CDC releases interim guidance on Zika testing and interpretation of results

Today, CDC published interim guidance for Zika virus antibody testing and interpretation of results. Because of the differences in recommended clinical management of Zika and dengue virus infections, and the risk of adverse pregnancy outcomes in women infected with Zika virus during pregnancy, a conservative approach to the interpretation of antibody test results is necessary to reduce the possibility of a missed diagnosis of either infections. The timing of IgM antibody testing and the thresholds of plaque reduction neutralization test (PRNT) have changed.

• Serum IgM antibody test should be performed if real-time reverse transcription polymerase chain reaction (rRT-PCR) results are negative regardless of the day the specimen was collected.

• Based on earlier flavivirus research and limited preliminary data specific to Zika virus, the historical use of a 4-fold higher titer by PRNT might not discriminate between anti-Zika virus antibodies and cross-reacting antibodies in all persons who have been previously infected with or vaccinated against a related flavivirus (i.e., secondary flavivirus infection).

• Together with a positive or equivocal IgM to Zika or dengue virus: 

A PRNT titer >10 will be interpreted as a evidence of infection with that specific flavivirus infection when the PRNT to the other flavivirus(es) tested is <10.

A PRNT titer <10 to a specific flavivirus will be interpreted as a no evidence of infection with  that virus.

If PRNTs are positive i.e.,  >10 to multiple flaviviruses, this will be interpreted as evidence of recent infection with a flavivirus.

CDC will continue to update this guidance as these data are preliminary and as additional rRT-PCR data becomes available. For more information about this guidance, visit Interim Guidance for Interpretation of Zika Virus Antibody Test Results.

Media Statement

For Immediate Release: Tuesday, May 31, 2016
Contact: Media Relations,
(404) 639-3286

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CDC releases interim guidance on Zika testing and interpretation of results

Researchers Develop Identification Tool for Anthrax Meningitis

Using the largest review of historical anthrax cases yet compiled, researchers from Weill Cornell Medicine and the U.S. government have created a checklist to identify patients who develop a common and potentially fatal secondary meningitis infection. This tool fills a known gap in managing patients during a large-scale outbreak such as a bioterror attack, in which traditional diagnosis using lumbar puncture and imaging may be impossible on a mass scale.

Dr. Nathaniel Hupert

In such a public health emergency, officials would need to triage patients to properly allocate medical and other resources to maximize patient survival. Anthrax patients with meningitis, an infection of the lining of the brain and nervous system, would be among those needing the most urgent and complex treatment.

"Our paper provides public health officials both in the United States and around the world with a very straightforward rule that could be implemented to both improve patient care and also improve the management of what assuredly would be very scarce resources," said senior author Dr. Nathaniel Hupert, an associate professor in the Department of Healthcare Policy and Research and the Joan and Sanford I. Weill Department of Medicine.

In the paper, published May 30 in Clinical Infectious Diseases, researchers based at the U.S. Centers for Disease and Control and Prevention, Weill Cornell Medicine and Stanford Medicine examined 363 cases of anthrax meningitis spanning from 1880 to 2013. The scientists pinpointed four key symptoms that raised the likelihood of anthrax meningitis: severe headache; altered mental status; classic physical signs of meningitis; and other neurological signs, such as confusion, imbalance and neck stiffness.

Using the tool could help doctors identify up to 89 percent of adult patients who were likely to have anthrax meningitis, even without laboratory tests or imaging; patients with more than one of the items on the checklist were 98 percent likely to have the condition. With 61 pediatric patients in the case series, the authors found similarly high accuracy for the tool among children.

"Our work shows that it's possible to create straightforward checklists that can be used with great effect in emergency situations," Dr. Hupert said. "A larger goal of our work at Weill Cornell Medicine and the Cornell Institute for Disease and Disaster Preparedness is to make sure that patient safety and healthcare quality don't fall by the wayside during small and large-scale disasters. I think this paper is a clear step in that direction."

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The deadly toxin acrolein has a useful biological role

Scientists from RIKEN in Japan have discovered that acrolein—a toxic substance produced in cells during times of oxidative stress—in fact may play a role in preventing the process of fibrillation, an abnormal clumping of peptides that has been associated with Alzheimer's disease and other neural diseases. The key to this new role is a chemical process known as 4+4 cycloaddition, where two molecules with "backbones" made up of four-atom chains come together to form a ring-like structure with eight atoms. The group found that in some circumstances, acrolein can combine with a class of molecules called polyamines, which themselves are important biological players, to make substances that can prevent the fibrillation of Aβ40 peptides

Schematic of the findings

"What is remarkable, says Ayumi Tsutsui, the lead author of the paper published on June 1 in Advanced Science, “is that the reaction involves acrolein and a class of substances known as polyamines, which are all associated with oxidative stress. Polyamines are known to play very important biological roles, but the mechanisms are still poorly understood." Levels of acrolein have been found to correlate with the progression of diseases such as cancer and stroke." According to Tamotsu Zako of Ehime University, who participated in the research, "It made sense to see acrolein simply as a dangerous substance that triggers disease, and many researchers saw it that way. But in our previous work we had discovered that acrolein could bind with polyamines such as spermine and spermidine to form eight-atom cyclic molecules, and we wondered what biological role these rings might play."

As the team began the experiments, they were surprised to find that these substances made from a combination of acrolein and the polyamines seemed to prevent the peptides known as amyloid-beta from aggregating together—a process linked to the progression of Alzheimer’s disease, where neurons are gradually killed by the accumulation of these amyloid peptides.

The group tested the hypothesis by incubating Aβ40 peptides in mixtures of acrolein, a polyamine known as spermine, and a cyclic compound formed by acrolein and polyamines. Neither of the first two molecules alone had any effect on fibrillation, but the cyclic compounds turned out to be powerful inhibitors. The researchers also found that when acrolein and polyamines were added together into a living cell, they combined naturally through 4+4 cycloaddition to create the diazacylooctane molecule.

According to Katsunori Tanaka, who led the team, “This is important for several reasons. First, it gives us insights into the mechanism through which polyamines—which we know to be tremendously important biologically—exert their action. And secondly, because acrolein and polyamines combine naturally in cells to form these powerful anti-fibrillation substances, it may open the way for us to influence the progression of terrible neurological disorders such as Alzheimer’s.”

Tanaka said that in the current experiment the group used Aβ40, an amyloid peptide with 40 amino acids in the chain, but that they also hope in the future to conduct experiments with Aβ42, which is more prone to fibrillation and is also believed to play a key role in Alzheimer’s disease.

Reference
•Ayumi Tsutsui, Tamotsu Zako, Tong Bu, Yoshiki Yamaguchi, Mizuo Maeda and Katsunori Tanaka, "1,5-Diazacyclooctanes, as Exclusive Oxidative Polyamine Metabolites, Inhibit Amyloid-β(1-40) Fibrillization", Advanced Science

Contact

Associate Chief Scientist
 Katsunori Tanaka
Biofunctional Synthetic Chemistry Laboratory
Associate Chief Scientist Laboratories

Jens Wilkinson
 RIKEN Global Relations and Research Coordination Office
 Tel: +81-(0)48-462-1225 / Fax: +81-(0)48-463-3687
 Email: [email protected]

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The deadly toxin acrolein has a useful biological role

From understanding to prevention: University to the fore in dementia education

The University of Tasmania is building on its reputation as a global leader in dementia research and education with the launch of Preventing Dementia, a new Massive Open Online Course (MOOC).

The course follows on from the international success of the University's Understanding Dementia MOOC, which has attracted more than 70,000 participants worldwide over the past three years.

Both MOOCs were developed by the Wicking Dementia Research and Education Centre, part of the University of Tasmania's Faculty of Health.

The new MOOC, Preventing Dementia, brings to light cutting-edge international research on potentially modifiable risk factors, and provides practical steps people can take if they wish to minimise their relative risk for this degenerative condition.

"Most of an individual's risk of dementia is related to their age as well as genetics," Wicking Centre Co-Director Professor James Vickers said.

"However, it has been recently determined that approximately 30 per cent of cases could be effectively prevented by attending to potentially modifiable risk factors at all stages of life – such as vascular health and mental stimulation.

"The goal of this MOOC is to encourage approaches and behaviours that may contribute to reducing risk, and hopefully to reduce the incidence of dementia in our ageing population."

The new five-week Preventing Dementia MOOC is open to anyone, anywhere, but is particularly relevant to health professionals, health policy professionals, aged-care service providers and people with an interest in brain health and/or dementia risk reduction.

Those taking part will have the chance to engage with a community of participants from across the globe, without assignments or exams, and to be involved in research in dementia prevention.

Professor Vickers said dementia research and education was imperative to address what had become a significant public health issue, particularly in Tasmania.

"Dementia is becoming the most significant public health issue globally, with the fastest rate of growth in cases in low- to middle-wealth countries," he said.

 "Tasmania will also be particularly impacted as we have the state with the oldest population, and also a suite of dementia risk factors such as low education, diabetes and poor vascular health."

