Showing posts with label Other Health News. Show all posts
Showing posts with label Other Health News. Show all posts

Wednesday, August 22, 2018

Toxin at heart of drug recall shows holes in medical safety net

August 22, 2018

Toxin at heart of drug recall shows holes in medical safety net 
Alexandra Harney, Ben Hirschler
SHANGHAI/LONDON (Reuters) - A toxin inadvertently produced in the manufacture of a widely prescribed medicine but not spotted for years raises questions about regulators’ ability to detect risks in a sprawling global drug supply chain increasingly reliant on factories in China.

China’s Zhejiang Huahai Pharmaceutical (600521.SS), which produces bulk ingredients for drugmakers, told its customers in late June it had found NDMA in its valsartan, an off-patent blood pressure drug originally developed by Novartis (NOVN.S). The discovery means that some of the 10 billion pills containing valsartan sold worldwide last year to prevent heart attacks and strokes had traces of N-nitrosodimethylamine (NDMA), classified as a probable human carcinogen. No one has been reported as sickened by the toxin, once used in the production of liquid rocket fuel... 

Wednesday, August 8, 2018

NIH researchers discover highly infectious vehicle for transmission of viruses among humans

NIH researchers discover highly infectious vehicle for transmission of viruses among humans

Researchers have found that a group of viruses that cause severe stomach illness — including the one famous for widespread outbreaks on cruise ships — get transmitted to humans through membrane-cloaked “virus clusters” that exacerbate the spread and severity of disease. Previously, it was believed that these viruses only spread through individual virus particles. The discovery of these clusters, the scientists say, marks a turning point in the understanding of how these viruses spread and why they are so infectious. This preliminary work could lead to the development of more effective antiviral agents than existing treatments that mainly target individual particles.

The researchers studied norovirus (link is external) and rotavirus (link is external)–hard-to-treat viruses that are the most common cause of stomach illness, or gastroenteritis, and that afflicts millions of people each year. The viruses cause symptoms ranging from diarrhea to abdominal pain and can sometimes result in death, particularly among young children and the elderly. Their highly contagious nature has led to serious outbreaks in crowded spaces throughout many communities; most notably in cruise ships, daycare centers, classrooms, and nursing homes. Fortunately, vaccines against rotavirus are now available and are routinely given to babies in the United States.

“This is a really exciting finding in the field of virology because it reveals a mode of virus spread that has not been observed among humans and animals,” said study leader Nihal Altan-Bonnet, Ph.D., senior investigator and head of the Laboratory of Host-Pathogen Dynamics at the National Heart, Lung, and Blood Institute (NHLBI). “We hope that it will provide new clues to fighting a wide range of diseases involving many types of viruses, including those that cause gastrointestinal illnesses, heart inflammation, certain respiratory illnesses, and even the common cold.”

The study was supported in part by the Intramural Research programs of the NHLBI and the National Institute of Allergy and Infectious Diseases (NIAID), both part of the National Institutes of Health. It is featured as the cover story of Cell Host & Microbe and appears online on August 8.

Until a few years ago, most scientists believed that viruses, particularly those responsible for stomach illnesses, could only behave as independent infectious agents. However, in 2015 Altan-Bonnet and her colleagues showed that polioviruses could transmit themselves in packets, or membrane-bound vesicles containing multiple virus particles. The scientists compared this new model of viral transmission to a Trojan horse: A group of membrane-bound viruses arrives at a host cell and deposits viruses in the cell while dodging detection by the immune system. The scientists did not know whether this system applied to animals and humans, or how effective these packets were in infecting host cells.

To find out, they focused on rotaviruses and noroviruses, which mainly get spread by accidentally ingesting tiny particles of an infected person’s stool — through, for example, contaminated food or liquids. The researchers obtained fecal samples of humans and animals (pigs and mice) and found that the viruses are shed in the stool as virus clusters inside membrane-bound packets. In addition, they found that these virus-containing vesicles were significantly more infectious than the free, unbound viruses within the samples.

Membrane-bound vesicles containing clusters of viruses,including rotavirus and norovirus,within the gut. 
Rotaviruses are shown in the large vesicles,while noroviruses are shown in the smaller vesicles. 
NIH Medical Arts
The researchers determined that the high level of infectiousness was likely due to the vesicles delivering many viruses at once to the target tissues; protecting their viral cargo from being destroyed by prolonged exposure to enzymes; and possibly by making their viral cargo invisible to the antibodies that are in the stool or gut of the host. More studies are needed, but the extreme potency of the virus packets, they said, has a clear consequence: it not only enhances the virus’ ability to spread more aggressively; it also increases the severity of the disease it causes. Handwashing (link is external) with soap and water helps prevent the spread of viruses.

“Our findings indicate that vesicle-cloaked viruses are highly virulent units of fecal-oral transmission, and highlight a need for antivirals targeting vesicles and virus clustering,” Altan-Bonnet noted.

NIH support also includes the following grant from NIAID: RO1-AI091985.

This press release describes a basic research finding. Basic research increases our understanding of human behavior and biology, which is foundational to advancing new and better ways to prevent, diagnose, and treat disease. Science is an unpredictable and incremental process — each research advance builds on past discoveries, often in unexpected ways. Most clinical advances would not be possible without the knowledge of fundamental basic research.

Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at https://www.nhlbi.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Wednesday, November 15, 2017

Listen: With Stricter Guidelines, Do You Have High Blood Pressure Now?

November 14, 201712:56 PM ET
Heard on All Things Considered
You may not have had high blood pressure Sunday, but you may have it today. Even if your blood pressure hasn't changed a smidge. What's up?

The rules shifted Monday. It used to be that we encouraged people to adopt healthy behavior to keep their blood pressure down but didn't label someone as having hypertension until systolic blood pressure (the top number) exceeded 140 millimeters of mercury and/or the diastolic blood pressure (the bottom number) exceeded 90 mm Hg. Lots of people watch those numbers closely.

Now the American College of Cardiology and the American Heart Association have updated blood pressure guidelines that move the goal post for many people.
Continue reading......

NIH blood pressure study supports important part of new AHA/ACC hypertension guidelines
Today the AHA and the ACC issued the first comprehensive new high blood pressure guidelines in more than a decade that indicate high blood pressure should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90. An important component of these guidelines was informed by the results of the Systolic Blood Pressure Intervention Trial (SPRINT), a clinical study sponsored in part by the NHLBI and designed to determine the best way to treat blood pressure in adults with hypertension, 50 years or older, who are at high risk for heart disease.

SPRINT, which began in the fall of 2009, included more than 9,300 participants, recruited from about 100 medical centers and clinical practices throughout the United States. It remains the largest study of its kind to date to examine how maintaining systolic blood pressure at a lower than previously recommended level would impact cardiovascular and kidney diseases.
http://hepatitiscnewdrugs.blogspot.com/2017/11/nih-blood-pressure-study-supports.html

Monday, November 13, 2017

NIH blood pressure study supports important part of new AHA/ACC hypertension guidelines

Data from landmark NIH blood pressure study supports important part of new AHA/ACC hypertension guidelines

This is a field of blood cells. The bi-concave disks are red blood cells or erythrocytes. The white cell with the dark purplish, multi-lobed nucleus is a neutrophil, a type of white blood cell or leukocyte. The smaller spikey objects are platelets.

What
Findings from a landmark study funded by the National Institutes of Health (NIH) support a key component of the new 2017 Hypertension Clinical Practice Guidelines announced by the American Heart Association (AHA) and the American College of Cardiology (ACC) at the annual AHA meeting in Anaheim, California.

In 2013, the National Heart, Lung, and Blood Institute (NHLBI), part of the NIH, adapted to changing times and refined its focus to generating high quality scientific evidence in support of the development of clinical practice guidelines worthy of the public trust. The new high blood pressure guidelines illustrate the utility and impact of NHLBI scientific studies.

Today the AHA and the ACC issued the first comprehensive new high blood pressure guidelines in more than a decade that indicate high blood pressure should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90. An important component of these guidelines was informed by the results of the Systolic Blood Pressure Intervention Trial (SPRINT), a clinical study sponsored in part by the NHLBI and designed to determine the best way to treat blood pressure in adults with hypertension, 50 years or older, who are at high risk for heart disease.

