|
|
| ||||
Mother's junk food 'harms child'Eating a poor diet when pregnant or breastfeeding may cause long-lasting health damage to the child, animal studies suggest. The offspring of rats fed fatty, processed food had high levels of fat in their bloodstream and around major organs even after adolescence. The animals had a raised diabetes risk - even if they ate healthily. The study, by the Royal Veterinary College and London's Wellcome Trust, features in The Journal of Physiology. Studies by the same team have already shown that rats whose mothers were fed junk food during pregnancy and breastfeeding were more likely to crave similar snacks themselves. However, the new twist is that even when weaned off this diet themselves, the damage may already have been done, they suggest. Dr Stephanie Bayol, one of the researchers, said: "It seems that a mother's diet whilst pregnant and breastfeeding is very important for the long-term health of her child. "We always say: 'You are what you eat', but in fact it may also be true that you are what your mother ate." Of particular concern was fat gathering around the major organs, which has been implicated in the development of type II diabetes. The rats with unhealthy mothers were more likely to have this, even if they were weaned off the junk food diet. However, there were interesting differences between the sexes, with the male offspring of unhealthy mothers having higher levels of insulin and normal blood sugar, while the reverse was true of females, who also tended to be fatter. Professor Neil Stickland, another of the researchers, said that there was no reason why the same principles should not apply to humans. "Humans share a number of fundamental biological systems with rats, so there is good reason to assume the effects we see in rats may be repeated in humans." He said that studies in humans had found links between the weight of parents and the weight of their children. Early influence Dr Pat Goodwin, from the Wellcome Trust, said that the study supported the growing evidence that there were many different risk factors which could contribute to someone becoming overweight. She said: "Pregnancy can be a difficult time for many mothers, but it is important that they are aware that what they eat may affect their offspring." However, Dr Simon Langley-Evans, a nutrition researcher from the University of Nottingham, said that the study did not prove that a mother's diet could affect the health of offspring beyond the effect on cravings and appetite. He said: "I'm not convinced they have shown this - everything you are seeing here could be the result of obesity caused by increased appetite. "What it does show is that this early influence from the mother is very important." Call to rethink child BMI testingUsing a child's body mass index (BMI) as a measure of the success of exercise targets may be misleading, say experts. UK researchers could find no difference in BMI between those exercising regularly and those missing targets. Writing in the Archives of Disease in Childhood, they said blood testing might be the only way to measure exercise benefits. However, another scientist said BMI did offer useful information, and testing should continue. The government recommends that children have an hour's moderate exercise or more every day to reduce the chance that they will become obese adults, with a higher risk of diseases such as diabetes or heart disease. BMI is used successfully in adults as a guide to overall fitness and the success of diet and exercise programmes, but there has been debate over its effectiveness when modified for use in children. Some experts have suggested that it is perfectly possible for an individual child to be "fat and fit", provided they are sufficiently active. The latest study, carried out at Peninsula Medical School in Plymouth, examined the exercise levels of 113 boys and 99 girls, born in 1995 and 1996, over a four-year period. All were fitted with devices called accelerometers, which measure every movement to give an accurate picture of the amount of exercise they did. In common with other studies, they found that just over half of the boys, and nearly nine out of 10 girls, fell short of the "hour a day" target. However, despite the variety of different exercise patterns, there was no impact on the relative BMI of the children. Even techniques used successfully in adults to predict health by measuring fat levels failed to differentiate between those meeting the target and those doing far less activity. This, however, did not mean that the children meeting the target were no more healthy - blood testing revealed clear differences in the underlying metabolic signs of health - such as insulin resistance and cholesterol levels. Diet not exercise Professor Terry Wilkin, who led the study, said: "BMI just doesn't pick up any differences in children - it's just not a sufficiently sensitive measure. "And you can't carry out blood testing on this scale in schools." He said other research suggested that it was almost impossible to change the overall amount of exercise taken by any child over a week, even if large amounts of sports were arranged at schools. "It could be that changing the diet of children will be the modifiable factor." Dr Richard Winsley, a researcher in child exercise science, said that in the absence of another practical test, BMI should continue to be used, as it still revealed a useful overview of the improving or declining fitness of large groups of children. He said: "Whether or not BMI is very good for