Friday, August 24, 2007
Wednesday, August 15, 2007
HPV vaccine does not treat HPV
HPV (Human papillomavirus) is a very common virus, some types cause cervical cancer, some cause gential warts. There has been confusion about whether women who have been infected with HPV could benefit from vaccination.
A study of more than 2000 women who already have HPV infection in Costa Rica found that Cervarix, a cervical-cancer vaccines, did not clear the virus from the bodies of the HPV-infected women. The author suggested that the vaccine "should not be used for the purposes of treating prevalent infections" and shoud target young women prior to their sexual debut because the infection happens shortly after sexual initiation.
Read the free article "Effect of Human Papillomavirus 16/18 L1 Viruslike Particle Vaccine Among Young Women With Pre-existing Infection: A Randomized Trial" JAMA. 2007 (7) ;298:743-753. August 15.
A study of more than 2000 women who already have HPV infection in Costa Rica found that Cervarix, a cervical-cancer vaccines, did not clear the virus from the bodies of the HPV-infected women. The author suggested that the vaccine "should not be used for the purposes of treating prevalent infections" and shoud target young women prior to their sexual debut because the infection happens shortly after sexual initiation.
Read the free article "Effect of Human Papillomavirus 16/18 L1 Viruslike Particle Vaccine Among Young Women With Pre-existing Infection: A Randomized Trial" JAMA. 2007 (7) ;298:743-753. August 15.
Tuesday, August 14, 2007
Waist size tells heart risk
Several studies have shown waist size is linked with heart attack, stroke and heart disease rsisk. They suggested that a waist circumference of over 35in for a woman, 40in for a man indicates a high risk of developing diabetes and heart disease.
A new US study looked for the early signs of atherosclerosis - narrowing and hardening of the arteries linked to the development of cardiovascular disease, of more than 2700 people with an average age of 45. Using MRI and EBCT scans that specially look for calcium deposits in the heart, they found the smaller a person's waist, the clearer the arteries, regardless of the body weight.
The researchers said the key message is to prevent accumulation of central fat early on in people's lives. "Even a small pot belly puts us at higher risk when compared to a flat tummy."
The report was published in the August 21 issue of Journal of the American College of Cardiology
A new US study looked for the early signs of atherosclerosis - narrowing and hardening of the arteries linked to the development of cardiovascular disease, of more than 2700 people with an average age of 45. Using MRI and EBCT scans that specially look for calcium deposits in the heart, they found the smaller a person's waist, the clearer the arteries, regardless of the body weight.
The researchers said the key message is to prevent accumulation of central fat early on in people's lives. "Even a small pot belly puts us at higher risk when compared to a flat tummy."
The report was published in the August 21 issue of Journal of the American College of Cardiology
Verapamil for cluster headache may cause heart problems
Cluster headache is a rare and severe form of headache that is more common in men. A drug, Verapamil, a type of calcium-channel blocker is increasingly used to treat cluster headaches and a range of symptoms including high blood pressure, angina and irregular heart beat.
A new study of 108 patients who had regular electrocardiograms (EKGs) found when high doses of Verapamil were used to prevent cluster headache, 1 in 5 patients developed some form of cardiac irregularity that could progress to serious heart problems.
More than 40% of the participants did not have access to the EKG service or unaware of the need for monitoring their heart. The researchers said that the drug is relatively new for treating cluster headache, therefore healthcare providers may be unaware of the problems. They highlighted the need for frequent EKG monitoring of patients treated with Verapamil for cluster headache.
The study "Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy." is published in the current issue of Neurology 2007 69: 668-675.
A new study of 108 patients who had regular electrocardiograms (EKGs) found when high doses of Verapamil were used to prevent cluster headache, 1 in 5 patients developed some form of cardiac irregularity that could progress to serious heart problems.
More than 40% of the participants did not have access to the EKG service or unaware of the need for monitoring their heart. The researchers said that the drug is relatively new for treating cluster headache, therefore healthcare providers may be unaware of the problems. They highlighted the need for frequent EKG monitoring of patients treated with Verapamil for cluster headache.
The study "Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy." is published in the current issue of Neurology 2007 69: 668-675.