SPRINT, which began in the fall of 2009, included more than 9,300 participants, recruited from about 100 medical centers and clinical practices throughout the United States. It remains the largest study of its kind to date to examine how maintaining systolic blood pressure at a lower than previously recommended level would impact cardiovascular and kidney diseases.

The pace of scientific advances today requires systematic synthesis for developing guidelines that will assist busy practitioners. The successful implementation of these guidelines will lead to improvements in the health of the nation and reduce the risks posed by heart disease and stroke. Heart disease is the United States’ leading cause of death.

In addition to primary sponsorship by the NHLBI, SPRINT is also co-sponsored by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke and The National Institute on Aging.

Who
Dr. David Goff, Director, Division of Cardiovascular Sciences, NHLBI, is available to comment on the SPRINT study and its relationship to the new high blood pressure guidelines.
Contact

For more information or to schedule an interview, please contact the NHLBI Office of Science Policy, Engagement, Education, and Communications at 301-496-5449 or nhlbi_news@nhlbi.nih.gov (link sends e-mail).

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI, a part of the National Institutes of Health (NIH), plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at www.nhlbi.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.
For more information about NIH and its programs, visit www.nih.gov.

Thursday, September 28, 2017

Hospital Impact—Pharmacy benefit managers are a lot like car dealers

Hospital Impact—Pharmacy benefit managers are a lot like car dealers
by Sheila Arquette |
Sep 28, 2017 8:26am 
The system for car purchases—where Americans buy cars from dealerships instead of directly from the companies making them—makes it hard to know how much it actually costs to make a car, so it’s hard to know you’re getting the best price. 
The same system applies to buying lifesaving prescriptions. Drug manufacturers set a list price, but consumers rarely pay that, and how much drugs should really cost is uncertain.
Continue reading.... 

Tuesday, July 11, 2017

There are more new cases of cancer each year than marriages in the UK

Cancer Diagnosis Now 'More Common Than Marriage'
Liam Davenport
July 11, 2017
The cancer diagnoses are divided almost equally among men (51%) and women (49%). Just more than half (53%) of all new cases are cancers of the breast, prostate, lung, and bowel.
Five-year survival rates range from more than 80% for breast cancer, prostate cancer, melanoma of the skin, Hodgkin's lymphoma, and thyroid and testicular cancer to fewer than 15% for lung and liver cancer and 6% to 7% for mesothelioma and pancreatic cancer.
Continue reading...

CANCER DIAGNOSIS NOW AS COMMON A 'LIFE MILESTONE' AS MARRIAGE OR GETTING A DEGREE
10 July 2017
Being diagnosed with cancer is now one of the most common life-changing events in people’s lives, Macmillan wants the public to be better informed about the reality of cancer diagnosis and treatment

There are more new cases of cancer each year than marriages in the UK, according to a new report from Macmillan Cancer Support.

The report, The C-Word: How we react to cancer today, reveals being diagnosed with cancer is one of the most common life-changing events in people’s lives. New analysis reveals:
Cancer is more common than new marriages: Latest figures show there are over 70,000 more new cases of cancer each year in UK than new marriages[i].

Cancer is more common than women having their first child: Latest figures show there are almost 50,000 more new cases of cancer each in year in England and Wales than women giving birth to their first child[ii].

Cancer is as common as graduating: Latest figures show there are a similar number of undergraduate degrees awarded each year in the UK[iii], compared with new cases of cancer.

Cancer affects many people at the “prime” of their life: More than 1.2 million people have been diagnosed with cancer under the age of 65 in the past 10 years, including more than 340,000 diagnosed in their 20s, 30s and 40s[iv].

Cancer is the most feared disease

Macmillan’s research reveals that while receiving a cancer diagnosis is an increasingly common life event, it is the disease people most fear getting (37%), ahead of Alzheimer’s (27%), stroke (7%), depression (4%), heart disease (4%) or multiple sclerosis (2%)[v].

For one in 10 people in the UK (10%), cancer is their biggest fear of all, ahead of losing a loved one, their own death or even terrorism[vi].

However, Macmillan’s report highlights that people’s perceptions and fears around cancer can be unhelpful in supporting them to understand their choices when they are diagnosed. When they were first told they had cancer, one in three people (34%) say they were in a daze and couldn’t take anything in[vii].

We all need to be better prepared and informed about cancer

As one in two people will get cancer at some point in their lives[viii] and more and more people are living longer after cancer[ix], Macmillan wants the public to have a better understanding of the reality of a cancer diagnosis.

The charity has released the report to coincide with the launch of its major new advertising campaign, Life with cancer, which Macmillan hopes will remove some of the fear around diagnosis and highlight the support that is available for people living with cancer today. The charity believes that life with cancer is still life and that people should have the right support in place to help them live it as normally as possible.

A positive new approach to cancer awareness, the campaign reflects the insight that 85% of people with cancer don’t want to be defined by the disease[x]. The series of recently released adverts, show that cancer doesn’t have to change who you are with an important message: life with cancer is still life.

Macmillan’s research shows that nine in ten (90%) people living with cancer say they are still living their lives as normally as they can[xi].

The charity believes that being as prepared as possible, knowing what to expect during and after treatment and being told what support is available from the moment of diagnosis, can support people to continue to live their lives.

Lynda Thomas, chief executive of Macmillan Cancer Support, says:

“Being told you have cancer changes your life, and it can leave people feeling as if they’ve been thrust into the unknown, bewildered and unprepared.

“But as more and more people are being diagnosed with cancer, it’s important that we are all better informed about what to expect if we do one day we receive this shocking news.

“Cancer is almost always life-changing, but it isn’t always life-ending. Life with cancer is still life – you’re still a dad, a sister, a grandparent, a friend. Macmillan has supported millions from the point of diagnosis, throughout their treatment and into the future. From our experience, we believe that living well with cancer begins at diagnosis. People should come away from those first appointments feeling informed about their choices and knowing what support is available.”

Jane Ives, 49, a mum of two from Hampshire, was diagnosed with breast cancer in 2014. She says:

“Getting a diagnosis of cancer was probably the single most terrifying thing that has happened to me. My biggest fear by far was not seeing my children fully grow up. Not being there for those milestones in their lives – their graduations, their weddings maybe. But here I am three years on and in a few weeks I will be at my eldest’s graduation, which will be a huge moment for both of us. While the fear never quite leaves you – you realise life goes on after cancer and you appreciate the here and now.”

Macmillan’s new report, The C-Word: How we react to cancer today, explores what it’s like to receive a cancer diagnosis in 2017, how our fears and preconceptions affect us in the moment we’re told, and how each of us can be prepared for the news. This is essential in helping people to live their best possible life with cancer.
Source -

Friday, November 4, 2016

Young Adults' Problem Drinking May Have Lasting Health Effects

Young Adults' Problem Drinking May Have Lasting Health Effects

PISCATAWAY, NJ – Young adults with symptoms of alcohol dependence may see health effects late in life—even decades after conquering their problem drinking, according to a study in the November 2016 issue of the Journal of Studies on Alcohol and Drugs.

Researchers found that, of 664 U.S. male veterans, those who had symptoms of alcohol dependence for at least five years in young adulthood generally had poorer physical and mental health by the time they were in their 60s.

And that was true even if they'd gotten control over their drinking problems by the age of 30.

The findings are surprising, said lead researcher Randy Haber, Ph.D., of the Palo Alto Veterans Affairs Health Care System, in Menlo Park, Calif.

It's clear that people's lives improve when alcohol dependence goes into remission, Haber pointed out, but it is not clear whether there are hidden consequences that remain after heavy drinking has ceased. For instance, evidence shows that both brain and body are affected by excessive drinking, but we don’t know how long these effects last.

The new findings suggest that years of alcohol dependence during young adulthood result in silent but "permanent" injuries that, in later life, appear to result in serious health problems, according to Haber.

