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Thursday, August 15, 2013

Research Finds Ways to Reduce the Danger of Cholesterol-lowering Statin Drugs

by Thilaka Ravi on? August 07, 2013 at 5:24 PM Drug News A recent study led by Dr. Richard Kim of the Lawson Health Research Institute, in collaboration with Dr. Robert Hegele of Robarts Research Institute, and researchers from Vanderbilt University, found that commonly occurring genetic variations in a person's genes could put the person at risk for statin-associated muscle injury. Research Finds Ways to Reduce the Danger of Cholesterol-lowering Statin Drugs
Statins, a class of drugs used to lower cholesterol, are among the best selling drugs in North America and around the world. However, statin myopathy, which results in muscle pain and weakness, is a common side effect affecting up to 10 percent of statin users.

Nearly 3-million Canadians are currently taking a statin. However, according to Dr. Kim, who is a physician at London Health Sciences Centre (LHSC) and holds the Wolfe Medical Research Chair in Pharmacogenomics at Western University, little is known about the blood levels of these drugs in a real world patient population. "Currently, we do not fully understand the drug exposure necessary for optimal statin therapy, making it difficult to predict an individual's dose requirement while minimizing the risk of side effects," states Dr. Kim. In his recent study, Dr. Kim set out to quantify patient's blood levels of statins and decipher the role genes play in statin uptake and absorption.

"We found that commonly occurring genetic variations in the genes that help to clear the drugs from the body, widely referred to as drug transporters, are key predictors of patients who will likely have high statin blood levels," says Dr. Kim. "We think those patients with high levels of statins in their blood are at a much greater risk for statin-associated muscle injury."

Currently, physicians can not readily identify at risk patients using the available clinical tests. However, Dr. Kim proposes using the pharmacogenetic tests presently available, in addition to the clinical variables he and his research team have outlined in their paper, would help to better identify these patients and prevent serious side effects. "This seems to be very relevant, especially for the many elderly patients who take these medications," says Dr. Kim.

As part of their personalized medicine program, Dr. Kim plans to utilize these pharmacogenetic tests and the algorithm they have created and apply them in a hospital and region wide fashion. As well, a larger clinical trial is being planned to compare their genomics-guided approach versus standard care in terms of better outcomes, cost-effectiveness, and prevention of adverse drug reactions.

The study, "Clinical and Pharmacogenetic Predictors of Circulating Atorvastatin and Rosuvastatin Concentration in Routine Clinical Care," was published in the July issue of Circulation: Cardiovascular Genetics.

Source-Eurekalert

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Tuesday, August 13, 2013

Telephone Coaching Does Not Reduce Hospital Use and Related Costs: Study

by Sheela Philomena on? August 07, 2013 at 1:00 PM Hospital News A recent study finds that one-to-one telephone health coaching did not seem to cut hospital use and related costs for patients with long term conditions. Telephone Coaching Does Not Reduce Hospital Use and Related Costs: Study
The study adds weight to the view that health coaching by itself does not appear to reduce hospital activity. The authors suggest that it may be more effective if it were better integrated into the respective care pathways for these groups of patients or were coupled with other interventions.

Telephone health coaching is used to provide guidance and support to patients with long term conditions. It involves regular phone calls between patient and health professional to promote healthy behaviours, help patients to manage their condition more independently, and identify any problems before they become critical.

As a result, it is thought that hospital admissions will be prevented, saving costs for healthcare systems. However, the current evidence base is unclear. So Ernst and Young and the Nuffield Trust were commissioned by the Department of Health to evaluate the impact of England's largest telephone health coaching service (Birmingham OwnHealth?) on hospital use and associated costs.

They analysed data from the first two years of the scheme (2006 to 2008), concerning 2,698 patients (average age 65 years) with heart failure, coronary heart disease, diabetes or chronic lung disease (COPD), and a history of inpatient or outpatient hospital use.

Intervention patients received a personalised care plan and a monthly telephone call from a care manager, typically lasting for 15 minutes. Matched control patients received usual care, which did not include telephone health coaching.

The annual number of emergency admissions increased by 0.05 per head more among intervention patients than matched controls (a relative increase of 13.6%).

