Bird flu research resumes - but not in U.S.

Drama surrounding research on the deadly H5N1 avian flu continues, as 40 scientists urge work on the virus to continue in countries that have established guidelines on the safety and aims of the research.  The United States is not among them.

This new correspondence, a letter from researchers published Wednesday in the journals Science and Nature, comes after a "voluntary pause" in the research, which scientists announced in January 2012.
"We declared a pause to this important research to provide time to explain the public-health benefits of this work, to describe the measures in place to minimize possible risks, and to enable organizations and governments around the world to review their policies (for example on biosafety, biosecurity, oversight, and communication) regarding these experiments," the letter states.
In many countries, those objectives have been achieved, according to the letter, and researchers who have permission from their governments to continue this research should do so.
But the United States has been unclear about how long it will be before it issues official guidelines for conditions under which H5N1 transmission research can continue, the letter says.  As such, laboratories in the United States and facilities abroad that receive U.S. funding should not proceed with their transmission studies.
Why is there so much controversy about studying this flu? Let's back up.
The H5N1 bird flu can be deadly to people, but as far as scientists know, it does not easily pass from person to person by way of respiratory droplets – yet.  Scientists are trying to figure out the means by which this could happen, so that they could help the world prepare for a possible disastrous pandemic.
The World Health Organization has recorded 355 humans deaths from H5N1 out of 602 cases, although some research has questioned this high mortality rate.
Two groups of scientists independently conducted studies published last year that involved genetically altering a strain of H5N1 influenza.  A research group in the Netherlands and a separate group at the University of Wisconsin each created a mutated version of the H5N1 virus, a version is more easily transmitted between mammals than what is found in nature.  Both groups used ferrets as test subjects, as these animals closely mimic the human response to the flu.
The results of these studies were not published right away, even though they had been accepted for publication, respectively, by Science and Nature. Concerns were raised in December 2011, partly because of a fear that the research could be misused and become a biological weapon. Other general safety concerns also arose.
Many groups weighed in on what to do with this research.  In February 2012, a World Health Organization committee recommended that the two controversial studies be published in their full form. The National Institutes of Health agreed in April.
Finally, the Nature study was published in May, led by University of Wisconsin-Madison researcher Yoshihiro Kawaoka.  The Science study, which came out in June, was led by Ron Fouchier at the Erasmus Medical Center in Rotterdam, Netherlands.
While the Nature study looked at how a bird flu virus could become airborne through mutations and re-assortment with other viruses, the Science study suggests mutations alone could do the trick. It would take between five and nine mutations for the H5N1 flu to become airborne, scientists said, which is a low range.
"It’s so easily mutated, so the risk exists in nature already, and not doing the research is really putting us in danger," Kawaoka said at a press conference Wednesday.
Kawaoka cannot continue his research in Wisconsin, funded by the National Institutes of Health, pending further guidance from the United States. Fouchier also receives some NIH funding, but the rest is supported by the European Union and other organizations, so his group can continue studying avian flu using those non-U.S. resources.
At Fouchier's facilities in the Netherlands, employees who work on avian flu wear "moon suits" and there's always a barrier between them and the virus, Fouchier said. Workers are also vaccinated against avian flu, although it is hard to find a company to produce the vaccine; the last vaccination was a year ago.
Fouchier's group is not restarting experiments immediately, but probably within the next few weeks, he said. His group will attempt to nail down exactly how many mutations - and which - are sufficient to make the H5N1 avian flu virus airborne, and whether these particular mutations can also make other bird flu viruses airborne.
Avian flu strains from Indonesia and Vietnam has been studied in the context of mutations so far.  But, says Fouchier, "there are other genetic lineages of H5N1 in Egypt, in China, for instance, that we would like to test whether also, in these countries, viruses may emerge with an airborne transmission phenotype."

Researchers urge eye screening as early as age 1

How many times have you seen a young child with a patch over one eye or wearing glasses with one lens blocked and wondered why?  Chances are that child has something called amblyopia (sometimes called "lazy eye"), where one eye is not being used by the brain because it doesn't see as well.

After looking at more than 10 years of data, researchers now say children as young as a year old can be reliably screened for amblyopia; by using a camera that takes pictures of the eye, symptoms of the condition can be detected long before it becomes apparent, according to a study published Monday in the journal Pediatrics.
The goal is to identify children with this problem as early as possible, says lead study author Dr. Susannah Longmuir, "so we can start treatment before they have a problem or treat it before it gets worse."
She says very young children can already be developing amblyopia, but they do not know they have a vision problem because it's all they know - and they appear to parents to have normal vision. But as they get older, the problem gets worse.
One eye could be out of focus, or the eyes aren't straight and the brain doesn't want to see double, so it turns off the bad eye, says Dr. Daniel Neely, chairman of the vision screening committee for the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), who was not involved in the research.
The brain then gets used to not using the eye, he says.  But the brain can be re-taught how to use the eye that's just not doing enough – if caught early.  That's where the patches, glasses or eye drops come in. By covering the good eye up or putting eye drops in to make the vision in the good eye blurry, the brain is forced to used the other eye.
"We know that after age 5, the effectiveness of the treatment is diminished," Neely adds.  "The problem is most vision screenings happen when kids go to school," he says - close to when the window of correction closes.
"Current U.S. Preventive Services Task Force (USPSTF) guidelines, issued in January 2011, only recommend testing children for this eye condition between the ages of 3 and 5, citing insufficient evidence to recommend testing younger children.
The study
Researchers at the University of Iowa designed a study to help the USPSTF by providing the necessary evidence to include toddlers in their recommendations, says Longmuir.
"We wanted to see if we could reliably screen the younger children (1 to 3 year olds) just as well as the 3-5 year olds," says Wanda Pfeifer, who is not only a co-author of the study but also a orthoptist (vision therapist) who works with Longmuir.
Volunteers across the state were trained "to conduct free vision screening events with the MIT PhotoScreener," according to the study.  This is a special purpose camera that takes pictures of the eye - which look a lot like the unflattering "red-eye" in family photos.  It measures the optic of the eye and looks for risk factors for amblyopia.
One of the strengths of the study is that everybody used the same device. Longmuir says screenings were typically done at daycare centers where they could easily find the primary age group they were targeting - 6 months to 4 years of age - but no child was turned away.
She says 210,695 screenings of children's eyes were conducted from May 2000 to April 2011. The youngest children were 6 months old, the oldest were 7 to 8 years old. The average age was 3.4 years.
The results
The researchers found no statistically significant differences in the reliability of photoscreens in the 1- to 2-year-old age group compared with that in the 3- to 5-year-old children.
"If you are a year old, the test is going to be as reliable as if they (the children) are 3 years old," says Pfeifer, who read all of the thousands of screens.
The takeaway
Get your child screened as early as age 1 because if your child is developing amblyopia, his or her vision could be corrected.  "By 7 or 8, your vision is locked in," says Longmuir.
Neely says if your child fails a screening, then it's time for a full eye exam. Parents and pediatricians need to be aware of the benefits of this screening.  If your child hasn't been screened,  parents should request it, says Longmuir.
Just last week AAPOS revised its guidelines to include screening for children as young as 1.