an individual person may be questionable. "But until someone comes up with a more successful, and equally practical alternative, then it is the best we have got." He said that physical activity in children could only benefit them, so parents and schools should continue to encourage it. "A lack of evidence doesn't mean that something doesn't actually work." Hearing loss link to stroke riskSudden hearing loss could be a warning sign of increased stroke risk, Taiwanese research suggests. People hospitalised for sudden hearing loss had more strokes in the following five years than otherwise healthy appendicitis patients. The article, in the journal Stroke, suggested no reason why the hearing problem could be linked to strokes. UK stroke specialist Dr Tony Rudd, of Guy's and St Thomas' Hospital, described it as "an unusual" finding. There are dozens of reasons, including some illnesses, such as mumps, measles, and meningitis, why someone might suffer sudden hearing loss. The suggestion of the research, which looked at 1,423 patients taken to hospital after losing their hearing, is that it could be a sign that the person has a far higher chance of stroke even some years afterwards. The hearing loss patients were compared with 5,692 patients taken into hospital for appendix removal - chosen because among hospitalised patients, they best represent the healthy population outside. The researchers found that after hearing loss, they were one-and-a-half times more likely to have a stroke in the five subsequent years. The study authors stressed that it was a preliminary finding, and the lack of information about other stroke risk factors in the patients could have skewed the findings. Dr Herng-Ching Lin, from Tapei Medical School of Health Care Administration, said: "To the best of our knowledge, no study has investigated the incidence or risk of cerebrovascular diseases following the onset of sudden sensorineural hearing loss." Neurological examinations He called for more studies to confirm the finding, but said that doctors should consider closer neurological examinations and subsequent check-ups for anyone brought to hospital for this kind of hearing loss. Dr Tony Rudd, a stroke specialist from Guy's and St Thomas' Hospital in London, said that while it was an "interesting association", the two might not turn out to be linked. "It's an unusual finding, quite surprising, but not one that you hear, and immediately think makes sense." He said that while stroke itself could cause hearing loss, this was "very rare", although patients who lost hearing because of blood supply problems to their inner ear might be investigated to see if similar problems could happen anywhere else. Sudden loss of hearing might be an early sign of strokePreliminary research culled from a national medical insurance records database in Taiwan suggests that sudden loss of hearing might be an early sign of vulnerability to stroke, foreshadowing an actual cerebrovascular event by as much as two years, according to a study reported in Stroke: Journal of the American Heart Association. Five-year follow-up data on 1,423 patients hospitalized for an acute episode of sudden sensorineural hearing loss (SSNHL) showed they were more than one-and-a-half times more likely to suffer a stroke than a control group of 5,692 patients who had been hospitalized for an appendectomy. Because the insurance records may not have contained reliable information, such as correct diagnostic codes or confounding factors, the findings should be considered tentative, said lead investigator Herng-Ching Lin, Ph.D., a professor at Taipei Medical University School of Health Care Administration. "To the best of our knowledge, no study has investigated the incidence or risk of cerebrovascular diseases developing following the onset of sudden sensorineural hearing loss," Lin said. "But because this is the first time any association has been suggested, and because there were many limitations in the data, the results need to be interpreted cautiously until additional independent studies are performed." The findings are limited because there is not a clear universal definition for SSNHL in the database that was reviewed. "Secondly, the database did not contain information regarding severity of hearing loss, extent of hearing recovery, tobacco use, body mass index and the medical history of cardiovascular disease and atrial fibrillation - all of which can contribute to stroke risk," Lin explained. Nonetheless, the researchers recommend that all SSNHL patients undergo a comprehensive neurological exam and blood testing to gauge their risk profile for stroke. 'Hospital risk' from radio tagsLifesaving equipment in hospitals may be switched off by radio-frequency devices used to track people and machines, Dutch scientists claim. Radio frequency identification devices (RFIDs) are on the rise in healthcare, helping identify patients, and reveal the location of equipment. The Journal of the American Medical Association study found they could interfere with machines. But NHS computer specialists said RFIDs could eventually make patients safer. There are two types of RFID, one which transmits information, and another, "passive", device which can be "read" by a powered machine when it is held nearby. They are small and cheap enough to be in everyday use in society, in everything from security and travel cards - such as London Transport's Oystercard, to anti-theft devices on goods in shops, and hospitals are starting to become aware of their potential. At Heartlands Hospital