Outpatient attendances also increased by 0.37 per head more among intervention patients than controls, while secondary care costs rose by ?175 per head more among intervention patients than controls.

Further checks showed that the researchers were unlikely to have missed reductions in emergency admissions because of unseen differences between intervention and matched control groups.

In summary, the authors say there was no evidence of reductions in hospital admissions, and no savings were detected from which to offset the cost of the intervention. Adam Steventon, Senior Research Analyst at the Nuffield Trust, who led the analysis for the study, said: "Policy makers are hoping that, by improving community-based care, unnecessary hospital admissions can be avoided. Birmingham OwnHealth? appears not to have achieved this aim, at least in the period that we studied. However, the effect of new services depends on the details of how they are implemented, and on the surrounding context, so it might be possible to improve the model."

Adam Steventon also summarises the findings in a video abstract. Dr Steventon says although the results were disappointing, the question remains whether other parts of the NHS could implement health coaching. He believes that more needs to be done about the elements that make up a successful hospital avoidance programme and "one of the largest lessons is to try to use some of the techniques that we implemented on an ongoing basis to improve care".

Source-Eurekalert

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Friday, July 26, 2013

Paid Sick Leaves Could Reduce Risk of Spread of Flu Infection

The researchers made use of data from the US Bureau of Labor Statistics to simulate a flu epidemic in Pittsburgh and Allegheny County. The researchers calculated the number of people with paid sick days and the probability of them actually using them and found that if all the employees had access to paid sick leaves, then the spread of flu infection could drop by six percent.

The researchers also observed the effect of giving the employees extra days off especially when they had the flu and found that giving the sick employees one extra day cut down the flu infection spread by 25 percent and giving two days off cut down the spread by 40 percent. The study has been published in the American Journal of Public Health.

"Our simulations show that allowing all workers access to paid sick days would reduce illness because fewer workers get the flu over the course of the season if employees are able to stay home and keep the virus from being transmitted to their co-workers", lead researcher Supriya Kumar said.

Source-Medindia

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Tuesday, July 23, 2013

Majority of Women Do Not Adopt Lifestyle Choices That Reduce Cancer Risks

by Kathy Jones on? June 15, 2013 at 1:28 PM Women Health News Underlining the challenges facing anti-cancer associations, a new study revealed that a majority of women do not follow the lifestyle choices recommended by the American Cancer Society that can reduce the risk of cancer. Majority of Women Do Not Adopt Lifestyle Choices That Reduce Cancer Risks
The new survey determined how women view diet and exercise in relationship to cancer and whether they believed that they were engaging in healthy behaviours, and if their diet and exercise choices really met the minimum recommendations.

Jennifer Irvine Vidrine, PhD and colleagues from The University of Texas MD Anderson Cancer Center (Houston) and Prevention Magazine (Emmaus, PA) found that less than 10 percent of women who admitted eating a healthy diet actually met the American Cancer Society's minimum fruit and vegetable intake recommendations, which is 2 servings of fruit and 3 servings of vegetables per day.

Less than 40 percent of women who confessed to doing regular physical activity met the American Cancer Society minimum recommendations of 30 minutes of moderate physical activity five days per week.

The study found that overall, more than half of the women who were surveyed failed to meet the minimum recommendations for physical activity and/or for daily consumption of fruits and vegetables.

The study has been published in the Journal of Women's Health.

Source-ANI

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Short Course of Self-Defense Training can Reduce Sexual Assaults Among Kenyan Girls

"Self-defense training taught these young girls to stand up and say 'no' with confidence, and empowered them to escalate their own defense to a higher level, if necessary," said Neville Golden, MD, senior author of the new study, which is now available online on the Journal of Adolescent Health website. "To our knowledge, this is the first study to demonstrate that a self-empowerment/self-defense course can reduce the incidence of rape in adolescent girls," added Golden, who is a professor of pediatrics at Stanford and the division chief of adolescent medicine at Packard Children's.

The study looked at 402 girls who participated in a self-defense program developed by a Kenya-based nongovernmental organization, No Means No Worldwide, that taught them verbal and physical self-defense techniques, and gave them information about how to get help if they were assaulted. Conducted in high schools, the program was designed to combat a culture in which discussing sexual assault is taboo.