The findings are based on men taking part in a larger study of Vietnam-era veterans. Haber's team focused on 368 men who did not report any symptoms of alcohol dependence at any point in adulthood, 221 who had at least three symptoms of dependence in young adulthood and middle-age and 75 who had symptoms in early adulthood but not after the age of 30.

Overall, the study found that men who had alcohol dependence symptoms for at least five years in early adulthood scored lower on standard measures of both physical and mental health once they'd reached their 60s.

For example, those with alcohol dependence in young adulthood had, on average, three medical conditions in later life whereas those without this history reported two. In addition, their scores on a depression scale were about twice as high.

Most important, these effects were seen even among men who'd been free of dependence symptoms for several decades.

The reasons are unclear. But, Haber said, other studies have shown that chronic drinking may injure parts of the brain involved in emotional regulation, self-control and decision making. It's possible, he noted, that years of alcohol exposure in early adulthood could have lasting effects on those brain areas.

Still, Haber stressed that this study is reporting "averages" and not what any one person is destined for.

He said that people who not only quit problem drinking but also turn their lifestyle around—eating well, not smoking and just generally "taking care of themselves"—will likely see health benefits that last into late life.

Plus, he said, there is a "whole body of literature" showing that when people with alcohol dependence go into recovery, their lives improve in almost every area.

"If you have entered (alcohol dependence) recovery, keep going," Haber said. "Live your life to its fullest."

Haber, J. R., Harris-Olenak, B., Burroughs, T., & Jacob, T. (November 2016). Residual effects: Young adult diagnostic drinking predicts late-life health outcomes. Journal of Studies on Alcohol and Drugs, 77(6), 859–867. doi:10.15288/jsad.2016.77.859

To arrange an interview with Randy Haber, Ph.D., please contact Michael Hill-Jackson at the VA Office of Public Affairs at 650-444-7380 or michael.hill-jackson@va.gov.

The Journal of Studies on Alcohol and Drugs (www.jsad.com) is published by the Center of Alcohol Studies at Rutgers, The State University of New Jersey. It is the oldest substance-related journal published in the United States.

To learn about education and training opportunities for addiction counselors and others at the Rutgers Center of Alcohol Studies, please visit AlcoholStudiesEd.rutgers.edu.

Monday, May 16, 2016

Increased physical activity associated with lower risk of 13 types of cancer

Increased physical activity associated with lower risk of 13 types of cancer

The investigators confirmed that leisure-time physical activity, as assessed by self-reported surveys, was associated with a lower risk of colon, breast, and endometrial cancers. They also determined that leisure-time physical activity was associated with a lower risk of 10 additional cancers, with the greatest risk reductions for esophageal adenocarcinoma, liver cancer, cancer of the gastric cardia, kidney cancer, and myeloid leukemia.

A new study of the relationship between physical activity and cancer has shown that greater levels of leisure-time physical activity were associated with a lower risk of developing 13 different types of cancer. The risk of developing seven cancer types was 20 percent (or more) lower among the most active participants (90th percentile of activity) as compared with the least active participants (10th percentile of activity). These findings, from researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and the American Cancer Society, confirm and extend the evidence for a benefit of physical activity on cancer risk and support its role as a key component of population-wide cancer prevention and control efforts. The study, by Steven C. Moore, Ph.D., NCI, and colleagues, appeared May 16, 2016, in JAMA Internal Medicine.

Hundreds of previous studies have examined associations between physical activity and cancer risk and shown reduced risks for colon, breast, and endometrial cancers; however, results have been inconclusive for most cancer types due to small numbers of participants in the studies. This new study pooled data on 1.44 million people, ages 19 to 98, from the United States and Europe, and was able to examine a broad range of cancers, including rare malignancies. Participants were followed for a median of 11 years during which 187,000 new cases of cancer occurred.

The investigators confirmed that leisure-time physical activity, as assessed by self-reported surveys, was associated with a lower risk of colon, breast, and endometrial cancers. They also determined that leisure-time physical activity was associated with a lower risk of 10 additional cancers, with the greatest risk reductions for esophageal adenocarcinoma, liver cancer, cancer of the gastric cardia, kidney cancer, and myeloid leukemia. Myeloma and cancers of the head and neck, rectum, and bladder also showed reduced risks that were significant, but not as strong. Risk was reduced for lung cancer, but only for current and former smokers; the reasons for this are still being studied.

“Leisure-time physical activity is known to reduce risks of heart disease and risk of death from all causes, and our study demonstrates that it is also associated with lower risks of many types of cancer,” said Moore. “Furthermore, our results support that these associations are broadly generalizable to different populations, including people who are overweight or obese, or those with a history of smoking. Health care professionals counseling inactive adults should promote physical activity as a component of a healthy lifestyle and cancer prevention.”

Leisure-time physical activity is defined as exercise done at one’s own discretion, often to improve or maintain fitness or health. Examples include walking, running, swimming, and other moderate to vigorous intensity activities. The median level of activity in the study was about 150 minutes of moderate-intensity activity per week, which is comparable to the current recommended minimum level of physical activity for the U.S. population.

There are a number of mechanisms through which physical activity could affect cancer risk. It has been hypothesized that cancer growth could be initiated or abetted by three metabolic pathways that are also affected by exercise: sex steroids (estrogens and androgens); insulin and insulin-like growth factors; and proteins involved with both insulin metabolism and inflammation. Additionally, several non-hormonal mechanisms have been hypothesized to link physical activity to cancer risk, including inflammation, immune function, oxidative stress, and, for colon cancer, a reduction in time that it takes for waste to pass through the gastrointestinal tract.

Most associations between physical activity and lower cancer risk changed little when adjusted for body mass index, suggesting that physical activity acts through mechanisms other than lowering body weight to reduce cancer risk. Associations between physical activity and cancer were also similar in subgroups of normal weight and overweight participants, and in current smokers or people who never smoked.

The study was a large-scale effort of the Physical Activity Collaboration of NCI’s Cohort Consortium, which was formed to estimate physical activity and disease associations using pooled prospective data and a standardized analytical approach.

“For years, we’ve had substantial evidence supporting a role for physical activity in three leading cancers: colon, breast, and endometrial cancers, which together account for nearly one in four cancers in the United States,” said Alpa V. Patel, Ph.D., a co-author from the American Cancer Society. “This study linking physical activity to 10 additional cancers shows its impact may be even more relevant, and that physical activity has far reaching value for cancer prevention.”

The National Cancer Institute leads the National Cancer Program and the NIH’s efforts to dramatically reduce the prevalence of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI website at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIH…Turning Discovery Into Health®
 
Reference
Moore SC, et al. Leisure-time physical activity and risk of 26 types of cancer in 1.44 million adults. JAMA Internal Medicine. May 16, 2016. DOI:10.1001/jamainternmed.2016.1548.
 

Wednesday, May 11, 2016

Public Reporting Measures Fail to Describe the True Safety of Hospitals

Public Reporting Measures Fail to Describe the True Safety of Hospitals
Study finds only one measure out of 21 to be valid
Release Date: May 10, 2016
 
Common measures used by government agencies and public rankings to rate the safety of hospitals do not accurately capture the quality of care provided, new research from the Johns Hopkins Armstrong Institute for Patient Safety and Quality suggests.
 
The findings, published in the journal Medical Care, found only one measure out of 21 met the scientific criteria for being considered a true indicator of hospital safety. The measures evaluated in the study are used by several public rating systems, including U.S. News and World Report’s Best Hospitals, Leapfrog’s Hospital Safety Score, and the Center for Medicare and Medicaid Services’ (CMS’) Star Ratings. The Johns Hopkins researchers say their study suggests further analysis of these measures is needed to ensure the information provided to patients about hospitals informs, rather than misguides, their decisions about where to seek care.
 
“These measures have the ability to misinform patients, misclassify hospitals, misapply financial data and cause unwarranted reputational harm to hospitals,” says Bradford Winters, M.D., Ph.D., associate professor of anesthesiology and critical care medicine at Johns Hopkins and lead study author. “If the measures don’t hold up to the latest science, then we need to re-evaluate whether we should be using them to compare hospitals.”
 