Aspirin may cut melanoma risk, study finds

Aspirin has long been known to provide multiple health benefits: Pain relief, heart attack prevention, and possible prevention of several kinds of cancers.

A new study from Stanford University looks specifically at aspirin's role in reducing the risk of melanoma , a form of skin cancer that is on the rise.

The study found a significant association between frequent usage of the drug and this form of cancer; aspirin users were less likely to get melanoma than those who did not take aspirin.

This is not proof, however, that aspirin is directly responsible for lowering the risk.

History of aspirin: From a tree, a 'miracle'

Why study this?

Researchers believe inflammation plays a big role in cancer development, and aspirin is an anti-inflammatory drug. Previous studies support the idea that in certain kinds of cancers, aspirin may be preventative.

"Aspirin also seems to specifically promote tumor cell death in certain cells, and one [type] are melanoma cells," said the study's senior author Dr. Jean Tang, who is an assistant professor of dermatology at Stanford University School of Medicine.

Participants

Researchers examined data from the Women's Health Initiative, a large sample of women ages 50 to 79 who reported information about themselves for an average of 12 years. The new study looked at nearly 60,000 women in this group.

Only Caucasian women were studied because melanoma risk increases in people with less skin pigment, and 95% of cutaneous melanoma cases are found in Caucasians.

Study setup

The study authors divided women into categories depending on whether they said they were taking aspirin, another kind of nonsteroidal anti-inflammatory drug (NSAID), or nothing.

A "user" of a drug was someone who took the medication at least twice weekly. Prescription records and bottle labels were checked to verify these drugs.

Women also reported their sun exposure, and researchers controlled for this in their analysis.

Results

During the period of the study, medical review confirmed 548 incident melanomas among participants.

Based on the entire data set, women who took aspirin appeared to have a 21% lower risk of melanoma on average. The longer these women took aspirin, the more protection they had. At one year, they cut their risk by 11%. Between one and four years, it was cut by 22%. At five years and up, risk reduction was 30%.

The results did not appear to be different in one age group vs. another, or whether the women had lighter or darker skin or a history of skin cancer.

Other NSAIDs and acetaminophen were not linked to melanoma risk in this study.

"The results of this study add to the results found by other studies that strongly suggest that aspirin may have anti-cancer properties," Tang said.

Limitations

If aspirin does have this effect, that doesn't mean other NSAIDs don't also work this way. Tang said that the women in the study tended to take aspirin more regularly and frequently than other NSAIDs, so this may have affected the results. Study authors also did not differentiate between women who took painkillers twice a week and those who took them more often.

Other researchers are studying aspirin and other NSAIDs for possible anti-cancer effects, she said.

Information about the women's sun exposure was self-reported, and their activities were not controlled in an experimental setting.

This was also restricted to postmenopausal women; it is unclear what the benefits would be, if any, if women started taking anti-inflammatory drugs earlier in life.

Bottom line?

"The results of this study add to the results found by other studies that strongly suggest that aspirin may have anti-cancer properties," Tang said.

But the research is not at the point of recommending that everyone take aspirin every day. Stronger evidence would come from a long, expensive clinical trial to examine aspirin against a placebo for cancer risk prevention, which is hard to come by in the current stringent government funding environment, she said

Why our noses are different shapes

There are pouches on each side of the human nose below the eyes that are called maxillary sinuses. They're involved in sinus infections, so you may already have a bias against them.

But Nathan Holton, a postdoctoral research fellow in the department of orthodontics at the University of Iowa, wanted to find out why there's such variation in these structures, and how they are affected by variation in the nasal cavity. A study on the subject is published in the journal The Anatomical Record.
Holton and colleagues took computed tomography scans of 40 people. About half of them were European-Americans, and the other half were African-Americans or native South Africans.
They found that the bigger the volume of the nasal cavity, the bigger the maxillary sinuses, in both populations. This is also associated with the overall face size, the researchers said, and suggests that the maxillary sinuses play a role in allowing the nose shape to vary. It appears that the sinuses make room for the nose.
But when the face size is about the same, maxillary sinuses tended to be 36% larger in people of European ancestry than of African ancestry because Europeans tend to have narrower nose shapes.
The various shapes of noses appear to be tied to adaptations to climate, Holton said. The nose must properly heat and humidify the air that you breathe. In a cold climate, it's advantageous to have a narrower nose. That's so that when a person inhales, more air comes into contact with the mucosal surface of nose, which provides moisture. The narrow nose maximizes the surface area.
"The fact that we have sinuses seems to allow for this accommodation of variation in nasal shape, which seems to be important, in evolutionary terms, with regard to climatic adaptation," Holton said.
The maxillary sinuses probably do not serve an important purpose in terms of nasal respiratory function, he said.

Breast-fed babies need Vitamin D supplements

Most new moms aim to breast-feed their babies - a practice encouraged by experts who tout the many health benefits of breast milk.

