Showing posts with label marijuana. Show all posts
Showing posts with label marijuana. Show all posts

Friday, January 3, 2014

2014 Going Viral - Viral Hepatitis Newsletters



January 2014

Hepatitis Newsletters


Welcome to 2014 folks, where did the year go? Once again we have an array of informative newsletters put together by incredible people completely devoted to HCV awareness and education.

**Updated Jan 11 to included Transplant Recipients International Organization
**Updated Jan 10 - NYC Hep C Task Force
**Updated Jan 7 - NIH News in Health
**Updated Jan 4 -  Hepatitis Foundation International.



TRIO is an independent, not-for-profit, international organization committed to improving the quality of life of transplant candidates, recipients, their families and the families of organ and tissue donors.
Through the TRIO Headquarters and a network of chapters, TRIO serves its members in the areas of: Awareness, Support, Education, and Advocacy. This TRIO web site is filled with information about these areas and our many programs, including local chapter contact information, so wander around these pages to learn more about TRIO or contact your local TRIO chapter. If you still don't find answers to what you are looking for, please email us at info@trioweb.org or call 1-800-TRIO-386. 

UNOS News


Full 3-part series: Too Risky to Transplant (3 prior articles in one place)
Categories
Categories 

This Months Newsletter

January Newsletter
Rose parade float - so how many TRIO members are in or help with that DLA float?
What do you think - of the redesigned TRIO web site . . .

In just a short time since the launch we have had thousands of visitors from all around the world visit the new web site.  How about you?  If you haven't already bookmarked the site, do it now at http://trioweb.org

Newsletter Archives

 Check Us Out On Twitter and Facebook



 

NYC Hep C Task Force
The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to work on projects in order to meet needs identified by the community.

NYC Viral Hepatitis Monthly E-Newsletter
January 2014 NYC Hep ABC Newsletter

In This Issue

NY Hep C ‘Baby Boomer’ Testing Law

NYS Hepatitis C Testing Law. 2171 requires healthcare providers to offer hep C test to baby boomers.

Requires full diagnostic testing for those who screen anti-body positive and either follow-up health care or referral to a health care provider who can provide follow-up health care.

Takes effect January 1, 2014

Read the ‘Hep C Testing Law Dear Colleague Letter‘ from Governor Cuomo.

NYS HCV testing law FAQ_12-9-2013 (PDF). Hep C Testing Law: Frequently Asked Questions from the NYS Department of Health. 

Webinar | Hepatic Encephalopathy: The Patient Perspective. American Liver Foundation. January 23rd (7 PM - 9:30 PM ET).

Beyond the Hype: What Sofosbuvir Means—and Doesn’t—for Global Hepatitis C Treatment.
Open Society Foundations.

And more.......
Click here to start reading....

Subscribe to this Newsletter

Join Us






January Features

Avoiding Anemia Boost Your Red Blood Cells

Anemia is a common blood disorder that can leave you feeling exhausted and sluggish. Many types of anemia are mild and short term. But the condition can become serious if left untreated
for a long time.

Read more about anemia

Dealing with Dementia
When Thinking and Behavior Decline

Feeling forgetful and confused may be a normal part of life. But if thinking problems or unusual behavior start to interfere with everyday activities, these could be signs of a brain condition known as dementia.

Read more about dementia.

Find Us On Facebook






Hepatitis Foundation International (HFI)

The Hepatitis Foundation International is dedicated to liver health and the prevention of liver related diseases. We inform and educate by making available reliable and up-to-date facts. We want you to make well-informed decisions for yourself and your loved ones' health and well-being. We are proud to present this website as your personal Internet gateway to hepatitis information and liver care.

Health-e Bytes™

Hepatitis Alert / Partners In Liver Wellness Newsletters

Click Here To Download Newsletter





Lifestyle...

— Obesity’s Impact on Kidneys
— Tighter Regulations Make for Safer Drugs
— Plain Soap and Water Still the Best

Grand Rounds...

— Understanding the Clinical Trial Process
— Reducing Viral Load — Saves Lives

In the Pipeline...

— Hepatitis C Phase III Drugs Treatment Pipeline

Helping Hands... Holiday Giving

Advocacy Alert: Legislation expanding hepatitis B and C education, testing and linkage to care services

T.I.PS. — Qualifying for SSI Disability with HCV; Free Consumer Action Handbook

Stay Updated







HCV Advocate

The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education

January 2014 HCV Advocate

In This Issue:

HCV Advocate's Top News of 2013
It is usually difficult to come up with the number 1 item and this year was no exception; so we decided that two different news items topped our list.....
Alan Franciscus, Editor-in-Chief

HEALTHWISE: New Hepatitis C Drugs: Disappointment or Hope?
Lucinda K. Porter, RN

Snapshots
Lucinda K. Porter, RN

HCV Advocate Eblast

Stay informed on the latest news...click here to register for email alerts

HEPATITIS B

HBV Journal Review

by Christine Kukka
HCV Advocate News & Pipeline Blog!

Be sure to check out the latest clinical trial postings at the HCV Advocate News & Pipeline Blog. Just click on the links to the Drug Companies below the banner to see which drugs are in trials right now, where the trials are, and how to register for one.

Connect With HCV Advocate






HepatitisWA

Perth, Australia

HepatitisWA (Inc) is a non-profit community-based organisation providing free services to the community. HepatitisWA aims to assist in obtaining the best possible care and support for people affected by hepatitis, reducing discrimination and stigma directed at people living with viral hepatitis and raising community awareness in relation to hepatitis.


The HepatitisWA Newsletter is a quarterly publication.

With each edition we endeavour to capture new developments in hep C treatment, management and other relevant topics.

This issue we cover the following:
• Ed's Story - Personal Perspective
• Going Viral - Viral Hepatitis News
• Hepatitis B Mapping Project - Feature
• Rising deaths from hep C spur New York city action - Community News
• Closer than you thINK - Feature
• Staying on track when eating out - Health & Lifestyle
• Sleep management and hepatitis C - Health & Lifestyle






HepCBC Hepatitis C Education and Prevention Society

HepCBC’s MONTHLY NEWSLETTER

January Newsletter (PDF)

The hepc.bull, has been “Canada’s hepatitis C journal” since the late 1990′s and has been published nonstop since 2001. The monthly newsletter contains the latest research results, government policy changes, activities and campaigns you can get involved in, articles by patients and caregivers, and a list of support groups plus other useful links.

In This Issue

WHO TO TREAT FIRST?
With approval of protease inhibitors, so many people want to start treatment, that waiting lists have developed. A limited number of people can be started on treatment each week. At the recent meeting in Boston, the AASLD (American Association for the Study of Liver Diseases) discussed who should be treated first.

MICHAEL’S STORY
Editor: Michael is a long-time member of HepCBC. The CanHepC list and the HepCan list. He and I have been emailing frequently since 2004. He has volunteered for HepCBC and has provided caring support and information to many fellow Hep C sufferers in our community, both by email and in person. Perhaps you have spoken to him on the phone.

ROB’S STORY
Six years later, I knew I had to go back. He welcomed me and said, “I told you I’d see you later.” So I went on the meds, and experienced ALL the negative symptoms of the meds and wound up in the hospital for a week.

Larry Hagman
Larry Hagman, perhaps best known for his role as J.R. Ewing of the TV series “Dallas”, died November 23 at age 81. His death was caused by complications from throat cancer, although he suffered from Hep C and liver cancer, too.

HCV Support Groups in Canada

AND MORE!!

Stay Connected







Caring Ambassadors Hepatitis C

The Caring Ambassadors Hepatitis C Program (CAP-Hepatitis C) is a national non-profit organization devoted exclusively to meeting the needs of the hepatitis C community.

The Caring Ambassadors Program mission is to help improve the lives of those affected by long-term diseases through advocacy, information, and support.

CAP News

In The News

CAP Hepatitis C Literature Review

December Monthly Pubmed Review of the most relevant research on hepatitis C.