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DAIRY AVOIDANCE REACHES DANGEROUS LEVELS, ESPECIALLY FOR WOMEN

A study has found for the first time that one in six adult Australians are choosing to avoid milk and dairy foods, the majority without a medical diagnosis, leading to public health concerns for women in particular. Far fewer participants cited not liking the taste or because they thought it’s fattening for not including diary in their diets. The study also revealed that the decision to avoid some or all dairy foods is influenced by a range of sources from outside medical practice such as the internet, media, friends or alternative practitioners. CSIRO’s Bella Yantcheva, behavioural scientist on the research team, explains the significance of the findings. “The scale of people restricting their diet without a medical reason is very concerning in terms of the public health implications, especially for women. “It means there is potential for nutritional deficiencies or imbalances, or the risk that an underlying health condition could be going untreated,” she said. Dairy foods are important for all of us, but especially for women owing to the calcium content, and foods from the dairy and alternatives group are important throughout life to reduce the risk of osteoporosis. However, the study revealed that more women are avoiding milk and dairy foods than men. These results follow the team’s similar findings on wheat avoidance, which showed around ten times as many Australians than diagnosed with coeliac disease are avoiding wheat-based foods. The study reveals that even more people are avoiding dairy products and, in fact, that around one third of the respondents avoiding dairy foods are also avoiding wheat-based foods. “The numbers show that cutting out significant, basic food groups isn’t a fad but something far more serious,” said Ms Yantcheva. According to the Australian Dietary Guidelines, dairy and grain-based foods are important for a balanced diet. They contribute significantly to our intake of fibre, protein and a wide range of essential vitamins and nutrients, on top of calcium in dairy’s case. “It’s not just about missing out on the food type being avoided and risking your health, but also possibly overconsuming other foods to compensate as well,” Ms Yantcheva said. The paper is published in this month's issue of Public Health Nutrition. Fast facts A study by CSIRO and the University of Adelaide reveals that one in six adult Australians are choosing to avoid milk and dairy foods, the majority without a medical diagnosis. Three quarters (74%) of avoiders are avoiding milk and dairy foods to relieve adverse gastrointestinal symptoms such as cramps, bloating or wind. The study showed that more women are avoiding milk and dairy foods than men although dairy foods are especially important for women owing to the calcium content. Milk, cheese and yoghurt have various health benefits and are a good source of many nutrients, including calcium, protein, iodine, vitamin A, riboflavin, vitamin B12 and zinc (Source: Australian Dietary Guidelines). For women aged 19-50 years, the Australian Dietary Guidelines recommend two and half serves of dairy or dairy alternatives per day, increasing to four serves per day after the age of 50. Men between the ages of 19 and 70 years should consume two and half serves a day, and increase to three and half serves after the age of 70 years. A serve of dairy is equal to 250mls of milk, two slices or 40g of cheese, or a 200g tub of yogurt. See your doctor if you have any concerns about your health. A study has found for the first time that one in six adult Australians are choosing to avoid milk and dairy foods, the majority without a medical diagnosis, leading to public health concerns for women in particular. The survey, undertaken by CSIRO and the University of Adelaide, found that the vast majority of avoiders (74%) are making this choice to relieve adverse gastrointestinal symptoms such as cramps, bloating or wind. Far fewer participants cited not liking the taste or because they thought it’s fattening for not including diary in their diets. The study also revealed that the decision to avoid some or all dairy foods is influenced by a range of sources from outside medical practice such as the internet, media, friends or alternative practitioners. CSIRO’s Bella Yantcheva, behavioural scientist on the research team, explains the significance of the findings. “The scale of people restricting their diet without a medical reason is very concerning in terms of the public health implications, especially for women. “It means there is potential for nutritional deficiencies or imbalances, or the risk that an underlying health condition could be going untreated,” she said. Dairy foods are important for all of us, but especially for women owing to the calcium content, and foods from the dairy and alternatives group are important throughout life to reduce the risk of osteoporosis. However, the study revealed that more women are avoiding milk and dairy foods than men. These results follow the team’s similar findings on wheat avoidance, which showed around ten times as many Australians than diagnosed with coeliac disease are avoiding wheat-based foods. The study reveals that even more people are avoiding dairy products and, in fact, that around one third of the respondents avoiding dairy foods are also avoiding wheat-based foods. “The numbers show that cutting out significant, basic food groups isn’t a fad but something far more serious,” said Ms Yantcheva. According to the Australian Dietary Guidelines, dairy and grain-based foods are important for a balanced diet. They contribute significantly to our intake of fibre, protein and a wide range of essential vitamins and nutrients, on top of calcium in dairy’s case. “It’s not just about missing out on the food type being avoided and risking your health, but also possibly overconsuming other foods to compensate as well,” Ms Yantcheva said. The paper is published in this month's issue of Public Health Nutrition. Fast facts A study by CSIRO and the University of Adelaide reveals that one in six adult Australians are choosing to avoid milk and dairy foods, the majority without a medical diagnosis. Three quarters (74%) of avoiders are avoiding milk and dairy foods to relieve adverse gastrointestinal symptoms such as cramps, bloating or wind. The study showed that more women are avoiding milk and dairy foods than men although dairy foods are especially important for women owing to the calcium content. Milk, cheese and yoghurt have various health benefits and are a good source of many nutrients, including calcium, protein, iodine, vitamin A, riboflavin, vitamin B12 and zinc (Source: Australian Dietary Guidelines). For women aged 19-50 years, the Australian Dietary Guidelines recommend two and half serves of dairy or dairy alternatives per day, increasing to four serves per day after the age of 50. Men between the ages of 19 and 70 years should consume two and half serves a day, and increase to three and half serves after the age of 70 years. A serve of dairy is equal to 250mls of milk, two slices or 40g of cheese, or a 200g tub of yogurt. See your doctor if you have any concerns about your health.

The survey, undertaken by CSIRO and the University of Adelaide, found that the vast majority of avoiders (74%) are making this choice to relieve adverse gastrointestinal symptoms such as cramps, bloating or wind.

Far fewer participants cited not liking the taste or because they thought it’s fattening for not including diary in their diets.

The study also revealed that the decision to avoid some or all dairy foods is influenced by a range of sources from outside medical practice such as the internet, media, friends or alternative practitioners.

CSIRO’s Bella Yantcheva, behavioural scientist on the research team, explains the significance of the findings.

“The scale of people restricting their diet without a medical reason is very concerning in terms of the public health implications, especially for women.

“It means there is potential for nutritional deficiencies or imbalances, or the risk that an underlying health condition could be going untreated,” she said.

Dairy foods are important for all of us, but especially for women owing to the calcium content, and foods from the dairy and alternatives group are important throughout life to reduce the risk of osteoporosis.

However, the study revealed that more women are avoiding milk and dairy foods than men.

These results follow the team’s similar findings on wheat avoidance, which showed around ten times as many Australians than diagnosed with coeliac disease are avoiding wheat-based foods.

The study reveals that even more people are avoiding dairy products and, in fact, that around one third of the respondents avoiding dairy foods are also avoiding wheat-based foods.

“The numbers show that cutting out significant, basic food groups isn’t a fad but something far more serious,” said Ms Yantcheva.

According to the Australian Dietary Guidelines, dairy and grain-based foods are important for a balanced diet.

They contribute significantly to our intake of fibre, protein and a wide range of essential vitamins and nutrients, on top of calcium in dairy’s case.

“It’s not just about missing out on the food type being avoided and risking your health, but also possibly overconsuming other foods to compensate as well,” Ms Yantcheva said.

The paper is published in this month's issue of Public Health Nutrition.

Fast facts

• A study by CSIRO and the University of Adelaide reveals that one in six adult Australians are choosing to avoid milk and dairy foods, the majority without a medical diagnosis.
• Three quarters (74%) of avoiders are avoiding milk and dairy foods to relieve adverse gastrointestinal symptoms such as cramps, bloating or wind.
• The study showed that more women are avoiding milk and dairy foods than men although dairy foods are especially important for women owing to the calcium content.
• Milk, cheese and yoghurt have various health benefits and are a good source of many nutrients, including calcium, protein, iodine, vitamin A, riboflavin, vitamin B12 and zinc (Source: Australian Dietary Guidelines).
• For women aged 19-50 years, the Australian Dietary Guidelines recommend two and half serves of dairy or dairy alternatives per day, increasing to four serves per day after the age of 50. Men between the ages of 19 and 70 years should consume two and half serves a day, and increase to three and half serves after the age of 70 years. A serve of dairy is equal to 250mls of milk, two slices or 40g of cheese, or a 200g tub of yogurt.
• See your doctor if you have any concerns about your health.

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DAIRY AVOIDANCE REACHES DANGEROUS LEVELS, ESPECIALLY FOR WOMEN

Empowering pediatric pain medicine

New study helps UAlberta pediatrician advocate for improved children’s pain management across the country

Samina Ali examines a child

Canada stands at the verge of a new standard of pediatric pain management, thanks to the dedicated leadership of Samina Ali. Over the last few years, she has been making headlines for leading several research projects revealing that Canada’s children are consistently undertreated for pain in emergency departments across the country, with lack of policies and self-reported knowledge gaps identified as leading causes.

Ali, an associate professor of pediatrics in the University of Alberta’s Faculty of Medicine & Dentistry, is the lead author of a recent study in the journal Pediatric Emergency Care that examines the best ways of minimizing acute pain for children and youth in the emergency room. She is now working with national communities of practice to introduce single-source educational tools for health-care professionals who work in emergency departments.

“This wasn’t a hypothesis-generating paper,” says Ali, who is also assistant dean of professionalism in the Faculty of Medicine & Dentistry. “This was a paper meant to help front-line clinical care providers—nurses, doctors, nurse practitioners or whoever might take care of children when they are ill or injured—with knowledge of basic, proven therapies that work and also happen to be very easy to use.”