Hospitals have reported their performance on quality-of-care measures publicly for years in an effort to answer the growing demand for transparency in health care. Several report performance using measures created by the Agency for Health Care Research and Quality (AHRQ) and CMS more than 10 years ago. Known as patient safety indicators (PSIs) and hospital-acquired conditions (HACs), these measures use billing data input from hospital administrators, rather than clinical data obtained from patient medical records. The result can be extreme differences in how medical errors are coded from one hospital to another.
 
“The variation in coding severely limits our ability to count safety events and draw conclusions about the quality of care between hospitals,” says Peter Pronovost, M.D., Ph.D., another study author and director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality. “Patients should have measures that reflect how well we care for patients, not how well we code that care.”
The researchers analyzed 19 studies conducted between 1990 and 2015 that directly addressed the validity of HACs and PSI measures, as well as information from CMS, the AHRQ and the Maryland Health Services Cost Review Commission’s websites. Errors listed in medical records were compared to billing codes found in administrative databases. If the medical record and the administrative database matched 80 percent of the time, the measure was considered a realistic portrayal of hospital performance.
 
Of the 21 measures developed by the AHRQ and CMS, 16 had insufficient data and could not be evaluated for their validity. Five measures contained enough information to be considered for the analysis.  Only one measure—PSI 15, which measures accidental punctures or lacerations obtained during surgery—met the researchers’ criteria to be considered valid.
 
“Patients and payers deserve valid measures of the quality and safety of care,” says Pronovost, who is also Johns Hopkins Medicine’s senior vice president for patient safety and quality. “Despite their broad use in pay for performance and public reporting, these measures no longer represent the gold standard for quality, and their continued use should be reconsidered.”
The researchers say they hope their work will lead to reform and encourage public rating systems to use measures that are based in clinical rather than billing data.
 
Pronovost recently outlined additional fixes that could be implemented by the rating community in a commentary published in the April 2016 issue of JAMA. Designating a separate reporting entity to establish standards for data collection and making funds available for systems engineering research were listed as possible starting points by Pronovost and his co-author, Ashish Jha from Harvard.
This work was supported by internal funds from the Johns Hopkins Armstrong Institute for Patient Safety and Quality. Established in 2011, the Armstrong Institute works to improve clinical outcomes while reducing waste in health care delivery both at Johns Hopkins and around the world. Led by Pronovost, the institute develops and tests solutions in safety and quality improvement that can then be shared at the regional, national and global levels. Using a scientific approach to improvement, the Armstrong Institute employs robust measures that can be broadly disseminated and sustained.
 
 
 
 

Friday, August 7, 2015

Tattooing may be ancient, but safety questions remain

Also see: 
Aug 5
Nationwide Recall Of A Thousand Virgins Grey Wash Tattoo Inks And Tattoo Kits Due To Microbial Contamination
Use of these products may cause bacterial infection and can lead to sepsis, a potentially life-threatening complication of an infection.

Health | Thu Aug 6, 2015 1:18pm EDT
Related: Health

Tattooing may be ancient, but safety questions remain
By Kathryn Doyle
Reuters Health – - Tattoo health and safety regulations tend to focus on short-term risks like infections, but little is actually known about the long-term risks of living with ink under your skin, according to a new review in The Lancet.

“Almost everybody these days has a tattoo, and nobody is talking about the side effects of ink deposits,” said senior author Dr. Andreas Luch of the German Federal Institute for Risk Assessment in Berlin.

“There is no proof that these ink ingredients are safe, being injected into the body,” Luch told Reuters Health.

Between one and five percent of tattooed people suffer a bacterial infection, and some people can have allergic reactions to the ink, according to the report.

Those are short-term effects. It is harder to measure the long-term effects of ink since tattoo inks are in most countries classified as cosmetics, Luch said.

Since the inks are classified as cosmetics, their long-term toxicology can’t be tested in animals, Luch said. In his opinion, tattoo inks should be a completely different product category.

The skin barrier effectively keeps surface cosmetics out of the body, he said.

But tattoo ink is injected into living tissue, which contains blood vessels, nerves and immune cells.

“We need to assume that all of these ink ingredients, including preservatives, processing aids or whatever, will become systemically available in the body over time,” Luch said. “Regulation based on cosmetics is insufficient.”

Examining the bodies of the deceased who have had tattoos for decades has shown that up to 90 percent of the ink has disappeared from the skin, he said.

“We cannot answer the question what is going to happen with these inks,” whether they accumulate in organs over time or are excreted, Luch said.

Similar questions remain for laser tattoo removal: when the pigments are fractured and fragmented under the skin - where do they go – he added.

“In the U.S. the (Food and Drug Administration) has the authority to regulate inks, but is not currently doing so,” said Dr. Michi Shinohara, a dermatologist at the University of Washington in Seattle who was not involved in the review.

“Regulation of tattoo parlors and tattoo artists is left to the states, and the requirements for operating vary widely from very minimal (bloodborne pathogen training) to fairly complex (hundreds of hours of apprenticeship),” Shinohara told Reuters Health by email.

There are no industry standards for ink ingredients, the industry is minimally regulated, and few problems with tattoos are reported to authorities, she said.

Modern tattoo inks mostly contain organic pigments, but can also include preservatives and contaminants like nickel, arsenic and lead, Luch and his coauthors note. In one study in Switzerland, preservatives banned for use in cosmetics were found in 14 percent of tattoo ink samples.

Reactions tend to be more common from colored inks than from black and white ones, Luch said.

Tattooing has been going on for at least 5,000 years, but has become a modern trend, with roughly 120 million people in the western hemisphere having at least one tattoo, Luch said.

“The acute risks are well known,” including pain, bleeding, infection and allergic reaction, Luch said. “The tattooist at least needs to explain that something like this could happen,” he said.

But long term risks, like organ toxicity or cancer, are still unknown, he said.

“It’s an individual decision, we cannot tell someone not to get a tattoo,” Luch said. “I wouldn’t like to have a tattoo on my skin, but if a person likes colored skin, what can I say?”

It’s not necessary for people to stop getting tattoos, Shinohara said, “but I think people should be smart about it - research the parlor, ask about any recent problems, follow the aftercare instructions and report immediately to the tattoo artist and a physician for any problems that occur after tattooing.”


SOURCE: bit.ly/1MXGlrm The Lancet, online July 23, 2015.

Monday, June 8, 2015

Three in 10 U.S. adults experience drinking problems

Three in 10 U.S. adults experience drinking problems
By Lisa Rapaport

(Reuters Health) - Roughly three in 10 U.S. adults have a drinking problem or have misused alcohol at some point in the past, a large study finds.

And less than one in five people with symptoms of addiction or dependence received treatment for the problem, according to survey responses from more than 36,000 adults nationwide who were asked about their alcohol consumption.

“The stigma of alcohol problems is a major barrier to getting treatment,” senior study author Deborah Hasin, an epidemiology professor at Columbia University in New York, said by email.

Hasin and colleagues focused their analysis on a medical condition known as alcohol use disorder, which is diagnosed based on the impact drinking has on daily life. Symptoms can include drinking more or longer than intended; finding that alcohol is negatively impacting family, work or school; and making dangerous choices such as driving while intoxicated or having unprotected sex.

While the condition is diagnosed based on the impact of alcohol rather than a set number of drinks, women can limit their risk of developing a problem if they consume no more than three drinks in one day or seven over the course of a week, according to the National Institute on Alcohol Abuse and Alcoholism. For men to minimize risk, the cap should be four drinks in one day or no more than 14 per week.

One drink in this scenario could be a 12-ounce beer, a 5-ounce glass of wine or 1.5-ounce shot of hard liquor.

Generally, if people misused alcohol, the problem emerged around age 26, the study found. People with the most severe addiction tended to develop symptoms by age 23, while more mild dependence generally surfaced around age 30.

Overall, men and white adults were more likely to develop an alcohol problem than women or minorities, but Native Americans had greater rates of severe addiction than whites.

Married or cohabiting couples were less likely to drink excessively than divorced or single adults.

Poverty made drinking more likely, with higher rates of serious drinking problems among low-income people than among those at the highest income levels.

