery patients after two years. In the standard-care group, only four of the 26 patients achieved that goal. The patients who lost the most weight were the most likely to eliminate their diabetes.
Both patient groups learned about low-fat, high-fiber diets and were encouraged to exercise. Both groups could meet with a health professional every six weeks for two years.
The death rate for stomach band surgery, which can cost $17,000 to $20,000, is about 1 in 1,000. There were only minor complications in the study. Stomach stapling has a 2 percent death rate and costs $20,000 to $30,000.
In the United States, surgeons perform more than 100,000 obesity surgeries each year.
The American Diabetes Association is interested in the findings. The group revises its recommendations each fall, taking new research into account.
"There is a growing body of evidence that bariatric surgery is an effective tool for managing diabetes," said Dr. John Buse of the University of North Carolina School of Medicine in Chapel Hill, the association's president for medicine and science.
"It's just a question of how effective is it, for what spectrum of patients, over what period of time and at what cost? Not all those questions have been answered yet."
Medical devices used in the study were provided by the manufacturers, but the companies had no say over the study's design or its findings, Dixon said.
Monday, January 21, 2008
Caffeine doubles miscarriage risk: study
CHICAGO (Reuters) - Pregnant women who drink two or more cups of coffee a day have twice the risk of having a miscarriage as those who avoid caffeine, U.S. researchers said on Monday.
They said the study provides strong evidence that high doses of caffeine during pregnancy -- 200 milligrams or more per day or the equivalent of two cups of coffee -- significantly increase the risk of miscarriage.
And they said the research may finally put to rest conflicting reports about the link between caffeine consumption and miscarriage.
"Women who are pregnant or are actively seeking to become pregnant should stop drinking coffee for three months or hopefully throughout pregnancy," said Dr. De-Kun Li of Kaiser Permanente Division of Research, whose study appears in the American Journal of Obstetrics and Gynecology.
"There has been a lot of uncertainty about this," Li said in a telephone interview. "There was no firm advice from professional societies to say what a pregnant woman should do about caffeine intake."
Li said anywhere from 15 to 18 studies have found a link between caffeine use during pregnancy and miscarriage. But that association has been clouded by the fact that many pregnant women avoid caffeine because it makes them nauseated, which could skew the results.
Li and colleagues took pains to control for that possibility. Their study involved 1,063 pregnant women who were members of the Kaiser Permanente health plan in San Francisco from October 1996 through October 1998. Women in the group never changed their caffeine consumption during pregnancy.
What they found was women who consumed the equivalent of two or more cups of regular coffee or five 12-ounce cans of caffeinated soda -- were twice as likely to miscarry as pregnant women who avoided caffeine.
This risk appeared to be related to the caffeine, rather than other chemicals in coffee, because they also saw an increased risk when the caffeine was consumed in soda, tea, and hot chocolate.
Li said many researchers think caffeine is harmful because it stresses the fetus' immature metabolism. It may also decrease blood flow in the placenta, which could harm the fetus.
"To me, the safe dose is zero," Li said. "If you really have to drink coffee, try to limit it to one cup or at the most two cups." Or better yet, switch to decaffeinated beverages, he added.
Based on the findings, Dr. Tracy Flanagan, director of women's health at Kaiser Permanente Northern California, said pregnant women should think about limiting coffee to one cup a day, and they might want to cut it out entirely.
"So many causes of miscarriage are not controllable," she said in a telephone interview. "This is an opportunity to do something active."
They said the study provides strong evidence that high doses of caffeine during pregnancy -- 200 milligrams or more per day or the equivalent of two cups of coffee -- significantly increase the risk of miscarriage.
And they said the research may finally put to rest conflicting reports about the link between caffeine consumption and miscarriage.
"Women who are pregnant or are actively seeking to become pregnant should stop drinking coffee for three months or hopefully throughout pregnancy," said Dr. De-Kun Li of Kaiser Permanente Division of Research, whose study appears in the American Journal of Obstetrics and Gynecology.
