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New Algorithm for Ruptured Aneurysms Improves Mortality Rate

Heart • • Public HealthJun 12 09

Researchers from the University of Washington in Seattle report that algorithms for the management of ruptured abdominal aortic aneurysm (rAAA) with a preference for endovascular repair (EVAR), serve as surrogates for an organized approach to managing the disease process and reducing overall mortality. These findings are from a study presented today at the 63rd Annual Meeting of the Society for Vascular Surgery®.

“The staff at Harborview Medical Center treat between 30 and 50 patients per year with rAAAs,” said Benjamin W. Starnes, MD, chief in the division of vascular surgery and associate professor of surgery at the University of Washington. “In this study we sought to evaluate the effect on mortality with the implementation of an algorithm to manage these patients with a preference for EVAR when feasible.”

During the study period, 187 patients with rAAA underwent attempted repair at Harborview Medical Center. Thirty-day mortality ratios were calculated and compared using Chi Square and Fisher’s Exact Test where appropriate, continuous variables were compared with a Mann-Whitney U test. Before implementation of the algorithm, (between July 1, 2002 and June 30, 2007) a total of 131 patients with rAAA were managed and treated. One-hundred and twenty-eight underwent surgical treatment and the 30-day mortality rate was 58 percent. Sixty-five percent of these patients were hypotensive at presentation.

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Doctor Works to Reduce Cancer Burden in Africa

CancerJun 12 09

In 2010, cancer will be the single leading cause of death worldwide, overtaking chronic illnesses such as heart disease and stroke. Already cancer causes more deaths than HIV/AIDS, tuberculosis and malaria combined. Almost three-quarters of new cases will occur in developing countries, with more than a million cases in sub-Saharan Africa by 2020, according to World Health Organization projections.

Scot Remick, M.D., director of the Mary Babb Randolph Cancer Center at West Virginia University, is leading U.S. efforts to help prepare for the growing cancer burden in Third World nations. He heads the International Working Group of the National Cancer Institute’s AIDS Malignancy Consortium, which has been instrumental in training doctors and building clinical trials for AIDS-related diseases in Uganda and Kenya.

“Most people don’t realize that by 2010 cancer will be the single greatest cause of mortality worldwide,” said Remick after returning from the May-June meeting of the American Society of Clinical Oncology, where he chaired an education session on the topic. “Anywhere from 15 to 20 percent of cancers are due to transmissible causes, and healthcare professionals in the industrialized world are likely to underestimate the role of infectious agents – even though they constitute a significant burden.”

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Depression Medications May Reduce Male Fertility

Depression • • Sexual HealthJun 12 09

As many as half of all men taking the antidepressant medication paroxetine (trade names Seroxat, Paxil) may have increased sperm DNA fragmentation—a predictor of compromised fertility. Research led by NewYork-Presbyterian Hospital/Weill Cornell Medical Center also found that the changes are reversible with normal levels of sperm returning after discontinuation of the drug.

The study is currently published in the online edition of the journal Fertility & Sterility, and represents one of the first scientific investigations into the effect of antidepressants on sperm quality.

“It’s fairly well known that SSRI antidepressants negatively impact erectile function and ejaculation. This study goes one step further, demonstrating that they can cause a major increase in genetic damage to sperm,” says Dr. Peter Schlegel, the study’s senior author. “Although this study doesn’t look directly at fertility, we can infer that as many as half of men taking SSRIs have a reduced ability to conceive. These men should talk with their physician about their treatment options, including non-SSRI depression medications.”

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Hormone May Help Combat Frailty in Older Women

Endocrinology • • Weight LossJun 12 09

Frail elderly women with unexplained weight loss may benefit from supplementation with the body’s appetite-stimulating hormone, ghrelin, or with similar agents, according to a new study. Results of the study, which was funded partially by the National Institutes of Health, were presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.

Unexplained weight loss is a common problem in older adults. It can lead to the development of frailty, a debilitating syndrome of declines across multiple body systems.

Frail individuals have much higher rates of functional decline, hospitalization and death than healthier people their age, said study lead investigator Anne Cappola, MD, ScM, assistant professor of medicine at the University of Pennsylvania School of Medicine, Philadelphia.

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63 percent of RA patients suffer psychiatric disorders, with depressive spectrum conditions most lik

Arthritis • • Psychiatry / Psychology • • Rheumatic DiseasesJun 12 09

Copenhagen, Denmark, Friday 12 June 2009: Over half (63%) of patients with rheumatoid arthritis (RA) also suffer from psychiatric disorders, with the majority of these (87%) occurring in the depressive spectrum, according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. Interestingly, over half (52%) of the patients studied indicated that they had experienced stress events before the onset of their RA.