Education also made a difference. Compared with people who attended college, adults who didn’t complete high school had greater odds of experiencing severe alcohol problems within the past 12 months, the study found.

After controlling for factors such as marital status, income and education, drinking problems were associated with other substance abuse disorders as well as with depression and bipolar disorder, the researchers report in JAMA Psychiatry.

“Although people often report drinking alcohol to self-medicate a psychiatric disorder, heavy drinking can also cause psychiatric symptoms,” Dr. Henry Kranzler, director of the Center for Studies of Addiction at the University of Pennsylvania, said by email.

Genetics can also play a role in making people more susceptible to both addiction and depression, said Alexis Edwards, a researcher at Virginia Institute of Psychiatric and Behavioral Genetics at Virginia Commonwealth University who wasn’t involved in the current study.

“We know that the liability to alcohol use disorder is influenced by genetics, and so is liability to basically every other psychiatric and substance use disorder,” Edwards said.

Researchers and clinicians focus on the impact of alcohol rather than on a specific number of drinks consumed because the outcomes of excessive use can vary and people often underestimate how much they drink, Hasin said.

“Drinking a nightly single glass of wine would be considered a low-risk pattern by almost any standard,” Hasin said. “For people who have several drinks at a party or a ball game, the answer isn’t that simple.”

People who have less severe problems with alcohol may not recognize that they are drinking to excess, said James MacKillop, a researcher in psychiatry and neuroscience at DeGroote School of Medicine at McMaster University in Ontario who wasn’t involved in the study.

“In my experience, individuals with moderate and severe alcohol use disorders would generally meet the colloquial definition of alcoholism, MacKillop said by email. “Individuals with mild alcohol use disorders are necessarily experiencing some level of alcohol-related impairment, but are less likely to self-identify as having alcoholism and may not meet the general perception of an alcoholic.”

SOURCE: bit.ly/1JzqIZ5 JAMA Psychiatry, online June 3, 2015


Friday, April 3, 2015

Readers’ Favorite Online Health Stories:Rashes, Sore Throats, Kidneys, and More


Readers’ Favorite Online Health Stories
Rashes, Sore Throats, Kidneys, and More

NIH News in Health aims to bring you a wide range of health-related stories, including articles about healthy lifestyles and both common and rare diseases. Some topics are consistently popular, viewed by hundreds or thousands of people month after month on the NIH News in Health website.

Here are 5 reader favorites, representing our most-viewed Web articles over the past 2 years. See if any of these topics might be useful to you or someone you know.

1. Red, Itchy Rash?
You’ve probably had a rash at some point or another, whether from poison ivy, soggy diapers, or something more unusual. Why does your skin break out in red blotches like that? More important, is there anything you can do about it? Dr. Stephen I. Katz, director of NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases, answers these questions and more while also addressing specific conditions, such as skin allergies, eczema, and psoriasis. “If you have any significant rash, you should see a dermatologist,” Katz says. A dermatologist, or skin doctor, is specially trained to figure out what’s causing a rash and help you get the right treatment.

2. Soothing a Sore Throat.
When you’ve got a sore throat, your throat may feel scratchy, and it may hurt when you swallow. Most sore throats are caused by viral infections such as the common cold or the flu. The best way to protect yourself from the germs that cause these infections is to wash your hands often. Try to steer clear of people who have colds or other contagious infections. And avoid smoking and inhaling second-hand smoke, which can irritate your throat.

3. Keep Your Kidneys Healthy.
Your kidneys aren’t very big—each is about the size of your fist—but they do important work. They keep you healthy by maintaining just the right balance of water and other substances inside your body. Unfortunately, if your kidneys start to malfunction, you might not realize it for a long while. Kidney disease usually won’t make you feel sick until the problem is serious and irreversible. That’s why it’s important to catch kidney disease early, so you can try to prevent or delay health problems. You’re at increased risk for kidney disease if you have diabetes, high blood pressure, heart disease, or a family history of kidney failure. Talk with your health care provider about whether you should be screened for kidney disease.

4. Should You Take Dietary Supplements?
More than half of all Americans take one or more dietary supplements daily or on occasion. Common supplements include vitamins, minerals, and herbal products, also known as botanicals. People take these supplements to maintain or improve their health. But not everyone needs to take supplements. “Learn about their potential benefits and any risks they may pose first,” says Dr. Paul M. Coates, director of NIH’s Office of Dietary Supplements. “Speak to your health care providers about products of interest and decide together what might be best for you to take, if anything, for your overall health.”

5. Waking Up to Anesthesia.
When you face surgery, you might have many concerns, including worries about going under anesthesia. General anesthesia is a combination of drugs that dampens pain, knocks you unconscious, and keeps you from moving during the operation. Although anesthesia is typically considered quite safe for most patients, many people have concerns about possible risks and side effects. Some people, especially elderly patients and children, can have lingering confusion and thinking problems for several days after anesthesia. Talk with your doctor if you have concerns, but don’t delay important surgery because of fear of anesthesia.

http://newsinhealth.nih.gov/issue/apr2015/feature2

Friday, August 8, 2014

FDA - Inks Used in Certain Tattoo Kits Cause Infections

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

Inks Used in Certain Tattoo Kits Cause Infections

Tempted to get a tattoo? Today, people from all walks of life have tattoos, which might lead you to believe that tattoos are completely safe.

But beware—there may be associated health risks.

Recently, the Food and Drug Administration (FDA) became aware of a problem after testing inks in home use tattoo kits marketed by White and Blue Lion, Inc. FDA has confirmed bacterial contamination in unopened bottles of the company’s inks.

According to Linda Katz, M.D., M.P.H., director of FDA’s Office of Cosmetics and Colors, using these inks for tattoos could cause infection. “FDA has confirmed one case of skin infection involving a consumer that used this company’s tattoo products,” Katz says, “and we are aware of other reports linked to tattoo products with similar packaging.”

Risks Can Be Severe
According to Katz, “Tattooing poses a risk of infection to anyone, but the risk is particularly high for those with pre-existing heart or circulatory disease, diabetes or compromised immune systems.”
She notes that injecting contaminated ink into the skin or using contaminated needles may result in infections at the site of the tattoo. Signs of localized infection include redness, swelling, weeping wounds, blemishes, or excessive pain at the site. If you experience any of these signs, seek medical care right away. Even after a localized infection has healed, the area may be permanently scarred.

Further, an infection that is left untreated or inadequately treated could spread through the bloodstream (a process known as sepsis). These infections may be associated with fever, shaking chills (rigors) and sweats. If these symptoms arise, treatment with antibiotics, hospitalization and/or surgery may be required.

Products Recalled, But Risk Remains
White and Blue Lion, Inc. recalled contaminated products on July 11, 2014, but FDA is still concerned that consumers and professional tattoo artists may be purchasing or using contaminated home tattoo kits and inks from other distributors.

Specifically, how can you identify kits and inks that you should not use because they may be contaminated? FDA advises you to watch out for inks intended for permanent makeup or traditional body tattoos that:

  • have no brand name, carry a dragon logo, and/or are missing the name and place of business of the manufacturer or distributor,
  • are sold singly and in kits containing anywhere from five to 54, or perhaps more, bottles of inks of various colors, and
  • are marked with “Lotch” [sic] and Batch numbers, and “Date produced” and “Best if used by” dates.
“If you’re buying tattoo inks or getting a tattoo from a professional tattoo artist, you should first examine the products to determine whether the inks or kits meet the above descriptions,” cautions Katz.

FDA’s goal is to encourage consumers and tattoo and permanent make-up artists to take certain precautions and to urge potentially infected clients to seek medical care. “Reporting an infection to FDA and the artist is important in order for FDA to investigate, and to enable the artist to take steps to prevent others from becoming infected,” says epidemiologist Katherine Hollinger, D.V.M., M.P.H., from the Office of Cosmetics and Colors.