Using 12 Cochrane systematic reviews encompassing hundreds of articles, Ali and her team have created a practical and easy-to-reference guideline that can help any health professional who may be treating a child for pain in the emergency department and beyond. She notes that only articles that had demonstrated proven results were included in the review.

One of the biggest gaps that leaves children at risk of being undertreated, Ali says, is that few hospitals have consistent policies in effect for situations involving children.

“For example, right now at the Stollery emergency department, if a nurse is doing blood work on an infant, she has a nurse directive to go get sucrose and give the child drops of this sucrose. It’s wonderful because we know that it takes away at least 20 per cent of their pain, if not more, and it’s such a simple, low-risk intervention,” she explains. “Now, if they happen to call the lab to draw that blood and the nurse is not in the room when the lab arrives to do the test, the lab has no protocol to use that same sucrose. We are offering differential care because we don’t have an overarching hospital policy for such an intervention.”

Ali notes that the Stollery Children’s Hospital Pain Committee is already working to implement such a policy.

In an attempt to ensure that there are less discrepancies in future pediatric pain management, Ali is also working with the Canadian Association of Pediatric Health Centres to create easy-to-use toolkits, which will be introduced to medical facilities that treat children across the country.

Parents should also be engaged in this process, Ali says. With several practices from breastfeeding to distraction techniques showing considerable reduction in children’s pain, parents should have the opportunity to voice which method would best suit their child during medical procedures.

“My ultimate vision is a place where the responsibility doesn’t sit on the individual care provider, or the individual parent, or the individual child. Rather, it’s built into the system that when you walk in—and it is just an expectation—we’re going to take the best pieces of information that are usable for your child and offer them to you to make this the least painful experience possible.”

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Empowering pediatric pain medicine

Radar, Bed Sensors Help Health Providers Detect Problems Early

Developing and evaluating motion-capture technology to help older adults “age in place” has been the focus of researchers at the University of Missouri for more than a decade. Previous research has utilized video game technology and various web-cameras to detect health changes in Tiger Place residents. Now, two new studies demonstrate how monitoring walking speed using radar and heart health by utilizing bed sensors help maintain older adults’ health and warn of impeding issues.

“In-home sensors have the ability to capture early signs of health changes before older adults recognize problems themselves,” said Marjorie Skubic, professor of electrical and computer engineering in the MU College of Engineering and director of MU’s Center for Eldercare and Rehabilitation Technology. “The radar enhances our ability to monitor walking speed and determine if a senior has a fall risk; the bed sensors provide data on heart rate, respiration rate, and overall cardiac activity when a senior is sleeping. Both sensors are non-invasive and don’t require seniors to wear monitoring devices.”

The radar sensors were used to monitor the walking speed of residents in 10 Tiger Place apartments for two years. The radar devices were concealed in a wooden box and placed in the living room of each senior resident. Residents also were provided monthly assessments by professionals to establish whether they were at risk for potential falls. The data collected were then compared to the data captured by the radar.

“Before using radar, we were able to estimate an individual’s walking speed and have an idea of their health status,” said Dominic Ho, co-author and professor of electrical and computer engineering in the MU College of Engineering. “Now, we have data that definitely shows how declines in walking speed can determine the risk for falls.”

Skubic and her team also developed a bed sensor with the ability to continuously monitor heart rate, respiration rate and overall cardiac activity. The bed sensors are made using a hydraulic transducer, which is a flexible tube of water. The transducer measures the ballistocardiogram, which is the mechanical effect of the blood flowing through the body as a result of the heart beating. In the study, four hydraulic transducers were placed under a mattress to capture cardiac data of the participants.

“Heart disease is a major cause of death for both men and women,” Skubic said. “Having a sensor continuously monitoring heart rate provides a significant benefit for older adults. The bed sensors also allow us to collect data on sleeping patterns– when people are in bed, how often they are in bed, and how long they are in bed. Similar to walking speed, sleep patterns can detect early signs of illness.”

The radar study and the bed sensor study provide non-invasive monitoring systems that help detect early signs of illness. Skubic and her team are working to investigate other sensors that can further improve very early detection of health changes so that health problems can be addressed while they are still small and manageable.

The study “Estimation of Human Walking Speed by Doppler Radar for Elderly Care” recently was accepted by the Journal of Ambient Intelligence and Smart Environments. Funding for the study was provided by the Agency for Healthcare Research and Quality. The study “Heart Rate Monitoring Using Hydraulic Bed Sensors Ballistocardiogram” recently was accepted by the Journal of Ambient Intelligence and Smart Environments. Marilyn Rantz, Curators’ Professor Emerita of Nursing in the Sinclair School of Nursing also contributed to the study. Funding for this work was provided by the National Science Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency.

By Molly Peterson

Story Contact: Jeff Sossamon, 573-882-3346, [email protected]

Published by the MU News Bureau, 329 Jesse Hall, Columbia, MO 65211  |  Phone: 573-882-6211  |  Fax: 573-882-5489  |  E-mail: [email protected]

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Radar, Bed Sensors Help Health Providers Detect Problems Early

Penn Study Shows Female Smokers More Likely to Kick the Habit by 'Timing' their Quit Date with their Menstrual Cycle

Brain circuitry involved in making 'good decisions' found to be modulated by menstrual cycle in cigarette-smoking women

Women who want to quit smoking may have better success by carefully timing their quit date with optimal days within their menstrual cycle, according to a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania. The results, published online this month in Biology of Sex Differences, were also presented at the annual meeting of the Organization for the Study of Sex Differences (OSSD), held at Penn.

Cigarette smoking remains the leading cause of preventable death in the United States, and women experience more severe health consequences from cigarette smoking than men, including a 25 percent increased risk of developing coronary heart disease and chronic obstructive pulmonary disease. Research also shows that women have greater difficulty with smoking cessation than men.

“Understanding how menstrual cycle phase affects neural processes, cognition and behavior is a critical step in developing more effective treatments and in selecting the best, most individualized treatment options to help each cigarette smoker quit,” said the study’s lead author, Reagan Wetherill, PhD, a research assistant professor of Psychology.

Wetherill and senior author Teresa Franklin, PhD, a research associate professor of Neuroscience in Psychiatry, have been studying the brains of premenopausal women who smoke cigarettes for several years in Penn’s Center for the Studies of Addiction. Their work is based on a significant animal literature showing that the natural sex hormones -- estrogen and progesterone -- which fluctuate over the course of the menstrual cycle modulate addictive behavior. The animal data show that during the pre-ovulatory, or follicular phase of the menstrual cycle, when the progesterone-to-estrogen ratio is low, women are more likely to be spurred toward addictive behaviors. Alternatively, during the early pre-menstrual or luteal phase of the menstrual cycle, when the progesterone-to-estrogen ratio is high, addictive behaviors are thwarted, suggesting that progesterone might protect women from relapsing to smoking.

In the current study, 38 physically healthy, premenopausal women who smoke and who were not taking hormonal contraceptives, ranging from 21 to 51 years of age, received a functional MRI scan to examine how regions of the brain that help control behavior are functionally connected to regions of the brain that signal reward.

The researchers theorized that the natural fluctuations in ovarian hormones that occur over the course of the monthly menstrual cycle affect how women make decisions regarding reward – smoking a cigarette -- and so-called “smoking cues,” which are the people, places and things that they associate with smoking, such as the smell of a lit cigarette or going on their coffee break. These “appetitive reminders” to smoke are perceived as pleasant and wanted, and similar to cigarettes, are also rewarding.

In 2015, the researchers showed that compared to when women are in the luteal phase of their menstrual cycle, which is the period of time following ovulation and prior to menstruation, women in the follicular phase – which begins at menstruation and continues until ovulation – have enhanced responses to smoking cues in reward-related brain regions.  This finding led them to further test whether groups differed in the strength of the functional connections that exists between regions exerting cognitive control and reward-related brain regions. The weaker the functional connections between cognitive control brain regions and reward signaling brain regions, the less ability women have to ‘Just Say No’ when attempting to quit. 

The women in the study were separated into two groups – those in their follicular phase and those in their luteal phase. Results revealed that during the follicular phase, there was reduced functional connectivity between brain regions that helps make good decisions (cortical control regions) and the brain regions that contain the reward center (ventral striatum), which could place women in the follicular phase at greater risk for continued smoking and relapse. Orienting attention towards smoking cues (pictures of smoking reminders such as an individual smoking) was also shown to be associated weaker connections between cognitive control regions in follicular females.

“These data support existing animal data and an emerging human literature showing that progesterone may exert protective effects over addictive behavior and importantly, the findings provide new insights into sex differences in smoking behavior and relapse,” Franklin said.  “Interestingly, the findings may represent a fundamental effect of menstrual cycle phase on brain connectivity and may be generalizable to other behaviors, such as responses to other rewarding substances (i.e., alcohol and foods high in fat and sugar).

“The results from this study become extremely important as we look for more ways to help the over 40 million individuals in the U.S. alone addicted to cigarettes,” Franklin, continued.  “When we learn that something as simple as timing a quit date may impact a woman’s cessation success, it helps us to provide more individualized treatment strategies for individuals who are struggling with addiction.”

Additional Penn authors include Kanchana Jagannathan, Nathan Hager and Melanie Maron.

Funding for the study was provided by National Institute of Health (P60-DA-005186-18, R21DA025882, R01DA030394, R01DA029845, K23AA02389), and Pfizer Pharma.