Abstract Index
CLINICAL TRIALS, COHORT STUDIES, PILOT STUDIES 1 - 5
BASIC AND APPLIED SCIENCE, PREC LINICAL STUDIES 5 - 13

HIV/HCV COINFECTION 13 - 18

COMPLEMENTARY AND ALTERNATIVE MEDICINE 18 - 19
MISCELLANEOUS WORKS 19 - 24
LIVER CANCER 24 - 30







GI & Hepatology News

GI & Hepatology News is the official newspaper of the AGA Institute and provides the gastroenterologist with timely and relevant news and commentary about clinical developments and about the impact of health-care policy. The newspaper is led by an internationally renowned board of editors.

January Issue - Please Check Back

Stay connected








American Liver Foundation

Liver Lowdown is the monthly general interest e-newsletter of the American Liver Foundation.

In accordance with the Foundation’s mission, the e-newsletter is disseminated to provide information about the prevention, treatment and cure of liver disease, as well as the organization’s research and advocacy endeavors.

Content includes updates about the Foundation’s educational and signature programs; an in-depth focus on specific types of liver disease, and profiles of liver patients’ and caregivers’ personal experiences

Recently Diagnosed with HCV?

If you or a loved one thinks you may be at risk or has been recently diagnosed with Hep C, we encourage you to go through this site to find information on risk factors, diagnosis, treatment and support.

January Newsletter - Check back

December Newsletter


INSPIRE: CONNECT WITH OTHER LIVER DISEASE PATIENTS

The Inspire.com website builds online health and wellness communities for patients and caregivers, in partnership with national patient advocacy organizations. In fact, Inspire.com has more than 80 exclusive national patient organization partnerships and over 300,000 members.

As we recognize the value of patient engagement, we have partnered with Inspire.com to create a global resource community focused on liver disease.

Take action now: Log on to www.inspire.com/groups/american-liver-foundation/ to become a member of the American Liver Foundation group, complete your profile, and join the specific liver disease discussions that interest you. The American Liver Foundation Inspire groups can also be accessed by clicking on the Inspire logo on our website’s home page: www.liverfoundation.org

ALF Website

The Hepatitis C: Diagnosis, Treatment, Support website

1-800-GOLIVER (1-800-465-4837)

In addition, questions sent on e-mail to info@liverfoundation.org will be promptly answered.

Join Our Mail List

Stay Connected

Check Us Out On Twitter and Facebook





Hepatitis C news, is an online community for those living with hepatitis C. Join us for news, views and features about hep C, read the real-life experiences of our guest bloggers, and learn about living well with the condition.

New In January

The effects of medical marijuana in treating hepatitis C
January 10th, 2014 Earlier this week New York became the 21st state to legalise marijuana for medical purposes. 

Five tips for a healthy 2014

As we reach the New Year, it’s a good time to think about some simple steps that can be taken for a happier and healthier you

Read More...

Talking to friends and family about hep C

Finding out that you have hepatitis C can be a shock. You may experience a range of emotions, from disbelief to anger, sadness or fear.

While it might be tempting right now to pull away from friends and family, research has shown that the support of friends and family is vital when living with a medical condition. Don’t underestimate the value of simply having someone to talk to.

Read more..

Check out
Hepatitis C News YouTube Channel

Stay connected






The Hepatitis C Mentor and Support Group (HCMSG)

The Hepatitis C Mentor and Support Group (HCMSG) was founded to address the lack of awareness, support, and services for people living with Hepatitis C (including patients co-infected with other conditions such as HIV/AIDS and Hepatitis B), and patients in need of or living with liver transplants. To address these needs, we provide resources and services to foster the development and operation of successful support groups for Hepatitis C and co-infected patients. These services are provided to prospective and current support group facilitators FREE OF CHARGE. In the future, we will also provide one-on-one mentoring services to Hepatitis C and liver transplant patients.

Assistance Programs for Patients

A partial list of programs to help people who do not have insurance coverage or financial resources to pay for testing, medical care, and medications to treat and cure Hepatitis C.


HCMSG Blog

News and Updates

We welcome your suggestions on what you would like to see in upcoming issues and any stories you want to share.

We can be reached at hepatitisCmsg@gmail.com

Find Us On Twitter and Facebook






Canadian Liver Foundation

News Updates

Canadian Liver Foundation’s Newsroom
Liver in the News

Newsletter
Livewell is our e-newsletter exclusively for friends and donors of the Canadian Liver Foundation. Each issue highlights liver health issues, exciting research projects, upcoming events and includes profiles of our outstanding volunteers and donors.

The Livewell newsletter is distributed 4x per year. Please click here to fill in the form and we will be happy to add you to our subscriber list!

CLF updates you and interacts with you on all things liver


Stay Updated







Hep C Connections - Website

Our mission is to educate the general public about hepatitis C and to provide resources and support for those affected by the virus. Hep C Connection offers a helpline to answer your questions regarding hepatitis C (HCV). You can expect respect, patience & understanding, in clear, jargon-free language from our staff & volunteers. Call 1-800-522-HEPC (4372) today!

Newsletter


December 2013 -- Check back for - January Newsletter

The Flu and Hepatitis C: High Risk of Complications

As we enter the months when we see an increase in the number of flu cases, you should ask your doctor about the flu vaccination because it has been shown to reduce a patient's risk for hospitalization from complications associated with the flu such as pneumonia, bronchitis, sinus infections and ear infections. Patients with chronic hepatitis C, particularly patients with cirrhosis, that fall ill with the flu may be at an increased risk for serious complications compared to the general population.

Full Article

Sign Up For Online Monthly Newsletter

Connect On Facebook







ACP Internist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP

Current Issue - January 2014

Gastroenterology

Long-term view for chronic pancreatitis
By Terri D’Arrigo

Unlike acute cases of pancreatitis, chronic cases present with varying degrees and types of pain, and without other clinical indicators such as calcification or damage to pancreatic ducts. It’s best to refer to a gastroenterologist early to clarify the diagnosis, so the internist can better manage the patient.
More

Washington Perspective

Health reform’s winners and losers: by the numbers
By Robert B. Doherty

Breaking down the numbers offers insight into who stands to gain the most from the reforms provided by the Affordable Care Act. But the broader coverage offered under the law means that the country as a whole is better off.
More

ACP Blog

Reflections on a near-death experience

Now that it has been nearly two months since my cardiac arrest and resuscitation, I have finally found the leisure and the motivation to put fingers to the keyboard to gather some thoughts and feelings about it. Of course these include at least in part the sort of changes in attitude and philosophy people are commonly supposed to experience, but for the most part, my own experience seems different.
More

Follow ACP On Twitter



Bloggers Corner

Of interest this month;
Hepatitis C: Resolve to Make Small Steps for Big Gains

By Lucinda Porter, RN |Published January 1, 2014

“Small deeds done are better than great deeds planned.” ~Peter Marshall The healthier you are, the easier it is to live with hepatitis C. We all know that we are supposed to exercise, eat better, and maintain a normal...

15 Steps to Recovery from Hepatitis C Treatment

Be on guard NOT to jump right back into your normal routine or take on more than your ready for right after you finish treatment. Just because treatment is finished does not mean your body is recovered yet. Pace yourself and give your body time to rebuild

Stay warm, see you all soon.
Check back for updates

Newsboy Photo Credit - bangordailynews.com

Saturday, November 30, 2013

Canada: Medical marijuana use without safety proof worries doctors



Canada

Medical marijuana use without safety proof worries doctors

Doctors being asked to prescribe cannabis without rigorous testing, CMA says

CBC News Posted: Nov 29, 2013 1:18 PM ET
Last Updated: Nov 29, 2013 10:28 PM ET

The Canadian Medical Association is worried that as large medical marijuana grow facilities get federal licences, more patients will be clamouring for a drug many doctors are uncomfortable prescribing..

http://www.cbc.ca/news/health/medical-marijuana-use-without-safety-proof-worries-doctors-1.2445249?cmp=rss


Friday, July 26, 2013

Marijuana may not exacerbate liver disease in at-risk patients


Marijuana may not exacerbate liver disease in at-risk patients

Last Updated: 2013-07-25 9:00:15 -0400 (Reuters Health)

By Rob Goodier

NEW YORK (Reuters Health) - Marijuana smoking doesn't appear to accelerate liver disease progression in HIV patients with hepatitis C coinfection, a new prospective study from Canada has found.