But breast milk is not perfect when it comes to vitamin D. A new study published Tuesday in a special edition of the Journal of the American Medical Association focusing on child health reiterates that breast-fed babies also need a vitamin D supplement.
The current recommendations to give babies being fully or partially breast-fed 400 IU, or International Units, of vitamin D each day "is quite satisfactory," said lead study author and registered dietitian Hope Weiler of McGill University in Canada.
In 2011, the Institute of Medicine also recommended 400 IU of vitamin D as being beneficial to infants, from newborns to babies up to 12 months - or even beyond.
But most babies who are breast-fed do not receive enough, because most new parents aren't giving their babies vitamin D supplements, according to Dr. Steven Abrams, a professor of pediatrics at Baylor College of Medicine and author of an accompanying editorial published in JAMA.
Abrams, who is also a member of the nutrition committee of the American Academy of Pediatrics (AAP), says only about 10 to 20% of babies who are breast-fed are also given vitamin D.
"We know very well if you don't have enough vitamin D, you can develop rickets as an infant or young child," Weiler said at a news conference on Tuesday. Rickets is a disorder which leads to softening and weakening of the bones.
Vitamin D is essential for growing healthy bones because it helps the body absorb calcium - without enough calcium, bone production may suffer.
Our bodies have the ability to produce vitamin D when our skin is directly exposed to the sun. However, you can't be wearing sunscreen to make this happen and babies younger than 6 months shouldn't be in the sun anyway - according to the AAP and FDA, 6 months is the earliest sunscreen should be applied to babies.
Babies who are exclusively breast-fed or even partially breast-fed are unlikely to get enough vitamin D because their mothers may lack it. Babies who are formula-fed usually receive enough vitamin D because the government requires that it be included in formula.
"A daily exposure of vitamin D intake of 400 IU per day has been demonstrated for almost 100 years to reliably prevent rickets in infants regardless of sunshine exposure or race," writes Abrams in the editorial.
Back in the 1920s, when the recommendations were first established, vitamin D supplements came in the form of a teaspoon of cod liver oil. These days, you can buy a bottle of the supplement and give your baby the recommended amount with an eye dropper.
It's hard to quantify how many babies get rickets because reporting is not required in the United States, but pediatricians like Abrams say they are seeing more cases: "'There's been a mini-epidemic of rickets in the U.S.," he says.
There doesn't appear to be strong pediatrician support for the recommendations, he says, and new parents may not be aware of the recommendation. In addition, families on a tight budget may need to be convinced that buying an over-the-counter vitamin D supplement is important.
A quick survey of some national pharmacy and retail chains shows a bottle of vitamin D drops for infants costs about $9 to $12. That could be a hardship for families on public assistance, which is why Abrams has suggested over the years that it may be worth making these supplements part of public assistance.

Childhood food, skin allergies on the rise

Food and skin allergies are becoming more common in American children, according to a new report from the Centers for Disease Control and Prevention. Both have been steadily increasing for more than a decade.

Food allergy prevalence increased from 3.4% to 5.1% between 1997 and 2011, while skin allergy prevalence more than doubled in the same time period. That means 1 in every 20 children will develop a food allergy and 1 in every 8 children will have a skin allergy.  According to the CDC, respiratory allergies are still the most common for children younger than 18.
The new report, which looked at data from the National Health Interview Survey, found that skin allergies decreased with age, while respiratory allergies increased as children got older.

Both food and respiratory allergies also increased with income level, meaning richer families had higher rates of childhood allergies. Hispanic children had lower rates than non-Hispanic white and black children in the survey. The report did not look into the potential reasons for this.
Scientists are still trying to figure out where allergies come from, and why they’re on the rise in the United States. Internal bacteria, genetics and environment may all play a role, says Dr. Edward Zoratti, head of the allergy and immunology division at Henry Ford Hospital in Detroit.
Why are food allergies on the rise?
When particles of pollen or certain types of food enter our bodies, they're called antigens. If your body has a sensitivity to that particle, it mistakes the harmless element for a dangerous invader, according to the American Academy of Allergy, Asthma and Immunology. The particle then becomes what we call an allergen.
Allergens cause your body to produce Immunoglobulin E, or IgE, antibodies. Antibodies are used to identify and destroy dangerous invaders. Unfortunately, IgE antibodies also release histamine and other chemicals that can create an allergic reaction.
That means anything that impacts our immune system could change our susceptibility to allergies, Zoratti says. For instance, our diet has changed over time – “and not for the better” – with more processed food and fewer natural nutrients. We’re also outdoors less and exercise less, all of which may be changing how our immune system reacts to these antigens.
Studies have been done in Europe, he says, that show children who are raised on farms are less likely to have allergies. Researchers believe exposure to animals and various microbes at a young age strengthens the immune system. It’s called the “hygiene hypothesis,” meaning our body’s ability to fight back has been weakened by too clean of an environment.
A lack of vitamin D may also be contributing to the rise in allergies. Many people in the United States have a vitamin D deficiency, Zoratti says. While scientists aren’t sure how Vitamin D works, they do know it plays a crucial role in the immune system. There’s also a growing concern that the antibiotics we take as children are killing off good bacteria in our gut, making it difficult for the good to fight off the bad.
“There’s been a lot of changes in the (microbes) that we’re exposed to, or that grow in and on our body,” Zoratti says.
Bottom line, scientists are still working to figure out why allergies are on the rise. If your child has an allergy or allergy symptoms, talk to their pediatrician and visit AAAI.org or AAFA.org for more information.

New discovery may be step toward ending malaria

Worldwide elimination of malaria would save hundreds of thousands of lives each year, according to the World Health Organization (WHO). But eradication remains elusive, because the parasite that causes the disease can evolve to withstand the effects of new malaria drugs and become drug-resistant.