What to Do
Consumers and tattoo artists should do the following:

  • Seek immediate medical care if you experience any signs of infection.
  • Don’t use tattoo inks and kits that have no brand name, carry a dragon logo, and/or are missing the name and place of business of the manufacturer or distributor.
  • Dispose of tattoo inks that meet this description.
  • Do not use recalled kits.
  • Report adverse events or side effects through FDA’s MedWatch Safety Information and Adverse Event Reporting Program.
Updated: August 7, 2014

For additional information addressing Hepatitis and tattoos visit:
The Official Blog of the Hepatitis and Tattoos Website
Part of the Hepatitis C Support Project and the HCV Advocate
Be sure to check out our other blogs: The HBV Advocate Blog and the The HCV Advocate News & Pipeline Blog

Tuesday, July 8, 2014

Amazing - Peek Inside the 21st Century Doctor's Bag



A Peek Inside the 21st Century Doctor's Bag: Mobile Health Technologies for Medical Education from Academic Medicine on Vimeo.

A Peek Inside the 21st Century Doctor's Bag: Mobile Health Technologies for Medical Education from Academic Medicine

 Shiv Gaglani is a medical student at Johns Hopkins and an editor of Medgadget, which covers innovations in medical technology. He curated the Smartphone Physical, which debuted at TEDMED in 2013, and is interested in the potential of mobile health technologies to improve medical education and clinical exam skills. In this video, Shiv, co-author of a recent Academic Medicine commentary with Dr. Eric Topol, demos three mobile health technologies: the smartphone-based electrocardiogram, ophthalmoscope, and stethoscope.

Thursday, June 26, 2014

Behind The Headlines: Cannabis use 'genetically linked' to schizophrenia


What is Behind the Headlines?
We give you the facts without the fiction. Professor Sir Muir Gray, founder of Behind the Headlines, explains more... 


Cannabis use 'genetically linked' to schizophrenia

Study finds people predisposed to [schizophrenia] and drug users share common genes,” the Mail Online reports. A new study suggests that ‘schizophrenia’ genes are associated with cannabis use.

It has long been known that there is an association between cannabis use and schizophrenia – but the “direction of travel” has been hotly debated.

Does cannabis use trigger the onset of schizophrenia in vulnerable individuals? Or are people with a genetic predisposition to develop schizophrenia more likely to use cannabis than the population at large (possibly as a coping mechanism)?

This latest study suggests that the latter may be the case; at least in some people. The study involved 2,082 healthy adults whose genetic make-up was examined for risk factors for schizophrenia.

People with more genetic risk factors (carrying more of the DNA variants that have been associated with schizophrenia) were more likely to have reported ever using cannabis.

However, it is important to note that none of the people in the study actually had a diagnosis of schizophrenia. In addition, as this is a cross-sectional study (see below), it cannot definitively answer the question of cause and effect.

A person’s risk for schizophrenia, or for cannabis use, are likely to be influenced by a complex mixture of genetic factors (including those not identified or examined here), lifestyle and environmental factors.

Where did the story come from?

The study was carried out by researchers from the Institute of Psychiatry, King’s College London; Queensland Brain Institute and QIMR Berghofer Medical Research Institute, Australia; the Department of Developmental Psychology and EMGO Institute for Health and Care Research, Amsterdam; the Washington University School of Medicine.

It was funded by the UK Medical Research Council and National Institute for Health Research; the Australian National Health, Medical Research Council and Australian Research Council; the Centre for Research Excellence on Suicide Prevention (CRESP – Australia); and the Netherlands Organization for Health Research and Development.

The study was published in the peer-reviewed medical journal Molecular Psychiatry.

The Mail Online reported the story accurately and informatively.

What kind of research was this?

This was a cross-sectional study using data collected in a larger cohort study. It aimed to assess the association between cannabis use and the level of genetic predisposition for schizophrenia.

As it is a cross-sectional study it is only able to describe this association and cannot prove cause and effect. That is whether the genetic predisposition caused them to use cannabis or that conversely, cannabis would cause them to develop schizophrenia.

What did the research involve?

A group of 2,082 unrelated healthy adults were recruited from the large Australian Twin Registry studies.

The participants were asked questions over the telephone on their cannabis (marijuana) use, including:
Did you ever use marijuana?
How old were you the very first time you tried marijuana (not counting the times you took it as prescribed)?
How many times in your life have you used marijuana (do not count times when you used a drug prescribed for you and took the prescribed dose)?

The genotype (each person’s genetic make-up) was obtained. These were compared with samples from a large Swedish study which has identified a number of single nucleotide polymorphisms (SNPs), DNA sequence variations, that are believed to increase the risk of developing schizophrenia.

The presence of more than one of these SNPs gives a “polygenic” (multiple gene variants) risk factor, and some SNPs are associated with a particularly higher risk (having the most significant associations with schizophrenia).

These risk scores were analysed in comparison with the answers to the cannabis questions to look for any associations.

In the second part of the study, the researchers looked at the polygenic risk scores of 990 twins (just over a third were identical twins).

They took the mean polygenic risk score from each pair of twins and used this to predict whether neither, one or both twins used cannabis.

What were the basic results?

Out of the 2,082 adults included in the study, 1,011 (48.6%) had ever used cannabis. The mean age of starting cannabis was 20.1 (95% Confidence Interval [CI] 19.7 to 20.5) and the mean number of times they’d used cannabis over their lifetime was 62.7 (95% CI 19.7 to 20.5).

The researchers found a significant association between a person’s extent of genetic predisposition for schizophrenia and their reported use of cannabis. People who had used cannabis had higher genetic risk scores for schizophrenia than those who had never used cannabis. The strongest associations were found between the higher risk SNPs and ever use of cannabis.

However, the results showed that the genetic risk factors they assessed only predicted a small amount of a person's risk of using cannabis. This meant that other factors have more of an influence on whether a person uses cannabis.

In the secondary analysis, twin pairs where both reported using cannabis had the greatest polygenic risk factors for schizophrenia.

Pairs where only one of them used cannabis had an intermediate level of risk factors, and the lowest burden was in those where neither used cannabis.

How did the researchers interpret the results?

The researchers say this study shows “that to some extent the association between cannabis and schizophrenia is due to a shared genetic aetiology [cause] across common variants. They suggest that individuals with an increased genetic predisposition to schizophrenia are both more likely to use cannabis and to use it in greater quantities.”

Conclusion

This study shows an association between genetic risk factors for schizophrenia and cannabis use. However, as it is a cross-sectional study, it cannot answer the often debated cause and effect question of whether cannabis use increases risk of schizophrenia, or whether there is a common genetic predisposition to both.

The study cannot prove that cannabis use is a risk factor for developing schizophrenia.

It also cannot prove that the genetic risk factors (SNPs – variations in the DNA sequence that have been associated with schizophrenia) also directly increase the risk of using cannabis. As the researchers’ results suggested, the genetic risk factors they assessed only predicted a small amount of a person's risk of using cannabis. There may be many other factors involved. A complex mixture of genetics (including DNA variations not examined here), lifestyle and environmental factors is likely to contribute to a person’s risk of developing schizophrenia, and to their risk of using cannabis.

It should also be noted that none of the participants in the study actually had a diagnosis of schizophrenia. Though the SNPs thought to increase the genetic risk of developing schizophrenia were identified in a large Swedish cohort study, the authors do point out that they may not be accurate.

They say that in this Swedish sample from which these SNPs were identified, use of cannabis may have been more common among the people who had schizophrenia than in the controls without schizophrenia.

They say this could mean that the SNPs actually increase risk of cannabis use rather than risk of schizophrenia.

A further limitation of the study is that cannabis use was self-reported which may give rise to inaccuracies in the estimated level of use. Also people may not have been willing to disclose any use of an illegal substance during a telephone interview.

Cannabis may not be as dangerous as other drugs (including legal drugs such as tobacco and alcohol) but it is certainly not safe. There are many negative effects of cannabis, including a risk of developing dependency, its tendency to reduce motivation and concentration, and the likelihood that it reduces male fertility.