"There has been a lot of uncertainty about this," Li said in a telephone interview. "There was no firm advice from professional societies to say what a pregnant woman should do about caffeine intake."
Li said anywhere from 15 to 18 studies have found a link between caffeine use during pregnancy and miscarriage. But that association has been clouded by the fact that many pregnant women avoid caffeine because it makes them nauseated, which could skew the results.
Li and colleagues took pains to control for that possibility. Their study involved 1,063 pregnant women who were members of the Kaiser Permanente health plan in San Francisco from October 1996 through October 1998. Women in the group never changed their caffeine consumption during pregnancy.
What they found was women who consumed the equivalent of two or more cups of regular coffee or five 12-ounce cans of caffeinated soda -- were twice as likely to miscarry as pregnant women who avoided caffeine.
This risk appeared to be related to the caffeine, rather than other chemicals in coffee, because they also saw an increased risk when the caffeine was consumed in soda, tea, and hot chocolate.
Li said many researchers think caffeine is harmful because it stresses the fetus' immature metabolism. It may also decrease blood flow in the placenta, which could harm the fetus.
"To me, the safe dose is zero," Li said. "If you really have to drink coffee, try to limit it to one cup or at the most two cups." Or better yet, switch to decaffeinated beverages, he added.
Based on the findings, Dr. Tracy Flanagan, director of women's health at Kaiser Permanente Northern California, said pregnant women should think about limiting coffee to one cup a day, and they might want to cut it out entirely.
"So many causes of miscarriage are not controllable," she said in a telephone interview. "This is an opportunity to do something active."
Food poisoning can be long-term problem
WASHINGTON - It's a dirty little secret of food poisoning: E. coli and certain other foodborne illnesses can sometimes trigger serious health problems months or years after patients survived that initial bout.
Scientists only now are unraveling a legacy that has largely gone unnoticed.
What they've spotted so far is troubling. In interviews with The Associated Press, they described high blood pressure, kidney damage, even full kidney failure striking 10 to 20 years later in people who survived severe E. coli infection as children, arthritis after a bout of salmonella or shigella, and a mysterious paralysis that can attack people who just had mild symptoms of campylobacter.
"Folks often assume once you're over the acute illness, that's it, you're back to normal and that's the end of it," said Dr. Robert Tauxe of the Centers for Disease Control and Prevention. The long-term consequences are "an important but relatively poorly documented, poorly studied area of foodborne illness."
These late effects are believed to make up a very small fraction of the nation's 76 million annual food poisonings, although no one knows just how many people are at risk. A bigger question is what other illnesses have yet to be scientifically linked to food poisoning.
And with a rash of food recalls — including more than 30 million pounds of ground beef pulled off the market last year alone — these are questions are taking on new urgency.
"We're drastically underestimating the burden on society that foodborne illnesses represent," contends Donna Rosenbaum of the consumer advocacy group STOP, Safe Tables Our Priority.
Every week, her group hears from patients with health complaints that they suspect or have been told are related to food poisoning years earlier, like a woman who survived severe E. coli at 8 only to have her colon removed in her 20s. Or people who develop diabetes after food poisoning inflamed the pancreas. Or parents who wonder if a child's learning problems stem from food poisoning-caused dialysis as a toddler.
"There's nobody to refer them to for an answer," says Rosenbaum.
So STOP this month is beginning the first national registry of food-poisoning survivors with long-term health problems — people willing to share their medical histories with scientists in hopes of boosting much-needed research.
Consider Alyssa Chrobuck of Seattle, who at age 5 was hospitalized as part of the Jack-in-the-Box hamburger outbreak that 15 years ago this month made a deadly E. coli strain notorious.
She's now a successful college student but ticks off a list of health problems unusual for a 20-year-old: High blood pressure, recurring hospitalizations for colon inflammation, a hiatal hernia, thyroid removal, endometriosis.