Researchers, however, now believe they have discovered a way to track the spread of drug-resistant malaria, and this discovery may help to finally eradicate the disease. Their study was recently published in the journal Nature Genetics.
“We’ve seen past cases of (malaria) drug resistance spread in a specific pattern,” said study author Nicholas White from Mahidol University in Bangkok, Thailand, and the University of Oxford in the UK. “It starts in Cambodia, spreads across Southeast Asia and crosses over to Africa, killing millions of children in the process.”
Resistance to artemisinins - the group of drugs doctors currently use to treat malaria - has been noticed in Cambodia in recent years, sparking concern that an untreatable type of malaria could spread worldwide.
But an international team of researchers says it has identified unique genetic fingerprints for artemisinin-resistant strains of the parasite. This, they say, may help detect and contain this hard-to-treat form of malaria before it spreads worldwide. They remain unsure, however, how soon humans might benefit.
Researchers looked at the genes of 825 malaria-causing parasites collected from 10 locations across Africa and Southeast Asia.
They found three previously undiscovered artemisinin-resistant strains of the parasite in western Cambodia. Each had a specific genetic makeup not seen in any other type of malaria-causing parasite.
This identification of genetic fingerprints specific to artemisinin-resistant malaria parasites is a significant step towards tracking and eventually stopping the spread of this type of malaria, said White.
In the future, the genetic fingerprints identified by the researchers could be used to create a blood test that may predict whether someone with malaria will respond to treatment with artemisinin, said WHO Global Malaria Program coordinator Dr. Pascal Ringwald. “Being able to test people in this way should quickly reveal which parts of the world the resistance has spread to,” said Ringwald.
Scientists can then push strategies, such as compulsory use of preventive medicines for travelers coming into these areas, to keep this type of malaria from moving beyond these areas, he added.
The WHO reports that global deaths from malaria have fallen by more than 25% since 2000, but around 3.3 billion people remain at risk of the disease – most of them children younger than 5.

Why many would-be bone marrow, blood stem cell donors back out

Upon being identified as potential bone marrow or blood stem cell donors, many people choose not to participate. As result, patients with blood cancers go without life-saving treatments.

About 40% of whites and 60% of nonwhites are no longer available for whatever reason to donate when contacted for confirmatory testing by blood sample, according to data from the National Marrow Donor Program and Be The Match. Surveys from Be The Match also suggest that about 10-23% of donors are unavailable specifically because they choose to opt out.  Why? That's the question researchers attempted to answer in a recent study.

"The most consistent factor associated with opting-out of the registry across all race/ethnic groups was ambivalence about donation - doubts and worries, feeling unsure about donation, wishing someone else would donate in one's place," writes Galen Switzer, a professor of medicine and psychiatry at the University of Pittsburgh, in the study, published in December in the journal Blood.

 "We wanted to know what might explain the higher rates at which ethnic minorities opt out of the registry when they're contacted as a potential match," says Switzer, the lead study author.

"Some of the ethnic groups had less trust that the stem cells that were collected would be allocated equitably. Members of ethnic minorities groups were also more likely to have been discouraged by someone else from donating."

For example, in phone interviews, minorities were more likely to disagree with the statement: "Stem cells go to the person who needs them most regardless of their race."

To increase would-be donor participation among all groups, the study authors suggest screening potential donors for "ambivalence", and then addressing more of the ambivalent donors' concerns head-on before they opt out unnecessarily.

"The ultimate goal in mitigating doubts and worries about donating," says Switzer, "is to ensure that potential donors are fully educated, confident, and most importantly, comfortable with their decision, no matter what choice they make."

Why many would-be bone marrow, blood stem cell donors back out

Upon being identified as potential bone marrow or blood stem cell donors, many people choose not to participate. As result, patients with blood cancers go without life-saving treatments.

About 40% of whites and 60% of nonwhites are no longer available for whatever reason to donate when contacted for confirmatory testing by blood sample, according to data from the National Marrow Donor Program and Be The Match. Surveys from Be The Match also suggest that about 10-23% of donors are unavailable specifically because they choose to opt out.  Why? That's the question researchers attempted to answer in a recent study.

"The most consistent factor associated with opting-out of the registry across all race/ethnic groups was ambivalence about donation - doubts and worries, feeling unsure about donation, wishing someone else would donate in one's place," writes Galen Switzer, a professor of medicine and psychiatry at the University of Pittsburgh, in the study, published in December in the journal Blood.

 "We wanted to know what might explain the higher rates at which ethnic minorities opt out of the registry when they're contacted as a potential match," says Switzer, the lead study author.

"Some of the ethnic groups had less trust that the stem cells that were collected would be allocated equitably. Members of ethnic minorities groups were also more likely to have been discouraged by someone else from donating."

For example, in phone interviews, minorities were more likely to disagree with the statement: "Stem cells go to the person who needs them most regardless of their race."

To increase would-be donor participation among all groups, the study authors suggest screening potential donors for "ambivalence", and then addressing more of the ambivalent donors' concerns head-on before they opt out unnecessarily.

"The ultimate goal in mitigating doubts and worries about donating," says Switzer, "is to ensure that potential donors are fully educated, confident, and most importantly, comfortable with their decision, no matter what choice they make."

Antioxidants in coffee, tea may not help prevent dementia, stroke

Drinking coffee and tea rich in antioxidants may not lower your risk of dementia or having a stroke, according to a new study published Wednesday in the online journal Neurology.

The study may call into question other research suggesting a diet high in antioxidants helps reduce the risk of dementia and stroke.
Researchers followed approximately 5,400 people aged 55 years and older for nearly 14 years. The participants had no signs of dementia when they began the study and most had never had a stroke. They were questioned about how often they ate 170 foods over the course of the past year and they were divided into three groups based on the levels of antioxidants in their diet - low, moderate or high.
Antioxidants are vitamins, minerals and other nutrients that help protect your cells and repair cell damage caused by free radicals. Free radicals, molecules responsible for aging and tissue damage, may be a factor in heart disease, cancer and other disease.
Foods loaded with antioxidants include blueberries, strawberries and raspberries, tomatoes, kale, bell peppers, corn, and spinach. The major antioxidant vitamins are Vitamin C, beta-carotene and Vitamin E. They're largely found in colorful fruits and veggies, especially those that are red, blue, purple, yellow and orange in color.
But most of the antioxidants consumed by study participants came in the form of coffee and tea, said study author Elizabeth Devore of Harvard Medical School and Erasmus Medical Center in Rotterdam, Netherlands.
Approximately 600 people developed dementia and about 600 had a stroke over the course of the study. But those who consumed antixoidant-rich diets did not change their risk of developing brain disease any more than those with low levels in their diets, researchers said.
"These results are interesting because other studies have suggested that antioxidants may help protect against stroke and dementia," said Devore. "It's possible that individual antioxidants, or the main foods that contribute those antioxidants - rather than the total antioxidant level in the diet - contribute to the lower risk of dementia and stroke found in earlier studies."
Dr. Richard Lipton, vice chairman of neurology at Albert Einstein College of Medicine says people tend to think antioxidants are called one thing and all have the same properties. But the paper is clear that 90% of the antioxidants came from coffee and tea and that doesn't have the same protective effect.
"This study is not saying that blueberries don't help you or a Mediterranean diet doesn't help you, it's saying this very specific dietary component doesn't reduce stroke and dementia risk." Lipton told CNN. "This study looked at a certain type of antioxidants primarily from coffee and tea and doesn't speak to antioxidants in fruits and vegetables and the Mediterranean diet."
In fact, the researchers say there is growing evidence that consuming lots of fruits, vegetables and even alcoholic beverages may be linked to a reduced risk of stroke - that specific antioxidant-rich foods and beverages are more important for lowering the risk of stoke than the overall antioxidant capacity of the diet.