In the 10 months after receiving self-defense training, more than half of these girls reported using what they had learned to fend off would-be attackers. The proportion of them who were raped fell from 24.6 percent in the year before training to 9.2 percent in the 10-month period after.

"There is a strict code of silence among rape victims in Kenya, especially with the stigma of HIV and AIDS," said Jake Sinclair, MD, the lead author of the new study and a pediatrician at John Muir Medical Center in Walnut Creek, Calif. "Typically, no one is going to admit that they were raped. Victim-blaming is the norm." Sinclair and his wife, Lee, co-founded No Means No Worldwide and have developed sexual-assault prevention curricula for several audiences in Kenya, including self-defense programs for girls and women, and educational programs to help boys recognize the harm inflicted by sexual assault.

The subjects of the study were 522 high school girls, ages 14 to 21, in two impoverished Nairobi slums: 402 received 12 hours of self-defense training over six weeks, as well as two-hour refresher courses at three-, six-, nine- and 10-month intervals; 120 in a comparison group received a one-hour life-skills class that is the current national standard in Kenya. Before and 10 months after the training, both groups answered anonymous questionnaires about their recent experiences of rape.

At the start of the study, nearly one in four girls reported that they had been forced them to have sex in the prior year; 90 percent of the victims knew their attackers. The study focused on rape and did not assess the entire range of behaviors classified as sexual assault under U.S. laws.

Among girls who received self-defense training, 56.4 percent used the skills they learned to fend off attackers in the subsequent 10 months. Of these girls, half used verbal skills alone, one-third started with verbal skills and added physical skills, and 17 percent used physical skills alone. Not only did total assaults drop sharply, but assaults by the two most common groups of perpetrators, boyfriends and relatives, decreased significantly. After receiving training, girls who were raped were more likely to seek help following an attack.

In contrast, among girls who had life-skills classes, the proportion who became victims of rape remained about the same.

"We were pretty stunned that the self-defense training was so effective," Sinclair said. "From the testimonials we collected, we saw that even a small girl could disable an attacker and get away, again and again."

The self-defense classes, which trained and employed local Kenyan women as instructors, were also cost-effective: providing the training cost $1.75 per student, whereas immediate after-care for rape in Kenya costs $86, a figure that does not account for long-term costs such as new HIV infections or unwanted pregnancies.

No Means No Worldwide is now testing the effectiveness of their curriculum for boys, which focuses on teaching boys not to perpetrate sexual assault. They are also working to disseminate the girls' self-defense curriculum more widely.

"Often, people focus on women as victims," said Cynthia Kapphahn, MD, a clinical associate professor of pediatrics at Stanford and an adolescent medicine specialist at Packard Children's who was also an author of the study. "This work shows that it's also important to focus on them as empowered beings; that approach can have an important role in a woman's ability to protect herself."

Source-Eurekalert

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Monday, July 22, 2013

Tobacco Laws may Reduce Adult Smoking

The researchers discovered that states with more restrictive limits on teens purchasing tobacco also have lower adult smoking rates, especially among women. And compared with states with less restrictive limits, they also tend to have fewer adult heavy smokers.

The study is published online June 13 in the American Journal of Public Health.

"In most states for many years, it has been illegal to sell cigarettes to people under 18, but few provisions are in place to prevent those sales," said the study''s first author Richard A. Grucza, PhD, associate professor of psychiatry. "This study shows that more restrictive policies can prevent teen smoking and be beneficial down the road."

Grucza''s team evaluated data from an ongoing National Cancer Institute survey that monitors smoking behavior in all 50 states.

Studying information gathered from 1998 to 2007 from 105,519 individuals ages 18 to 34, the researchers looked at whether people ever had smoked, whether they currently were smoking, and, if they did smoke, whether they smoked more than 10 cigarettes per day.

They also looked at the smoking restrictions in place in states when the study subjects were 17 years old.

"We looked at age 17 because in most states, it was illegal for anyone under 18 to buy tobacco products," Grucza said.

But how individual states chose to enforce the laws varied. Grucza''s team focused on nine smoking-related policies and found that in states with enforcement policies, not only did 17-year-olds have more difficulty purchasing cigarettes, but that when they reached their 20s or 30s, they were less likely to smoke.