The study also revealed a number of other interesting findings about the emotional burden of RA:

  * Cognitive dysfunction was diagnosed in 23% of patients, with 16% of this attributed to depression
  * A third (33%) suffered from sleep disorders
  * Those with depression also exhibited more severe RA (measured by X-ray), greater functional insufficiency and pain, as well as having received less aggressive treatment than patients without depression. (No significant differences in age, duration of illness, gender or DAS28* scores were noted between the two groups)
  * Significantly, cognitive impairments were found more often (p=0.02) in patients older than 50 years (39% vs. 9%)
  * The age of the first prednisone intake was significantly higher (p<0.05) in patients with depression compared to those without (48 vs. 30 years)

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3 studies confirm the value of etanercept therapy in treating juvenile idiopathic arthritis

ArthritisJun 12 09

Copenhagen, Denmark, Friday 12 June 2009: Three new studies have individually shown the anti-TNF (tumour necrosis factor) therapy etanercept to be effective, with a good safety profile, in children under four years of age with juvenile idiopathic arthritis (JIA), and associated with improved Health-Related Quality of Life (HRQoL) in a substantial proportion of children with JIA. The data are being presented at the Paediatric Rheumatology European Society Congress (PReS) 2009, a joint congress with the 2009 Congress of the European League Against Rheumatism (EULAR) in Copenhagen, Denmark.

The first study, conducted in Italy, showed entanercept to be effective, with a good safety profile, in children under four years of age (an as yet unlicensed patient population for the treatment). Thirty-three patients under four years of age with unresponsive JIA (24 female, 9 male) were treated with etanercept for an average of 23 months. After the first 6 months of treatment, 82% achieved the ACR Pedi 30* response and 48% achieved the ACR Pedi 70* response. There was a low rate of mild adverse events, whilst one patient temporarily suspended treatment following hospitalisation for an infection.

The second study, conducted in The Netherlands, from the Arthritis and Biological in Children (ABC) project, observed impressive improvements in the Health-Related Quality of Life (HRQoL) of 53 patients with previously refractory (unresponsive) JIA in seven Dutch centres during entanercept use of at least 27 months. These comprised both disease-specific improvements (inflamed joints, functional impairment, erythrocyte sedimentation rate (ESR), a laboratory marker of inflammation) (p<0.001) and all generic HRQoL outcomes impaired by JIA (including pain, movement and dexterity) (p<0.05).

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RA individuals from lower GDP countries keep working despite worse symptoms than richer countries

Arthritis • • Rheumatic DiseasesJun 12 09

Copenhagen, Denmark, Friday 12 June 2009: Individuals diagnosed with rheumatoid arthritis (RA) in lower gross domestic product (GDP) countries (GDP below $11,000) are more likely to continue working despite higher disease activity and functional disability scores compared to their counterparts in higher GDP countries (GDP >$24,000) according to a new multinational study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark.

Among 1,650 individuals from 30 countries whose symptoms had begun during the 2000’s and who remained working after RA diagnosis, disability levels according to the Health Assessment Questionnaire (HAQ*) were 0.25 vs. 0.82 in men and 0.50 vs. 0.94 in women (p<0.001) in higher-GDP and lower-GDP countries, respectively, and the Disease Activity Scores (DAS28**) were 3.1 vs. 4.7 in men, and 3.5 vs. 4.8 in women (p<0.001). A Kaplan-Meier analysis (95% CI) showed that the probability of individuals continuing work for 2 years was 80% and the probability of continuing to work for 5 years was 68%.

Dr Tuulikki Sokka, Jyväskylä Central Hospital, Finland, who leads the project said: “Work disability is the most costly consequence of RA, and the rheumatology community would welcome better treatment strategies to effectively address this. However, real-life data from 30 countries indicate that work disability is still a major issue in early RA during this decade, and especially in low-GDP countries where people continue to work with considerable disease activity and functional limitations.”

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Inactivity, Obesity Factors in Adult Asthmatics Higher Health Care Use

Asthma • • ObesityJun 10 09

Health care use is higher in adult asthmatic patients when compared with non-asthmatic patients, and inactivity and obesity are contributing to this increase, according to a report published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).

Shilpa Dogra, MSc, of the Lifespan Health and Performance Laboratory at York University in Toronto, Ontario, Canada, and colleagues, also found that overnight hospital stays were more common in inactive asthmatic patients regardless of body mass index (BMI), whereas both BMI and physical activity were important determinants of physician consultations.