"Based on previous studies, physicians have counseled patients that marijuana is harmful to their livers," Dr. Marina Klein, of McGill University Health Centre in Montreal, told Reuters Health by email.

"The results of our study suggest that physicians can reassure their patients that marijuana use, while it may have other deleterious effects, likely will not make their liver disease progress more rapidly," said Dr. Klein, who led the study, published online June 28 in Clinical Infectious Diseases.

Patients in Canada can apply for permission to use marijuana for medicinal purposes. The United States has conflicting marijuana laws. The federal government outlaws it, but 18 states allow for medicinal use, including two, Colorado and Washington, that also allow for recreational use.

The researchers followed up with 690 patients at 17 Canadian HIV clinics for an average of 2.7 years. The patients had HIV-hepatitis C coinfection at baseline, but did not have significant liver fibrosis (aspartate aminotransferase-to-platelet ratio (APRI) < 1.5).

At baseline, more than half of the patients said they had smoked marijuana in the past six months (median, seven joints per week) and 40% of those did so daily. A similar proportion said they used the drug for symptom relief.

In the course of the study, 19% of the patients reached an APRI score of 1.5, and 15% percent progressed to a score of 2. Eight patients, representing 1.2% of the study group, developed cirrhosis and 11, or 1.6%, developed end-stage liver disease (ESLD).

On multivariate analysis, there was no link between marijuana smoking and progression to liver disease based on the APRI score.

The researchers did find an association between marijuana use and progression to a clinical diagnosis of cirrhosis, with a hazard ratio of 1.33 per 10 additional joints per week. But when they reevaluated the findings using a lagged model of marijuana exposure, the association became statistically insignificant.

The lagged model measured marijuana use six to 12 months before the period during which liver disease developed, while the main model measured marijuana use during the same time that liver disease was diagnosed.

"The idea, really, was to make sure that smoking started before the participants got a liver problem and using the exposure and outcome at the same interval doesn't allow that (e.g. patients may have simply increased their use because they had symptoms of a disease that was already present). When we did this, it no longer looks as though marijuana is associated with any of the outcomes we investigated," Dr. Klein said.

That bias may explain some of the associations found between marijuana use and liver disease in past studies, she added.

SOURCE: http://bit.ly/12LdD5o

Clin Infect Dis 2013.

Wednesday, July 10, 2013

Marijuana not associated with liver disease progression in HIV/HCV coinfection

Marijuana not associated with liver disease progression in HIV/HCV coinfection

Brunet L. Clin Infect Dis. 2013;doi:10.1093/cid/cit378.
 
July 10, 2013
Smoking marijuana did not lead to liver disease progression among people coinfected with HIV and hepatitis C, researchers from McGill University have found.

“The literature regarding the effects of cannabis on liver diseases is conflicting,” the researchers wrote in Clinical Infectious Diseases. “Cell culture and animal model studies support that cannabinoids could have a therapeutic effect on liver injury and fibrosis progression. However, three cross-sectional studies in patients with chronic HCV suggest that daily cannabis use is associated with fibrosis and steatosis.”

The study included 690 patients who were positive for HCV but did not have significant fibrosis or end-stage liver disease (ESLD). The patients were part of the Canadian Coinfection Cohort and visited their providers every 6 months, contributing to 1,875.3 person-years of follow-up, with a median follow-up time of 2.7 years. At each visit, they reported their marijuana use, including how often they smoked and the amount they consumed.

At baseline, 53% of the patients reported smoking marijuana in the past 6 months. The median consumption was seven joints per week, and 40% of the patients smoked daily. Among the patients, 19.1% developed liver fibrosis and 14.8% developed cirrhosis, according to APRI score. Eleven patients developed ESLD and eight patients developed clinical cirrhosis.

Multivariate analysis showed that marijuana use was not associated with fibrosis or cirrhosis as measured by APRI score. Smoking marijuana did accelerate progression to clinical cirrhosis (HR=1.33 per 10 joints/week; 95% CI, 1.09-1.62). Marijuana smoking was also associated with an increased risk of clinical cirrhosis and ESLD combined (HR=1.13; 95% CI, 1.01-1.28). However, if the exposure lagged 6 to 12 months before diagnosis, they were no longer associated (HR=1.10; 95% CI, .95-1.26).

“A causal association is unlikely: hazard ratios were weak and most importantly were attenuated when accounting for temporality in the exposure-disease relationship and there was no dose-response relationship,” the researchers wrote. “It is likely that previous studies have been biased by reverse causality as patients use more marijuana to relieve symptoms as liver disease progresses.”

Disclosure: The researchers report no relevant financial disclosures.

Source - Healio

Friday, August 31, 2012

PodMed: Hepatitis C screening

PodMed: A Medical News Roundup from Johns Hopkins

By Rick Lange, MD, and Elizabeth Tracey
Johns Hopkins Medicine Published: August 31, 2012



Monday, June 25, 2012

Herbal cannabis use in fibromyalgia: Associated w-negative psychosocial parameters

Published in Arthritis Care & Research

Herbal Cannabis Use In Fibromyalgia Patients

Cannabinoids were used by 13% of patients referred with a diagnosis of FM. The association of herbal cannabis use with negative psychosocial parameters raises questions regarding the motive for this self-medication practice.

Patients with chronic pain, including fibromyalgia (FM), may seek treatments outside mainstream medicine. Medicinal cannabinoids are popularly advocated for pain relief but with limited evidence for efficacy in FM. The extent of use of cannabinoids in FM is unknown.

We have documented the self-reported prevalence of cannabinoid use in 457 patients carrying the diagnosis of FM and referred to a tertiary care pain centre. We validated the diagnosis of FM and examined the associations of cannabinoid use in these patients.

Cannabinoids were being used by 13% of all patients, 8% of whom used herbal cannabis (marijuana), 24% used prescription cannabinoids and 3% used both herbal cannabis and prescription cannabinoids. One third of all males used cannabinoids. Current unstable mental illness (36% vs. 23%; p=.2), opioid drug-seeking behaviour (17% vs. 4%; p=.1), and male gender (26% vs. 7%; p=.2) were all associated with herbal cannabis use. There was a trend for cannabinoid users to be unemployed and receiving disability payments.

The diagnosis of FM was validated in 32 patients, with 155 assigned another primary diagnosis. When the FM group was analyzed separately, significant associations were lost, but trends remained.

Cannabinoids were used by 13% of patients referred with a diagnosis of FM. The association of herbal cannabis use with negative psychosocial parameters raises questions regarding the motive for this self-medication practice.

Although cannabinoids may offer some therapeutic effect, caution regarding any recommendation should be exercised pending clarification of general health and psychosocial problems, especially for those self-medicating.  
Source

Wednesday, June 6, 2012

Behind the Headlines-Cannabis lung health risks underestimated

One third of people think cannabis is harmless despite the fact that smoking it is 20 times more likely to cause cancer than tobacco,” The Daily Telegraph reported today. The Independent says that young cannabis users “do not realise the huge danger to their health”.

The stories are based on a new report, published by the British Lung Foundation, which says that public awareness of the health consequences of smoking cannabis is “worryingly low”, with almost one-third of the British population believing that smoking cannabis is not harmful to health. This figure rises to almost 40% among those aged under 35, the age group most likely to have smoked it, according to the survey. The report also highlights that many of the same cancer-causing compounds in cigarettes are also present in cannabis, and that the way cannabis is smoked may mean that the body retains more of these harmful products than when smoking a similar quantity of tobacco. One study has suggested that over the course of a year smoking a single joint each day could do the same lung damage as smoking 20 cigarettes per day over the same period.

The report calls for a public health education programme to raise awareness of the impact on the lungs of smoking cannabis and on its links to wider health problems, as well as more investment in research on the health consequences of using cannabis.

What did the report look at?