Vitamin supplements may not protect your heart
Some previous researches have found viatmin C, E and beta carotene linked to reduced risk of cardiovascular disease, but a new study published in the journal Archives of Internal Medicine casts doubt on these findings.
The latest study involved 8000 women who have a history of cardiovascular disease, randomly assigned to 2 groups : one taking vitamin alone or in combination and one a placebo over 9 years. The results showed that the antioxidants, either alone or in combination had no effect on reducing the risk of heart disease or death in high-risk women.
Some experts suggested that the form of vitamin in over-the-counter dietry supplements may be different from the vitamins found in fruits and vegetables and recommended that lifestyle change with healthy diet and regular exercises is the key to prevent heart disease.
Read the abstract - "A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women - Results From the Women's Antioxidant Cardiovascular Study " Arch Intern Med. 2007;167 (15):1610-1618. 13-27 August.
The latest study involved 8000 women who have a history of cardiovascular disease, randomly assigned to 2 groups : one taking vitamin alone or in combination and one a placebo over 9 years. The results showed that the antioxidants, either alone or in combination had no effect on reducing the risk of heart disease or death in high-risk women.
Some experts suggested that the form of vitamin in over-the-counter dietry supplements may be different from the vitamins found in fruits and vegetables and recommended that lifestyle change with healthy diet and regular exercises is the key to prevent heart disease.
Read the abstract - "A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women - Results From the Women's Antioxidant Cardiovascular Study " Arch Intern Med. 2007;167 (15):1610-1618. 13-27 August.
Friday, August 10, 2007
Rethink preventive treatments in elderly people
Researchers from the UK and New Zealand said that "preventive treatments in elderly people may simply change the cause of death rather than prolonging life" in the article "Preventive health care in elderly people needs rethinking" in BMJ Online First.
As an example, they said that elderly patients will not necessarily reduce their risk of death caused by cardiovascular disease if they are given statins, their cause of death will most likely be "substituted" for cancer. Doctors are given financial incentives to persuading patients to accept such preventive treatments that are expensive and can be harmful to them.
The authors called for a more sophisticated model to assess preventive treatments in the elderly and concluded that cash may be better spent in relieving suffering through cataract, joint replacement operations and caring for people with dementia.
As an example, they said that elderly patients will not necessarily reduce their risk of death caused by cardiovascular disease if they are given statins, their cause of death will most likely be "substituted" for cancer. Doctors are given financial incentives to persuading patients to accept such preventive treatments that are expensive and can be harmful to them.
The authors called for a more sophisticated model to assess preventive treatments in the elderly and concluded that cash may be better spent in relieving suffering through cataract, joint replacement operations and caring for people with dementia.
Doubts over laughing gas safety
A large scale study of 2000 patients undergoing major surgery in hospitals in Australia, UK, Asia and Middle East has raised doubts over the safety of the common anaesthetic known as laughing gas.
Australian researchers found that avoiding using nitrous oxide cut the risk of surgery complications like wound infections, pneumonia, nausea and vomiting. They also found a possible link between nitrous oxide and the risk of heart attacks and concluded that the routine use of nitrous oxide in patients undergoing major surgery should be questioned
The study "Avoidance of Nitrous Oxide for Patients Undergoing Major Surgery: A Randomized Controlled Trial" is published in the current issue of the journal Anesthesiology. 107(2): 221-231,August 2007 ( full text via HILO with Athens password )
Read the RCoA's response.
Australian researchers found that avoiding using nitrous oxide cut the risk of surgery complications like wound infections, pneumonia, nausea and vomiting. They also found a possible link between nitrous oxide and the risk of heart attacks and concluded that the routine use of nitrous oxide in patients undergoing major surgery should be questioned
The study "Avoidance of Nitrous Oxide for Patients Undergoing Major Surgery: A Randomized Controlled Trial" is published in the current issue of the journal Anesthesiology. 107(2): 221-231,August 2007 ( full text via HILO with Athens password )
Read the RCoA's response.
