Screening all children identify number children
William Neal of West Virginia University in Morgantown, who led the new study.
Neal said treating youth with cholesterol-lowering drugs, the so-called statins, would curb the risk that they went on to develop heart problems in middle age. Heart disease is the leading cause of death in the Western world.
Based on data from West Virginia, Neal and colleagues found that more than one percent of all fifth-graders had cholesterol levels that warranted drug treatment. But a third of those children didnt have relatives with heart disease or high cholesterol, and so wouldnt have been screened under the current guidelines, issued by the governments National Cholesterol Education Program.
I have gradually become convinced that universal screening in children is not only preferable, but necessary, said Neal. He added that although universal screening would be expensive, it would save a lot of money later on if heart disease could be prevented.
But not all scientists agree that screening is a good idea. For example, the U.S. Preventive Services Task Force, a federal expert panel, currently doesnt recommend routine cholesterol screening in any children.
Unfortunately, there is no evidence that starting a ten-year-old on cholesterol-lowering drugs will prevent heart disease 40 years later, said Dr. Michael L. LeFevre, a member of the task force.
He said statin treatment in children was still controversial, and that no long-term safety data existed.
The new study tapped into data from more than 20,000 children who had been screened at public schools in West Virginia over five years.
More than seven in 10 school kids had first-degree relatives with heart disease, and about one percent of those had bad cholesterol LDL cholesterol levels that might require drug treatment in addition to diet changes and exercise, according to the researchers.
Yet among the kids without heart disease, the percentage of children who might benefit from treatment was closer to two percent than to one, meaning that family history didnt seem to make a difference.
It is therefore prudent to implement universal screening in the pediatric population independent of family history, the researchers conclude.
SOURCE here Pediatrics, online July 12, 2010. source
Unlike other food allergieswhich might disappear kids grow
Unlike other food allergieswhich might disappear as kids grow up or respond to doctor-supervised challenges allowing a child to build up a tolerance to the food — a peanut allergy usually lasts a lifetime, Shreffler and colleagues note in the Journal of Allergy and Clinical Immunology. And the severity of reactions may vary widely one accidental exposure may lead to a minor rash, the next could be fatal.
The research team, from Berlins University Hospital Charite and Mount Sinai Medical Center in New York, wanted to know if a therapy could be developed that was safe to take by mouth and would reduce the threat of accidental peanut ingestion in peanut-allergic kids.
These patients were carefully selected to have an extremely low probability of growing out of their peanut allergy, said Shreffler, who now practices at Bostons General Hospital.
In the study, the first of its kind, tiny amounts of crushed peanuts were given by mouth to build up tolerance to peanut proteins. To limit the danger of a fatal reaction, the 23 children enrolled in the study were admitted to the hospital for the first week of therapy.
It took an average of 7 months of increasing doses for the kids to work up tolerance to one kernels worth of crushed peanut or 500 milligrams, more than is usually eaten in an accidental ingestion, the investigators say. After they reached 500 mg and were able to consume it daily without side effects for 8 weeks, they took two weeks off and then faced a new peanut food challenge.
Before this time, however, more than a third of the kids 35 percent dropped out of the study, a rate quite high compared to other studies, the investigators note. Allergic reactions ranging from upset stomach to wheezing were common in all the children. Four, or 17 percent, dropped out because of a bad allergic reaction, a higher adverse reaction rate than some previous work. One patient quit during the hospital phase because of anxiety. Two, including the youngest participant, who couldnt stomach the taste of the peanut/applesauce concoction, were dropped because they wouldnt follow the trial rules.
Fourteen children made it to the end of the study. At the final food challenge, all but two of them were able to tolerate 1 gram of peanut compared to .19 gram at the beginning of the study, leading the investigators to conclude that some patients might benefit from this approach known as oral immunotherapy.
The glass is half full, Shreffler said. The therapy was able to increase tolerance levels in many more than would have had any change on their own, he said while urging caution.
Whether the protection lasts longer than two weeks is not answered yet.
Theres evidence there may have been a permanent shift, but we havent proven that yet. Weve only taken the first step, Shreffler said.
The Food and Drug Administration does not regulate therapies such as this and Shreffler urges patients to be wary of anyone offering it.
Theres nothing regulatory to prevent Johnny allergist from starting to give crushed up peanuts to patients in the office, he said.
If a pill is developed, the FDA would become involved.
Thats the best hope. It could be in a pill form or it could be a well defined protocol, Shreffler said, but a good understanding of whats safe and who would benefit is at least five years away.