Electronic health records improve colon cancer screening rates

Centralized record-keeping systems may help improve rates of colon cancer screening, according to a new study.

Researchers at the Group Health Cooperative, a non-profit health care and insurance system in Washington state, used electronic health records to identify and monitor almost 5,000 patients who were due for a colon cancer screening but hadn't gotten it.
One group of patients received "normal care" - reminders from their doctor during appointments. A second group received a letter in the mail encouraging them to get screened; a third group got a call from a medical assistant on top of all of that, and a fourth group got a "patient navigator" to manage the screening process.
Each additional step increased the percentage of people who got screened, from 26% in the "normal" group to 65% in the patient navigator group.

"With a simple centralized program, we leveraged our electronic health records to identify those who needed screening," said Dr. Beverly Green, the lead study author and a practicing family physician at GHC. "We doubled the colon cancer screening rates."
Traditionally, Green says, colon cancer screening rates are much lower than with other cancers - namely breast and cervical cancers - largely because of one major factor: Convenience.
"You have to take off a day of work, maybe two. The prep is uncomfortable. You have to have somebody to drive you," said Green. "People don't like the idea of (colonoscopies); they're fearful of it."
But she said, colonoscopy wasn't the only screening option offered.
"While [patients are] mustering up their strength to have a colonoscopy, 5 years have passed, and in that period of time, they could be doing a stool card."
A stool card - also known as a Fecal Occult Blood Test (FOBT) - involves putting a small stool sample on a card and mailing it into a lab, where technicians look for trace amounts of blood.
Current U.S. Preventative Services Task Force recommendations say patients should do either a stool card each year, beginning at age 50; a flexible sigmoidoscopy every 5 years along with stool testing, or a colonoscopy every 10 years.
One major criticism of the study is that, although researchers were able to double screening rates, the number of colonoscopies - considered the most sensitive screening tool - actually went down.
"A lot more people did get screened," Green says, "but a few people, because we sent them a stool card, did that in place of a colonoscopy."
And she says while a stool card isn't as effective as a colonoscopy - it'll catch 75% of colon cancers, but very few, if any, pre-cancerous lesions - some testing is better than no testing.
"The best test for colorectal [cancer] screening is the test the patient will do, and one they'll keep doing on time."

Why teens may be behind on vaccinations

A new survey finds even though vaccines for certain teenage illnesses are available and are found to be safe, many parents aren't having their teens inoculated. The question is why?

Researchers looked at parent questionnaires collected through a national survey called "Reasons for Not Vaccinating Adolescents: National Survey of Teens, 2008-2010." Investigators wanted to better understand why moms and dads aren't taking their older children in for recommended inoculations.
“These vaccines are safe and effective and people should really have their teens get them," says Dr. Paul Darden, lead author of the study and professor of pediatrics at the University of Oklahoma College of Medicine. “Parents say pediatricians are telling them about the vaccines, yet they just don’t seem to understand why they are necessary or are skeptical about their safety."
When parents of teens were asked why their children didn't receive certain forms of the tetanus, diphtheria, pertussis (Tdap) and meningitis vaccine, some parents noted these shots were not recommended or not necessary, according to the study. Others did not have a reason.
Regarding the controversial and fairly new vaccine that protects against the sexually transmitted human papillomavirus - which has been linked to cancer - some parents also said it was not necessary. In other cases parents noted their children were not sexually active or were not the appropriate age to receive the vaccine.
Concerns of mothers and fathers about the safety of the HPV vaccine grew each year, from 4.5% in 2008 to 16.4% in 2010, according to the study. The number of parents who said they would not vaccinate their children for HPV increased from 39.8% in 2008 to 43.9% in 2010. The main concern was safety.
Investigators were surprised, because the vaccine has been found to be very effective in preventing the virus that causes cervical cancer in young women.
“We thought perhaps many parents would think the HPV vaccine would give kids permission to have sex, and therefore not allow their children to get it. But that wasn’t it,” explained Darden. “They seemed to be skeptical of its safety, which is odd, because it’s shown to be effective with few side effects. We have a vaccine that protects against cancer. Why not vaccinate your child? I don’t get it.”
Although cost was not a major concern, it was a factor for some parents, the study found.
The lackadaisical attitude of some parents when it comes to these kids’ vaccines has study authors concerned. Investigators concluded more doctors need to stress to parents the benefits of these particular vaccines and why it’s important to get their teenagers vaccinated.

Alcohol may improve breast cancer survival

Although drinking alcohol is known to be a risk factor for developing breast cancer, a new study suggests that alcohol may not have any effect on whether you survive the disease.  In fact, researchers found that being a moderate drinker may actually improve your chances of survival.