in Birmingham, patients heading for the operating theatre wear an RFID wristband, so that even when anaesthetised, their full identity, including a picture, can be downloaded into a PDA held nearby. Turned off The latest research, conducted at Vrije University in Amsterdam, tested the effect of holding both "passive" and powered RFIDs close to 41 medical devices, including ventilators, syringe pumps, dialysis machines and pacemakers. A total of 123 tests, three on each machine, were carried out, and 34 produced an "incident" in which the RFID appeared to have an effect - 24 of which were deemed either "significant" or "hazardous". In some tests, RFIDs either switched off or changed the settings on mechanical ventilators, completely stopped the working of syringe pumps, caused external pacemakers to malfunction, and halted dialysis machines. The device did not have to be held right up to the machine to make this happen - some "hazardous" incidents happened when the RFID was more than 10 inches away. Patient safety Dr Donald Berwick, from the Institute of Healthcare Improvement in Cambridge, Massachusetts, said: "Design in isolation is risky - even the most seductive technology will interact in the tightly-coupled healthcare world in ways physicians and other members of the healthcare team had better understand, or they and their patients may pay a dear price." A spokesman for NHS Connecting for Health, which manages various IT projects across the health service, said that RFIDs had the potential to deliver big improvements in patient safety, reducing mistakes caused by the wrong identification of patients. She said: "Any product such as this which is for use in a healthcare setting has to meet a standard which means it is very unlikely to interfere with medical equipment. "This risk is more likely to come from RFID tags from other sources - such as a travel card, a tag on clothing, or on another retail item." A spokesman for the Medicines and Healthcare Products Regulatory Agency said that, as for mobile phone use, individual Trusts needed to make risk assessments about the use of RFIDs. He said: "Despite much debate in the literature on the subject of electromagnetic interference (EMI) of medical devices by mobile telephones and other sources of radiofrequency transmission, the MHRA has received very few reports of adverse events caused by this problem over the last seven years or so. "Of those incidents reported, only a very small number have been proven to be as a direct result of EMI." Hospital rise for child diabetesThe number of children in England needing emergency hospital care for complications of diabetes has risen, figures show. Last year, 3,317 were admitted to hospital with the potentially coma-inducing complication diabetic ketoacidosis compared to 2,617 in 2002. Patient group Diabetes UK claimed that cuts in NHS services were partly to blame for this trend. The Department of Health said it was committed to improving services. Diabetic ketoacidosis can be the first obvious sign of unchecked diabetes in a child, with symptoms such as sluggishness and fatigue, weight loss, stomach pain and vomiting. If not treated quickly, these symptoms can worsen and eventually lead to coma and death. Once diagnosed, children with type I diabetes use insulin injections to manage their blood sugar levels - but if they are very poorly-controlled, ketoacidosis can arise again. The steady rise in the number of cases since 2002 was revealed in a Parliamentary answer. Douglas Smallwood, the chief executive of Diabetes UK, said that parents needed to be better educated in the tell-tale signs and more needs to be spent on specialist diabetes services aimed at children. He said: "The number of children being rushed to AandE with such a life-threatening complication is shocking. "In other research, specialist diabetes staff have reported that cuts in diabetes services results in increased emergency hospital admissions. "With increased awareness and more investment, the number could be dramatically reduced." The charity said while the figures were just based on hospital admission in England, the problem was likely to be UK-wide. 'Vital support' But Professor Peter Hindmarsh, from the Institute of Child Health, who leads a committee asked by the government to look at the care of children with diabetes, said the reasons were more complex. "There are an increasing number of people being diagnosed with diabetes - probably because of greater awareness - and people tend to stay in hospital at this point. "However, the shortage of specialist care might have something to do with; we haven't got enough people on the ground to deliver the service." A spokesman for the Department of Health acknowledged that it was vital that children and young people with diabetes had access to support from a specialist team. "The government has recognised that the quality of diabetes care for children and young people can be variable and we set up a working group to establish what needed to be done to improve this." Dummy use link to ear infectionsParents should avoid using a dummy in infants who are prone to ear infections, research suggests. In a five-year study of almost 500 Dutch children, researchers found almost double the risk of recurrent ear infections in those who used a dummy. Writing in the Family Practice journal they said doctors should advise parents of the risk. Scientifically known as acute otitis media, ear infections are very common in young children. Antibiotics do not generally work and the infection tends