The report has been published by the British Lung Foundation (BLF). It reviews the current evidence on the impact of smoking cannabis on lung health and also on wider physical and mental health. It also includes the results of a survey it commissioned on public awareness of the health consequences of smoking cannabis.

Who uses cannabis?

The latest figures show that nearly one-third (30.7%) of people aged 16 to 59 in England and Wales have used cannabis in their lifetime, a figure which rises to 34.5% among 16-24 year olds. It’s estimated that about 2.2 million people aged 16 to 59 have used cannabis in the last year. This makes cannabis the most commonly used illicit drug in the UK. The report does not distinguish between different methods of using cannabis (e.g. eating foods containing it), but smoking the drug is generally acknowledged to be the most common method of use.

What type of cannabis do people smoke?

The report says that the type of cannabis people smoke has changed over the last decade, with increasing numbers smoking marijuana, also known as ‘herbal’ cannabis. This is made up of the plant’s dried leaves and female flower heads (the other type being hashish, which is made up of the secreted resin, leaves and flower heads compressed into blocks).

It seems that in recent years there has been a trend towards cannabis smokers using marijuana rather than hashish - in 2008, marijuana comprised 81% of all police cannabis seizures, compared to 30% in 2002.

Is it true that the cannabis available today is stronger than in the past?

The potency of cannabis is measured according to its concentration of a chemical called tetrahydrocannabinol (THC), the main component associated with its mood-altering effects. The report says that in the UK the strength of herbal cannabis, as measured by the amount of THC it contains, almost doubled between 1995 and 2007 (from 5.8% to 10.4%). The report suggests this means that previous research on the effects of cannabis may not be applicable to current smokers.

What does cannabis smoke contain?

The report says that the constituents of cannabis smoke are similar to those of tobacco smoke apart from the presence of THC (which is only in cannabis) or nicotine (which is only in tobacco). This means that cannabis smoke has the same carcinogens (substances that cause cancer) as tobacco smoke, although concentrations of these may be up to 50% higher. Like tobacco, cannabis also contains toxic carbon monoxide.

It also points out that although people generally smoke cannabis less often than tobacco cigarettes, the way they inhale means the amount of smoke reaching the lungs is greater. The respiratory tract and the rest of the body may also retain far more of the products of cannabis smoke than when smoking a similar quantity of tobacco. Given the similarities in their constituents, there is concern that regularly smoking cannabis could have similar health risks as regular tobacco smoking, says the BLF.

Also, people often mix cannabis with tobacco. There is strong evidence that smoking tobacco causes lung cancer and chronic lung disease. This makes it difficult to isolate whether health problems are specifically caused by cannabis or tobacco, says the report.

What lung conditions is cannabis linked to?

The report says that although cannabis is the world’s most widely used illicit drug, there is surprisingly little research into its effects on lung health, with far less about the effects of cannabis smoke than tobacco smoke. However, it says there is now research showing that the active component, THC, can suppress the immune system and that cannabis smokers may be at risk of:

  • respiratory problems such as chronic coughing, wheezing, sputum production, acute bronchitis, airway obstruction
  • infective lung conditions such as tuberculosis and Legionnaire’s disease
  • pneumothorax (collapsed lung)
  • lung cancer - one study, which was widely quoted in the papers, suggested that smoking just one cannabis cigarette a day for one year increases the risk of developing lung cancer by a similar amount to smoking 20 tobacco cigarettes for the same period. It concluded that 5% of lung cancers in those aged 55 or under may be caused by smoking cannabis.

However, the report points out that there is a lack of conclusive evidence as to the possible effect that smoking cannabis has on lung function and the risk of developing chronic obstructive pulmonary disease (COPD). There is evidence that smoking cannabis with tobacco leads to a greater risk of COPD than smoking tobacco alone.

What about other health conditions?

The report says the wider impacts of smoking cannabis are well-documented and may include dependence, increased risk of motor vehicle accidents, increased risk of cardiovascular disease and of mental health problems.

Can cannabis be used medicinally?

Some research suggests that cannabis may have legitimate medical uses including the treatment of chronic pain, the prevention of vomiting caused by cancer chemotherapy, and the relief of pain and diarrhoea in Crohn’s disease. However using “crude cannabis” as a medicine is still not sanctioned because of its toxic components, says the report, and further work is needed to develop safe and effective cannabis-based medicines.

What else did the report find?

The BLF also commissioned a survey of a representative sample of 1,045 people across Britain to find out more about levels of public awareness of the health consequences of smoking cannabis.

The survey found that 88% believed that tobacco smoking poses a greater risk of lung cancer than smoking cannabis. However, one study has suggested that smoking just one cannabis cigarette every day for one year increases the risk of developing lung cancer by a similar amount to smoking 20 tobacco cigarettes for the same period, although further research is needed to confirm these findings and to identify the mechanisms by which cannabis smoking may cause lung cancer.

People were also asked to identify which activities from a list provided were harmful to health. While 88% identified smoking tobacco as harmful and 79% identified eating fatty foods, 68% identified smoking cannabis as harmful.

What does the BLF recommend?

The BLF suggests a public health campaign targeted at younger people on the potential health risks of smoking cannabis. It also recommends further investment in research to provide “more conclusive” evidence on the effects of smoking cannabis on lung function, COPD and lung cancer.

http://www.nhs.uk/news/2012/06june/Pages/cannabis-lung-health-risks-underestimated.aspx

Links to the headlines
Young cannabis users 'do not realise the huge danger to their health'. The Independent, June 6 2012
Cannabis: One joint equivalent to 'smoking 20 cigarettes'. Evening Standard, June 6 2012
Cannabis health dangers 'underestimated'. The Daily Telegraph, June 6 2012
One cannabis joint a day 'is as bad as 20 cigarettes'. Metro, June 6 2012

Further reading New report reveals dangerous lack of public understanding of the health risks of cannabis. British Lung Foundation, June 6 2012

Behind the Headlines provides an unbiased and evidence-based analysis of health stories that make the news.

Each day the NHS Choices team selects health stories that are making headlines.

These, along with the scientific articles behind the stories, are sent to Bazian, a leading provider of evidence-based healthcare information.

Bazian's clinicians and scientists analyse the research and produce impartial evidence-based assessments, which are edited and published by NHS Choices.

Medical marijuana outlets not linked to crime

Journal of Studies on Alcohol and Drugs

Medical marijuana outlets not linked to crime

PISCATAWAY, NJ – Despite some concerns to the contrary, neighborhoods with medical marijuana dispensaries may not have higher crime rates than other neighborhoods—at least in one California city.

That's the conclusion of a new study in the July issue of the Journal of Studies on Alcohol and Drugs. Researchers found that, across Sacramento neighborhoods, there was no evidence that having a higher density of medical marijuana dispensaries was related to higher rates of violent crime or property crime.

As more U.S. states have legalized the use of marijuana for medical reasons, there have been growing concerns that the dispensaries that sell the drug—and the people who go there—will become targets for crime.

"The reality is, we haven't had any evidence to support those claims," said Nancy J. Kepple, M.S.W., a researcher at the University of California, Los Angeles, who led the new study.
Kepple and her colleague, Bridget Freisthler, Ph.D., looked at violent and property crime rates and the density of medical marijuana outlets in 95 different areas of Sacramento in 2009. Not surprisingly, commercial districts and neighborhoods with high unemployment rates tended to have more property crime and violent crime. But there was no correlation between crime and the concentration of medical marijuana outlets.

"This conclusion suggests that we should further question whether medical marijuana dispensaries are related to crime," Kepple said.

But, she stressed, the study is far from the final word. The researchers looked at neighborhoods at only one point in time. So it's not clear whether a neighborhood's crime patterns might change over time, after more medical marijuana dispensaries are opened.

"This study is a good first step," Kepple said. "But it was not designed to address the bigger picture of how these dispensaries might be affecting neighborhoods."

In addition, the findings are based on one city, and other cities might have different experiences. Right now, 17 U.S. states and the District of Columbia allow medical marijuana use.

Kepple said that further studies in other cities, and studies that follow crime rates over time, would help. "The more research that's done, the more complete a picture we'll have."