Clinical trials are underway testing other therapies too, he said, but in the meantime, total avoidance of peanuts and keeping an EPI pen on hand for an emergency injection in case of accidental ingestion, are the only sure ways to protect against a fatal reaction.
According to U.S. government figures, peanuts and tree nut allergies are the leading causes of fatal and near fatal food-allergic reactions.
SOURCE link.reuters.com/nyx36m Journal of Allergy and Clinical Immunology, July 2010 source
For many patients in united states
Jersey Chen of Yale University School of Medicine, whose study appears in the Journal of the American College of Cardiology.
An advanced type of heart stress test called myocardial perfusion imaging, in which doctors inject a radioactive tracer in patients to test blood flow, accounted for 74 percent of radiation exposure from heart scans.
Heart catheterization and stentingprocedures in which thin tubes are fished through blood vessels to open blocked arteries — were the second biggest contributor to radiation exposure, Chen said.
More than half of the heart procedures using radiation were done in the doctors own office, the team found.
Policymakers have been concerned that there is a rise in physician office imaging and a rise in total use of imaging, Chen said in a telephone interview.
I think there is legitimate concern that easy availabilityconvenience — makes the threshold for testing lower. Whether it is inappropriate or not, our study cant say.
While doctors disagree over how much, most agree that radiation can cause cancer, and researchers are growing concerned that an explosion in the use of medical imaging is making it more likely that patients may develop cancer.
A report last year by the National Council on Radiation Protection and Measurement found that Americans receive seven times more radiation from diagnostic scans than in 1980.
Chens team, looking specifically at radiation exposure from heart imaging procedures, studied medical claims records from nearly 1 million patients aged 18 to 64 insured by United Healthcare.
They calculated the annual radiation dose based on three exposure ranges less than 3 millisieverts a year, the average exposure level for people from the sun and environment between 3 and 20 millisieverts a year and more than 20 millisieverts a year, the upper safety limit for workers exposed to radiation.
Of those who got heart procedures using radiation, most fell into the middle range but more than 3,000 patients got more than 20 millisieverts a year over the three-year period and 75 people got more than 50 millisieverts a year.
The average patient who gets a nuclear stress test is going to get 16 millisieverts each time. Its going to increase their risk on a statistical basis, Chen said.
Dr. Pamela Douglas of Duke University in North Carolina and a former president of the American College of Cardiology said doctors need to pay attention to radiation but she said the benefits of these heart tests and procedures should be weighed against the risk that a cancer might develop down the road.
Lets not get hysterical, she said in a telephone interview.
Overall, patients with heart disease are doing way better. The procedures are helping people. If we can change them or tweak them to help reduce radiation exposure even more, that would be wonderful.
Editing by Eric Walsh source
We are encouraged significant increase colon cancer
Thomas Frieden told reporters in a telephone briefing.
But, he added, more than a third of Americans who need to be screened havent been screened.
CDC researchers analyzed survey results from the state-level 2008 Behavioral Risk Factor Surveillance Survey for the report, available at www.cdc.gov/vitalsigns.
They found colon cancer screening rates rose from 52 percent of those who should get the tests in 2002 to 63 percent in 2008. Americans are advised to get a colon cancer screen, usually in the form of a colonoscopy, starting at age 50 and at age 40 if there is a family history of the disease.
A separate report found that 81 percent of women aged 50 to 74 got mammograms in 2008, virtually the same as in 2006.
The findings indicated that more than 22 million men and women have not had a potentially life-saving screening test for colorectal cancer and about 7 million women age 50 to 74 have not had a recent mammogram, the CDC said in a statement.
Any screening is good and the overall increase is the main message there, Frieden said. Nevertheless, there is a lot more progress we could make with colon cancer screening.
Frieden said there are differences of opinion over how many lives could have been saved by early screening. Colonoscopies can detect and remove pre-cancerous growths before they become tumors and mammograms can catch tumors while they are small and easily removed.
LIVES SAVED
The American Cancer Society says that more than 106,000 Americans were diagnosed with colon cancer in 2009 and nearly 50,000 died of it.
What is debated is exactly how many of those would be prevented by colon cancer screening getting as high as can plausibly be expected, Frieden said.
You can argue for 10,000. You can argue for 30,000, he added. I think we can certainly say more than 10,000 very comfortably. For every person who dies from preventable colon cancer it is one too many.
In 2009, 194,000 Americans got breast cancer and 40,000 died. Each year about 12,000 lives are saved as a result of mammography, Frieden said.