Media Contact
        
Stephanie Simon
215-349-5660

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Penn Study Shows Female Smokers More Likely to Kick the Habit by 'Timing' their Quit Date with their Menstrual Cycle

Changes in dieters’ social networks may undermine weight-loss efforts

Efforts to lose weight may be unsuccessful because of an important mismatch between the social contacts created by individuals desiring to lose weight, and the factors that are actually beneficial for achieving weight loss goals, according to a Yale study.

Published online in the journal Obesity, the study evaluated how an individual’s desire to lose weight is associated with changes in social contact with others perceived to be either thinner or heavier. Matthew A. Andersson, postdoctoral associate at the Center for Research on Inequalities and the Life Course in Yale’s Department of Sociology, and his co-author, Nicholas A. Christakis, the Sol Goldman Family Professor of Social and Natural Science, examined how individuals change their close social relationships when desiring to lose weight and whether these changes help to achieve or undermine weight-loss goals.

According to the researchers, individuals hoping to lose weight interacted more frequently and were more likely to possess social ties with heavier individuals while lessening their interactions and decreasing their likelihood of ties with thinner individuals. “We want to gain a closer understanding of how social networks shape the desire to lose weight in the first place,” Andersson says. “We were surprised to find that individuals who desire to lose weight may make social network changes that undercut their weight loss goals.”

The researchers suggest that a personal motivation to lose weight may elicit increased social involvement with heavier individuals due to the fact that those who desire to lose weight are more likely to experience weight discrimination and stigma. Individuals may manage this stigma by selecting similarly heavy peers.

While these network changes may be consistent with managing weight stigma, they also tend to diminish weight loss. These findings may help explain unsuccessful weight loss attempts in the population.

“By publishing this study, we are contributing to knowledge about how social networks relate to body mass. Future research should track actual peer body mass to gain more insight into what we found in this study. With a fuller understanding of how social networks relate to weight loss, interventions may better address any interpersonal dynamics occurring outside clinical settings,” says Andersson.

By Bess Connolly Martell

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Changes in dieters’ social networks may undermine weight-loss efforts

Persons with diabetes face financial stress, often sacrifice health care and food

Some of the current fixes aimed at reducing the financial burden of chronic illness—including the ability to enroll in a health care plan under the Affordable Care Act—are not enough to save those with diabetes from the stress of having to figure out how to manage their health and put food on the table.

In a study about those living with the disease, researchers at the University of Michigan School of Public Health found a number of pressures led half of adults with diabetes to report perceptions of financial stress, and one-fifth to say they have experienced health and food insecurity. Insecurity means their household economic situation allows limited access to medications, supplies and food.

The study, reported in the journal Medical Care, examined various factors impacting cost-related nonadherence (CRN) within the diabetic population, the term to describe when patients can't follow doctors' orders because of the cost of doing so.

"Financial burden for people with chronic illness is complex," said Minal Patel, U-M assistant professor of health behavior and health education. "It's not as simple as offering reduced copays or co-premiums. It's a whole range of things that we need to address."

Cost-related nonadherence is estimated to impact 20 percent of all patients in the United States, who, when faced with financial burden, often don't follow doctor's orders.

In the study of nearly 35,000 adults from the National Health Interview Survey, 11 percent, or 4,200, identified as diabetic, and 14 percent of that group reported cost-related nonadherence to their medical plans. This was compared with 7 percent CRN from the general population without diabetes.

Close to a quarter of those surveyed reported food insecurity, which was strongly associated with CRN.

Insecurity doesn't always mean a real or perceived lack of something. In the case of food, for example, it can mean a person does not have the ability to afford the kinds of meals to maintain their best health. Diet for those with diabetes is critical to optimal health.

Patel said while the Affordable Care Act has worked to improve access to health care, gaps remain in coverage and there still are high rates of cost-sharing associated with the plans. This is particularly burdensome for persons with diabetes who not only need prescriptions but require devices and supplies to monitor and manage their disease.

Patients with diabetes also face associated health problems of obesity, high blood pressure and eye-related conditions that are not addressed consistently through plans under the ACA, or require self-management resources that fall outside the scope of what a health insurance plan would typically cover.

The researchers found that talking with a health care provider about lower cost options helped mitigate CRN. Although diabetic patients were more likely to have these conversations than others, only 27 percent of them were sharing concerns with their doctors.

"If you are in a clinic primarily aimed at serving low-income populations, you're probably going to have those conversations because providing affordable care is central to the mission of these health care settings," Patel said. "But in a lot of other health care settings physicians don't always know what to do. We need to support through policy and infrastructure changes, a better communication situation for patients and physicians."

She suggests better screening and counseling, physician training and better preparation for patients prior to their appointments with doctors to access affordable options. The quality of patient-physician interaction around these issues may change the way affordable options are sought out.

Co-authors from the U-M School of Public Health include John Piette, Kenneth Resnicow, Theresa Kowalski-Dobson and Michele Heisler. Heisler and Piette also have appointments in the U-M Medical School. Patel, Resnicow, Piette and Heisler are members of the U-M Institute for Healthcare Policy and Innovation.

This study used the Michigan Center for Diabetes Translational Research supported from grant number P30DK092926 from the National Institute of Diabetes and Digestive and Kidney Diseases.

More information:

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Persons with diabetes face financial stress, often sacrifice health care and food

The brain needs to 'clean itself up' so that it can 'sort itself out'

A piece of research led by the Achucarro Basque Center for Neuroscience, the University of the Basque Country (UPV/EHU), and the Ikerbasque Foundation has revealed how the brain’s cleaning up mechanisms function in neurodegenerative diseases.

When neurons die, their remains need to be eliminated quickly so that the surrounding brain tissue can continue functioning. A type of highly specialised cell known as microglia is responsible for this process which is called phagocytosis (derived from the Greek “phagein”, to eat, and “kitos”, cell). These tiny cells have numerous branches that are constantly on the move inside the brain and are specially equipped to detect and destroy any foreign element, including dead neurons. Or that is what has been believed until now.

In this study, which has just been published by the journal Public Library of Science (PLoS) Biology, the process of neuronal death and microglial phagocytosis in the diseased brain has been studied for the first time. To do this, brain samples taken from epilepsy patients at the University Hospital of Cruces and from epileptic mice were used.

Neurons are known to die during the convulsions associated with epilepsy. But contrary to expectations, in this condition the microglia are “blind” and incapable of either finding them or destroying them. Their behaviour is abnormal. And the dead neurons that cannot be eliminated build up and damage the neighbouring neurons further, which leads to an inflammatory response by the brain which harms and damages it even further.

This discovery opens up a new channel for exploring therapies that could palliate the effects of brain diseases. In fact, the research group that authored this work is right now exploring the development of drugs to encourage this cleaning up process, phagocytosis, that could help in the treatment of epilepsy patients.

The study was led by Dr Amanda Sierra, head of the Glial Cell Biology laboratory of the Achucarro Basque Center for Neuroscience, and the experimental work was conducted mainly by the researchers Oihane Abiega, Sol Beccari and Irune Díaz-Aparicio. Other Achucarro and UPV/EHU researchers such as Juan Manuel Encinas, Jorge Valero, Víctor Sánchez-Zafra and Iñaki París also participated in it.

This piece of international research was coordinated from the Basque Country and had the participation of research groups from CIC bioGUNE (Derio), the University of Bordeaux (France), the University of Southampton (UK), Université Laval (Canada), and the Baylor College of Medicine (USA).

Full bibliographic informationO Abiega et al. "Neuronal hyperactivity disturbs ATP microgradients, impairs microglial motility, and reduces phagocytic receptor expression triggering apoptosis/microglial phagocytosis uncoupling" PLoS Biol 14(5): e1002466. doi:10.1371

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Education as protector against dementia, but what exactly do we mean by education?

Attaining a higher level of education is considered to be important in order to keep up good cognitive functioning in old age. Higher education also seems to decrease the risk of developing dementia. This is of high relevance in so far that dementia is a terminal disease characterized by a long degenerative progression with severe impairments in daily functioning.

Scientific theories assume two mechanisms; first, that individuals with a high level of education may engage in a healthier lifestyle which protects them against dementia, and, second, that high education builds up a so called ‘cognitive reserve’, which is the ability to keep up a good cognitive performance despite brain pathology. Nonetheless, there is a lack of knowledge about how exactly education does that and how much education is possibly”enough”. Therefore, we examined in our study in more detail how education – its concepts and its operationalisation – impacts the risk of developing dementia.

In our study, the Leipzig Longitudinal Study of the Aged (LEILA75+), individuals aged 75 years and older were recruited from the population registry office in the city of Leipzig, Germany. A total of 1,692 community-dwelling individuals (with 11.3% living in retirement homes) were identified.

Trained psychologists and physicians visited the participants in their home environment and conducted a standardized interview including a cognitive assessment for dementia diagnosis. These interviews were repeated in up to five follow-up assessments at an interval of 1.5 years and a final assessment after 15 years.

Examining the data obtained, we observed that every additional year of education significantly decreased the risk of developing dementia, even after taking into consideration age, gender, living situation, having had a stroke, heart attack diabetes, or depression. In particular, ‘having completed more than ten years of education’ or a ‘tertiary level of education’ appeared to be an important threshold for significantly reducing dementia risk. Complex classifications of education, which focused on occupational expertise and hierarchy of levels, did not seem to be relevant concerning dementia risk.