It would also be good to know why, at least in this study, medical marijuana outlets were not linked to crime rates, according to Kepple.

Does, for example, a dispensary's level of security matter? In this study, information on outlets' security measures was not incorporated. Therefore, it is not possible to tell how those might have factored in. Future studies, Kepple said, should look at whether strong security systems seem to deter crime.

###

Kepple, N. J., & Freisthler, B. (July 2012). Exploring the ecological association between crime and medical marijuana dispensaries. Journal of Studies on Alcohol and Drugs, 73(4), 523-530.
Available at: www.jsad.com/jsad/link/73/523
To arrange an interview with Nancy J. Kepple, M.S.W., or Bridget Freisthler, Ph.D., please contact Alex Boekelheide at alex.boekelheide@publicaffairs.ucla.edu or (310) 206-0159.
The Journal of Studies on Alcohol and Drugs is published by the Center of Alcohol Studies, Rutgers, The State University of New Jersey. It is the oldest substance-abuse journal published in the United States.

Thursday, May 17, 2012

More Evidence Links Early Cannabis Use to Psychosis

From Medscape Medical News > Psychiatry
More Evidence Links Early Cannabis Use to Psychosis
Megan Brooks

May 17, 2012 — Early adolescent cannabis use may contribute to the development of symptoms of schizotypal personality disorder (SPD) in adulthood, according to new data from a longitudinal cohort study.

"The uniqueness of this study lies in the demonstration of an association between early cannabis use and subsequent schizophrenia-like symptoms that persisted into adulthood and that was not explained by early anxiety or depressive disorders, or exposure to other drug and cigarette use," study author Deidre M. Anglin, PhD, assistant professor of clinical psychology, City College and Graduate Center, City University of New York, told Medscape Medical News.

"In addition, this study adds to the literature by demonstrating that this association...was not only limited to those already exhibiting higher levels of these symptoms during childhood and adolescence," she added.

The study is published in the May issue of Schizophrenia Research.
Mounting evidence indicates that cannabis use is temporally associated with the development of schizophrenia in some young people, but less is known about its relationship to latent SPD traits. SPD symptoms are characterized by attenuated psychotic symptoms that include unusual perceptual experiences and beliefs and odd and withdrawn behavior.

To investigate, Dr. Anglin and colleagues analyzed prospective data on 804 participants enrolled in the longitudinal Children in the Community cohort study from upstate New York.
As part of the study, participants were assessed for cannabis use and Axis I and II disorders, beginning at a mean age of 13 years (range, 9 - 18 years), and again at around the ages of 16, 22, and 33 years.
During the 3 assessments, about 70% of participants (n = 567) reported ever using cannabis; the majority reported experimental or rare use. Only 17% (n = 97) reported early cannabis use, defined as regular use before the age of 14 years.

These early users were significantly more likely than nonusers to use other drugs (19% vs 2%) and to smoke cigarettes (86% vs 36%); they were also more likely to have major depression (9% vs 4%) but not anxiety disorder (23% vs 27%). Early cannabis users had only a "slightly higher" mean level of SPD symptoms.

The researchers report that cannabis use before the age of 14 years "strongly predicted" schizotypal symptoms in adulthood, independent of early adolescent schizotypy, major depression, anxiety, other drug use, and cigarette use. Over the trajectory, early cannabis users demonstrated higher levels of SPD symptoms (.24 SD unit difference, Cohen's d, P < .01) than nonusers.
Importantly, they note, the effect of early cannabis use on SPD symptoms into adulthood was not restricted to those already showing SPD symptoms in adolescence or to those with signs of depression or anxiety or use of other drugs or cigarettes.

Large Body of Evidence
This study, said Dr. Anglin, adds to "the large body of evidence relating cannabis use with psychosis by demonstrating that cannabis use occurring earlier in development may also play a role in the development of subthreshold schizophrenia-like symptoms."

Study coauthor Cheryl Corcoran, MD, from the New York State Psychiatric Institute and Columbia University, in New York City, told Medscape Medical News what is "truly noteworthy is that cannabis use may play a role in the formation of schizophrenia symptoms beyond psychotic symptoms, such as its characteristic oddness and negative symptoms of low motivation and low social drive."
"From an epidemiological perspective, this study was well done and controlled for important potential confounds, including earlier symptoms, depression, anxiety, other drug use, and cigarette smoking," Dr. Corcoran added.

Reached for comment, Wayne Hall, PhD, from the University of Queensland Centre for Clinical Research in St. Lucia, Australia, who was not involved in the study, told Medscape Medical News that the results are "largely confirmatory of the literature."

The authors note that additional research is needed to determine the underlying mechanisms for the association of early cannabis use and SPD symptoms and to determine whether these effects of using cannabis on SPD symptoms vary with duration of use throughout the life course.
It is unclear, the study authors add, "whether the effects of early cannabis use are minimized among those who stop smoking at some other developmentally critical point (eg, in their early 20s or even later)."

The study was funded by grants from the National Institute of Drug Abuse and the National Institute of Mental Health. The authors and Dr. Hall have disclosed no relevant financial relationships.
Schizophrenia Res. 2012;137:45-49.
Abstract

http://www.medscape.com/viewarticle/764024

Monday, April 30, 2012

Monday Hepatitis C News Ticker-Research and Headlines

Most management decisions were relatively simple, and most patients could be followed primarily by nurse practitioners and physician assistants The field of HCV therapeutics is moving rapidly and much remains to be learned; thus, firm predictions are inherently risky. It is likely, however, that for the foreseeable future, management decisions will require much more thought than they did in the “easy” days of interferon alfa–based regimens.

Interferon-Associated Retinopathy and Non-HCV Related Eye Conditions
This paper reports a case of pegylated interferon-associated retinopathy in a patient with chronic hepatitis C. A 32-year-old female with chronic hepatitis C undergoing pegylated interferon and ribavirin combination therapy complained of visual blurring. Features of interferon-associated retinopathy, including ocular complications such as cotton wool spots, retinal hemorrhages, macular edema, and branch retinal vein occlusion, were found in the fundus of both of her eyes

Coffee reduced HCV replication with regular coffee having a more pronounced effect. Coffee significantly reduced HCV replication at concentrations achievable by coffee consumption, while caffeine as well as caffeine degradation products interfered with HCV replication at high concentrations (about 100 µM or more).

Website 

Advances in the treatment of hepatitis C virus infection.
Thomas DL. Antivir Med. 2012 Apr;20(1):5-10.

The addition of a protease inhibitor (PI) to what has been the standard HCV therapy of peginterferon alfa and ribavirin dramatically improves sustained virologic response rates in treatment-naive patients with genotype 1 infection.

Similar results have been observed in some treatment-experienced patients in whom prior peginterferon alfa/ribavirin therapy has failed. The use of these new agents has also permitted response-guided therapy, wherein early sustained virologic response to treatment allows for a shortened treatment duration.

However, these new PIs add cost and adverse effects to HCV therapy. Boceprevir is associated with increased risk of anemia and dysgeusia, and telaprevir is associated with increased risk of anemia and skin and gastrointestinal adverse effects. Early studies indicate that the addition of PIs results in high response rates in patients with HCV/HIV coinfection. Other studies suggest that combinations of PIs and other direct-acting antivirals may ultimately permit cure when used in interferon sparing regimens....

New @ NATAP

Analysis of long-term persistence of resistance mutations within the hepatitis C virus NS3 protease after treatment with telaprevir or boceprevir





Liz Highleyman
Adding GS-7977 to pegylated interferon and ribavirin for 12 weeks led to a sustained response rate of 90% for previously untreated chronic hepatitis C patients with difficult-to-treat genotype 1, researchers reported at the 47th International Liver ...Continue Reading...