clear on its own within a few days but some children are prone to repeated bouts. The researchers from University Medical Center, Utrecht said some studies before had found a link between dummy use and ear infections but they had not been very accurate. Their research followed 476 children aged under four years, 216 of whom used a dummy. There was a 90% increased risk of recurrent ear infections in those who sucked a dummy compared with those who did not. Susceptibility The researchers said results suggested that the first infection may increase susceptibility to future ear infections. And using a dummy may allow bacteria to more easily migrate from secretions in the nose to the middle ear, they suggested. Study leader, Dr Maroeska Rovers, said: "Paediatricians and GPs can use this information in their daily practice - they can dissuade parents from using a pacifier [dummy] once their child has been diagnosed with acute otitis media to avoid recurrent episodes." Professor Steve Field, chair of the Royal College of GPs said there had been previous studies but they had not been put together very well. "This is a very useful piece of research that shows use of dummies in children under the age of four who have a history of ear infections is not a good idea. "There's no need to panic but - in those children - not using a dummy is likely to prevent recurrence." New Test Could Aid Children Suffering From Reflux DiseaseA nuclear medicine imaging test was used to confirm that children with respiratory problems may be more likely to develop gastroesophageal reflux disease, according to researchers at SNM's 55th Annual Meeting. The nuclear imaging technique, known as scintigraphy, was also shown to be more effective in detecting the disease in these children than traditional barium X-ray technology. The results indicate that scintigraphy could become an important diagnostic tool for detecting reflux disease, a serious condition that can lead to chronic chest pain, vomiting, weight loss and lung impairment in children who suffer from it. "Unfortunately, reflux disease is a common problem in children, especially for those with respiratory problems," said Wajiha Nasir, a researcher at the Nuclear Medicine Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan. "If left untreated, the disease can seriously impede children's health, growth and development, not to mention their quality of life. Our results show that scintigraphy is highly effective at safely diagnosing the condition." Reflux disease occurs when the esophagus becomes irritated or inflamed by stomach contents. The stomach produces hydrochloric acid after a meal to aid in the digestion of food. Normally, a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter, prevents the acid from going back up the esophagus. With reflux disease, however, the sphincter relaxes between swallows, allowing stomach contents and corrosive acid to well up and damage the lining of the esophagus. The chronic condition affects up to a third of adults, and many infants and children also suffer from it. Some of these children outgrow the condition as their digestive systems mature, but many do not. Researchers have long suspected that children who have respiratory problems such as asthma might also be more susceptible to reflux disease. Scintigraphy is a diagnostic test in which a two-dimensional picture is obtained through detection of a radiation emitted by a radioactive source given to the body. In this study, 55 children aged six months to 12 years who had asthma or lower respiratory tract infections were orally administered a commonly used radioactive imaging agent that was then detected through scintigraphy technology. The test detected reflux disease in 66.6 percent of the children, revealing a strong association between reflux disease and respiratory disease. In addition, scintigraphy proved more effective at detecting the disease than traditional barium x-rays. Children in the study who exhibited reflux disease were given medication to treat reflux. At a three-month follow-up visit, most of the children's symptoms had improved after receiving the medication. "Scintigraphy is one of the simplest radionuclide tests to administer, with a very low radiation burden," said Nasir. If performed routinely for children suffering from bronchial asthma and recurrent respiratory tract infections, this test could get children the treatment they deserve." 'Benign' malaria found to just as deadlyAustralian scientists have found that a strain of malaria previously considered to be 'benign' is actually potentially fatal. The scientists from the Menzies School of Health Research, in Darwin challenge the current perception that Plasmodium falciparum (P. falciparum) can be severe and life-threatening whereas Plasmodium vivax (P. vivax) tends to be mild. P. vivax and P. falciparum are the two major strains of malaria which affect humans and traditionally, attention has focused on P. falciparum, which is the dominant strain in Africa and considered to be the more virulent and deadly strain of the disease. Almost half of the malaria prevalent in Asia is due to P. vivax and there are as many as 400 million cases of vivax malaria each year - 300 cases are reported each year in people returning to Australia from malaria endemic countries. The parasite has developed resistant to standard treatments making it difficult to treat in countries such as Indonesia and Papua New Guinea (PNG) and new research conducted in PNG and Indonesia has shown that P. vivax is far from benign. 