Hungry hormone and over-eating
British scientists discovered that the hormone Leptin, made by fat cells, is responsible for reducing hunger and increasing the feeling of fullness hunger, it also controls the fondness for food.The findings could lead to new insights into obesity and how to treat the condition.
They studied two teenagers with a rare genetic disorder that do not produce any leptin. They eat excessively and are severely obese. However, when they were treated with leptin, they became more choosey about food, ate less and lost weight.
Their brain activities in response to different food and non-food pictures were recorded using fMRI. The scientists found that the pictures stimulated activity in the area called striatal regions that are associated with pleasant emotions and desires. When the patients were treated with leptin, responses to food pictures in these area were reduced and were activated mostly by foods the patients liked and only when they were hungry.
The researchers said that the findings should "encourage a more sympathetic attitude to people with weight problems" and "will be a key step in the prevention and treatment of obesity". Some experts said such a small study cannot provide conclusive evidence. Read the press release.
The article "Leptin regulates striatal regions and human eating behaviour" is published online in the journal Science, 9 August 2007 (subscription required)
They studied two teenagers with a rare genetic disorder that do not produce any leptin. They eat excessively and are severely obese. However, when they were treated with leptin, they became more choosey about food, ate less and lost weight.
Their brain activities in response to different food and non-food pictures were recorded using fMRI. The scientists found that the pictures stimulated activity in the area called striatal regions that are associated with pleasant emotions and desires. When the patients were treated with leptin, responses to food pictures in these area were reduced and were activated mostly by foods the patients liked and only when they were hungry.
The researchers said that the findings should "encourage a more sympathetic attitude to people with weight problems" and "will be a key step in the prevention and treatment of obesity". Some experts said such a small study cannot provide conclusive evidence. Read the press release.
The article "Leptin regulates striatal regions and human eating behaviour" is published online in the journal Science, 9 August 2007 (subscription required)
Thursday, August 09, 2007
Statin delays artery damage in FH children
According to a randomised, double-blinded, placebo-controlled study in the Netherlands, statin therapy is safe and effective in treating children with familial hypercholesterolemia ( FH ), researchers found that early initiation of statin treatment in FH children as young as 8 delays the early artery damage.
214 children of 8 - 18 were randomised to receive treatment with pravastatin 20 or 40 mg depending on their age or placebo for 2 years.
Follow-up data for 186 children with an average of treatment period of 4.5 years showed that earlier initiation of statin treatment results in a smaller carotid artery intima-media thickness (IMT) at a later age. Furthermore, no serious clinical or laboratory adverse events were reported.
The results showed that the age of statin initiation was a strong, independent predictor for the increased thickening between the intima and media, however, the researchers suggested further clinical trials will be required to determine the optimal age for beginning statin therapy in FH children.
The study "Statin Treatment in Children With Familial Hypercholesterolemia: The Younger, the Better" is published in the journal Circulation. 2007; 116: 664-668
214 children of 8 - 18 were randomised to receive treatment with pravastatin 20 or 40 mg depending on their age or placebo for 2 years.
Follow-up data for 186 children with an average of treatment period of 4.5 years showed that earlier initiation of statin treatment results in a smaller carotid artery intima-media thickness (IMT) at a later age. Furthermore, no serious clinical or laboratory adverse events were reported.
The results showed that the age of statin initiation was a strong, independent predictor for the increased thickening between the intima and media, however, the researchers suggested further clinical trials will be required to determine the optimal age for beginning statin therapy in FH children.
The study "Statin Treatment in Children With Familial Hypercholesterolemia: The Younger, the Better" is published in the journal Circulation. 2007; 116: 664-668
Monday, August 06, 2007
Coffee reduces liver cancer risk
Italian researchers carried out a meta-analysis of 10 published studies on the relation between coffee drinking and risk of hepatocelluar carcinoma, a common type of liver cancer. The studies included participants in Greece, Italy and Japan, some with liver cancer and many without.
They found a 41 % reduction in the risk for liver cancer among coffee drinkers compared with those who never drank coffee. The researchers said that the studies from Europe and Japan showed the same relationship between coffee drinking and reduced liver cancer risk suggested consistency of these results. However, they cautioned that it is difficult to "derive a causal inference on the basis of observational studies alone."