"The results of the study showed there was no adverse relationship between drinking patterns before diagnosis and breast cancer survival," said Polly Newcomb, director of the cancer prevention program at the Fred Hutchinson Cancer Research Center in Seattle and the lead author of the study.
"We actually found that relative to non-drinkers there were modestly improved survival rates for moderate alcohol intake."
The researchers followed close to 25,000 breast cancer patients for an average of 11 years, and found that women who drank moderately - three to six drinks per week - before developing breast cancer were 15% less likely to die from the disease.
More importantly, she says, drinking after diagnosis also didn't appear to impact survival.
"Whether you drink post diagnostically - again, moderately - doesn't appear to adversely impact your mortality," Newcomb said.
So does that mean women who have a history of breast cancer are free to drink up?
"The results of our study would suggest that moderate alcohol consumption after a diagnosis of breast cancer does not adversely impact either breast cancer-specific or overall survival," she said.
Another benefit of moderate alcohol intake - a reduction in the risk of cardiovascular disease in women with breast cancer, according to Newcomb. "Cardiovascular disease is importantly being recognized as a contributor to mortality among breast cancer survivors."
The study found that women who drank those same three to six drinks per week before being diagnosed with breast cancer were 25% less likely to develop heart disease.
The bottom line, says Newcomb? "This is good news for women because it might help direct some of their choices after their diagnosis."
Dr. Sandra Swain, president of the American Society of Clinical Oncology, which published the study Monday in the Journal of Clinical Oncology,  agreed the findings are good news for breast cancer patients, but cautioned that more research should be done to confirm them.

Study finds baby's spit-cleaned pacifier is OK

As a parent, there are undoubtedly a few things you do now that before you had children you thought were gross: Changing diapers, wiping up vomit and using your own spit to clean off a child's pacifier, just to name a few.

Though it's hard to admit, most parents have done the latter. You're out at the mall when your kid drops his pacifier and there's not a place to clean it nearby. So you pick it up, suck on it a bit and hand it back to your baby.
What's the harm?
Turns out cleaning a recently dropped pacifier with your saliva - meaning you put it in your mouth before inserting it back into your baby's - may actually help strengthen your child's immune system and keep him from developing certain allergies, according to a new study in the journal Pediatrics. When parents cleaned pacifiers in this way their children were significantly less likely to develop eczema, a skin condition considered to be the most common early form of allergies.

The study
Researchers enrolled about 180 Swedish children in the study and took samples of their saliva. Babies whose parents had put the pacifier in their own mouths to clean it had a different microbe soup, if you will, then those whose parents had either rinsed the pacifiers under water or boiled it.
At 18 months the children whose parents licked the pacifiers had one-third the risk of developing eczema compared to children whose parents used a different cleaning method.
The scientists also looked at the number of respiratory infections among the children.  They found that both groups, on average, had the same number of infections, no matter how the pacifiers were cleaned.
Behind the results
It seems counter-intuitive - wouldn't adding your germs to the floor dirt on the pacifier make your baby sick?
Scientists think that sucking the pacifier transfers some of Mom or Dad's bacteria to the infant. Research has shown that babies need to be exposed to a wide variety of bacteria, viruses and other organisms to help their immune systems develop and mature properly. If this doesn't happen early, the baby's system tends to overreact to harmless particles like cat hair, pollen, or various foods, treating them as if they are dangerous, which can lead to allergies.
Our emphasis to keep things exceedingly clean over the last few decades may actually be depriving a baby's immune system of some of the organisms it needs to help it thrive, according to the study.
Takeaway
"Should we change our behavior based on this study?" asks Dr. Elizabeth Matsui, a pediatric allergist and immunologist at Johns Hopkins Children's Center and member of the American Academy of Pediatrics Section on Allergy and Immunology Executive Committee. "I would say no."
"But this study does bring up intriguing questions about the oral bacteria and how it might influence a developing immune system in a positive say to protect against allergy," adds Matsui. She says more studies are needed to see if these findings can be replicated.
Bottom line: The next time you're out at the mall and have forgotten an extra pacifier, don't be too concerned if you need to clean the dropped one with your own saliva.

Report questions benefits of salt reduction

Reducing salt consumption below the currently recommended 2,300 milligrams – about 1 1/2 teaspoons– per day maybe unnecessary, according to a new report released Tuesday by the Institute of Medicine (IOM).

The news follows a decades-long push to get Americans to reduce the amount of salt in their diet because of strong links between high sodium consumption and hypertension, a known risk factor for heart disease.
The IOM, at the request of the Centers for Disease Control and Prevention, reviewed recent studies published through 2012 that explored ties between salt consumption and direct health outcomes like cardiovascular disease and death. The organization describes itself as "an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public."
Researchers determined there wasn't enough evidence to say whether lowering salt consumption to levels between 1,500 and 2,300 mg per day could increase or decrease your risk of heart disease and mortality. But lowering sodium intake might adversely affect your health, the panel found.
"These new studies support previous findings that reducing sodium from very high intake levels to moderate levels improves health," said committee chair Brian Strom, the George S. Pepper professor of public health and preventive medicine at the University of Pennsylvania's Perelman School of Medicine. "But they also suggest that lowering sodium intake too much may actually increase a person's risk of some health problems."
Those problems, he said, could include heart attack or death.
The current Dietary Guidelines for Americans recommend that a sub-group of people - anyone older than  51, African Americans, and people with high blood pressure, diabetes or chronic kidney disease - limit their salt intake to 1,500 mg a day.
The IOM committee found no benefit, but possibly a risk of poor health outcomes with lower salt intake in people with these pre-existing conditions, but said that evidence is inconsistent and limited.
"While the current literature provides some evidence for adverse health effects of low sodium intake among individuals with diabetes, CKD (kidney disease), or pre-existing CVD (cardiovascular disease), the evidence on both the benefit and harm is not strong enough to indicate that these subgroups should be treated differently from the general U.S. population," the report said.
"Thus, the committee concluded that the evidence on direct health outcomes does not support recommendations to lower sodium intake within these subgroups to, or even below, 1,500 mg per day."
American adults eat on average 3,400 mg of salt a day, according to the IOM. Groups like the American Heart Association (AHA) support reducing that number. In 2011, the AHA called for a reduction in daily consumption, recommending all Americans eat no more than 1,500 mg a day.
The IOM report, the AHA said Tuesday, does not accurately assess salt impact on health. "While the American Heart Association commends the IOM for taking on the challenging topic of sodium consumption, we disagree with key conclusions," said the association's CEO, Nancy Brown. "The report is missing a critical component – a comprehensive review of well-established evidence which links too much sodium to high blood pressure and heart disease."
The Salt Institute says it welcomes the IOM study, calling it a major breakthrough in the salt debate.
"This whole thing has been blood pressure-driven and this study finally looks at overall health outcomes," said Morton Satin, vice president of science and research for the institute.
"The study makes it very, very clear that the level of 1,500 mg that has been recommended in the dietary guidelines is not warranted, despite this full-throated cry for these levels by some organizations ... We hope this is the opening of the much broader review of the available evidence and a devotion to ensuring that our guidelines reflect the science."
The IOM panel was not asked to make recommendations on what a healthy range should be. It says more research is needed to help shed light on how lower sodium levels affect health in all Americans.
On Monday, the Center For Science In The Public Interest published results of a new investigation on what they call the food industry's failed efforts to reduce sodium levels in pre-packaged and restaurant foods.  It called for phased-in limits in an effort to prevent heart disease.  The group tracked nearly 500 food products between 2005 and 2011.
"The strategy of relying on the food industry to voluntarily reduce sodium has proven to be a public health disaster," said  CSPI executive director Michael F. Jacobson.  "Inaction on the part of industry and the federal government is condemning too many Americans to entirely preventable heart attacks, strokes, and deaths each year."