P. vivax was found to be responsible for a significant amount of illness with high rates of severe disease and death and in many cases, victims were infected with a mixture of both parasites with a resulting higher still risk of severe disease than infection with a single parasite. Dr. Price says that the findings provide important information about the burden of malaria associated with P. vivax infection and should focus attention on treating and preventing the disease. Dr. Price says the research revealed that in a region where multidrug-resistant strains of malaria are common, P. vivax infection is associated with severe and fatal malaria, particularly in young children. Dr. Price also says it shows that people infected with both types of malaria parasites are more likely to suffer from a severe case of malaria and die from the disease. He says both strains of malaria must be considered when measures are implemented to eliminate these parasites from regions where they co-exist. Dr. Price says more research is needed in other settings to confirm the findings and to learn more about the pattern of severe malaria associated with P. vivax, in particular, with multi drug-resistant strains. Experts say calls for increased efforts to control malaria internationally will need to ensure that P. vivax receives appropriate attention. The study is published this week in the International journal PLoS Medicine. Study cracks amoeba attack tacticThe tiny creature behind tens of thousands of dysentery deaths each year has a crafty method of slipping past our immune system, claim researchers. US scientists say amoebae can get rid of giveaway chemicals on their surface. The study in the journal Genes and Development suggests a similar technique helps malaria parasites get into human cells. A UK specialist said amoebic dysentery, once diagnosed, is curable but the findings could aid vaccine development. It is suspected that the number of people infected by amoebae amounts to millions worldwide. Most of them will never suffer bloody diarrhoea, which is the first sign of amoebic dysentery, an infection which kills approximately 70,000 people each year. In most symptomless cases, the body's immune system eventually gets rid of the infection, but it can persist for years on end. Researchers from Johns Hopkins and Stanford universities in the US believe they have found out why the single-celled organism is capable of evading the immune system for so long. Existing research on the plasmodium malaria parasite revealed that it used a type of cell chemical called a "rhomboid enzyme" to help it get into the host cell. A scan of the DNA of other parasites revealed the same chemical in amoebae, and led to the discovery this chemical was capable of getting rid of a protein called lectin found on its surface. Surface security Normally the immune system works out the difference between friend and foe by looking for "foreign" surface proteins and, by cutting them loose, the amoeba is able to stay undisturbed. Dr Sin Urban, who led the study, said: "This is the first enzyme to be identified which looks like it could mediate immune system evasion." Now the hunt could be on for drugs which specifically target the rhomboid enzyme. Dr Graham Clark from the London School of Hygiene and Tropical Medicine, said that while effective treatments for amoebic dysentery did exist, it was often hard to identify, and could be mixed up with bacterial infection or even Crohns disease. "In theory, this idea could help people who are trying to work on a vaccine. "But if you understood how these proteins are being 'sloughed off', that could help you get around this process." Ovulation moment caught on cameraA human egg has been filmed in close-up emerging from the ovary for the first time, captured by chance during a routine operation. Fertile women release one or more eggs every month, but until now, only animal ovulation has been recorded in detail. Gynaecologist Dr Jacques Donnez spotted it in progress during a hysterectomy. The pictures, published in New Scientist magazine, were described as "fascinating" by a UK fertility specialist Human eggs are produced by follicles, fluid-filled sacs on the side of the ovary, which, around the time of ovulation, produce a reddish protrusion seen in the pictures. The egg comes from the end of this, surrounded by a jelly-like substance containing cells. The egg itself is only the size of a full-stop, and the whole ovary, which contains many immature eggs, just a couple of inches long. They belonged to a 45-year-old Belgian woman, and Dr Donnez, from the Catholic University of Louvain, told New Scientist that the pictures would help scientists understand the mechanisms involved. He said that some theories had suggested an "explosive" release for the egg, but the ovulation he witnessed took 15 minutes to complete. Professor Alan McNeilly, from the Medical Research Council's Human Reproduction Unit in Edinburgh, said that this fitted with his own research into the ovulation process. He said: "It really is a fascinating insight into ovulation, and to see it in real life is an incredibly rare occurrence. "It really is a pivotal moment in the whole process, the beginnings of life in a way." Light therapy 'can slow dementia'Dementia could be slowed significantly by treatments which reset the body's natural clock, researchers have said. The Dutch team used brighter daytime lighting - with or without the drug melatonin - to improve patients' sleep, mood and cut aggressive behaviour. It concludes that these can slow