If insurance companies stopped requiring co-payments for screening tests, that could help increase the number of people willing to be screened, Frieden said.
The report also showed that people with health insurance are far more likely to be screened for cancer, with 66 percent of those insured getting the recommended breast or colon screening compared to 36 percent of those without.
Currently, about 46 million Americans, or 15 percent of the population, has no health insurance. A new healthcare law signed in March is projected to extend coverage to 32 million more Americans, mainly by requiring them to buy it. source
A major risk is birds infect pigs
A major risk is that the birds would infect pigs, which are suspected mixing vessels for new strains of influenzanotably the ongoing pandemic of H1N1 swine flu, the researchers wrote in the Biomed Central journal BMC Infectious Diseases, available here
What is significant about the work is that for a long time folks thought this was just an issue in shorebirds and ducks, Tom Smith of the University of California Los Angeles, who directed the study, said in a telephone interview.
We havent been doing surveillance on wild passerines. Most of the money for doing disease work in birds comes when one works on game species.
Using National Science Foundation and National Institutes of Health funds, Smith and colleagues teamed up with David DeSante at the California-based Institute for Bird Populations to test songbirds for avian influenza viruses at the same time they were banding the birds for other research.
They tested more than 13,000 birds from 225 different species in 41 U.S. states, and found low-pathogenic avian influenza in 22 species, notably fox sparrows, Cassins finches, Swainsons thrush and Western tanagers.
NEW RESERVOIR
Ducks are considered the main reservoir for avian influenza viruses. Even highly pathogenic influenza rarely sickens most species of duck, but it wipes out chickens and sometimes other poultry such as turkeys.
Low-pathogenic viruses rarely make birds sick, and Smith said it was not clear what effect the infections had on the songbirds. They were certainly flying around, he said.
The team has also found avian influenza viruses in songbirds in Africawork that has not been published yet.
UCLAs Trevon Fuller said the team looked at satellite data and information from the U.S. Department of Agriculture and found a big factor was farming.
There is less habitat for wild birds, Fuller said. So the wild birds are being forced to congregate in smaller areas, and with higher density there is more opportunity for infected birds to shed virus, he said.
In farms you have things like starlings and cowbirds and house sparrows all interacting. Those are areas where you would want to be more vigilant.
H5N1 bird flu has killed or forced the destruction of more than 300 million birds, according to the world animal health organization OIE.
It rarely infects people but has been documented in 500 people since 2003 and has killed 296 of them.
Experts say the danger is that the virus will evolve just slightly into a form that people can easily catch and pass to one another, causing the transmission rate to soar and producing a pandemic in which millions of people could die.
H1N1 swine flu is the result of a so-called reassortment between pig and avian flu viruses. It has so far been about as deadly as seasonal influenza in terms of numbers but has killed far more children and young adults around the world than flu usually does.
Editing by Paul Simao source
The study shows even middle aged men need advice about
The study shows that even middle-aged men need advice about spreading and catching STDs, especially AIDS, which is deadly and incurable, Dr. Anupam Jena of Harvard Medical School in Boston and colleagues wrote.
Users of ED erectile dysfunction drugs had higher rates of HIV, chlamydia, gonorrhea and syphilis in the 12 months before filling their first ED drug prescription, although only HIV and chlamydia were statistically significant in this period, Jenas team wrote.
At a minimum, use of ED drugs seems to correlate with higher-risk sexual behavior, either in the number or type of sexual encounters.
Jena and colleagues looked at the health insurance records of 33,968 men with at least one prescription for an ED drug and more than 1 million men without a prescription, searching billing codes for STDs.
Rates of HIV per 100,000 men in the previous year were 66.5 for men who did not get an ED drug but 147.2 for men who did. Rates of chlamydia where almost triple for men who took an ED drug41 per 100,000 compared to 15 per 100,000 for men not using the drugs.
Erectile dysfunction drugs are popular and include Pfizers Viagra, known generically as sildenafil, vardenafil, sold under the brand name Levitra by GlaxoSmithKline and Eli Lilly and Cos Cialis, known generically as tadalafil.
They all belong to a class called phosphodiesterase-5 inhibitors and they work by increasing blood flow.
As many as 40 percent of men aged 57 to 85 have some degree of erectile dysfunction, editors of the journal wrote in a summary of the findings.
Dr. Thomas Fekete of Temple University School of Medicine in Philadelphia said the study reminds us that men older than 40 years remain sexually active, even if they need chemical assistance to do so.