"We estimated that if all states had effective policies in place, it would reduce the prevalence of smoking by about 14 percent and the rates of heavy smoking by 29 percent," he said.

The four most effective restrictions included those on cigarette vending machines, in which the machines either were eliminated or housed in locations inaccessible to those under 18; identification requirements for purchasing cigarettes; restrictions on repackaging cigarettes so that five or 10 could be sold at a time, rather than an entire 20-cigarette pack; and prohibiting distribution of free cigarettes at public events.

Because cigarettes have been regulated by the U.S. Food and Drug Administration (FDA) since 2009, many of the more restrictive policies are in effect nationally, so Grucza''s team believes future smoking rates among adults may decline at least partly as a result of those policies.

Interestingly, they found the policies to restrict youth access to tobacco had a big impact on women but didn''t seem to influence smoking rates in men.

"We can only speculate about why, but a number of past studies have shown that underage women and girls often have an easier time getting alcohol or tobacco than underage men," Grucza said. "We suspect that policies like those that require checking IDs may have evened things out by making it just as difficult for underage women to buy cigarettes as it is for underage men."

As more states around the country implement and enforce more restrictive policies, Grucza expects they may further reduce smoking rates.

"A lot of states still have not adopted all of these policies," he explained. "In 2006, which is the last year for which we have data, only four states required a photo ID, and only 20 states had any kind of identification requirements at all. So there''s still a lot of room for improvement."

Grucza said some states are considering restricting youth access even more. In New York, there is a proposal to raise the age for tobacco purchases to 21. Meanwhile, in Alabama, Mississippi, Alaska and Utah, the minimum age for tobacco purchases already has been raised to 19.

Funding for this research comes from the National Institute on Drug Abuse and the National Cancer Institute of the National Institutes of Health (NIH). It also was supported by grants from the American Cancer Society and the American Foundation for Suicide Prevention. NIH grant numbers: R21 DA0266, R01 DA031288, R01 DA0269112, T32 DA07313, K01 DA025733, K02 DA021237 and P01 CA89392.

Grucza RA, Plunk AD, Hipp PR, Cavazos-Rehg P, Krauss MJ, Brownson RC, Bierut LJ. Long-term effects of laws governing youth access to tobacco. American Journal of Public Health, First Look vol. 103 (8), June 13, 2013.

Washington University School of Medicine''s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children''s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children''s hospitals, the School of Medicine is linked to BJC HealthCare.

Source-Newswise

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Saturday, July 20, 2013

Giant Cell Arteritis Treated in a 'Fast Track' Approach may Reduce the Risk of Blindness

Of the patients evaluated by the ''fast track'' principle from March 2010 to December 2012, 11.1% had transient visual manifestations, and none went on to suffer from permanent visual loss.

GCA is a condition in which medium and large-size arteries, usually in the head and neck, become inflamed (sometimes referred to as temporal arteritis). Symptoms of GCA, which include aching and soreness in and around the temples, jaw pain while eating, and loss of vision, often develop suddenly. Permanent visual loss is one of the most serious complications of GCA; in one study, visual manifestations were reported in 26% of patients, and permanent visual loss in up to 15%.2

Speaking on behalf of the SONOVAS study group, Dr. Andreas P. Diamantopoulos from the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway said: "Giant cell arteritis should be regarded as a medical emergency because without prompt treatment it can lead to permanent blindness. Our data suggests that a fast-track approach significantly reduces this risk, encouraging findings that will now need to be confirmed in larger groups of patients."

This was in marked contrast to the results seen in the 28 patients who were traditionally evaluated between March 2010 and February 2012. In this group, visual disturbances were observed in seven patients, of whom six (21.5%) suffered from permanent vision loss in one or both eyes. The difference between the two groups with regard to permanent visual loss was statistically significant (p=0.035).

Patients suspected to have GCA were consecutively evaluated between March 2010 and December 2012 using colour Doppler ultrasound (CDUS). The ''fast- track'' principle (quick evaluation by CDUS within 24 hours, and immediate initiation of treatment if appropriate) was implemented in the outpatient clinic from March 2012.

During the evaluation period, a total of 46 patients were diagnosed with GCA. All of these patients fulfilled the ACR Classification Criteria for GCA* and produced a positive CDUS result of the temporal artery.