"I can't eat fatty foods. I can't eat things that are fried, never been able to eat ice cream or milkshakes," says Chrobuck. "Would I have this many medical problems if I hadn't had the E. coli? Definitely not. But there's no way to tie it definitely back."
The CDC says foodborne illnesses cause 325,000 hospitalizations and 5,000 deaths a year. Among survivors, some long-term consequences are obvious from the outset. Some required kidney transplants. They may have scarred intestines that promise lasting digestive difficulty.
But when people appear to recover, it is difficult to prove that later problems really are a food-poisoning legacy and not some unfortunate coincidence. It may be that people prone to certain gastrointestinal conditions, for instance, also are genetically more vulnerable to germs that cause foodborne illness.
For now, some of the best evidence comes from the University of Utah, which has long tracked children with E. coli. About 10 percent of E. coli sufferers develop a life-threatening complication called hemolytic uremic syndrome, or HUS, where their kidneys and other organs fail.
Ten to 20 years after they recover, between 30 percent and half of HUS survivors will have some kidney-caused problem, says Dr. Andrew Pavia, the university's pediatric infectious diseases chief. That includes high blood pressure caused by scarred kidneys, slowly failing kidneys, even end-stage kidney failure that requires dialysis.
"I don't want to leave the message that everyone who had symptoms ... is in trouble," stresses Pavia.
Miserable as E. coli is, it doesn't seem to trigger long-term problems unless it started shutting down the kidneys the first time around, he says. "People with uncomplicated diarrhea, by and large we don't have evidence yet that they have complications."
Other proven long-term consequences:
_About 1 in 1,000 sufferers of campylobacter, a diarrhea-causing infection spread by raw poultry, develop far more serious Guillain-Barre syndrome a month or so later. Their body attacks their nerves, causing paralysis that usually requires intensive care and a ventilator to breathe. About a third of the nation's Guillain-Barre cases have been linked to previous campylobacter, even if the diarrhea was very mild, and they typically suffer a more severe case than patients who never had food poisoning.
While they eventually recover, "We don't know a great deal about what happens to those people five years later. What does 'normal' look like?" Tauxe says.
_A small number of people develop what's called reactive arthritis six months or longer after a bout of salmonella. It causes joint pain, eye inflammation, sometimes painful urination, and can lead to chronic arthritis. Certain strains of shigella and yersinia bacteria, far more common abroad than in the U.S., trigger this reactive arthritis, too, Tauxe says.
What about other patient complaints?
A variety of other organ problems might be triggered by HUS, that severe E. coli — because it causes blood clots all over the body that could leave a trail of damage, says Utah's Pavia. Among his hottest questions: HUS patients often suffer pancreatitis. Does that increase risk for diabetes later in life?
But proving a connection will require tracking a lot of patients who can provide very good medical records documenting their initial foodborne illness, he cautions.
Scientists only now are unraveling a legacy that has largely gone unnoticed.
What they've spotted so far is troubling. In interviews with The Associated Press, they described high blood pressure, kidney damage, even full kidney failure striking 10 to 20 years later in people who survived severe E. coli infection as children, arthritis after a bout of salmonella or shigella, and a mysterious paralysis that can attack people who just had mild symptoms of campylobacter.
"Folks often assume once you're over the acute illness, that's it, you're back to normal and that's the end of it," said Dr. Robert Tauxe of the Centers for Disease Control and Prevention. The long-term consequences are "an important but relatively poorly documented, poorly studied area of foodborne illness."
These late effects are believed to make up a very small fraction of the nation's 76 million annual food poisonings, although no one knows just how many people are at risk. A bigger question is what other illnesses have yet to be scientifically linked to food poisoning.
And with a rash of food recalls — including more than 30 million pounds of ground beef pulled off the market last year alone — these are questions are taking on new urgency.
"We're drastically underestimating the burden on society that foodborne illnesses represent," contends Donna Rosenbaum of the consumer advocacy group STOP, Safe Tables Our Priority.