There has been concern that these phosphodiesterase-5 inhibitors have become lifestyle drugs used to intensify sexual pleasure, even in men without ED, Fekete wrote in a commentary.
The study was unable to document why the men got the drugs and also would not account for men who may have bought such drugs over the Internet.
Fekete found something else puzzling. If the estimated rate of ED in men older than 40 years was 20 percent to 40 percent, it seems surprising that less than 7 percent of these men with insurance coverage received prescriptions for ED drugs, he wrote.
This implies that despite sexual dysfunction, at least one third of men were either satisfied with their sex lives or obtained ED drugs through other channels for example, Internet pharmacies, he added.
The study found that in 2006, 3.6 percent of men over 40 used Viagra, 1.7 percent used Cialis and 1 percent Levitra.
Reporting by Maggie Fox editing by Todd Eastham source
A report european school management and technology
New medications likely to be hit hardest under tough pricing regulation include antibiotics, as well as treatments for heart disease and immune system disorders such as multiple sclerosis and chronic meningitis, it said.
The report comes as governments across Europe are seeking to slash drugs prices as they reign in spending to try to tackle runaway budget deficits.
Germanys government approved a draft bill on Tuesday which aims to eventually save some 2 billion euros 2.4 billion each year on the cost of patented drugs by breaking up drugmakers pricing power, and Greece has also moved to slash drug prices by more than a fifth on average.
Our study shows the consequences that pricing and reimbursement regulation can have on pharmaceutical innovation. It also shows that, incorrectly applied, regulation can reduce the value of pharmaceutical projects and curtail the resources available to carry them out, Hans Friederiszick of ESMT CA said in a statement with the report.
Rational investors will naturally look for the most profitable investment choices, which is why regulation has a direct impact on the number and characteristics of the medications developed.
This means the more innovative drugs were like to get the most attention he said, whilst important areas like the development of new antibiotics may get left behind.
Drugmakers, such as GlaxoSmithKline and AstraZeneca are already cutting back on research and development RampD as they try to position themselves for a huge cliff of patents on big-selling drugs that are set to expire over the next five years.
The EMST report said that while European governments predominantly see pharmaceutical pricing models as a way of controlling public health costs, they may not realize or acknowledge the implications for product value, and therefore for the development of new drugs.
It said that internal reference pricing IRPa system used within Europe whereby prices in one country are taken as a reference point for others in negotiations — could result in an almost 12 percent drop in prices.
Beyond that, another pricing system called external price benchmarking EPBa model widely used across OECD countries — can lead to an almost 6 price drop.
Having some regions of the world under IRP and others under EPB magnifies the problem, since internal prices are then exported to external markets, leading to a 19.8 percent drop in portfolio value, the report said.
Reference pricing is common throughout the Europe Union and even beyond, with countries including Japan and Canada also taking account of European prices when deciding reimbursement.
Editing by Louise Heavens source
The researchers hope figurecalculated for first time will
The researchers hope this figurecalculated for the first time — will help make health care providers more aware of these families and provide them with additional support.
I think people have vastly underestimated the number of children who are affected by a parents cancer, Dr. Paula Rauch, who was not involved in the study, told Reuters Health.
It has been easier to measure the number of people who die from cancer, and often people still imagine that most cancer deaths and cancer survivors are elderly and dont have dependent children, added Rauch, who is founder and director of the Parenting At a Challenging Time, or PACT, program at Massachusetts General Hospital, Boston.
Dr. Kathryn Weaver of Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina and colleagues analyzed data from 13,385 cancer survivors who participated in U.S. national health surveys conducted between 2000 and 2007.
The analysis revealed that an estimated 18 percent of newly diagnosed cancer survivors and 14 percent of all U.S. cancer survivors live with one or more of their minor children.
Scaling these numbers up to reflect the entire U.S. population, the authors calculated that about 1.58 million cancer survivors in the U.S. are living with about 2.85 million children. An estimated 562,000 kids are living with a parent in the early phases of cancer treatment and recovery.
The figures are likely an underestimate of the true number of cancer survivors living with minors, the researchers say, because the study did not include survivors who live with grandchildren, nieces and nephews, or other young family members.
Weaver and her colleagues say that parents who are cancer survivors and their families may need extra support, but that talking to patients about family and home life is often not part of the treatment process.
For example, parents with cancer might have extra stress from worrying about the possibility of not being able to see their children grow up. Spouses of survivors often have to take on the roles of both parents during treatment, and the cost of treatment can put strain on the family. In addition, the authors say, children of survivors might need counseling or extra attention at school.