Furthermore, the risks of the tobacco and nicotine which are usually consumed at the same time need to be taken seriously. Read more information about the health risks associated with cannabis.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links to the headlines
Are cannabis smokers genetically more likely to develop schizophrenia? Study finds people predisposed to the condition and drug users share common genes. Mail Online, June 24 2014

Links to the science
Power RA, Verweij KJH, Zuhair M, et al. Genetic predisposition to schizophrenia associated with increased use of cannabis. Molecule Psychiatry. Published online June 24 2014

http://www.nhs.uk/news/2014/06June/Pages/Cannabis-use-genetically-linked-to-schizophrenia.aspx

Wednesday, May 21, 2014

Pancreatic and Liver Disease Deaths Rise Due to Advancements in Other Cancer Care


Pancreatic and Liver Disease Deaths Rise Due to Advancements in Other Cancer Care

Liver cancer can be curable when caught early so get screened, advises Loyola hepatologist
 5/21/2014 
 
Newswise — Money changes everything. To date, lung, breast, prostate and colorectal cancers have accounted for the largest number of cancer deaths. In response, these cancers currently receive the most research funding from the National Cancer Institute and are highlighted through public health campaigns, special event fundraising and celebrity spokespeople.

And the extra money and attention is working to end those cancers and move other cancers up in frequency of cause of death.

Cancer Research reports that “by 2030 more people will be diagnosed with breast, prostate and lung cancers than with pancreatic cancers, but more pancreatic cancer and liver cancer patients will die of their disease.”

What should people do? Get screened if you are at risk.

“Primary liver cancer, hepatocellular carcinoma, is curable when caught early, so if you have high risk factors such as cirrhosis, particularly cirrhosis from hepatitis C virus, you should get screened,” says Steve Scaglione, MD, board certified hepatologist at Loyola University Health System. Hepatologists are specialists in treating liver disease. “Unlike a colonoscopy, liver cancer screening is non-invasive; just an ultrasound, every six months.” If liver cancer is diagnosed, curative treatment options are available and include surgery and liver transplantation.

There are more than 100 kinds of liver disease including cirrhosis, alcoholic induced, fatty and hepatitis. Hepatitis C is the leading cause of liver cancer in America. More than 5 million people are living with hepatitis, called a silent epidemic because it often is not detected until it has spread to the liver.

Screening measures for hepatitis C are not only recommended by public health organizations such as the Centers for Disease Control but are now mandated by lawmakers. In Colorado, a bill was signed into law on May 20, 2014 funding hepatitis screening. Specifically, hepatitis C testing is recommended for Baby Boomers (those born between 1945 and 1965) because they are estimated to be five times more likely to contract the disease.

The Loyola hepatology team offers treatment at 11 Loyola locations located in Illinois and also conducts research and research trials to improve prevention and treatment. “As new resources are devoted to these less common, but more deadly forms of cancer there is a higher likelihood of research advances to improve patient outcomes,” says Susan Uprichard, PhD, associate professor and director of hepatology research at Loyola University Stritch School of Medicine. “Patients who seek treatment from an academic medical center such as Loyola have the advantage of not only receiving the most progressive care but they also have the potential to participate in life saving research trials.”

Thursday, April 24, 2014

Vitamin D – should you take it?

Egg yolks contain a small amount of vitamin D istockphoto.comVitamin D – should you take it? 
By Lindsay Kobayashi
Posted: April 24, 2014

Egg yolks contain a small amount of vitamin D
iStockphoto.com

My hunch is that it depends. Vitamin D is a nutrient that helps our bodies regulate the metabolism of calcium and phosphate (1). Most vitamin D comes from sunlight, while it is also found in certain foods including fatty fish, mushrooms, egg yolks, vitamin-D fortified foods. For example, milk in many countries is always fortified with vitamin D, and some brands of breakfast cereals and orange juice are fortified as well (2).  Vitamin D can also be obtained through taking vitamin D supplements found at your local grocery or health food store. The classic health consequences of inadequate vitamin D are rickets in children, and low bone mineral density and osteoporosis in older adults (3). Low vitamin D has also been associated with increased risk for many other health conditions including breast, prostate, and colorectal cancer, multiple sclerosis, and cardiovascular disease (4-6). However, the quality of scientific evidence for these relationships varies because it is actually quite challenging methodologically to study the cause-effect relationship of vitamin D on health.

Because definitive high-quality evidence is lacking, the actual beneficial effect of vitamin D on health has been heavily debated in recent years. Like many other dietary or lifestyle factors that have been linked to health outcomes with scientific uncertainty (examples: coffee, alcohol, vitamin C, herbal supplements), the available information about whether to take vitamin D supplements can be very confusing. Here is where we stand right now:

In 2011, the American Institute of Medicine released an expert report on the dietary reference intakes for vitamin D (3). They stated that, for people aged 1 to 70 years old including pregnant and lactating women, the recommended dietary allowance (RDA) is 600 IU per day of vitamin D. For adults aged over 70 years the RDA is 800 IU per day. Intake should not exceed 4000 IU per day for people aged 9 years and over. The full RDA guidelines can be found here. Interestingly, their expert panel concluded that current scientific evidence is insufficient to conclude that vitamin D plays a causal role in non-bone-related health conditions (3). Now, this statement may or may not mean that vitamin D has no effect on health aside from bone conditions, simply that our current knowledge is insufficient.

Supplements can be a good source of vitamin D
iStockphoto.com
Supplements can be a good source of vitamin D istockphoto.comFast forward to today, and it doesn’t seem like our evidence base has evolved much. An ‘umbrella’ review of evidence on the link between blood plasma concentrations of vitamin D and 137 unique health outcomes was published in the British Medical Journal earlier this month (7). The review was the largest synthesis of knowledge to date, and the authors unfortunately had to conclude that:
“Despite a few hundred systematic reviews and meta-analyses, highly convincing evidence of a clear role of vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable”
The authors concluded that vitamin D supplementation is probably linked to decreased dental caries (cavities) in children, reduced parathyroid hormone concentrations in patients with chronic kidney disease requiring dialysis, and to an increase in maternal vitamin D concentrations at term, and an increase in birth weight (7). These are very specific conditions that apply only to children, pregnant mothers, and chronic kidney disease patients. The authors also concluded that the evidence is ‘suggestive’ for a correlation between higher blood vitamin D concentrations and a lower risk of several conditions including colorectal cancer, non-vertebral fractures, cardiovascular diseases, depression, high body mass index, and type 2 diabetes (7). However, a major point to note is that these are correlations, which means that although vitamin D has been associated with these health conditions, it may not cause them. Because of the limitations of current research, including the difficulty in measuring the actual vitamin D intake of people, and how much of this actually gets absorbed and has a biological effect, the timing between vitamin D intake and disease onset, and determining the actual dose of vitamin D that may protect against disease, we don’t have definitive answers right now.

So, what should we do about our own health? It is clearly too soon to make any strong recommendations about population-level vitamin D supplementation. Following the current RDA for vitamin D is good, and achieving this level for yourself may include supplementation if you don’t eat many foods containing vitamin D. Always talk to your family physician if you have any concerns about your own health or vitamin D intake. And finally, as always, keep yourself informed with high quality information to make decisions for your own health.

References
1)      National Health Service. Vitamins and minerals – vitamin D. http://www.nhs.uk/Conditions/vitamins-minerals/Pages/Vitamin-D.aspx (accessed 21 April 2014).
2)      National Institutes of Health. Vitamin D: Fact sheet for consumers. http://ods.od.nih.gov/factsheets/VitaminD-QuickFacts/#h3 (accessed 21 April 2014).
3)      Committee to Review Dietary References Intakes for Vitamin D and Calcium, Institute of Medicine: Dietary Reference Intakes for Calcium and Vitamin D. Edited by Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Washington, DC: The National Academies Press; 2011.
4)      Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81.
5)      Munger KL, Zhang SM, O’Reilly E, HernĂ¡n MA, Olek MJ, Willett WC, et al. Vitamin D intake and incidence of multiple sclerosis. Neurology 2004;62(1):60-5.
6)      Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008;117:503-11.
7)      Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JPA. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ2014;348:g2035

Source PLOS Blogs

Tuesday, April 8, 2014

Blood Test Could Detect Common Cancers

NPR - Simple Blood Test To Spot Early Lung Cancer Getting Closer 
by Richard Harris
April 06, 2014 1:22 PM ET
Listen Here 

Researchers at Stanford University have discovered a simple blood test has the potential to identify many different cancers.