Copper in hospital rooms may stop infections

Hospital-acquired infections are a huge problem in the United States. Wouldn't it be amazing if they could be prevented merely through the materials used in the hospital room?

Researchers at the Medical University of South Carolina explored covering key surfaces in hospital intensive care units in copper alloy, and found that this is an effective measure against the spread of some key types of bacterial infections. Their study is published in the journal Infection Control and Hospital Epidemiology.
Background
Up to $45 billion a year is spent on health care costs related to hospital-acquired infections, and an estimated 100,000 deaths occur annually because of them, the study authors wrote.
The antimicrobial properties of copper have been known for hundreds of years, said Michael Schmidt, the study's senior author - for at least 4,500 years. Ancient Indians realized that if water sits in a copper pot, this prevents illness, because the copper kills the bacteria. It's not used as often nowadays because molded plastics and stainless steel have taken over, being easy and in expensive.
How does it work? Copper is used to transmit electrons in walls for electricity. Similarly, bacteria will donate electrons to the copper metal, which places the organism in an electrical deficit. As a consequence, free radicals are generated inside the cell. The cell's proteins essentially get bleached, and its DNA get fractured. The electrical potential of the cell also gets collapsed.
"It's pretty hard to develop resistance from that multi-hit mechanism of action," Schmidt said.
How they did it
The study authors conducted the trial in the intensive care units of three different hospitals. Patients were randomly placed in copper or non-copper rooms. The study took place between July 2010 and June 2011.
Copper is an expensive material, so researchers carefully chose which parts of the ICU room should have the coating, based on the likelihood of a patient, staff member or visitor touching it. These included the rails that the patient uses to lift himself or herself out of bed, chair arms, the IV pole, the remote control and the tray that's used over the bed. On the whole, copper surfaces covered less than 10% of the room in the settings used in this study.
The researchers were most interested in the spread of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). They compared the rates of hospital-acquired infections from any cause, or colonization with one of these two types of bacteria in the patients. Colonization means the bacteria is present on the person - such as on the skin, respiratory tract or gastrointestinal tract - without signs or symptoms of infection, said lead study author Dr. Cassandra Salgado.
Results
Rooms with copper alloy surfaces were associated with lower infection and colonization for both of these types of bacteria than in normal ICU rooms. For hospital acquired infections, the rate was lowered from 0.081 to 0.034.
Implications
The challenge, of course, is investing the capital into buying new furniture and equipment for ICU rooms, Schmidt said. But he calculates that the cost of outfitting a room in this way would be recovered, in terms of money saved from preventing infections, after three months.
The researchers did not look at whether this intervention affects a patient's 30-day readmission rate, or whether it would work in a hospital room that's not part of an ICU.
Other researchers are looking at whether copper also stops carbapenem-resistant Enterobacteriaceae (CRE), a deadly, antibiotic-resistant strain of bacteria, Schmidt said.
"Bacteria have sex so quickly among their friends in their hospital environment, it may actually reduce the spread of CRE and other multi-drug resistant microbes, simply because the DNA is fractured," Schmidt said.
Some of the study authors reported financial connections to the Copper Development Industry, which is the market development, engineering and information services arm of the copper industry.
But this isn't the only research team that's looking into this question. A separate group at the University of California, Los Angeles, received a $2.5 million federal grant in 2012 to study the germ-fighting effectiveness of copper in hospitals. The cost effectiveness of that is still unclear, said Dr. Daniel Uslan, director of the antimicrobial stewardship program at UCLA's Geffen School of Medicine.
"I suspect the costs will be favorable, but more data is needed and I hope our study at UCLA will answer this important question," he said in an e-mail. "We also don't yet know which surfaces in a room are most critical. Can you get by with just coating one or two items, or do all the touch surfaces need to be copper coated? Obviously the costs will change dramatically depending on the number of surfaces coated."

Vaccine-autism connection debunked again

Many expectant parents are wary of all the recommended vaccines their newborns are supposed to get in the first hours, days and even the first couple of years, believing that too many vaccines too soon may increase their child's risk for autism.