Our findings thus suggest that predominantly education expressed in the number of years has a protective effect against dementia, with an important threshold for completing more than ten years of education or a tertiary level. One way to interpret our findings is that factors like learning objectives or qualifications do not necessarily explain the effect that education has on dementia risk. It seems to be rather the duration of mental training – i.e. years of education – that is the factor lowering dementia risk. Further investigations should explore the details of the pathways from education to dementia risk. Moreover, further research should evaluate what level of education would be optimal as a major public health goal, especially for developing countries, in order to reduce the effect of dementia on health care systems and society.

Our observations also emphasize the importance of considering definitions and operationalisation in dementia research. Only by being aware of these will it be possible to gain a better understanding of the processes which influence dementia risk.

View the Age & Ageing paper ‘Education as protector against dementia, but what exactly do we mean by education?‘

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New evidence shows Affordable Care Act is working in Texas

Report shows state’s uninsured rate drops by nearly one-third and is lowest since 1999

The percentage of Texans without health insurance has dropped by 30 percent since the Affordable Care Act (ACA) went into effect, cutting the state’s uninsured rate below 1999 levels. That’s one of the conclusions of a new report released today by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation (EHF).

Credit: http://ift.tt/1MJqH29 University

The report found the uninsured rate among Texas adults dropped from 26 percent in September 2013 to 18 percent in March 2016. Researchers also discovered a steady decline in the uninsured rate for every age, ethnic and income-level group across the state.

“These latest numbers confirm the continuing downward trend in the number of uninsured Texans that began as the ACA was implemented,” said Elena Marks, EHF’s president and CEO and a nonresident health policy fellow at the Baker Institute. “For more than a decade prior to the ACA, the uninsured rate remained above 20 percent and was rising. It’s now clear that it’s moving in the opposite direction, and the ACA deserves the credit.”

The report found that Texans between the ages of 50 and 64 experienced the largest decrease in their percentage of uninsured. The group’s uninsured rate plummeted from 21 percent to 10 percent since the ACA went into effect — a drop of more than 51 percent.

“For the older group, the ACA made health insurance much more affordable, because the law limits insurers from charging older adults no more than triple the cost for the same health insurance plans as younger adults,” said Vivian Ho, the chair in health economics at the Baker Institute and director of the institute’s Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “However, limiting premium variation by age made Marketplace policies less attractive to younger adults, which is why their uninsured rate fell less.”

Researchers also found the percentage of uninsured Texans who earned annual incomes between $16,000 and $47,000 dropped by more than 42 percent. The group’s uninsured rate declined from 23 percent in 2013 to 13 percent in 2016.

“Texans with low to moderate incomes were able to use federal subsidies to help pay for health insurance premiums for ACA Marketplace plans,” Ho said. “Those subsidies made coverage affordable for many who could not have purchased plans without that help.”

In fact, Ho and Marks note that the U.S. Department of Health and Human Services reports that 84 percent of the 1.3 million Texans now enrolled in ACA Marketplace health insurance plans received subsidies to help pay for premiums.

Researchers said that while it’s evident the ACA has helped drop the uninsured rate in Texas, it’s also clear that a significant number of Texans with the lowest incomes remain uninsured. The report found that 46 percent of Texans earning less than $16,000 a year don’t have health insurance.

“The ACA as implemented in Texas offers little hope for Texans with the lowest incomes,” Marks said. “They make too much to qualify for traditional Medicaid and not enough to get a subsidy to help pay for their premium. They’re stuck in the ‘coverage gap,’ and unless Texas expands Medicaid or comes up with another system of coverage for this group, they will remained uninsured.”

According to the report, the “coverage gap” affects mostly people of color in working families and was recently estimated by the Kaiser Family Foundation to include 766,000 Texans.

The report is the 21st in a series on the implementation of the Affordable Care Act in Texas co-authored by Marks and Ho.

The Health Reform Monitoring Survey (HRMS) is a quarterly survey of adults ages 18-64 that began in 2013. This report is a summary of data extracted from the HRMS surveys in Texas administered between September 2013 and March 2016.

The HRMS is designed to provide timely information on implementation issues under the ACA and to document changes in health-insurance coverage and related health outcomes. The Baker Institute and EHF are partnering to fund and report on key factors about Texans obtained from an expanded, representative sample of Texas residents (HRMS-Texas).

The HRMS was developed by the Urban Institute, conducted by GfK and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute. The analyses and conclusions based on HRMS-Texas are those of the authors and do not represent the view of the Urban Institute, the Robert Wood Johnson Foundation or the Ford Foundation.

To schedule an interview with Marks, contact Brian Sasser, director of communications at the Episcopal Health Foundation, at [email protected] or 832-795-9404.

To schedule an interview with Ho, contact Jeff Falk, associate director of national media relations at Rice, at [email protected] or 713-348-6775.

Related materials:  

Full survey report: http://ift.tt/1O1QmcD.

Episcopal Health Foundation: http://ift.tt/1ccJjvt

Marks bio: http://ift.tt/1TvDgFK

Ho bio: http://ift.tt/1nyWA6O 

The Episcopal Health Foundation was established in 2013 and is based in Houston. With more than $1.2 billion in estimated assets, the Foundation is a 501(c)(3) not-for-profit corporation that operates as a supporting organization of the Episcopal Diocese of Texas. EHF works to improve the health and well-being of the 10 million people in the 57 counties of the Diocese by investing in communities through grant-making, outreach to Diocesan churches and critical research to advance community health.

Founded in 1893, Rice University’s Baker Institute ranks among the top 10 university-affiliated think tanks in the world. As a premier nonpartisan think tank, the institute conducts research on domestic and foreign policy issues with the goal of bridging the gap between the theory and practice of public policy. The institute’s strong track record of achievement reflects the work of its endowed fellows, Rice University faculty scholars and staff, coupled with its outreach to the Rice student body through fellow-taught classes — including a public policy course — and student leadership and internship programs. Learn more about the institute at http://ift.tt/1EUoiQv or on the institute’s blog, http://ift.tt/1xPkifc.

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Google searches for 'chickenpox' reveal big impact of vaccinations

Countries that implement government-mandated vaccinations for chickenpox see a sharp drop in the number of Google searches for the common childhood disease afterward, demonstrating that immunization significantly reduces seasonal outbreaks.

That's one of the findings from a new University of Michigan-led study that analyzed thousands of Google searches for "chickenpox." The researchers downloaded and analyzed freely available Google Trends data from 36 countries on five continents, covering an 11-year period starting in 2004.

The technique is sometimes called digital epidemiology and has previously been used to identify outbreaks of diseases like influenza, rotavirus and norovirus. But the chickenpox study is the first to use digital epidemiology to show the effectiveness of a vaccine, said Kevin Bakker, a doctoral student in the U-M Department of Ecology and Evolutionary Biology.

"It is really exciting to see human information-seeking behavior—Google searches—being reduced by vaccination implementation," Bakker said. "It's a very clear signal, and it shows that the vaccine is having a strong effect."

He said the approach offers a novel way to track the global burden of childhood diseases and to illustrate the population-level effects of immunization—especially for diseases, like chickenpox, where clinical case data are scarce. However, the technique is limited to countries where internet service is widely available.

Bakker is lead author of a paper on the topic scheduled for online publication May 30 in the Proceedings of the National Academy of Sciences. The work will also be a chapter in his doctoral dissertation.

The study is one of the most comprehensive digital epidemiology efforts to date, Bakker said. Examining data from several dozen countries enabled the researchers to identify the seasonality of chickenpox outbreaks, which occurred in the springtime worldwide, he said.

The main idea behind digital epidemiology studies is that the number of Google searches spikes in response to an infectious-disease outbreak as worried parents and others seek information about symptoms, treatment, vaccines and related topics.

To demonstrate that internet queries about chickenpox can be used as a reliable proxy for disease incidence, Bakker and his colleagues had to show that Google Trends data accurately reflected clinical cases. But chickenpox is not included in the World Health Organization's global monitoring system for vaccine-preventable diseases, and only a handful of countries report cases to national-level public health officials.

Bakker and his colleagues found that in the three countries that require reporting of chickenpox cases but do not require vaccination against the disease—Mexico, Thailand and Estonia—Google searches for "chickenpox" were strongly correlated with reported cases. In the United States and Australia, two countries that report chickenpox and require the vaccine, the correlation still held but was weaker.

These correlations enabled the researchers to create a forecasting model to predict the timing and magnitude of chickenpox outbreaks based on Google Trends data.

"These results suggest that information seeking can be used for rapid forecasting, when the reporting of clinical cases is unavailable or too slow," the authors wrote.

But the most interesting results, according to Bakker, were analyses showing a reduction in searches for "chickenpox" following the implementation of a government-mandated vaccination program for the disease.

This effect was most striking in Germany, which gradually increased its vaccination requirements over the course of several years, beginning in 2004. Google Trends data are available for the full period and show stepwise drops in Google searches for "chickenpox" following each new vaccination requirement.

"These results demonstrate that if you institute nationwide vaccination for chickenpox there is a very clear reduction in searches, which is a way to infer a strong reduction in total disease incidence," Bakker said.

One of the strengths of the study is that chickenpox is a disease with distinct symptoms, unlike influenza and other illnesses that have been studied using digital epidemiology, Bakker said.

Chickenpox is a highly contagious disease caused by the varicella zoster virus. It causes a blister-like rash, itching, tiredness and fever. The rash appears first on the stomach, back and face and then spreads over the entire body, causing between 250 and 500 itchy blisters, according to the Centers for Disease Control and Prevention. In adults, the same virus can cause shingles.