deterioration by 5% - which a UK specialist said meant patients living in their own homes for months longer. The study appears in the Journal of the American Medical Association. The disruption to the body's circadian rhythm - the natural cycle that governs sleep and wakefulness - can be one of the most difficult of dementia symptoms for carers to cope with. It can mean that people with the illness can be asleep during the day, but fully awake for periods during the night. Other studies have suggested that the use of bright room lighting and melatonin can help adjust the "clock", and the researchers from the Royal Netherlands Academy of Arts and Sciences in Amsterdam managed to recruit 189 care home residents to take part in an unique trial. Six of the care homes taking part had lighting installed, and this was turned on between 9am and 6pm every day. Some of the patients, most of whom had some form of dementia, received melatonin, a naturally-occurring hormone, and their progress was then monitored for at least the next year. Those who had melatonin, but no extra lighting, had better sleep patterns, but tended to be more withdrawn and have a worse mood. However, patients having melatonin and bright light together managed to avoid these mood problems. Even having the light without melatonin slowed "cognitive deterioration" by 5% compared with those homes which did not install brighter lighting, and depressive symptoms fell by 19%. 'Spectacular' The study authors said that care homes should consider introducing the lights for their residents with dementia. Dr Michael Hastings, from the Medical Research Council Laboratory for Molecular Biology in Cambridge, and himself a researcher into circadian rhythms and Alzheimer's disease, said the study results were "spectacular". "Although 5% may not sound like a huge amount, it compares well with treatments such as Aricept designed to slow the progression of the illness. "Over the course of Alzheimer's, it could represent six months, and you have to remember that the light therapy is completely non-invasive, and melatonin is a very gentle drug." He said that sleep disturbances were often the "final straw" for relatives trying to cope for people with dementia. "You can have a situation where someone is asleep for part of the day, then at 3am will be awake, wandering around the house, turning the gas on. Relatives can manage quite a few of the symptoms of mild or moderate dementia, but this can be too much. "It's a crunch issue, and if someone could be kept at home for an extra six months, rather than placed in a care home, there are huge personal and social benefits." He added that since circadian rhythm disruption was a feature of other neurological diseases, such as Huntington's and Parkinson's, there might also be an application for the therapy elsewhere. Teen cancer diagnoses 'delayed'Teenagers with cancer often face significant delays in being initially diagnosed, researchers have warned. Three studies presented to the Teenage Cancer Trust conference in London will show the teenagers themselves tend to seek help quickly when symptoms appear. The delays usually occur because GPs fail to spot cancer signs, or hospital doctors order the wrong tests. Professor Tim Eden, one of the researchers behind the work, said it was important to educate professionals. Cancer causes 11% of all deaths in the 15-24 age group. Teenagers diagnosed with cancer are now more likely to survive the illness, but the improvements are not as dramatic as those seen in young children. Four or more GP visits Professor Eden, who is based at the University of Manchester, studied 115 patients with bone tumours. He found the time between spotting the first symptom and a diagnosis ranged from four to 184 weeks - the average time was about 15 weeks. The delay was worse if the patient was aged 12 or over, and if the patient went to their GP rather than A&E, where X-rays were more likely to be carried out. A second study looked at 95 patients with a variety of tumours and found the interval ranged from two to 192 weeks, with an average wait of 9.5 weeks until diagnosis. A third study by Sam Smith, a teenage cancer nurse at Manchester's Christie Hospital, surveyed 200 young people, and found 80% sought help within four weeks of noticing pain, a lump or swelling, weight loss or tiredness. Almost all of them had two or three of these symptoms. But 54% of patients with Hodgkin lymphoma, 59% with brain tumours and 46% with bone tumours visited their GP four or more times with symptoms before referral. 'Reduce distrust' Professor Eden said: "It would appear that when we compare these data with studies of children with cancer, teenagers and young adults do face greater delays in diagnosis, particularly for bone and brain tumours and Hodgkin lymphoma. "And the older the patient, the longer the delay. "In our studies the professional interval has always been longer than patient symptom interval." He said there were delays at both GP and hospital levels. Professor Eden said it was important to raise awareness amongst doctors of the signs of cancer in teenagers and to speed up their response. "Whether this will improve survival remains unclear but it will reduce anxiety, anger and distrust of doctors." Professor Steve Field, chairman of the Royal College of GPs, said: "It's very easy to look back and say 'a GP should have seen something' but cancer in this age group is extremely rare." But he added: "When a patient is found to have cancer, the GP should look back and see whether or not there were signs that could