A new study published in the Journal of Pediatrics Friday may put them at ease. Researchers found no association between autism and the number of vaccines a child gets in one day or during the first two years of the current vaccine schedule.
The research was led by Dr. Frank DeStefano, director of the Immunization Safety Office at the Centers for Disease Control and Prevention. Together with two colleagues, DeStefano and his team collected data on 256 children with autism spectrum disorder (ASD) and 752 children who did not have autism. The children were all born between 1994 and 1999 and were all continuously enrolled in one of three managed-care organizations through their second birthday.
The researchers not only counted how many vaccines a child was given, they also counted how many antigens within the vaccines children were exposed to over three different time periods: birth to 3 months, birth to 7 months and during the first two years. They also calculated the maximum number of antigens a child would receive over the course of a single day.
An antigen is an immune-stimulating protein found in a vaccine that prompts the body's immune system to recognize and destroy substances that contain them, according to the NIH.
Some vaccines, like Hepatitis B, only contain one antigen for this one virus. However, at the time these children were vaccinated, the typhoid vaccine had 3,000 antigens per dose and the measles, mumps, rubella (MMR) vaccine had 24.
"When we compared those roughly 250 children with ASD and the roughly 750 children who did not have ASD, we found their antigen exposure, however measured, were the same," said DeStefano. “There was no association between antigenic exposure and the development of autism."
The researchers also found no association between antigenic exposure and ASD.
Geraldine Dawson, chief science officer of the science and advocacy group Autism Speaks, called the research a "well-done study." She was not affiliated with the research.
"The big challenge that we face is the fact that we still don't understand the causes of autism - genetic or environmental," she said. "So while this answers one question parents may have, we still have many more to be addressed."
Dawson and DeStefano both believe the study should be reassuring for parents concerned about the vaccine schedule. Vocal critics have argued that children receive too many vaccines too soon, and that the frequency of the shots is one factor in why some children develop autism.
"I would tell an expectant mom that one of the more important things you can do to protect an infant's health is get them vaccinated on time according to the recommended schedule," DeStefano said. He says vaccines protect against serious life-threatening diseases and delaying them can put your child unnecessarily at risk.
"The bottom line is the number of vaccines, or the number of antigens in the current schedule, given on time ... is not associated with a risk of autism."
In 2011, the British medical journal BMJ said a now-retracted study linking autism to the vaccine that prevents measles, mumps and rubella was an "elaborate fraud" that did long-lasting damage to public health. An investigation by the journal said the study's author, Dr. Andrew Wakefield, misrepresented or altered the medical histories of all 12 patients whose cases formed the basis of the 1998 study.
Wakefield told CNN's "AC360" that his work had been "grossly distorted" and he was the target of a "ruthless, pragmatic attempt to crush any attempt to investigate valid vaccine safety concerns."
The now-discredited paper panicked parents and led to a sharp drop in the number of children getting the vaccine. Measles cases increased in the ensuing years.

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'I couldn't walk': Woman loses 276 pounds

Theresa Borawski sat down heavily on a neighbor's porch, somewhere in between her front door and her good friend's driveway. The distance between the two was less than half a mile. It might as well have been 20.

She had already taken a break on a tree stump near the road. This was the last stop, she told herself as she stood up from the porch slowly. She was going to make it.

Reaching her friend's house was like reaching the finish line of a much longer race.

"I was just like I had run in a marathon," Borawski remembers. "It was the biggest moment in my life."

"He had to bring me home because I couldn't walk back," she laughs, "but ..."

But the victory was sweet for a woman who just six months before had primarily relied on a wheelchair to get around, a woman who had lived in her house for two years without walking to the mailbox.

At her heaviest in March 2011, Borawski weighed 428 pounds.

"I could no longer participate in life's activities and was forced to become a spectator while people around me lived their life," she wrote on iReport.com. "Today, I am 276 pounds lighter, 14 jean sizes smaller, and no longer need a wheelchair, walker or cane to get around. I am a walking, talking miracle and have been given a second chance at life."

Borawski's father died when she was 8. Friends and family showed their sympathy with food. The lunch lady at school put extra fries on her tray; the neighbors gave her more candy at Halloween. Her grandparents were caterers, and their extended family got together often for exorbitant meals.

"I learned at a very young age that food makes the happy times better and the sad times more bearable," she says.

She was heavy throughout high school and college but says her weight never really affected her life until 2003, when a series of setbacks sent her into a downward spiral.

Borawski lost her church job of 15 years and moved more than 200 miles to start anew. She lost her grandfather and best friend back-to-back a few months later. Then her new job was cut from the church's budget.

"All of a sudden I'm 42 years old, living alone, unemployed, no income whatsoever," she says.

So she comforted herself with food and decided to go back to college.

Professor Chuck Bowden wasn't surprised by Borawski's amazing transformation. She caught his attention right away as a student willing to work hard.

"I already knew she was dedicated," Bowden says. "I think starting over as a college freshman had to be a challenge -- almost just as impressive."

Over the next four years, Borawski gained weight steadily. Her doctor diagnosed her with rheumatoid arthritis, an extremely painful chronic disease that inflamed her joints. The extra pounds she was carrying only made the condition worse.

She used a walker or cane to get around. When she graduated from Mid Michigan Community College, she could barely walk across the stage to get her diploma.

By January 2011, "my life was in complete chaos," Borawski says. She was working at the college and traveled around campus in an electric wheelchair.

"I always heard her whirring down the hall," Bowden remembers. He and Borawski had become friends and chatted often about the future. "With the (arthritis) and the extra weight, I got very concerned that she might ... not be able to take care of herself."

His fears weren't far off.

Borawski had difficulty standing long enough in the shower to wash and condition her hair. She could only shop at stores that had mobile carts; it took her a week to carry in her groceries from the car because she could only carry one or two bags at a time. She was seriously considering moving into an assisted living facility.

"I could barely function," Borawski says. She got up, rode around in her wheelchair, popped painkillers, ate and went to bed every night at 7 p.m. "Every bit of energy I had went to just living."

Her wake-up call came on March 1, 2011. Her sister phoned to tell her she was getting bariatric surgery. Borawski pleaded with her not to -- she had heard horror stories about the procedure's aftereffects. When the sister hung up, Borawski went to the refrigerator and took out a bottle of peach soda.

"Something just clicked in my head," she says. A quick calculation made Borawski realize she had been drinking nearly 7,000 calories a week in soda -- the equivalent of 2 pounds.

She opened up the bottle and dumped it down the drain. Then she did the same with the rest of her stash.

At that moment, Borawski gave up sugar cold turkey.

Ten days later, she went to the doctor and had lost 7 pounds. She bought a calorie-counting book on the way home and started reading food labels. Soon after, she restricted her calorie intake to 1,000 calories a day (experts warn against eating less than 1,200 calories a day because it sends your body into starvation mode). She says she wasn't hungry at that limit because of her lack of mobility.

"Because I was so heavy, I had a lot of success really quickly. I lost 45 pounds between March and Memorial Day."

In October 2011, Borawski walked to her mailbox without a cane for the first time. Her next trip was to the neighbor's mailbox. The first time she walked down the steps at work, her student assistant cheered.