Since U.S. vaccinations began in 1996, the annual number of chickenpox cases in the country has declined by 92 percent, the annual number of hospitalizations has dropped by 84 percent, and the annual number of deaths has decreased by 90 percent, according to CDC.

Bakker's co-authors on the PNAS paper are Micaela Martinez-Bakker of Princeton University, Barbara Helm of the University of Glasgow and Tyler Stevenson of the University of Aberdeen. Bakker was supported by a Michigan Institute in Computational Discovery and Engineering Fellowship.

Contact

Jim Erickson
Senior Public Relations Representative
[email protected]  
(734) 647-1842

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The American Association for Cancer Research Expresses Appreciation for the U.S. Senate’s Unanimous Approval of S. Res. 459 Recognizing May as National Cancer Research Month

AACR Thanks Senators Dianne Feinstein and Johnny Isakson and Representatives Kevin Yoder and Emanuel Cleaver

The U.S. Senate on Wednesday, May 25, unanimously approved Senate Resolution 459, recognizing May as National Cancer Research Month. The resolution was introduced by Senators Dianne Feinstein (D-Calif.) and Johnny Isakson (R-Ga.), co-chairs of the Senate Cancer Coalition.

A companion resolution, H. Res. 717, was introduced by Representatives Kevin Yoder (R-Kan.) and Emanuel Cleaver (D-Mo.) to recognize May as National Cancer Research Month. The bipartisan resolutions were co-sponsored by 10 additional senators, 17 additional representatives, and supported by 74 advocacy organizations, listed below.

"This outpouring of bipartisan support to designate May as National Cancer Research Month is a testament to our nation's recognition that cancer research is saving more and more lives every day," said Margaret Foti, PhD, MD (hc), chief executive officer of the AACR. "The American Association for Cancer Research is deeply grateful to Senators Dianne Feinstein and Johnny Isakson, and to Representatives Kevin Yoder and Emanuel Cleaver, for their leadership in acknowledging May as National Cancer Research Month in Congress. Their support helps to raise public awareness about today's exciting progress against cancer and the enormous promise for preventing and curing more cancers in the future because of cancer research.  This requires an absolute, ongoing commitment from Congress to provide robust, sustained, and predictable increases in federal funding for cancer research and biomedical science."

Since 2007, when Congress first declared the month of May as National Cancer Research Month, the AACR has been a major proponent and supporter of this initiative, engaging with researchers, clinicians, patients, survivors, and advocacy groups in its quest to cure and prevent cancer. Congressional resolutions elevate awareness of the importance of cancer research to legislators as well as the broader community.

This May, the AACR partnered with the Association of American Cancer Institutes (AACI) and the American Society of Clinical Oncology (ASCO) for an annual Hill Day featuring several AACR leaders including AACR President Nancy Davidson, MD, and three AACR Scientist↔ Survivor Program patient advocates.  The AACR also spearheaded a social media campaign called "Real Hope Is," featuring contributions from patients, survivors, caregivers, researchers, and clinicians about their cancer journey, which was featured on Facebook's National Cancer Research page.

Introduced by Feinstein and Isakson, S. Res. 459 was co-sponsored by Sens. Kelly Ayotte (R-N.H.), Richard Blumenthal (D-Conn.), Sherrod Brown (D-Ohio), Maria Cantwell (D-Wash.), Chuck Grassley (R-Iowa), Amy Klobuchar (D-Minn.), Jerry Moran (R-Kan.), Gary Peters (D-Mich.), Mike Rounds (R-S.D.) and Sheldon Whitehouse (D-R.I.).

"All Americans will be affected by cancer at some time in their lives, and battling this disease requires a strong commitment from Congress," said Feinstein. "To better understand the hundreds of types of cancer, increase survival rates, and develop new therapies, we must increase funding for cancer research. Significant progress has been made in screening and treatment, but many types of cancer are still detected at late stages, when survival rates are very low. This issue is compounded by the fact that incidents of some types of cancer are increasing—we can't afford to shortchange federal cancer research."

Separately this month, a companion resolution, H. Res. 717, was introduced by Reps. Kevin Yoder (R-Kan.) and Emanuel Cleaver (D-Mo.) to recognize May as National Cancer Research Month. H. Res. 717 was co-sponsored by Representatives Dan Benishek (R-Mich.), Kevin Cramer (R-N.D.), Mark DeSaulnier (D-Calif.), Debbie Dingell (D-Mich.), Mike Fitzpatrick (R-Pa.), Frank Guinta (R-N.H.), Richard Hanna (R-N.Y.), Denny Heck (D-Wash.), Brian Higgins (D-N.Y.), Eleanor Holmes Norton (D-D.C.), Donald Payne Jr. (D-N.J.), Scott Peters (D-Calif.), Joe Pitts (R-Pa.), Todd Rokita (R-Ind.), Eric Swalwell (D-Calif.), Dina Titus (D-Nev.) and Chris Van Hollen (D-Md.).

"Cancer doesn't pick and choose which lives to affect based on political party or what region of the country you're from – it touches everyone," said Yoder. "It will kill more Americans this year than any war, yet we are spending a fraction of the money on research that we spend at the Department of Defense. This effort to designate May as Cancer Research Month is a great way to raise awareness and continue to fight for the resources we need to find a cure."
Read the full text of the Senate resolution.

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The American Association for Cancer Research Expresses Appreciation for the U.S. Senate’s Unanimous Approval of S. Res. 459 Recognizing May as National Cancer Research Month

Is endurance training bad for you? Sports medicine physicians in Saarbrücken find no evidence of heart damage from long-term endurance training by elite master athletes

In 2012, Belgium scientists published a study that concluded that repeated bouts of intensive endurance exercise at the elite level may result in the pathological enlargement of the right ventricle, which, according to the article, is associated with potential health hazards including sudden cardia death. The publication was the cause of considerable debate among experts in the medical and sports communities. Sports medicine physicians at Saarland University have now tested the conclusions of the 2012 study by examining the hearts of elite master endurance athletes. Their findings refute the hypothesis proposed by their Belgian colleagues. The Saarland research team could find no evidence that years of elite-level endurance training causes any long-term damage to the right ventricle. The study has been published in the respected medical journal ‘Circulation’.

The media reports with depressing regularity the sudden cardiac death of endurance athletes. Just a few weeks ago, television channels, newspapers and the internet reported that Dutch professional cyclist Gijs Verdick had died in hospital a week after suffering a double heart attack during a race.

The potential hazards that endurance exercise poses to the heart have been the subject of discussion in the medical community for over a century. Although there is now general consensus that the enlarged heart of an athlete is a healthy reaction reflecting the adjustment of the organ to regular endurance training, a number of studies seem to suggest that high levels of endurance exercise can cause pathological changes to the structure of the heart. This was the conclusion reached by a team of Belgian cardiologists and sports medicine physicians in a study published in 2012 that received considerable global attention (http://ift.tt/25wFt6Y). The researchers established a link between extreme endurance exercise training and the acute enlargement and functional impairment of the right ventricle immediately after exercise. More precisely, they observed enlargement and reduced functionality of the right ventricle in athletes who had taken part in several hours of competitive endurance sport. However, longitudinal studies have so far failed to confirm the hypothesis formulated by the authors that endurance exercise results in long-term damage to the right ventricle, now referred to as ‘exercise-induced arrhythmogenic right ventricular cardiomyopathy’ (ARVC). It was therefore not clear whether the acute enlargement of the right ventricle after extreme endurance activity, which the Belgian group had identified and which had been frequently discussed among professionals, actually did lead to a potentially life-threatening chronic condition.

For the Saarbrücken research team led by cardiologist and sports medicine physician Prof. Dr. Jürgen Scharhag and Dr. Philipp Bohm, the hypothesis that endurance exercise leads to the pathological enlargement of the right ventricle was not immediately obvious. Scientists at the Saarbrücken Institute of Sports and Preventive Medicine have for years been examining elite athletes from a wide variety of disciplines, including triathletes, swimmers and professional footballers. In all that time, the Saarbrücken researchers never found any evidence underpinning the hypothesis posited by the Belgian team. They therefore decided to test the hypothesis explicitly.

They examined 33 elite master athletes (average age: 47) and compared them to a control group of 33 men who were similar in terms of age, size and weight but who had not done any kind of endurance exercise. The group of athletes, which included former Olympians as well as previous Ironman participants and champions, have been training at an elite level for around 30 years and still continue to train for an average of about 17 hours a week.

The Saarbrücken scientists were able to confirm that the hearts of these athletes, who have been engaged in elite level endurance activities for many years, were, as expected, significantly larger and stronger than those of members of the control group. ‘But we found no evidence of lasting damage, pathological enlargement or functional impairment of either the right or left ventricle in the athletes who had been doing long-term intensive elite-level endurance exercise,’ explains Philipp Bohm, who is now working at the Cardiology Centre at the University Hospital Zürich.

By focusing on highly trained and active elite master athletes, the Saarbrücken research team found a clever means of circumventing a problem faced by researchers interested in these questions. Although cardiovascular magnetic resonance imaging (cardiac MRI) is the best method of examining the heart and, in particular, the right ventricle, it has not been available for very long and it is not a routine technique for examining athletes. Systematic long-term MRI-based studies of athlete hearts will therefore not be available in the foreseeable future. Data from longitudinal studies, in which subjects have been monitored by MRI for years, potentially decades, simply does not exist. ‘Our cohort of elite master athletes therefore represents our best means of investigating the long-term impact of years of competition-level endurance sport,’ explains Jürgen Scharhag.