Every week, her group hears from patients with health complaints that they suspect or have been told are related to food poisoning years earlier, like a woman who survived severe E. coli at 8 only to have her colon removed in her 20s. Or people who develop diabetes after food poisoning inflamed the pancreas. Or parents who wonder if a child's learning problems stem from food poisoning-caused dialysis as a toddler.
"There's nobody to refer them to for an answer," says Rosenbaum.
So STOP this month is beginning the first national registry of food-poisoning survivors with long-term health problems — people willing to share their medical histories with scientists in hopes of boosting much-needed research.
Consider Alyssa Chrobuck of Seattle, who at age 5 was hospitalized as part of the Jack-in-the-Box hamburger outbreak that 15 years ago this month made a deadly E. coli strain notorious.
She's now a successful college student but ticks off a list of health problems unusual for a 20-year-old: High blood pressure, recurring hospitalizations for colon inflammation, a hiatal hernia, thyroid removal, endometriosis.
"I can't eat fatty foods. I can't eat things that are fried, never been able to eat ice cream or milkshakes," says Chrobuck. "Would I have this many medical problems if I hadn't had the E. coli? Definitely not. But there's no way to tie it definitely back."
The CDC says foodborne illnesses cause 325,000 hospitalizations and 5,000 deaths a year. Among survivors, some long-term consequences are obvious from the outset. Some required kidney transplants. They may have scarred intestines that promise lasting digestive difficulty.
But when people appear to recover, it is difficult to prove that later problems really are a food-poisoning legacy and not some unfortunate coincidence. It may be that people prone to certain gastrointestinal conditions, for instance, also are genetically more vulnerable to germs that cause foodborne illness.
For now, some of the best evidence comes from the University of Utah, which has long tracked children with E. coli. About 10 percent of E. coli sufferers develop a life-threatening complication called hemolytic uremic syndrome, or HUS, where their kidneys and other organs fail.
Ten to 20 years after they recover, between 30 percent and half of HUS survivors will have some kidney-caused problem, says Dr. Andrew Pavia, the university's pediatric infectious diseases chief. That includes high blood pressure caused by scarred kidneys, slowly failing kidneys, even end-stage kidney failure that requires dialysis.
"I don't want to leave the message that everyone who had symptoms ... is in trouble," stresses Pavia.
Miserable as E. coli is, it doesn't seem to trigger long-term problems unless it started shutting down the kidneys the first time around, he says. "People with uncomplicated diarrhea, by and large we don't have evidence yet that they have complications."
Other proven long-term consequences:
_About 1 in 1,000 sufferers of campylobacter, a diarrhea-causing infection spread by raw poultry, develop far more serious Guillain-Barre syndrome a month or so later. Their body attacks their nerves, causing paralysis that usually requires intensive care and a ventilator to breathe. About a third of the nation's Guillain-Barre cases have been linked to previous campylobacter, even if the diarrhea was very mild, and they typically suffer a more severe case than patients who never had food poisoning.
While they eventually recover, "We don't know a great deal about what happens to those people five years later. What does 'normal' look like?" Tauxe says.
_A small number of people develop what's called reactive arthritis six months or longer after a bout of salmonella. It causes joint pain, eye inflammation, sometimes painful urination, and can lead to chronic arthritis. Certain strains of shigella and yersinia bacteria, far more common abroad than in the U.S., trigger this reactive arthritis, too, Tauxe says.
What about other patient complaints?
A variety of other organ problems might be triggered by HUS, that severe E. coli — because it causes blood clots all over the body that could leave a trail of damage, says Utah's Pavia. Among his hottest questions: HUS patients often suffer pancreatitis. Does that increase risk for diabetes later in life?
But proving a connection will require tracking a lot of patients who can provide very good medical records documenting their initial foodborne illness, he cautions.
Sunday, January 13, 2008
Seven New Cholesterol Genes Discovered
SUNDAY, Jan. 13 (HealthDay News) -- Seven new cholesterol-regulating genes, some of which influence the risk of heart disease, have been identified in an international study of almost 20,000 people in three countries.