Blood Test Could Detect Common Cancers

Early-stage lung and prostate cancers as well as their recurrence can be detected with a simple blood test, according to a study presented at the ANESTHESIOLOGY™ 2013 annual meeting. Serum-free fatty acids and their metabolites may be used as screening biomarkers to help diagnose early stages of cancer, as well as identify the probability of recovery and recurrence after tumor removal, researchers found.

"While cancer is the second-leading cause of death worldwide, diagnosis at the early stages of cancer remains challenging," said Jinbo Liu, M.D., M.S., researcher at Cleveland Clinic, and lead study author. "In this study, we identified compounds that appear to be new screening biomarkers in cancer diagnosis and prognosis."

The study looked at blood samples from 55 patients with lung cancer and 40 patients with prostate cancer and compared them to blood samples of people without cancer. In a second phase of the study, blood was examined preoperatively from 24 patients scheduled for curative lung cancer surgery and again at six and 24 hours after the surgery.

The cancer patients had one- to six-times greater concentrations of serum-free fatty acids and their metabolites (the biomarker) in their blood than patients without cancer. In the second phase, the serum-free fatty acid concentrations decreased by three to 10 times within 24 hours after tumor removal surgery.

Lung cancer is the most common cancer worldwide as well as the leading cancer killer in both men and women in the United States. It causes more deaths than the next three most common cancers combined (colon, breast and prostate), according to the American Lung Association.

Prostate cancer is the most common cancer in American men, other than skin cancer, according to the American Cancer Society. While there is a blood test for prostate cancer, the prostate-specific antigen test, or PSA, has a high false-positive rate that results in many unnecessary biopsies and complications, according to Dr. Liu. The test developed in this study could be a helpful additional blood test for prostate cancer.

"This is an exciting first step to having an uncomplicated way to detect early stages of lung, prostate and perhaps other cancers," said Daniel I. Sessler, M.D., chair of the Outcomes Research Department at Cleveland Clinic. "It could also be used to measure the success of tumor resection surgery, immediately after surgery and long-term for recurrence screening."

Story Source:
The above story is based on materials provided by American Society of Anesthesiologists (ASA). Note: Materials may be edited for content and length.

Video Source - NewsyScience

Tuesday, March 4, 2014

Your Liver Delivers - Protect It From Harm

Your Liver Delivers - Protect It From Harm

Your liver works hard to protect your health. It’s a rugged, strong organ. But certain things—like alcohol, drugs, viruses, and excess weight—can damage it. You may not even realize when your liver is struggling, because liver disease usually has no symptoms until the problem becomes severe. Help your liver to guard your health by avoiding the things that might cause it harm.

The liver is the largest organ inside your body. It’s about the size of a football, and rests just under your ribs against the right side of your stomach.

“The liver performs an amazing set of functions that keep you healthy,” says Dr. Jake Liang, a liver specialist and researcher at NIH.

Your liver helps fight infections. It cleans your blood by getting rid of your body’s natural waste products and other harmful substances, including alcohol and drugs. “The liver also transforms the foods you eat into energy and nutrients your body can use, and it regulates how nutrients flow to different parts of the body when needed,” Liang says.

Your liver can keep working even if part of it is damaged or removed. But if it starts to shut down completely—a condition known as liver failure—you can survive for only a day or 2 unless you get emergency treatment.

Many things can affect liver function. Some liver problems are inherited from your parents, some are caused by viruses (certain kinds of hepatitis), and some are related to your behavior. Certain liver diseases go away on their own. Others can last a lifetime and cause serious illness.

Although liver disease often has no symptoms, warning signs can include a swollen abdomen, nausea, itching, or jaundice (having a yellow tint to the skin and the whites of the eyes).

NIH supports large research networks across the country to learn more about liver disease. For instance, teams of scientists nationwide have joined forces to study rare and often-deadly liver disorders that strike newborns and older children.

“Research networks are important because no single medical center has enough patients with rare diseases to do a rigorous study or test new treatments,” says Dr. Edward Doo, a liver disease expert at NIH. “With this large pediatric network, we can combine the efforts and expertise of many clinical centers that specialize in rare childhood liver diseases.”

Other NIH studies are focusing on an increasingly common type of liver disorder—known as fatty liver disease—that affects both children and adults. A healthy liver contains just a little fat or none at all. But too much fat buildup in liver cells can cause swelling and damage. Over time, the excess fat can lead to cirrhosis, liver cancer, and even liver failure.

“Estimates vary, but 2 different studies in the past decade suggest that about 30% to 45% of Americans have excess fat in the liver,” says Dr. Yaron Rotman, an NIH specialist in fatty liver disease. “It’s also becoming a huge problem for children and teens.”

Drinking too much alcohol can cause fatty liver. But a growing number of people who drink little or no alcohol are also being diagnosed with fatty liver. “The rise seems to be tied to the nation’s obesity epidemic,” says Doo.

Studies suggest that fatty liver disease now also affects about 1 in 10 children nationwide. As with adults, most children with fatty liver disease are overweight and resistant to insulin, a critical hormone that regulates energy.

In its early stages, fatty liver disease usually has no symptoms. It’s often first detected by blood tests for liver function. But these tests can’t tell the difference between mild fatty buildup and more serious damage. And some people with fatty liver disease can have normal blood tests. The only sure way to diagnose the severity of fatty liver disease is by getting a liver biopsy. For this test, a doctor inserts a thin needle through the skin and into the liver to remove a small piece of tissue for analysis.

NIH-funded scientists have been searching for simpler ways to measure the severity of fatty liver disease. They’re also conducting clinical studies to assess possible treatments. There are currently no approved medications for fatty liver or its more severe form called NASH, or non-alcoholic steato-hepatitis.

“To treat fatty liver disease, we recommend lifestyle changes: Weight loss for people who are overweight, and exercise and a healthy diet to help reduce fat,” Rotman says. “In many patients, just a 5-8% reduction in body weight will translate into a large improvement to liver damage.” For people with alcohol-related fatty liver, stopping alcohol use can reverse or prevent further liver injury.

Another common type of liver disease—known as viral hepatitis—can be caused by at least 5 different viruses, named hepatitis A, B, C, D, and E. These infections can injure your liver and keep it from working properly.

“Collectively, about 20% of people worldwide may be affected by a hepatitis virus infection,” Liang says. “It’s a major public health problem.” The most common types in the United States are hepatitis A, B, and C.

Each hepatitis virus causes a different form of liver disease. All the viruses can trigger acute, or short-term, hepatitis. Hepatitis B, C, and D can also cause chronic hepatitis, in which the infection lasts a long time, sometimes for your whole life.

People are often exposed to hepatitis A and E viruses through contaminated food or water. “The other hepatitis viruses often pass through some type of break in the skin barrier, sometimes by injections or by close contact with blood or other body fluids,” Liang adds. Hepatitis B, C, and D can spread through sexual contact.

Because many infected people have few symptoms, they may not realize they have viral hepatitis. They can spread the infection to others without even knowing it.

Viral hepatitis is often treated with antiviral medications. Hepatitis A, B, and D infections can be prevented by vaccines. Practicing good hygiene—such as washing your hands and avoiding contact with infected blood—can also help block the spread of viral hepatitis.

Another potentially dangerous type of liver disease can be caused by taking certain drugs or supplements. “It’s important to be aware that a lot of drugs can cause liver injury,” Liang says. “This especially can be a problem for people who are taking several different medications.”

Taking too much acetaminophen (Tylenol) is the most common cause of sudden liver failure. “It’s particularly dangerous if you mix alcohol with acetaminophen or certain other drugs,” Liang adds. Talk with your doctor or pharmacist about all the medications you take and how they might affect your liver.

Maintain a healthy weight, stay physically active, and limit your alcohol use. Keep your liver healthy, and it will protect you for a lifetime.

Check out the March issue of NIH News in Health, the monthly newsletter bringing you practical health news and tips based on the latest NIH research