Internet access to the publication is available at:
„Right and Left Ventricular Function and Mass in Male Elite Master Athletes“ (12 April 2016):

http://ift.tt/25ygHXE

Full bibliographic information„Right and Left Ventricular Function and Mass in Male Elite Master Athletes“
Jürgen Scharhag et al.

Circulation. 2016 May 17

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Is endurance training bad for you? Sports medicine physicians in Saarbrücken find no evidence of heart damage from long-term endurance training by elite master athletes

Migraine prevention: Monoclonal antibodies could become additional therapy option

Preventing or shortening the duration of migraine attacks – established drug treatment options and those that could shape future therapies were discussed at the Congress of European Academy of Neurology in Copenhagen.

Affecting six to eight percent of males and ten to twelve percent of females, migraine is among the most prevalent neurological conditions. According to the World Health Organization (WHO) it is one of the top five neurological disorders and costs sufferers years of ill health. “In 2015 around 109 healthy years of life were lost per 100,000 people due to migraine. This figure could be changed for the better in future thanks to improvements in therapy options. Advances in migraine prevention give hope that we will be able to improve quality of life for sufferers in future,” explained Prof Till Sprenger from DKD HELIOS Clinic Wiesbaden, Germany, at the Second Congress of the European Academy of Neurology (EAN) in Copenhagen.
 
Mechanisms in preventive treatments unclear
 
“There is still little research on how the currently available preventive treatments actually work. One potential mechanism could be the suppression of cortical spreading depression (CSD) – a wave that moves across the cerebral cortex with a reduction in neuronal excitability,” Prof Sprenger explained. In animal models CSD has been suggested to underlie human migraine visual aura. Many preventive medicines are able to suppress this process. Generally speaking, an approximately 50 percent reduction in migraine days in at least half of patients is seen as a realistic therapeutic goal. Preventive therapies should also significantly reduce the intensity of pain and ensure that when attacks do occur they are more manageable.
Drugs with proven efficacy
 
“First-choice drugs are usually beta-blockers such as propranolol and metoprolol, the anticonvulsants valproate and topiramate, and the calcium channel blocker flunarizine. Several randomised, placebo-controlled studies show that these medications can reduce the frequency of migraine attacks, even though the majority of them were originally developed to treat other indications,” Prof Sprenger observed. There is also hope surrounding the prophylactic effect on migraine attacks from newer substances such as angiotensin-converting enzyme and angiotensin II receptor antagonists – especially candesartan. “Candesartan proved effective in two placebo controlled studies, in which 16 mg of candesartan was compared with a placebo and 160 mg of propranolol. Candesartan was demonstrated to have similar effectiveness to propranolol, and both were superior to placebo,” the expert confirmed.
 
New treatment hope: monoclonal antibodies targeting CGRP
 
Hopes are currently being placed in monoclonal antibodies that target a neuropeptide called CGRP (Calcitonin Gene-related Peptide). CGRP plays a key role in the pathogenesis of primary headache. CGRP receptor antagonists have already been developed for the treatment of acute migraine and prevention. Whilst they are highly effective, they also have numerous disadvantages: in some cases treatment had to be abandoned due to acute side effects, including marked increases of liver enzymes, with the result that CGRP receptor antagonists have not been approved to date. According to studies published to date, the new monoclonal antibody against CGRP, or its receptor, appears to be better tolerated.  “Although safety and effectiveness in treating episodic and chronic migraine still have to be confirmed in phase three studies, I am confident that we will have access to new medicines that have been specifically developed for this indication to help us tackle the problem of primary headache,” Prof Sprenger added.
 
Botulinum toxin shortens migraine attacks
 
The application of botulinum toxin type A (BTX-A; onabotulinumtoxinA) has also become an established therapy for the treatment of chronic migraines. Chronic migraines are associated with a frequent incidence of headache, leading to a high level of suffering in the individual affected. The positive effects of this therapy have been well proven in major studies, and the substance has also demonstrated its effectiveness in the treatment of chronic migraines in clinical practice.

Bibliographische AngabenSources: World Health Organisation (2016): Neurological Disorders: Public Health Challenges, Chapter 2: Global burden of neurological disorders. Estimates and projections; EAN 2016 Teaching Course, Sprenger T, Advances and challenges in the preventive treatment of headache

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UCLA researchers identify protein that could prevent tumor growth in cervical cancer

UCLA scientists have identified a protein that has the potential to prevent the growth of cervical cancer cells. The discovery could lead to the development of new treatments for the deadly disease.

Courtesy of Molecular and Cellular Biology

Cervical cancer cells. The disease is the second most common cause of cancer-related deaths in women.

In a five-year study using human samples and mouse models, researchers led by Dr. Eri Srivatsan, a member of the UCLA Jonsson Comprehensive Cancer Center, found that a protein known as cystatin E/M can inhibit cellular inflammation, which is a major contributor to the growth of cervical cancer.

Typically, inflammation develops after a woman contracts the human papilloma virus from a male partner; the virus can eventually lead to the development of cervical cancer. Environmental factors such as smoking also are closely associated with the disease.

The UCLA researchers discovered that cystatin E/M prevents a protein called NFkB, which regulates inflammation, from entering the nucleus of cervical cancer cells. As a result, decreased inflammation slows tumor cell growth.

“When key inhibitory mechanisms break down, cancer cells produce inflammation that helps fuel cancer cell growth,” said Srivatsan, who is a professor in UCLA’s department of surgery. “By identifying this protein, we have discovered a key regulator of this breakdown. This is the first time we have found that inhibition of the protein kinase by cystatin E/M plays a regulatory role in cell inflammation.”

The study is published online in the journal Molecular and Cellular Biology.

Worldwide, cervical cancer is the second most common cause of cancer-related deaths in women. In the United States, HPV is detected in 90 percent of cervical cancer tumors and is the most common sexually transmitted disease, Srivatsan said.

Although cystatin E/M and its basic function had previously been identified, little else was known about the protein’s molecular activity until 2008, when Srivatsan and colleagues’ initial findings were published in Genes Chromosomes and Cancer.

The new study built upon that research. Srivatsan’s team analyzed 20,000 genes in two sets of cell lines — one set that expressed the cystatin E/M protein and the other that didn’t. They also analyzed 66 samples of normal and cancerous cervical tissues to determine the molecular mechanism that inhibits cancer cell growth.

In future research, Srivatsan’s team will aim to determine whether cystatin E/M could inhibit tumor cell growth in chemo-radiation–resistant breast cancers in human tissue culture and animal models.

Dr. Neda Moatamed, a UCLA assistant professor of pathology and laboratory medicine and a member of the Jonsson Cancer Center, was a co-author of the study. The research was supported by the VA Greater Los Angeles Healthcare System.

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UCLA researchers identify protein that could prevent tumor growth in cervical cancer

Researchers find new signs of stress damage in the brain, plus hope for prevention

Chronic stress can make us worn-out, anxious, depressed—in fact, it can change the architecture of the brain. New research at The Rockefeller University shows that when mice experience prolonged stress, structural changes occur within a little-studied region of their amygdala, a part of the brain that regulates basic emotions, such as fear and anxiety. These changes are linked to behaviors associated with anxiety and depressive disorders

There is good news, too: an experimental new drug might prevent these changes.

Branching out: The neurons in the medial amygdalas of mice (top) lost branches after 21 days of brief, stressful experiences (middle). However, neurons in stressed mice treated with acetyl carnitine kept their branches (bottom).

“There have been hints that the amygdala displays a complex response to stress,” says lead author Carla Nasca, a postdoc in Bruce S. McEwen’s lab. “When we took a closer look at three regions within it, we found that neurons within one, the medial amygdala, retract as a result of chronic stress.

“While this rewiring can contribute to disorders such as anxiety and depression, our experiments with mice showed that the neurological and behavioral effects of stress can be prevented with treatment by a promising potential antidepressant that acts rapidly,” Nasca says.

In the research, published May 31 in Molecular Psychiatry, her team found this protective approach increased resilience among mice most at risk for developing anxiety or depression-like behaviors.

A close look at the amygdala

The brain’s limbic system controls emotions and memory, and it comprises a number of structures, including the amygdala, which is found deep in the brain. Scientists interested in the neurological effects of stress have focused on several structures in the limbic system, but the medial amygdala has thus far received little attention in stress studies.

To see what was going on in this area, as well as two other parts of the amygdala, Nasca and her team first subjected mice to 21 days of periodic confinement within a small space—an unpleasant experience for mice. Afterward, they tested the mice to see if their behaviors had changed—for instance, if they had begun to avoid social interaction and showed other signs of depression.  They also analyzed the neurons of these mice within the three regions of the amygdala.

One area saw no change with stress. In another, the basolateral amygdala, they saw that neurons’ branches became longer and more complex—a healthy sign of flexibility and adaptation, and something that had been shown up in previous work. But in the medial amygdala, they neuronal branches, which form crucial connections to other parts of the brain, appeared to shrink. The loss of connections like these can harm the brain, distorting its ability to adapt to new experiences, leaving it trapped in a state of anxiety or depression.

Protecting neurons

This effect could be prevented. The scientists repeated the stress experiment, and this time they treated mice nearing the end of their 21 days of chronic stress with acetyl carnitine, a molecule Nasca is studying for its potential as a rapid-acting antidepressant. These mice fared better than their untreated counterparts; not only were they more sociable, the neurons of their medial amygdalas also showed more branching.