"I would predict that some of these genes will be the targets for future drugs," said the study's senior author, Goncalo Abecasis, an associate professor of biostatistics at the University of Michigan School of Public Health.
In their report, published in the Jan. 13 issue of Nature Genetics., the researchers also confirmed the role of 11 previously identified cholesterol-related genes in the risk of heart disease.
"What was most exciting was that only the genetic changes that affect LDL cholesterol influence the risk of heart disease," Abecasis said. "Every genetic change that raises the level of LDL cholesterol influences the risk of heart disease."
LDL cholesterol is well known to be the "bad" kind that forms plaques that eventually can block arteries, causing heart attacks and other cardiovascular troubles. LDL cholesterol is the target of statins, drugs given to reduce coronary risk. HDL cholesterol is the "good" kind, which does not contribute to plaque formation.
"The conventional wisdom is that HDL cholesterol is good for you," Abecasis said. "But in our studies we found no major impact from those genes changing HDL cholesterol levels."
The research, done in collaboration with University of North Carolina and Harvard University researchers, started with genetic studies of 8,800 people from Italy, Sweden and Finland.
The researchers examined more than 2 million genetic variations in those individuals, eventually concentrating on 25 genetic variants, which together are responsible for about 25 percent of levels of blood lipids such as cholesterol.
The study associated incidence of different variants with the incidence of heart disease in those individuals. The results were then confirmed in a study of 11,000 individuals from the three populations.
Future research centering on the newly identified genes could produce "drugs that are as effective as statins in affecting the risk of heart disease," Abecasis said.
Another paper in the same issue of the journal reported the possible discovery of the long-sought "thrifty gene," whose existence was proposed more than three decades ago.
A study of more than a half-million genetic variants in 2,000 Europeans and Indian Asians found that a gene designated MLXIPL works the way the thrifty gene is said to do, turning excess blood glucose into fat tissue.
"These genes are advantageous during times of famine," said research leader Dr. James Scott, a professor of cardiovascular medicine at Imperial College in London.
However, in this era of plenty, the thrifty gene can be a serious problem.
"It's hard to say we've proved that it is a thrifty gene," Scott said. "But it looks like it has all the characteristics of such a gene. We hope this goes a long way toward proving it."
The thrifty gene would be "part of the very complex genetics of a complex disease such as obesity or of heart disease," Scott said. "This would be another step on the pathway of understanding why a person's family history is an indication of the risk of cardiovascular disease."
More information
The different cholesterols are described by the American Heart Association.
"I would predict that some of these genes will be the targets for future drugs," said the study's senior author, Goncalo Abecasis, an associate professor of biostatistics at the University of Michigan School of Public Health.
In their report, published in the Jan. 13 issue of Nature Genetics., the researchers also confirmed the role of 11 previously identified cholesterol-related genes in the risk of heart disease.
"What was most exciting was that only the genetic changes that affect LDL cholesterol influence the risk of heart disease," Abecasis said. "Every genetic change that raises the level of LDL cholesterol influences the risk of heart disease."
LDL cholesterol is well known to be the "bad" kind that forms plaques that eventually can block arteries, causing heart attacks and other cardiovascular troubles. LDL cholesterol is the target of statins, drugs given to reduce coronary risk. HDL cholesterol is the "good" kind, which does not contribute to plaque formation.
"The conventional wisdom is that HDL cholesterol is good for you," Abecasis said. "But in our studies we found no major impact from those genes changing HDL cholesterol levels."
The research, done in collaboration with University of North Carolina and Harvard University researchers, started with genetic studies of 8,800 people from Italy, Sweden and Finland.
The researchers examined more than 2 million genetic variations in those individuals, eventually concentrating on 25 genetic variants, which together are responsible for about 25 percent of levels of blood lipids such as cholesterol.
The study associated incidence of different variants with the incidence of heart disease in those individuals. The results were then confirmed in a study of 11,000 individuals from the three populations.
Future research centering on the newly identified genes could produce "drugs that are as effective as statins in affecting the risk of heart disease," Abecasis said.