The study "Coffee drinking and hepatocellular carcinoma risk: A meta-analysis" is published in the journal Hepatology, Volume 46, Issue 2 (August 2007), pp 430-435. Read the abstract.
They found a 41 % reduction in the risk for liver cancer among coffee drinkers compared with those who never drank coffee. The researchers said that the studies from Europe and Japan showed the same relationship between coffee drinking and reduced liver cancer risk suggested consistency of these results. However, they cautioned that it is difficult to "derive a causal inference on the basis of observational studies alone."
The study "Coffee drinking and hepatocellular carcinoma risk: A meta-analysis" is published in the journal Hepatology, Volume 46, Issue 2 (August 2007), pp 430-435. Read the abstract.
Paediatric SpRs' view of educational supervision
A questionnaire was sent to 129 paediatric SpRs in years 3 -5 in the North Thames region in the UK to find out their views of the educational supervision they receive from consultants. Participation was anonymous to encourage them to express their views and feelings.
There was 67% response rate. Many trainees found little value in the educational supervision, about a third rated the educational supervision they had received "a complete waste of time". Some found that it was little more than a form filling exercise.
When asked how the educational supervision can be improved, the trainees suggested that educational supervisors should learn to listen instead of talking, understand the needs of individual trainees and be encouraging.
Read the free article "Paediatric specialist registrars' views of educational supervision and how it can be improved: a questionnaire study", Journal of the Royal Society of Medicine 2007;100:375-378
There was 67% response rate. Many trainees found little value in the educational supervision, about a third rated the educational supervision they had received "a complete waste of time". Some found that it was little more than a form filling exercise.
When asked how the educational supervision can be improved, the trainees suggested that educational supervisors should learn to listen instead of talking, understand the needs of individual trainees and be encouraging.
Read the free article "Paediatric specialist registrars' views of educational supervision and how it can be improved: a questionnaire study", Journal of the Royal Society of Medicine 2007;100:375-378
Does this child have appendicitis?
Appendicitis is a common cause of pediatric abdominal pain, but the evaluation of abdominal pain in children can be quite difficult because the symptoms are very vague.
According to a new study led by the Johns Hopkins Children's Center, many American children suffer a ruptured appendix, a life-threatening complication because younger children have fewer classic symptoms of nausea, vomiting and pain in the abdomen making it easy to miss the diagnosis.
The researchers reviewed the frequency of the most common symptoms of actual appendicitis in children by analysing 25 studies and identified some of the most telltale signs that will help doctors to narrow down the diagnosis and prompt them to refer the child to a surgeon for evaluation.
These include "rebound" tenderness or pain that occurs after pressure is removed abruptly from the lower right abdomen; abdominal pain that starts around the belly button and migrates down to the right and an elevated white blood cell count. They also suggested that CT scans should be avoided if possible.
The study is published in the July 25 issue of JAMA. 2007;298:438-451. Read the abstract.
According to a new study led by the Johns Hopkins Children's Center, many American children suffer a ruptured appendix, a life-threatening complication because younger children have fewer classic symptoms of nausea, vomiting and pain in the abdomen making it easy to miss the diagnosis.
The researchers reviewed the frequency of the most common symptoms of actual appendicitis in children by analysing 25 studies and identified some of the most telltale signs that will help doctors to narrow down the diagnosis and prompt them to refer the child to a surgeon for evaluation.
These include "rebound" tenderness or pain that occurs after pressure is removed abruptly from the lower right abdomen; abdominal pain that starts around the belly button and migrates down to the right and an elevated white blood cell count. They also suggested that CT scans should be avoided if possible.
The study is published in the July 25 issue of JAMA. 2007;298:438-451. Read the abstract.
Thursday, August 02, 2007
Cauliflower and broccoli can cut prostate cancer risk
Almost 32,000 cases of prostate cancer are diagnosed every year in Britian and the risks increase with age.
A new study "Prospective Study of Fruit and Vegetable Intake and Risk of Prostate Cancer" published in the Journal of the National Cancer Institute (JNCI), volume 99, number 15, p.1200-1209, found eating cauliflower and broccoli regularly can almost halve a man's chances of developing prostate cancer. Experts advise the best way to reduce cancer risk is to eat a balanced diet with lots of fruit and vegetables a day. Read the abstract.