have been picked up earlier." Intensive Control Of Blood Sugar Does Not Reduce Heart Risk In Type 2 DiabetesThe findings from the American ACCORD and the Australian ADVANCE trials, and a comprehensive editorial comparing their methods and results, are published in the 5th June issue of the New England Journal of Medicine (NEJM). What will come as a surprise to many diabetes experts is that neither study found evidence to support the widely held belief that aggressive reduction of blood sugar, to below the 7 per cent standard, significantly reduces cardiovascular risk and death for patients with Type 2 diabetes. The American ACCORD study, supported by the NIH's National Heart, Lung, and Blood Institute (NHLBI), involved over 10,000 Type 2 diabetes patients and was stopped in February this year, after an average of 3.5 years, instead of the planned 5.6 years, because of safety concerns. The intensive blood sugar reduction group had 22 per cent higher risk of death (54 more deaths), compared to the standard group. The higher risk of death started to appear within 1 to 2 years after the aggressive method of lowering blood sugar started having an effect. All the remaining patients are now following a regimen with a standard blood sugar target. The Australian ADVANCE study, designed by experts at the Australia's George Institute for International Health, involved over 11,000 type 2 diabetes patients from 20 different countries, who were treated and followed up for five years. The study did not find any significant increase in heart risk and death, but it did find a reduction of kidney disease risk of 4.1 percent compared with 5.2 percent among patients who followed a less aggressive regimen. Type 2 diabetes shortens lifespan, usually because it brings a higher risk of cardiovascular disease. But while the disease is characterized by the body's failure to control blood sugar, the relationship between blood sugar and cardiovascular risk is not straightforward. The disease itself shows a strong link with cardiovascular risk, yet the risk increase for each percentage increase in blood sugar is only modest, wrote Drs Robert G Dluhy and Graham T McMahon in an editorial accompanying the two studies in the same issue of the NEJM. An earlier UK study (the UKPDS trial) showed that reducing blood sugar (glycated hemoglobin) from 8 to 7 per cent did not reduce cardiovascular events, although a subgroup of patients taking metformim did experience a lower risk of cardiovascular events. And another study of patients with Type 1 diabetes (the DCCT/EDIC trial), showed a long term reduction in cardiovascular complications that appeared only many years after starting on the glucose lowering regimen. These two latest studies both investigated the effect of lowering blood sugar to near-normal levels on cardiovascular risk. Although they both compared the effect of standard versus intensive treatment, they were quite different in that most patients in both studies were given a variety of drugs, with and without insulin, but the American ACCORD study did not restrict the aggressiveness of the regimen, while in the Australian ADVANCE study, all patients had to take the sulfonylurea gliclazide (modified release) at the start, according to the editorial writers. The two trials also differed significantly in design and the types of drugs used, although they were similar in that neither trial required patients to modify lifestyle or diet. For example, in the American ACCORD trial, the patients were randomly assigned to intensive or standard therapy for lowering blood pressure, or to receive the cholesterol lowering drug fenofibrate or placebo, whereas in the Australian ADVANCE trial, patients were randomly assigned to take either perindopril and indapamide (to lower blood pressure) or to receive placebo. Another example of where the two trials differed was that in the the Australian ADVANCE trial fewer than 20 per cent of patients took thiazolidinediones (a class of drugs used to treat Type 2 diabetes), whereas in the American ACCORD trial, 90 per cent of patients in the intensive therapy group, and 58 per cent in the standard group took the thiazolidinedione drug rosiglitazone (Avandia). Also, in the Australian ADVANCE trial, only about half the patients were receiving aspirin and statins to control nonglycemic cardiovascular risk, whereas in the American ACCORD trial, at least three quarters of them were. In both trials the completed follow-up was between 3.5 and 5.0 years. The participants were typical adults with Type 2 diabetes, with an average age of 62 to 66 years, having had diabetes for 8 to 10 years, and a median blood sugar (glycated hemoglobin) level of 7.2 to 8.1 per cent when they started the trial. On average, patients in the intensive blood sugar control group in the Australian ADVANCE trial met the treatment goal of a mean blood sugar level of 6.5 per cent, but few patients met the more aggressive goal of below 6 per cent in the American ACCORD trial, which had to finish early, as already explained. According to Dluhy McMahon, writing in the editorial, the most compelling message from both studies is that: "Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events within that time frame." And a particularly "troubling" result from the American ACCORD trial was that: "Near-normal glucose control (achieved with the use of combination therapy incorporating heavy use of thiazolidinediones, sulfonylureas, metformin, and insulin) is associated with significantly increased risks of death from any cause and death from