For health care providers, the most important thing is to screen all members of the family and find outwhat are their issues Weaver said. Some families certainly may be doing very well. Others may have multiple family members that are struggling.
SOURCE link.reuters.com/wyc64m Cancer, online June 28, 2010. source
The results study british researchers call into question
Statins are one of the most widely used drugs for the treatment and prevention of heart disease, both among people who already have it and among high-risk but healthy people. They are among the most successful drugs of all time and have been credited with preventing millions of heart attacks and strokes.
But in a meta-analysisa study which reviews all previous published scientific evidence on a specific area — Professor Kausik Ray and colleagues from the University of Cambridge and Addenbrookes Hospital found scant evidence that statins saved lives in the short term in groups without heart disease.
There is little evidence that statins reduce the risk of dying from any cause in individuals without heart disease, they wrote in the study in Archives of Internal Medicine journal.
This, along with harms caused by statins in some subgroups, have called into question the benefit of statins in primary prevention prevention of the development of heart disease.
Heart disease is the biggest killer of men and women in the rich world and is also a growing problem in developing nations.
SIDE EFFECTS
Although statins are widely seen as safe and effective drugs, a study published last month found that people taking them may have higher risks of liver dysfunction, kidney failure, muscle weakness and cataracts. Scientists have warned such side effects should be closely monitored.
In their analysis, the Cambridge team combined data from 11 studies involving 65,229 people. A total of 32,623 individuals were assigned to take statins and 32,606 individuals were assigned to take placebo.
Over an average of 3.7 years of follow-up, 2,793 participants died, including 1,447 on placebo and 1,346 on statins. The scientists said the small reduction in the statin group was not statistically significant.
While low-density lipoprotein LDL, or bad cholesterol levels, were higher among those taking placebo than those taking statins 134 milligrams per deciliter versus 94 milligrams per deciliter, this had no effect on the risk of premature death.
The scientists said their results showed the need for caution when extending the potential benefits of statins to a wider population.
Professor Peter Weissberg of the British Heart Foundation noted the findings but said they were only short-term.
The people in these studies were followed for less than four years on average. Since heart and circulatory disease develops over many decades, its reasonable to assume that we would see a significant improvement in mortality after a longer period of follow-up, he said in a statement.
He also said premature death was not the only consideration when seeking to prevent heart disease.
Many studies have shown that statins prevent non-fatal heart attacks and strokes, he said. Preventing serious ill health, such as heart failure resulting from a heart attack, or disability due to a stroke, is every bit as important as lengthening lives.
Editing by David Holmes source
While some grownups may experience delayed
One of the things we worry about when we see children whove had a fall and hit their head is whether weve missed something serious, said Dr. David Johnson of the University of Calgary in Canada, who worked on the new study, published in the journal Pediatrics.
That worry became very real to him, he said, when a girl he treated for a head injury suddenly got very sick after having been fine for eight hours after a fall.
One of the blood vessels in her brain had ruptured, it turned out, and the building pressure in her skull left her with permanent brain damage before the doctors could intervene.
Nobody had systematically looked at just how often this occurs, said Johnson. What we found was that its very, very uncommon.
Over an eight-year period, Johnson and colleagues found almost 18,000 children who had been judged by emergency physicians throughout Calgary, Canada, to have only minor head injuries. Those injuries included cases in which the child did not have memory loss and hadnt lost consciousness for longer than one minute.
None of the children went on to have bleeding in their brain leading to consciousness impairment more than six hours after they had first been evaluated. However, five had delayed bleeding in which their consciousness wasnt impaired, corresponding to a rate of 3 in 10,000.
While the findings dont mean that serious brain damage cant occur in the first place, or that concussion shouldnt be taken seriously, they should be reassuring to parents, said Johnson.
A general recommendation to a parent is if their child after the fall is alert and interactive and has had no vomiting, then they neednt worry, he said.
Dr. Jeffrey Bazarian, who wasnt involved in the study, said the findings meant that if a doctor determined that a child was fine, he/she probably was. But he stressed that parents should always see a doctor if they are concerned, since bleeding in the brain sometimes starts right away and might not always be easy to detect.
The problem is this is hard for a parent to be able to judge, to be able to make this medical decision, said Bazarian, of the University of Rochester in New York.
Especially in toddlers, he added, it can be hard to tell whether they have memory loss, for instance. The younger kids are, the more cautious parents need to be about taking their kid to see the doctor, he said.
SOURCE link.reuters.com/qam33m Pediatrics, online June 21, 2010. source