Journals

Annals Of Hepatology
May-June, Vol. 11 Issue 3, 2012

Does the persistently normal aminotransferase levels in hepatitis C sitll have relevance?
Jorge Méndez-Navarro, Margarita Dehesa-Violante

Prevention of hepatocellular carcinoma: a concise review of contemporary issues
Vincent Wai-Sun Wong, Henry Lik-Yuen Chan


Treatment of recurrent genotype 4 hepatitis C after liver transplantation: early virological response is predictive of sustained virological response. An AISF RECOLT-C Group Study
Francesca Romana Ponziani, Alessandro Milani, Antonio Gasbarrini, Raffaella Zaccaria, Raffaella Viganò, Maria Francesca Donato, Maria Cristina Morelli, Lucia Miglioresi, Luisa Pasulo, Maria Rendina, Daniele Di Paolo, Maria Marino, Pierluigi Toniutto, Stefano Fagiuoli, Maurizio Pompili


In The News

Media Advisory - Interview Local Nurses Dedicated to the Hepatitis C Community: National Nursing
Week - May 7 to 13, 2012

TORONTO, April 30, 2012 /PRNewswire via COMTEX/ -- During National Nursing Week, Canadians will recognize and celebrate the important contributions nurses make daily to patient care in Canada. The role nurses play in the prevention and management of chronic hepatitis C, a potentially life-threatening virus, provides a powerful example of their impact as supporter, educator and counsellor.

Canadians living with chronic hepatitis C often fear the judgment of others because the virus infecting them is often associated with injection drug use. The reality is that people can contract the virus through a number of different ways including, body piercings, tattoos, blood transfusions or personal care items (razors).

Members of the Canadian Association of Hepatology Nurses (CAHN) build trusted relationships with patients by not focusing on how the hepatitis C virus was contracted, but rather on providing care and support that is beneficial, respectful and can lead to a cure.

The road to a cure is a difficult journey for patients living with chronic hepatitis C. While treatments can be very successful at getting rid of the virus, the stigma associated with the disease often requires patients to struggle through chemotherapy-like side effects in isolation.

CAHN wants to shatter the stigma for those people living with chronic hepatitis C by helping Canadians recognize that anyone, including someone they know and love, could be living with this virus. Stigma must not be a barrier to detection and treatment.

This National Nursing Week, celebrate the leadership provided by CAHN nurses in the prevention and management of chronic hepatitis C.

What: Interview opportunities with nurses and individuals living with chronic hepatitis C willing to share their stories Who: Cheryl Dale, President of the Canadian Association of Hepatology Nurses, CAHN members and individuals living with chronic hepatitis C Where: The following communities across Canada: Ontario (Toronto, Oakville, Mississauga, Guelph, Hamilton, Kitchener-Waterloo, Newmarket, Sutton, Sudbury, North Bay, and London), Quebec (Montreal), British Columbia (Vancouver, Kelowna, and Nanaimo), Alberta (Edmonton), Nova Scotia (Halifax), and Saskatchewan (Prince Albert) When: National Nursing Week (May 7-13, 2012)

SOURCE Canadian Association of Hepatology Nurses
Copyright (C) 2012 PR Newswire. All rights reserved

Hep C Bulletin: Medication Management
There are hundreds of medications that are metabolized by the liver - both prescription and over-the-counter drugs. In an ideal world, each person would have a physician who knows all about his or her medical history and monitors every pharmaceutical he or she takes. In the real world, many of us are left to fend for ourselves in this arena. Instead of turning one's well-being over to the medical system, being diagnosed with Hepatitis C should put those affected in the driver seat to control their fate:
• by making sure they know what kind of stress every drug taken places on the liver
• by instigating a dialogue with their primary healthcare provider about monitoring their liver's health when necessary

In the end, develop the patience to learn about your medications and the courage to speak up to a doctor about their effect on your liver. Being responsible for these two simple steps can help those with chronic Hepatitis C take an active role in receiving the best healthcare possible.
Continue Reading....

Gilead Sciences Looks For Hepatitis C Cure
Why the emphasis on hep c? While Gilead Sciences has branched out into treatments for cardiovascular diseases, its primary expertise in in anti-viral drugs, particularly for HIV infections, which lead to AIDS if untreated. Because of the effectiveness of its single-tablet, multi-drug combinations, Gilead dominates that market. Gilead also markets Viread for Hepatitis B. The past generation of Hepatitis C therapies have limited effectiveness, have a number of side effects, and cannot be administered orally.

Before the Pharmasset acquisition Gilead had four hepatitis drugs in phase II trials, and three in phase I, and said they would likely be made into a successful combination therapy. Pharmasset added Phase III candidate PSI-7977 (now GS7977), Phase II candidate Mericitabine, and Phase II candidate PSI-938, all for hep C. Pharmasset also brought candidates for HIV and hepatitis B treatment.

Thursday Gilead executives reviewed recent hep C data and clarified their strategy. The GS-7977 plus ribavirin hepatitis C (HCV) genotype 1 Phase 2 study showed no detectible virus after 12 weeks of treatment, but at end of treatment the majority of patients relapsed. GS-7977 plus BMS-790052 (owned by Bristol Myer BMY) showed high hepatitis C cure rates: >90% for genotype 2/3 and 100% for genotype 1.

Based on those and other results, Gilead is designing Phase III studies that could be fully enrolled by the end of May. Several paths are available to get therapies to market, but they need to talk more to regulators before the final trials are initiated. They would clearly prefer an all-Gilead single tablet regimen that cures most hep C, so working with Bristol Myer would be a fall back position. Given the number of drugs Gilead owns and could combine with 7977, it is a good, but not certain, bet that something will work.

At the same time it is a race, since other companies are also trying to break into the all-oral hepatitis market. It is a huge market. An estimated 150 million people have chronic hepatitis C, with the U.S. figure likely somewhere between 3 and 6 million (many people have undiagnosed hep c).

It is too early, I think, to put a number on the value of a hep c cure, but note that Gilead paid $11 billion for Pharmasset. They went through most of their cash and borrowed some $5.5 billion to do it. Gilead annual cash flow runs around $2 billion.

The main risk here is that a competitor (or multiple competitors) will also create an all-oral hepatitis c therapy, and might even gain FDA approval first. Even so, it is a big market and I don't think Gilead's present price reflects much of this opportunity.............
Read full article here

Stem Cells

Stem cell researchers map new knowledge about insulin production      
Monday, 30 April 2012   

Scientists from The Danish Stem Cell Center (DanStem) at the University of Copenhagen and Hagedorn Research Institute have gained new insight into the signaling paths that control the body's insulin production. This is important knowledge with respect to their final goal: the conversion of stem cells into insulin-producing beta cells that can be implanted into patients who need them. The research results have just been published in the journal PNAS.

Insulin is a hormone produced by beta cells in the pancreas. If these beta cells are defective, the body develops diabetes. Insulin is vital to life and therefore today the people who cannot produce their own in sufficient quantities, or at all, receive carefully measured doses – often via several daily injections. Scientists hope that in the not-so-distant future it will be possible to treat diabetes more effectively and prevent secondary diseases such as cardiac disease, blindness and nerve and kidney complications by offering diabetes patients implants of new, well-functioning, stem-cell-based beta cells.

"In order to get stem cells to develop into insulin-producing beta cells, it is necessary to know what signaling mechanisms normally control the creation of beta cells during fetal development. This is what our new research results can contribute," explains Professor Palle Serup from DanStem.
"When we know the signaling paths, we can copy them in test tubes and thus in time convert stem cells to beta cells," says Professor Serup.

The new research results were obtained in a cooperative effort between DanStem, the Danish Hagedorn Research Institute and international partners in Japan, Germany, Korea and the USA. The scientific paper has just been published in the well-respected international journal PNAS (Proceedings of the National Academy of Sciences of the United States of America) entitled Mind bomb 1 is required for pancreatic β-cell formation.

Better control of stem cells
The signaling mechanism that controls the first steps of the development from stem cells to beta cells has long been known.

"Our research contributes knowledge about the next step in development and the signaling involved in the communication between cells - an area that has not been extensively described. This new knowledge about the ability of the so-called Notch signaling first to inhibit and then to stimulate the creation of hormone-producing cells is crucially important to being able to control stem cells better when working with them in test tubes," explains Professor Palle Serup.