Investigators analyzed self-reported data of an adult population of 6,835 with asthma and 78,051 without asthma from the 2005 Canadian Community Health Survey (CCHS), a nationally representative population-based cross-sectional survey. Their findings include:

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WHO getting close to declaring H1N1 pandemic

Public HealthJun 10 09

The World Health Organization is getting close to declaring a full H1N1 influenza pandemic but wants to make sure countries are well prepared for such a move to prevent a panic, its top flu expert said Tuesday.

Keiji Fukuda, acting WHO assistant director-general, voiced concern at the sustained spread of the new strain in countries, including more than 1,000 cases in Australia, following major outbreaks in North America where it was first detected.

The disease, widely known as swine flu, which has infected over 26,500 people in 73 countries, with 140 deaths, has also spread widely in Britain, Spain and Japan.

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Kansas abortion clinic won’t reopen after murder

Public HealthJun 10 09

The family of a murdered Kansas abortion doctor said on Tuesday they would not reopen his clinic, which was one of only a few in the United States willing to provide late-term abortions.

George Tiller, 67, died in the foyer of his church, shot once in the face as he served as an usher at Sunday services on May 31.

Police quickly arrested anti-abortion protestor Scott Roeder, 51, and have charged him with first-degree murder and aggravated assault in the killing.

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Relationship found between napping, hyperactivity, depression and anxiety

Depression • • Psychiatry / Psychology • • Sleep AidJun 08 09

Napping may have a significant influence on young children’s daytime functioning, according to a research abstract that will be presented on Monday, June 8 at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies.

Results indicate that children between the ages of 4 and 5 who did not take daytime naps were reported by their parents to exhibit higher levels of hyperactivity, anxiety and depression than children who continued to nap at this age.

According to lead author Brian Crosby, PhD, postdoctoral fellow of psychology at Pennsylvania State University, previous studies have shown that poor or inadequate sleep is linked with symptoms of hyperactivity, anxiety and depression; researchers involved in this study were happy to demonstrate the potential importance of napping for optimal daytime functioning in young children, as napping is often overlooked in favor of nighttime or total sleep.

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Antidepressant curbs cancer-related mental ills

Cancer • • Psychiatry / PsychologyJun 04 09

People with cancer often suffer mental impairment, but it seems this can be alleviated by treatment with Paxil, an SSRI-type antidepressant, according to results of a National Cancer Institute-supported study.

The findings were reported this week at the American Society of Clinical Oncology’s annual meeting in Orlando.

“Cancer and its treatment impact important areas of cognitive function such as attention and memory, which are essential to patients’ effective psychosocial functioning and quality of life,” Dr. Pascal Jean-Pierre, from the University of Rochester, New York and colleagues point out in a meeting paper.

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Chinese researchers find way to make pig stem cells

Flu • • Public HealthJun 04 09

Researchers have found a way to transform ordinary cells from pigs into powerful stem cells in a move that may have implications for human health.

With these stem cells, they hope to modify porcine genes that are related to the immune system so that pigs’ organs may some day be used for people in need of transplants.

In an article published in the Journal of Molecular Cell Biology, the researchers from China described how they managed to re-programme ordinary cells taken from the ear and bone marrow of a 10-week-old pig using a virus.

“The cells changed and developed in the laboratory into colonies of embryonic-like stem cells,” wrote the researchers, led by Xiao Lei, who heads the stem cell lab at the Shanghai Institute of Biochemistry and Cell Biology.

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Bird flu viruses need warm nose to set up shop

FluJun 04 09

Influenza viruses that normally infect birds are adapted to proliferate most efficiently at temperatures higher than those encountered in the upper airways of humans, according to a new report.

“I think this study helps explain two things,” Dr. Raymond J. Pickles told Reuters Health. It could be the reason why people need to be exposed to large amounts of bird virus to get infected “and, second, why these infected individuals do not show the classic cough, sneezing, and transmissibility of seasonal flu’s.”

Pickles, at the University of North Carolina at Chapel Hill, and his colleagues developed a model of the human airway to investigate the influence of temperature on human and bird influenza virus replication and spread.

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U.S. House Democrat doubtful of more flu money now

FluJun 04 09

U.S. House Majority Leader Steny Hoyer on Wednesday said President Barack Obama may not get the extra $2 billion he requested to combat the H1N1 flu strain that has infected thousands of Americans.

A pending war funding bill that has already passed the House of Representatives included $2 billion while the Senate version had $1.5 billion.

Lawmakers are trying to resolve their differences but Hoyer was skeptical that more flu funds would be added for now.

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