Another paper in the same issue of the journal reported the possible discovery of the long-sought "thrifty gene," whose existence was proposed more than three decades ago.
A study of more than a half-million genetic variants in 2,000 Europeans and Indian Asians found that a gene designated MLXIPL works the way the thrifty gene is said to do, turning excess blood glucose into fat tissue.
"These genes are advantageous during times of famine," said research leader Dr. James Scott, a professor of cardiovascular medicine at Imperial College in London.
However, in this era of plenty, the thrifty gene can be a serious problem.
"It's hard to say we've proved that it is a thrifty gene," Scott said. "But it looks like it has all the characteristics of such a gene. We hope this goes a long way toward proving it."
The thrifty gene would be "part of the very complex genetics of a complex disease such as obesity or of heart disease," Scott said. "This would be another step on the pathway of understanding why a person's family history is an indication of the risk of cardiovascular disease."
More information
The different cholesterols are described by the American Heart Association.
Friday, January 11, 2008
People live 4.5 years after dementia strikes: study
LONDON (Reuters) - People with dementia survive an average four-and-a-half years after diagnosis, researchers said on Friday in a study they hope might help care-givers plan for patients with Alzheimer's and other, similar illnesses.
Researchers know dementia raises the risk of dying early but the study is the first to estimate how long people are likely to survive with the condition, said Carol Brayne, a researcher at the Institute of Public Health at the University of Cambridge.
"This gives people a rough idea of how long they are looking at," said Brayne, who led the study published in the British Medical Journal. "This can add more to the information that physicians and families have."
An estimated 24 million people worldwide have the mental confusion marked by memory loss and problems with orientation that signals Alzheimer's disease and other forms of dementia.
The researchers, who said the number of people with dementia was expected to rise to 81 million globally by 2040, studied 13,000 people aged 65 or older who were assessed for the condition at regular intervals between 1991 to 2005.
During this time, 438 people developed dementia, of whom 81 percent died. Age, gender and disability were the main factors determining how long a person survived, the researchers said.
Women lived for 4.6 years compared to 4.1 years for men. There was nearly seven years difference in survival between the youngest and oldest, with people aged 65 to 69 living 10.7 years and those over 90 living 3.8 years, the researchers found.
"The type of care and the environment where a person is living is also important," Brayne said in a telephone interview.
The study also found that the most frail patients died on average three years sooner than people who are more robust, even with age factored in.
The findings might help policy makers, families and health professionals better plan and care for people with dementia to determine things such as how long a person might be in an institution, the researchers said.
"Some of these results may seem self-evident but they answer questions asked by those caring for and advising people with dementia," the researchers wrote.
"We hope the estimates will be valuable to patients, clinicians, carers, service providers and policy makers."
Researchers know dementia raises the risk of dying early but the study is the first to estimate how long people are likely to survive with the condition, said Carol Brayne, a researcher at the Institute of Public Health at the University of Cambridge.
"This gives people a rough idea of how long they are looking at," said Brayne, who led the study published in the British Medical Journal. "This can add more to the information that physicians and families have."
An estimated 24 million people worldwide have the mental confusion marked by memory loss and problems with orientation that signals Alzheimer's disease and other forms of dementia.
The researchers, who said the number of people with dementia was expected to rise to 81 million globally by 2040, studied 13,000 people aged 65 or older who were assessed for the condition at regular intervals between 1991 to 2005.
During this time, 438 people developed dementia, of whom 81 percent died. Age, gender and disability were the main factors determining how long a person survived, the researchers said.
Women lived for 4.6 years compared to 4.1 years for men. There was nearly seven years difference in survival between the youngest and oldest, with people aged 65 to 69 living 10.7 years and those over 90 living 3.8 years, the researchers found.
"The type of care and the environment where a person is living is also important," Brayne said in a telephone interview.
The study also found that the most frail patients died on average three years sooner than people who are more robust, even with age factored in.