The study tracked 29,000 men over a 4-year period, reserachers also monitored their eating habits particularly intake of different vegetables. Read the press release.
A new study "Prospective Study of Fruit and Vegetable Intake and Risk of Prostate Cancer" published in the Journal of the National Cancer Institute (JNCI), volume 99, number 15, p.1200-1209, found eating cauliflower and broccoli regularly can almost halve a man's chances of developing prostate cancer. Experts advise the best way to reduce cancer risk is to eat a balanced diet with lots of fruit and vegetables a day. Read the abstract.
The study tracked 29,000 men over a 4-year period, reserachers also monitored their eating habits particularly intake of different vegetables. Read the press release.
UK childhood cancer survival lag behind EU
A study published in the current issue of Lancet Oncology, Volume 8, Number 8, ( subscription required) found that children suffering from cancer in the UK have lower survival rates than their European counterparts. The study highlighted trials on Wilm's tumour - common childhood tumour in Germany.
The authors said that most children in Germany are provided regular check-ups by primary-care paediatricians and increased survival was linked to early diagnosis through routine or incidental examination. They believe children in the UK have been receiving a less thorough treatment .
They called for routine surveillance of children as standard across the UK and said that health visitors needed to be more aware of the symptoms of cancer.
The authors said that most children in Germany are provided regular check-ups by primary-care paediatricians and increased survival was linked to early diagnosis through routine or incidental examination. They believe children in the UK have been receiving a less thorough treatment .
They called for routine surveillance of children as standard across the UK and said that health visitors needed to be more aware of the symptoms of cancer.
Agenda for change
Agenda for change - the new pay structures rolled out in 2004 in the NHS was intended to improve services for patients by rewarding staff fairly.
The King's Fund found that the agenda for change was rushed and lack of proper implementation after carrying out case studies of 10 NHS Trusts. This means that the intended benefits of the pay reform may never happen and there are few signs it has improved productivity or transformed practice.
The King's Fund found that the agenda for change was rushed and lack of proper implementation after carrying out case studies of 10 NHS Trusts. This means that the intended benefits of the pay reform may never happen and there are few signs it has improved productivity or transformed practice.
Tuesday, July 31, 2007
The more alcohol you drink, the higher bowel cancer risk
A Cancer Research UK study found that a large glass of wine or a pint of beer a day increases the risk by about 10 %.
The research shows that the more alcohol you drink, the greater your risk of developing bowel cancer. However, the authors said that people can reduce their risk of cancers by cutting down on alcohol. The findings are published in the International Journal of Cancer. (subscription needed)
More than 30,000 new cases of bowel cancer are diagnosed each year in the UK alone. The lifetime risk for bowel cancer is 1 in 20 for men and 1 in 18 for women.
The research shows that the more alcohol you drink, the greater your risk of developing bowel cancer. However, the authors said that people can reduce their risk of cancers by cutting down on alcohol. The findings are published in the International Journal of Cancer. (subscription needed)
More than 30,000 new cases of bowel cancer are diagnosed each year in the UK alone. The lifetime risk for bowel cancer is 1 in 20 for men and 1 in 18 for women.
Friday, July 27, 2007
Diabetes drugs double heart failure risk
More than 1.5 million prescriptions for rosiglitazone (Avandia) and pioglitazone (Actos) were issued in England alone last year, but experts warn these 2 commonly used diabetes drugs could double the risk of heart failure, even for those who have never suffered the condition, in a new study in the journal Diabetes Care.
The two drugs are prescribed to millions of patients to treat type 2 diabetes and approved by NICE for use on the NHS. Experts call for a re-evaluation of the benefits and risks of both drugs in view of the concerns on cardiovascular safety.
Drug agencies urge patients not to panic over research findings and should contact their doctors if concerned. Read more ...
The two drugs are prescribed to millions of patients to treat type 2 diabetes and approved by NICE for use on the NHS. Experts call for a re-evaluation of the benefits and risks of both drugs in view of the concerns on cardiovascular safety.