cardiovascular causes, the very outcomes the trial was designed to prevent." However, the Australian ADVANCE trial did confirm predicted reductions in kidney disease outcomes (new-onset microalbuminuria and nephropathy), wrote Dluhy McMahon. According to the New York Times, diabetes researchers are saying that the message from these trials is that patients should try to get at least moderate control of blood sugar to protect against eye, kidney and nerve disease, but not for protecting against heart disease, for which other measures, like drugs to control cholesterol, reduce blood pressure and reduce risk blood clotting, as well as changes to diet and exercise, are probably more effective and safer. This is probably at odds with what the Australian investigators claimed about their study, which according to a press release, said that in addition to the reduction in kidney disease risk, they found that the study: Showed a 30 per cent reduction in the development of proteinuria, a well established marker of increased cardiovascular risk. Achieved a positive trend towards reduction in the risk of cardiovascular death (12 per cent), although not statistically significant. A doctor told the New York Times that given the age of the patients in the trial, and the fact they had had diabetes for years, the two trials showed how difficult it was to effect changes in people in whom a lot of damage may already have been done. Perhaps a trial on younger patients, newly diagnosed with Type 2 diabetes, would have given a different result. Link Between Chronic Inflammation And Cancer ConfirmedAccording to scientists at the Massachussets Institute of Technology, chronic inflammation of the intestine or stomach has been linked to DNA damage and thus increased cancer risk. These results were released on June 2, 2008 in the Journal of Clinical Investigation (JCI). Inflammation can be caused by many factors, including infectious agents such as Helicobacter pylori and Hepatitis C, which are already known to increase cancer risk in the stomach and liver, respectively. The inflammatory response produces cytokines, the chemicals in the immune response that encourage cell proliferation and suppress apoptosis, which can also contribute to an increased risk of cancer. In most normal situations, damage induced to DNA during an inflammatory response is repaired by the cell's internal error correction system -- but if this is not functioning properly, there is a higher chance that mutation will occur, increasing the risk of cancer. Knowing the connection between these factors and cancer can help doctors better guide patients who might be at risk for inflammation induced cancers. "That variation could influence the susceptibility of individuals and how they are going to respond to a chronic inflammation response," said senior author Leona Samson, director of the CEHS. By performing two separate studies, the team discovered that chronic inflammation in mice generally increased the development of tumors. This was tested additionally using mice who were already less able to repair DNA damage and thus more susceptible to cancerous mutations. While this was long hypothesized, these studies help confirm the idea that inflammation can be linked to cancer. "It's something that was expected but it was never formally proven," said lead author Lisiane Meira, research scientist in MIT's Center for Environmental Health Sciences (CEHS). In the JCI study, colon inflammation was induced using a chemical compound that mimics a human colitis. This induced a higher rate of cancer. According to Meira: "Lo and behold, the DNA repair deficient mice were more susceptible." A second study, in collaboration with James Fox, director of the Division of Comparative Medicine at MIT, and one of his students, Chung-Wei Lee, meant to solidify the first. In this, mice were infected with H. pylori, and those lacking the proper DNA repair mechanisms were more likely to have pre-cancerous regions in the stomach. The latter study is further related to another piece published by Fox, which showed that treating infection with this bacterium quicly could prevent cancer development. These results indicate that individuals who are less able to perform DNA damage with chronic inflammation, such as ulcerative colitis, are more susceptible to cancer than others, according to Meira. However, there is another effect of inflamation that they postulate might influence this -- during the inflammatory response to infection, immune cells like macrophages and neutrophils excrete oxygen and nitrogen species that might damage DNA. |
|
| HISTORY OF HOSPITALS | |
|
Today the United States is home to 6,021 hospitals that contain over 1 million hospital beds. U.S.hospitals annually admit some 34 million patients who are assigned a bed and receive medical or surgical treatment as inpatients. Hospitals also provide outpatient treatment in clinics or other walk-in, or ambulatory, settings for an additional 483 million patients every year.
Hospitals in the United States are classified by the services they provide (general or specialized), the length of stay they offer patients (short stay or long-term care), and by their ownership (not-for-profit, proprietary, or government owned). Although most U.S. hospitals are classified as not-for-profit, any one hospital will fall into several of the above categories. For example, Methodist Hospital in Houston, Texas, with more than 300,000 sq m (3 million sq ft) of space, is one of the largest short-stay, not-for-profit, general hospitals in the country. |
|