The findings might help policy makers, families and health professionals better plan and care for people with dementia to determine things such as how long a person might be in an institution, the researchers said.
"Some of these results may seem self-evident but they answer questions asked by those caring for and advising people with dementia," the researchers wrote.
"We hope the estimates will be valuable to patients, clinicians, carers, service providers and policy makers."
Thursday, January 3, 2008
Possible Parkinson's trigger identified
LONDON (Reuters) - A glitch in the way cells clear damaged proteins could be the trigger for the symptoms of Parkinson's disease, researchers said in a finding that could lead to new treatments for the incurable condition.
The U.S. team focused on a process called autophagy in which cells digest and recycle damaged molecules, including proteins, that develop as cells grow older. This system essentially renews cells to keep them functioning properly.
This mechanism is also important for nerve cells in the brain where defective proteins can kill cells and cause the debilitating symptoms of Parkinson's, such as tremors, said Ana Maria Cuervo, a cell biologist who led the study.
"We have found in Parkinson's there are problems in removing abnormal proteins," said Cuervo of the Albert Einstein College of Medicine of Yeshiva University.
The finding could potentially lead to drugs to treat the symptoms but not cure the disease, which affects more than a million patients in the United States alone and is marked by the death of brain cells that produce dopamine.
Dopamine is a neurotransmitter, or message-carrying chemical, associated with movement.
Cuervo had previously shown how mutant forms of a protein called alpha-synuclein -- found in a tiny percentage of Parkinson's patients -- blocked the breakdown of substances and prevented cells from clearing damaged proteins.
In the study in The Journal of Clinical Investigation on Wednesday, the team showed how in the majority of patients dopamine modifies normal proteins to act like the mutated ones to trigger tremors and other symptoms.
"What we have found is dopamine modifies alpha-synuclein that really resembles the mutation," Cuervo said. "That is why they have the same symptoms."
Problems in this process have also been linked with other neurodegenerative conditions such as Alzheimer's and Huntington's disease, though the specific mechanisms that cause problems in those conditions are different, she said.
Cuervo said a drug to fix the breakdown in Parkinson's patients was years away because it would take researchers time to understand fully how the process worked.
"This is not something that is going to lead to a treatment tomorrow," she said. "The hope is within five years we can get companies to find a drug able to activate this system."
The U.S. team focused on a process called autophagy in which cells digest and recycle damaged molecules, including proteins, that develop as cells grow older. This system essentially renews cells to keep them functioning properly.
This mechanism is also important for nerve cells in the brain where defective proteins can kill cells and cause the debilitating symptoms of Parkinson's, such as tremors, said Ana Maria Cuervo, a cell biologist who led the study.
"We have found in Parkinson's there are problems in removing abnormal proteins," said Cuervo of the Albert Einstein College of Medicine of Yeshiva University.
The finding could potentially lead to drugs to treat the symptoms but not cure the disease, which affects more than a million patients in the United States alone and is marked by the death of brain cells that produce dopamine.
Dopamine is a neurotransmitter, or message-carrying chemical, associated with movement.
Cuervo had previously shown how mutant forms of a protein called alpha-synuclein -- found in a tiny percentage of Parkinson's patients -- blocked the breakdown of substances and prevented cells from clearing damaged proteins.
In the study in The Journal of Clinical Investigation on Wednesday, the team showed how in the majority of patients dopamine modifies normal proteins to act like the mutated ones to trigger tremors and other symptoms.
"What we have found is dopamine modifies alpha-synuclein that really resembles the mutation," Cuervo said. "That is why they have the same symptoms."
Problems in this process have also been linked with other neurodegenerative conditions such as Alzheimer's and Huntington's disease, though the specific mechanisms that cause problems in those conditions are different, she said.
Cuervo said a drug to fix the breakdown in Parkinson's patients was years away because it would take researchers time to understand fully how the process worked.
"This is not something that is going to lead to a treatment tomorrow," she said. "The hope is within five years we can get companies to find a drug able to activate this system."
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