Stress does not affect everyone the same way. This is true for both humans and mice—some individuals are just more vulnerable. Nasca and her colleagues’ experiments included mice at high risk of developing anxiety- and depression-like behaviors in response to stress. Treatment with acetyl carnitine also appeared to protect these mice, suggesting that a similar preventative approach might work for depression-prone people.

Both humans and rodents naturally produce acetyl carnitine under normal conditions and several depression-prone animal models are deficient in acetyl carnitine. In a separate study, Nasca and colleagues are examining whether people with depression have abnormally low levels of the molecule.

“Chronic stress is linked to a number of psychiatric conditions, and this research may offer some new insights on their pathology,” McEwen says. “It seems possible that the contrasting responses we see within the amygdala, and the limbic system in general, may contribute to these disorders’ differing symptoms, which can range from avoiding social contact to experiencing vivid flashbacks.”

This work was supported by The American Foundation for Suicide Prevention, The Hope for Depression Research Foundation, the National Institutes of Health (grant RO1 MH41256) and the National Center for Advancing Translational Sciences, National Institutes of Health Clinical and Translational Science Award program (grant UL1 TR000043).

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Researchers find new signs of stress damage in the brain, plus hope for prevention

Antipsychotic Prescribing Trends in Youths with Autism and Intellectual Disability

About one in ten youths treated with an antipsychotic are diagnosed with autism spectrum disorder or intellectual disability. Conversely, one in six youths diagnosed with autism spectrum disorder has been prescribed antipsychotics. These findings are reported in the June 2016 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). Furthermore, the results suggest that the proportion of adolescents with autism or intellectual disability has increased among youths treated with antipsychotics and that more youths with autism or intellectual disability have received antipsychotics.

Currently, second-generation antipsychotics are the only FDA-approved medications for youth with autism. However, these are approved only for the symptomatic control of irritability and aggression. They do not have an indication for youth with intellectual disability, and they do not seem to affect the core symptoms of autism spectrum disorders, such as social and communication difficulties, or the core symptoms of intellectual disability, such as problems with understanding and responding appropriately to information from the outside world.

Performing a meta-analysis of 39 studies and over 350,000 youth with mental illness, a group of researchers led by Christoph U. Correll, MD, of Hofstra Northwell School of Medicine, examined the frequency and time trends of antipsychotic prescribing in youth with autism spectrum disorders or intellectual disability, mostly drawing on data from large registry-based studies.

"Although the increased prescribing of antipsychotics in youth with autism spectrum disorders or intellectual disability cannot be judged as appropriate or inappropriate based on database studies, side effects of antipsychotics can be quite problematic, especially in children and adolescents," said Correll. "Therefore, clinicians should perform very careful risk: benefit evaluation before and after starting youth with autism spectrum disorders or intellectual disability on an antipsychotic, always trying to maximize non-pharmacologic interventions as well as pharmacologic or non-pharmacologic treatments for comorbidities, including attention-deficit/hyperactivity disorder, anxiety disorders, obsessive-compulsive disorder, and sleep disorders."

Based on the study results and the known adverse effects of antipsychotics, the authors concluded that clinicians should consider using psychosocial interventions that are proven to be efficient for behavioral dysregulation such as irritability and aggression, before prescribing antipsychotics to adolescents with autism or intellectual disability. The authors further stressed that when prescribing antipsychotics, it is imperative to regularly monitor both their efficacy and tolerability in patients through body weight, fasting lipids and glucose, extrapyramidal side effects, sedation, and sexual/reproductive adverse effects, and to manage abnormalities appropriately.

Full bibliographic informationThe article is "Antipsychotic Use Trends in Youth With Autism Spectrum Disorder and/or Intellectual Disability: A Meta-Analysis" by Su Young Park, Chiara Cervesi, Britta Galling, Silvia Molteni, Frozan Walyzada, Stephanie H. Ameis, Tobias Gerhard, Mark Olfson, and Christoph U. Correll (doi: 10.1016/j.jaac.2016.03.012). It appears in the Journal of the American Academy of Child and Adolescent Psychiatry, Volume 55, Issue 6 (June 2016), published by Elsevier.

Source: Elsevier

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Antipsychotic Prescribing Trends in Youths with Autism and Intellectual Disability

Consensus in the Fight Against Colorectal Cancer

In colorectal cancer, the presence of invasive tumor cells at the advancing edge of the tumor can provide valuable information on prognosis. Initiated by the Colorectal Cancer Research Group at the Institute of Pathology, University of Bern, a consensus conference was held to determine how this phenomenon should best be put into practice. Together with colleagues from eleven countries, an internationally standardized scoring method was established.

With over a million new cases per year, colorectal cancer is one of the most commonly diagnosed cancers across the globe. Despite recent advances in medical research, the prognosis of patients who present with advanced tumors remains relatively poor. The treatment of colorectal cancer requires an interdisciplinary approach. After surgery is performed to remove the cancer with part of the colon, the specimen is then examined by a physician with specialist training pathology who is responsible for confirming the diagnosis and determining tumor stage.

Additionally, in order to evaluate the biological behavior of an individual tumor the pathologist can also examine certain biomarkers, either microscopically or by additional molecular analysis. The information from such biomarkers may be of prognostic value, or predict response to a given therapy, so that treatment strategies can be tailored to individual patients.

Biomarkers for more precise prognosis

The phenomenon of ‘tumor budding’ has received increasing attention in the medical literature as an indicator of aggressiveness in colorectal cancer. Single cancer cells or small clusters of cancer cells gain the ability to detach from the main tumor body and increase the risk of colonization of other organs via lymphatic and blood vessels, ultimately leading to fatality. However, until now, there has been no established and internationally recognized system to assess tumor budding in order for it to be used to influence clinical management decisions that directly affect patient care.

Bernese efforts to achieve consensus

At the end of April 2016, an international tumor budding consensus conference (ITBCC) initiated by the Colorectal Cancer Research Group was held in order to develop an internationally standardized method of assessing tumor buds. The method is cheap, can be performed anywhere and can replace in some circumstances expensive molecular testing. This was a revolutionary step in improving biomarker assessment in colorectal cancer.

The next step is to implement tumor budding as a prognostic indicator in national guidelines as well as colorectal cancer reporting recommendations of the World Health Organization (WHO), the UICC (Union Intérnationale Contre le Cancer) and the AJCC (American Joint Committee on Cancer). «Reporting of tumor budding by pathologists worldwide will help serve as the basis for future clinical studies geared at the development of novel therapies targeted at tumor buds», says Alessandro Lugli, Head of the Division of Clinical Pathology at the Institute of Pathology.

http://ift.tt/1sIgL59

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Consensus in the Fight Against Colorectal Cancer

Whiplash syndrome: better prediction of long-term consequences

Possible long-term consequences from a whiplash trauma can be effectively predicted if the injured persons are subdivided into different risk groups shortly after the car accident. This is shown by a Danish study that was presented at the Congress of the European Academy of Neurology in Copenhagen.

Chronic pain and other neurologic complaints often persist intractably many years after a car accident as consequences of a whiplash injury. Dividing injured individuals into risk groups shortly after the accident allows one to accurately predict which individuals are especially in danger of suffering from long-term effects from whiplash, physically as well as psychosocially. This was shown in a new study conducted by the Danish “Whiplash Study Group” and presented at the Second Congress of the European Academy of Neurology (EAN) in Copenhagen.

Risk group system suitable for long-term forecasts

Study author Dr M.K. Rasmussen from the University of Aarhus: “We developed a system years ago to divide patients into risk groups. As it now turns out, this system lets us not only predict whether or not the injured individuals will be able to work again after a year. It also allows us to estimate long-term effects.” In this study a questionnaire was given to 326 individuals who had sustained a whiplash injury twelve to fourteen years earlier. It covered on-going pain, non-painful complaints, prescribed analgesics and non-medical treatment also in comparison to the time prior to the whiplash accident. In addition, sick leaves were recorded as was the subjective assessment of the patients regarding the ramifications of the accident. Prof Kasch, lead investigator of the Danish Whiplash Study Group: “It turned out that more than a decade after the fact the people most heavily affected were those who had been assigned to the highest risk groups shortly after the accident.” Specifically, they suffered substantially more often from neck, head, shoulder and arm pain as well as low back pain. They also exhibited a number of non-painful neurologic symptoms more often. They required pain medication more frequently as well, from mild analgesics to strong opioids and suffered to a greater extent from posttraumatic stress symptoms.

Factors for division into risk groups

An accident patient has to undergo a clinical examination within four days after the accident in order to assign him or her to a risk group. The physicians assess the following factors: the type and nature of the pain, the type and number of non-painful complaints as well as neck mobility. If a patient has strong neck pain, headaches and is in a negative emotional state, these are important indicators for judging whether someone will be able to work again after a whiplash trauma. In the preceding studies, it was determined that fewer than 4 per cent of the patients in Risk Group 1 were still unable to work one year after the accident. In the highest-risk group Risk Group 7, this figure was nearly double as high at 7.68 per cent.

Sources:  Kasch H, Kongsted A, Qerama E, et al, A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study. BMJ Open 2013;3:e002050; EAN 2016 Abstract: Rasmussen MK et al, Risk assessment within 4 days after whiplash injury identifies long-term painful and non-painful neurologic disability. A twelve-year prospective study

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Whiplash syndrome: better prediction of long-term consequences