Source-Eurekalert

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Sunday, July 14, 2013

Men Perform Oral Sex on Their Partners to Reduce Risk of Infidelity

The study was conducted to find out why men performed oral sex on females, as the act did not lead to reproduction.

243 adult men in heterosexual relationships were surveyed and the researchers found that cunnilingus is used by men to discourage their female partners from cheating by increasing her relationship satisfaction, a theory which the authors referred to as a mate-retention strategy, the Huffington Post reported.

The study has been published in the Journal of Evolutionary Psychology.

Source-ANI

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Wednesday, June 26, 2013

Some Older Adults Need to Consume More Fish Oil to Reduce Risk of Metabolic Syndrome

by Mita Majumdar on? June 25, 2013 at 12:05 PM Health Watch New study sheds more light on gene-diet interactions in obese adults. Genes are one of the many factors that can cause obesity and type 2 diabetes which are the variables of metabolic syndrome. Some Older Adults Need to Consume More Fish Oil to Reduce Risk of Metabolic Syndrome
The ADIPOQ gene with many of its variants is one such contributor to these disorders. This gene instructs the production of hormone adiponectin in the fat cells. Adiponectin is a protein hormone that plays a role in the insulin sensitivity, glucose metabolism and fat burning. It increases insulin sensitivity by burning fatty acids and inhibiting the production of glucose in the liver.

Studies have found that some ADIPOQ gene variants are responsible for lower adiponectin concentrations in the blood. Decreased adiponectin concentration means less efficient fat burning and less glucose utilization and therefore a greater risk of developing type-2 diabetes and obesity. However, this happens only in those people who carry this 'risk variant' of ADIPOQ gene.

There are ways to increase blood adiponectin levels. Interestingly, studies have found evidence of gene - diet interactions in obesity. They claim that people who are risk variant carriers can improve their adiponectin through certain nutrients, especially fatty acids.

So, Aseel AlSaleh and colleagues at Kings College London, School of Medicine, London, conducted a trial to find out how dietary n3 PUFAs such as fish oil interacts with adiponectin gene (ADIPOQ) variant to affect blood adinopectin concentration.

This study included 142 healthy men and 225 women aged 45-70 years for 12 months from which only 310 people completed the study.

The researchers randomly assigned daily doses of 0.45, 0.9, and 1.8 g 20:5n3 and 22:6n3 (1.51:1), or placebo, in 3 capsules taken as dietary supplements. Oily fish intake was restricted to 1 portion per month throughout the 12-month period.

Blood samples for the analysis of plasma lipids, glucose, and insulin and serum adiponectin were drawn after a minimum 8-hour overnight fast preceded by a low-fat evening meal.

DNA testing of five ADIPOQ gene variants [?11391 G/A (rs17300539), ?11377 C/G (rs266729), ?10066 G/A (rs182052), +45 T/G (rs2241766), and +276 G/T (rs1501299)] was done.

The researchers found that serum adiponectin concentration significantly increased in subjects more than 58 years old, and that too after the highest dose (1.8 g/d) of fish oil supplement.

'If aging is associated with development of adiponectin resistance, the increase observed in only the oldest participants may reflect an ability to respond only after a high intake of n3 PUFA,' they analyzed.

They also found that the interaction among SNP +45 T/G genotype, treatment, and age was only nominally significant as far as serum adiponectin is concerned. Earlier studies have shown that +45 TT genotype (risk gene variant) is associated with lower serum adiponectin and increased risk of type 2 diabetes, obesity, and adverse metabolic marker. The researchers thus reasoned 'interaction of the +45 TT genotype with high-dose n3 PUFA supplements may serve a protective function in susceptible older individuals'.

They concluded that older people who have +45 TT genotype may reduce the risk of metabolic syndrome associated type 2 diabetes and obesity if they increase the consumption of fish oil.

'A recommendation to +45 TT homozygotes to increase consumption of oily fish to maintain adiponectin concentrations with advancing years would be justified,' they reported.

The study is published in Journal of Nutrition.

References:

http://jn.nutrition.org/content/early/2013/05/08/jn.112.172585.full.pdf
http://www.gbhealthwatch.com/GND-Obesity-T2DM-ADIPOQ.php

Source-Medindia

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