This new knowledge about the characteristics of the Notch signaling mechanism will enable scientists to design new experimental ways to cultivate stem cells so that they can be more effectively converted into insulin-producing beta cells.

David vs Goliath in stem cells: the global power of blogs
The conflict in Ireland over stem cells is still brewing and bubbling this week as I’ve been blogging it.

It is remarkable to me that as just one person I have in a few days been able to have a substantial impact in that dialogue via this blog.

There has been a rather large push lately, especially in the past week, by the “adult stem cells only” crowd in Ireland to advance their cause via press releases and use of traditional media.
For example, the Irish Times published a piece on stem cells in Ireland that almost entirely regurgitated verbatim verbiage from the Adult Stem Cell Foundation of Ireland (ASFI). Rather than a news piece, it was really a propaganda piece.

A more balanced piece was found in the Irish Examiner, presenting arguments from both ASFI, which only advocates use of adult stem cells, and also the Irish Stem Cell Foundation, which advocates the use of all stem cells.

What does the Internet “think” of this issue?
A Google search for Adult Stem Cell Foundation of Ireland yields some remarkable results. While the Irish Times propaganda piece pops up as #1 in the search results sadly, the Irish Examiner piece is #4. Strikingly, two of my blog pieces (here and here) from this week are sandwiched in between at #2 and #3. I also posted another piece that is I believe #12 in the search results.

Thus, in just a manner of 4 days the pieces just mentioning ASFI on this blog have generated enough traffic and interest to be of major importance by Google, impact that is essentially comparable to those of two major traditional newspapers in Ireland. The Times’ circulation in 2011 was almost 400,000 and the Examiner is about 60,000 I believe.

How is it that a blog written by me can compete with these relatively gargantuan media businesses? The reality is that highly read blogs written by a single person can vie with newspapers for influence on specific topics.

Perhaps my pieces will fade in Google’s view over time, but the impact now is surprising to me. I take this power in a very sober manner and consider this a big responsibility. At the same time this tells me that even one patient advocate or stem cell researcher can have a surprisingly powerful influence on the discourse on specific issues.

Of course this power can and is used effectively by people on the other side of the stem cell battlefront. Many examples of powerful “adult stem cells only” blogs are apparent on the Internet.
No matter one’s opinion on issues such as stem cells, an indisputable reality of today is that blogs are quite powerful tools.

Healthy You

Vitamin D supplements may protect against viral infections during the winter
New research published in the Journal of Leukocyte Biology suggests that the older population could benefit from vitamin D supplementation in autumn and winter to protect against viral infections
Vitamin D may be known as the sunshine vitamin, but a new research report appearing in the Journal of Leukocyte Biology shows that it is more than that.

According to the report, insufficient levels of vitamin D are related to a deficiency in our innate immune defenses that protect us from infections, neoplasias or autoimmune diseases. Since vitamin D levels decrease during autumn and winter when days are shorter and sunlight is relatively weak, this may explain why people are more prone to viral infection during these times. It also suggests that vitamin D supplementation, especially in older populations, could strengthen people's innate immunity against viral infections.

"There are numerous studies showing the benefits of maintaining adequate Vitamin D levels. As more and more research into Vitamin D is conducted, we are learning that it is extremely important for human health. Our study is no different, and vitamin D supplements should be considered one of many tools that might help when conventional therapies are not enough," said Victor Manuel Martinez-Taboada, M.D., a researcher involved in the work from the Division of Rheumatology at the Hospital Universitario "Marque's de Valdecilla," Facultad de Medicina at the Unversidad de Cantabria, in Santander, Spain.

To make this discovery, the researchers compared the changes in the blood levels of vitamin D among three groups of healthy subjects: young (age range: 20-30), middle (age range: 31-59), and elderly (age range: 60-86). They found decreased levels of vitamin D with aging, prompting researchers to compare whether such changes kept any relationship with toll-like receptor (TLR) expression measured on lymphocytes and monocytes and function after in vitro stimulation with specific ligands for each of the nine human TLRs and measurement of effector molecules, such as proinflammatory cytokines. Specifically, they found that the TRL most affected by a vitamin D insufficiency is TLR7, which regulates the immune response against viruses. Finally, scientists studied whether there was any difference in the three age groups depending on the season of the year since it is well known that a limited sun exposure during darker winter months is related with vitamin D deficiency.

"Any school teacher will tell you that people tend to be sicker during the winter than any other time of the year," said John Wherry, Ph.D., Deputy Editor of the Journal of Leukocyte Biology. "There have been numerous studies showing several environmental factors during winter months may allow viruses to spread easier. This study shows that sunlight, or more precisely the lack of vitamin D, could have a role in the seasonally higher rates of infection. More extensive studies must be conducted for this link to be conclusive, but since vitamin D supplements are inexpensive and generally safe, this is a really exciting discovery."

###

The Journal of Leukocyte Biology publishes peer-reviewed manuscripts on original investigatins focusing on the cellular and molecular biology of leukocytes and on the origins, the developmental biology, biochemistry and functions of granulocytes, lymphocytes, mononuclear phagocytes and other cells involved in host defense and inflammation. The Journal of Leukocyte Biology is published by the Society for Leukocyte Biology

Details: Lorena Alvarez-Rodriguez, Marcos Lopez-Hoyos, Maite Garcia-Unzueta, Jose Antonio Amado, Pedro Muñoz Cacho, and Victor Manuel Martinez-Taboada. Age and low levels of circulating vitamin D are associated with impaired innate immune function. J Leukoc Biol May 2012 91:829-838; doi:10.1189/jlb.1011523 ; http://www.jleukbio.org/content/91/5/829.abstract

Anxiety, Depression Often Go Hand-in-Hand With Arthritis

Mental health screening, treatment could improve quality of life for these patients, report suggests

MONDAY, April 30 (HealthDay News) -- Depression or anxiety affect one-third of Americans with arthritis who are aged 45 or older, a new study shows.

Researchers from the U.S. Centers for Disease Control and Prevention also found that even though anxiety is nearly twice as common as depression among people with arthritis, doctors tend to focus more on depression in these patients.


The study included nearly 1,800 people with arthritis or other rheumatic conditions who took part in the CDC's Arthritis Conditions and Health Effects Survey. Among the study participants, 31 percent reported anxiety and 18 percent reported depression.

One-third of the patients reported at least one of the two conditions and 84 percent of those with depression also had anxiety. Only half of those with anxiety or depression sought mental health treatment in the previous year, according to the study, which was published in the April 30 issue of the journal Arthritis Care &amp; Research.

"Given their high prevalence and the effective treatment options that are available, we suggest that all people with arthritis be screened for anxiety and depression," study leader Dr. Louise Murphy, of the Arthritis Program at the CDC, said in a journal news release.

"With so many arthritis patients not seeking mental health treatment, health care providers are missing an intervention opportunity that could improve the quality of life for those with arthritis," she added.
In the United States, 27 million people age 25 and older have osteoarthritis, and 1.3 million adults have rheumatoid arthritis, according to the American College of Rheumatology.

More information
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases offers advice on how to live with arthritis.
Copyright © 2012 HealthDay. All rights reserved.

Of Interest

Is Marijuana Medicinal?
By: DONALD I. ABRAMS, M.D. and JODIE TRAFTON, PH.D.
04/24/12 

POINT: Cannabis can relieve neuropathic pain.
As an oncologist, I treat cancer patients who have nausea, vomiting, weight loss, pain with and without opioids, insomnia, and depression. With cannabis, I can recommend that they try one medicine instead of five or six prescriptions that will interact either with one another or with their cancer chemotherapy.

Studies show that cannabis and cannabinoids are effective for peripheral neuropathic syndromes associated with HIV, multiple sclerosis, or posttraumatic or postsurgical causes. A study of diabetic neuropathy is ongoing; cannabis has not yet been studied for chemotherapy-induced neuropathy. Other data show that cannabis and cannabinoids may be synergistic with opioids in relief of chronic pain without altering pharmacokinetics.



We conducted a randomized, placebo-controlled study of cannabis for patients with HIV-related peripheral neuropathy at San Francisco General Hospital because preclinical studies and anecdotal patient reports said it was helpful. Average neuropathic pain scores in the week before being admitted to our research center were about 60 out of 100.