Drug agencies urge patients not to panic over research findings and should contact their doctors if concerned. Read more ...
Thursday, July 26, 2007
Oscar the cat and the dying patients
This Thursday issue of the NEJM publishes an unusual article about the story of Oscar the cat that "has an uncanny ability to predict when residents are about to die", written by Dr. Dosa, a Rhode Island Hospital geriatrician and Brown University professor.
Oscar, the 2-year old cat, was adopted as a kitten and grew up in the advanced dementia unit at a nursing and rehabititation center where Dr Dosa works. After 6 months, the staff noticed that Oscar would make ward rounds, sniffing and observing patients. He seems to have the sense about when patients are about to die and would sit beside them when the time is near.
He has predicted 25 cases by curling next to the patients during their final hours, his presence has alerted staff to contact patients' family about the end-of-life stage and most families are grateful for the warning. However, Oscar's ability of sensing the impending death remains a mystery and no one knows if his behaviour is scientifically significant.
Read the free full text article "A Day in the Life of Oscar the Cat" in NEJM, 2007, July 26, Volume 357:328-329
Oscar, the 2-year old cat, was adopted as a kitten and grew up in the advanced dementia unit at a nursing and rehabititation center where Dr Dosa works. After 6 months, the staff noticed that Oscar would make ward rounds, sniffing and observing patients. He seems to have the sense about when patients are about to die and would sit beside them when the time is near.
He has predicted 25 cases by curling next to the patients during their final hours, his presence has alerted staff to contact patients' family about the end-of-life stage and most families are grateful for the warning. However, Oscar's ability of sensing the impending death remains a mystery and no one knows if his behaviour is scientifically significant.
Read the free full text article "A Day in the Life of Oscar the Cat" in NEJM, 2007, July 26, Volume 357:328-329
Obesity is socially contagious
A new study that looked at data collected over 32 years from the Framingham Heart Study, an ongoing cardiovascular study begun in 1948, found that when an individual became obese, the chance that a friend will become obese increased by 57 % even if they were geographically distant.
Researchers said that obesity spread through social ties (see diagram in the article), particularly close friendship. Some experts said the results suggested that people influence one another's behavior and share the ideas about what an acceptable weight is, so it might be more effective to treat obese people in groups than individuals to slow this worldwide epidemic. Read the press release.
The study "The Spread of Obesity in a Large Social Network over 32 Years" is published in NEJM, July 26, Volume 357:370-379. Free full text.
Wednesday, July 25, 2007
Does high-veggie diet stop cancer return?
According to a study published last week, daily servings of fruits and vegetables does not increase breast cancer survival rates. The current results contradict previous findings that diet made a big difference in reducing breast cancer risk.
Breast cancer survivors were assigned to 2 groups : a control group that followed the FDA nutrition guidelines and an intervention group that was instructed to consume 8 servings of fruits and vegetables, plus 16 ounces of fresh vegetable juice and permitted to eat meat but consume no more than 20% of total calories from fat.
Some cancer experts said that the study was poorly designed and executed: participants self-reported their eating habbits, most did not reach the target of fat reduction and the participants already ate more fruit and vegetables than most Americans before the study started. Some experts said the conclusions were misleading fearing it would discourage breast cancer survivors from pursuing a healthy diet.
The study "Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer" was published in JAMA. 2007;298:289-298. Read the abstract.
Read the press release at ABC News.
Breast cancer survivors were assigned to 2 groups : a control group that followed the FDA nutrition guidelines and an intervention group that was instructed to consume 8 servings of fruits and vegetables, plus 16 ounces of fresh vegetable juice and permitted to eat meat but consume no more than 20% of total calories from fat.
Some cancer experts said that the study was poorly designed and executed: participants self-reported their eating habbits, most did not reach the target of fat reduction and the participants already ate more fruit and vegetables than most Americans before the study started. Some experts said the conclusions were misleading fearing it would discourage breast cancer survivors from pursuing a healthy diet.
The study "Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer" was published in JAMA. 2007;298:289-298. Read the abstract.
Read the press release at ABC News.
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