After a 2-day run-in period, patients were randomized to smoke cannabis or placebo three times a day for 5 days. Among 50 patients who completed the study, neuropathic pain decreased by about 34% with cannabis versus 17% with placebo. Our threshold for a positive response was at least a 30% reduction in pain; this was reported by 52% on cannabis and 24% on placebo (Neurology 2007;68:515-21).

We also used a more objective heat-capsaicin method to assess pain. An area on the forearm was heated to 40° C for half an hour and then capsaicin (the active ingredient in chili peppers) was applied. This creates an area of hypesthesia and allodynia that can be measured using a brush and a piece of foam while the patient looks in another direction.

On the heat-capsaicin tests, the area of hypesthesia or allodynia either increased or was the same after smoking placebo but decreased approximately 30% after smoking cannabis. We calculated that the number needed to treat to get a beneficial effect was 3.6, which is equivalent to that with gabapentin, the mainstay treatment for our patients with HIV-related peripheral neuropathy.

A crossover study in 28 patients with HIV-associated neuropathy at the University of California, San Diego found that pain decreased with cannabis versus placebo. The number needed to treat was 3.5. (Neuropsychopharmacology 2009;34:672-680).

Investigators at the University of California, Davis, randomized 38 patients with central and peripheral neuropathic pain to low- or high-dose cannabis or placebo. They found a linear analgesic dose response for both doses of cannabis, compared with placebo, and reported that the effect was not due to lysis of anxiety but to reduction of core nociception as well as emotional responses to pain. (J. Pain 2008;9:506-21).

Dr. Donald I. Abrams
A randomized, double-blind, four-period crossover study in Montreal looked at 23 participants with postsurgical neuropathic pain who inhaled increasing dosages of tetrahydrocannabinol (THC). Results showed that the average daily pain intensity was significantly lower and quality of sleep improved in the highest-dose THC group, compared with the placebo group (CMAJ 2010;182:e694-701).

We recently completed a study funded by the National Institute on Drug Abuse to look at effects of combined use of opioids and cannabis, in which
we also assessed effects on pain.

We saw a significant 26% reduction in pain with the addition of vaporized cannabis in the cohort as a whole. Pain reduction was greater in the morphine group (a 31% decrease) compared with the oxycodone group (a 23% decrease). We saw no adverse safety effects. Although we know quite well that the study was too small to make a definitive claim, this was a tantalizing demonstration of potential synergy between opioids and cannabinoids, (Clin. Pharmacotherapeutics 2011;90:844-51).

Every 10 years since cannabis was removed from the medical formulary in 1942, some august government body in the United States looks at cannabis in medicine. They all conclude the same thing – that it’s a valuable medicine, and should be available. That usually goes ignored, however. An Institute of Medicine report in 1999 said the accumulated data indicate a potential therapeutic value for cannabinoid drugs in the treatment of pain, control of nausea and vomiting, and appetite stimulation.

Dr. Donald I. Abrams is a professor of clinical medicine at the University of California, San Francisco. He declared having nothing to disclose except that he went to college in the 1960s. This debate took place at the annual meeting of the American Academy of Pain Medicine.

COUNTERPOINT: But chronic use is harmful.
Marijuana doesn’t meet standards to be considered a medicine.

There’s a massive lack of standardization in the product. Compounds have very different, in some cases opposing, effects. Potency varies depending on the strain and how it was prepared.

There’s also no standardization around administration. Smoking or inhaling marijuana – the most common routes speed drug uptake and the effects of cannabinoids on reward processing, which increases addictiveness.

Smoking marijuana is carcinogenic and causes lung damage. Yes, a study suggested twice-a-month use doesn’t really change your lung capacity, but that changed with daily, frequent use. The typical use pattern is about four times per day, daily, in medical patients.

Pain studies looked at acute use of cannabis for a week or so. They haven’t looked at chronic effects. We don’t know the impact of tolerance and dependence in patients with chronic pain, or the effect of constant activation of reward circuits by marijuana on new behavior patterns over time. That’s typically what you have trouble with in chronic pain patients – getting them up, getting them going, getting them back into life. Marijuana could make that more difficult.

Dr. Jodie Trafton
A meta-analysis of 18 randomized, double-blind, controlled trials of cannabis for chronic pain found a greater effect with cannabis than with placebo, but this was not huge. If a patient starts out with a pain score of 8 out of 10, it will drop to about 7.4 – a 7.5% reduction in score. We’re talking about going from severe to a little less severe pain. Patients on cannabis were much more likely to have alterations in perception, motor function, and cognitive function (Pain Med. 2009;10:1353-68).

In the crossover study of 23 patients that Dr. Abrams cites, low-dose and high-dose THC decreased pain, but there was no difference in the middle doses, compared with placebo. And look at the levels of pain scores: You’re going from an average of 6.1 to 5.4, from moderate pain to moderate pain. That’s less than 1 point on a 10-point scale, and you’re getting all of the adverse effects and behavioral changes in conjunction with that. Is that worth it?

The 28-patient crossover study he cites started with 34 patients. There were some serious cannabis-related issues, including acute psychosis and intractable cough, in the patients who didn’t complete it. One patient started using methamphetamine again. This is not a particularly low rate of problems.

We don’t have a lot of data to say what happens to patients with chronic pain who use marijuana over time. There are more data on what happens when people in the general population use marijuana chronically. The best characterized chronic effects include a motivational syndrome, poor concentration, attention and judgment, impaired social skills, introversion, deteriorating personal habits and depersonalization, mood disorders, anxiety disorders, insomnia, increased risk of schizophreniform illness and psychosis, more negative life events, and withdrawal.

Studies have found functional impairments related to chronic marijuana use. People who use marijuana over long periods of time develop at least partially persistent problems on neuropsychological tests – problems that don’t go away even if they stop using marijuana.

There’s also evidence of a relationship between cannabis and mood disorders. Cross-sectional studies show that people who use cannabis daily or near-daily are 3.4 times more likely to have major depression. Longitudinally, if you are diagnosed with cannabis dependence, you have a 6.4-fold increased chance of being diagnosed with major depression within a 12-month time period.

It appears that cannabis is inducing the mood disorders, not the mood disorders driving cannabis use. A Dutch study of 3,854 adults with no history of mood disorders found that cannabis use at baseline was associated with a doubling in risk for developing any mood disorder, a 60% increased risk for major depression, and a five-fold increased risk for bipolar disease (Addiction 2007;102:1251-60).

If cannabis use makes people tend toward mood disorders, and chronic pain patients tend toward mood disorders, how much harder are you making it by suggesting they try marijuana to get that 1-point decrease in pain?

Frequent marijuana use is associated with development of dependence. Withdrawal symptoms occur whenever drug levels start to decrease over time. Withdrawal starts within 2-4 hours, and symptoms last for weeks. Symptoms include irritability, anger or aggression, nervousness or anxiety, sleep difficulty, decreased appetite or weight loss, restlessness, depressed mood, and a variety of physical symptoms causing significant discomfort.

The main reasons that people say they want to use medical marijuana are to treat nervousness, anxiety, insomnia, and depressed mood. All of these potentially are withdrawal symptoms.

One study showed a vast majority of California patients seeking a physician’s recommendation for medical marijuana – well over 95% were already self-medicating with marijuana. We would expect that population to be dependent.

A separate study confirmed that 10 of the 15 "clinical benefits" reported by 1,746 medical marijuana users were the easing of problems that can be found on a list of withdrawal symptoms (J. Psychoactive Drugs 2011;43:128-35).

Chronic pain patients already have high comorbidity with depression, functional problems, and high rates of disability. Recommending medical marijuana increases risk in an already at-risk population.

Jodie Trafton, Ph.D., is director of the Program Evaluation and Resource Center in the Office of Mental Health Operations, Veterans Affairs Palo Alto (Calif.) Health Care System. The views expressed are those of Dr. Trafton and do not necessarily represent those of the Department of Veterans Affairs. She declared having no financial disclosures.