A new study from the US finds few young women being treated for cancer take steps to preserve their fertility, for instance so they can start a family later.
Dr Mitchell Rosen, of the University of California, San Francisco (UCSF), and colleagues, also found disparities among different groups of young women, with some more likely to take steps to freeze eggs or embryos than others.
Writing in the 26 March early online view of the journal Cancer, the researchers say their findings show there is a need to boost provisions of counseling on fertility preservation to women of reproductive age undergoing cancer treatment.
Rosen told the press:
"Although more women are getting counseled regarding reproductive health risks, many women are still not receiving adequate information about their options at the time of cancer diagnosis."
More than 120,000 women under the age of 50 are diagnosed with cancer every year in the US, where, as survival rates improve daily, concerns turn to quality of life post-cancer.
Many chemotherapy and other cancer treatments can leave a woman infertile or bring on early menopause, and should this happen she may regret losing her ability to have children.
But, with techniques like egg or embryo freezing more widely available than ever, women who have been diagnosed with cancer do have the option to improve their chances of conceiving again later.
To establish which women are taking advantage of these fertility preservation options, Rosen and colleagues surveyed women who had been diagnosed with cancer between the ages of 18 and 40 years, who were registered in the California Cancer Registry between 1993 and 2007.
The survey asked questions about acute ovarian failure, early menopause (before the age of 45), and failed conception.
The researchers focused on five cancer types: leukemia, Hodgkin's disease, Non-Hodgkin Lymphoma, breast cancer, and gastrointestinal cancer.
A total of 1,041 women responded to the survey, of which 918 had received treatments that could affect their fertility, such as chemotherapy, pelvic radiation, pelvic surgery, and bone marrow transplant.
The researchers examined the relationships between age, gender, ethnicity, and other sociodemographic characteristics and the odds of using fertility preservation services.
They found that 61% of the women received counseling on the risks that cancer treatment can have on their fertility from their doctor or other clinician.
Overall, only 4% of women took up the option of fertility preservation, although rates showed a tendency to increase over time. For example, in 1993, the take up rate was 1%, whereas in 2005 to 2007 it was between 6% and 10%.
Rosen said:
"Routine counseling regarding reproductive health risk and options for preserving reproductive potential will improve the quality of life among survivors, and the overall quality of care."
The researchers also found that certain groups were more likely to receive information about their reproductive health when they were diagnosed with cancer, and also more likely to take steps to preserve their fertility, than other groups.
The women most likely to receive counseling about the effects of cancer treatment on their fertility, and also most likely to preserve fertility beforehand, were younger, Caucasian, childless, heterosexual, and college educated.
Rosen and colleagues conclude that disparities in sociodemographic health characteristics likely affect women's access to fertility preservation services.
"An opportunity lies ahead to explore educational and policy interventions to ameliorate health disparities that may exist in the growing use of fertility preservation," said Rosen.
http://www.medicalnewstoday.com/articles/243441.php
The first volume of a "book of cancer knowledge" has been published, which scientists say will speed up the search for new cancer drugs.
The "encyclopaedia" details how hundreds of different cancer cells respond to anti-cancer agents.
UK, US and European researchers say the data, published in Nature, is a step towards tailoring cancer medicine to a patient's genetic profile.
A cancer charity said the work would help in testing new cancer drugs.
Cancer cells grown in the laboratory are an essential tool in cancer research.
Hundreds of different cell lines exist, allowing scientists to study the effect of new cancer drugs on the human body.
Now, a team at the Wellcome Trust Sanger Institute near Cambridge and various cancer institutes around the world have released two papers cataloguing data on hundreds of cancer cell lines.
The UK team, working with colleagues in the US, Paris and Switzerland, screened more than 600 cancer cell lines with 130 drugs, identifying genetic signatures linked with drug sensitivity.
Already clues are emerging that could be of benefit to patients, including the discovery that a rare bone cancer in children (Ewing's sarcoma) appears to be vulnerable to certain drugs.
Personalised medicine
Dr Mathew Garnett of the Sanger Institute is lead researcher on one of the two papers published in the journal Nature.
He told the BBC: "It's bringing together two very large and very powerful data sets and asking which cell line is the most sensitive and what is behind that sensitivity.
"This is the largest study of its kind linking drug response with genetic markers. You need these very large studies to identify small subsets of cells that are sensitive to drugs."
Dr Levi Garraway of The Broad Institute of Harvard and MIT, Cambridge, US, is a senior member of the research team behind the second paper, which profiled 24 drugs across nearly 500 cell lines.
He told the BBC: "Developing this large cell-line resource with all the associated genetic details is another piece in the pie to get us to our goal of personalised cancer medicine.
"We're trying to get smarter about understanding what the right drug is using the genetic information in each tumour. This is a stepping stone along the way."
The next step is use the information to help decide on tailored treatments for cancer patients.
This would involve getting a genetic "fingerprint" of their tumour, which could be matched to information in the database.
Some cancer drugs are already available for individuals with a certain genetic makeup.
The best known is Herceptin, a breast cancer drug that works in patients with an overactive HER2 gene.
Professor Charles Swanton, based at Cancer Research UK's London Research Institute, said the papers were "an invaluable resource" that provided "extremely useful intelligence" for cancer researchers.
He added: "This new resource will help speed up cancer research and may well begin to guide further developments in personalised cancer medicine."
http://www.bbc.co.uk/news/health-17537242
Doubts are being raised over government claims the NHS in England is making good progress on its savings target.
The health service has been told to find £20bn in savings by 2015 - the equivalent of 4% of its budget a year.
But it has been told that this saving must not come from cuts, but instead be made through productivity savings.
Financial results released this week suggested £5.8bn would be saved this year, but experts have questioned the extent of the savings.
The figure - quoted in the 2011-12 quarter three financial results - was hailed as "encouraging" by senior Department of Health officials.
If that level of saving is maintained it will mean the £20bn target is met.
Lack of detail
But Professor John Appleby, chief economist at the King's Fund think tank, said there was a lack of detail about where the savings were being made.
He said it seemed as if ministers were relying on the pay freeze and the cut in money given to hospitals to make a large chunk of the savings.
But he said this could have the effect of not incentivising staff to work as hard as they had done, while for hospitals the cuts could see them deliver services less well.
"These would not be productivity savings, they would be cuts," he added.
He also said the NHS faced a "pretty impossible" job in continuing to make gains in the long-term.
It emerged last week that senior NHS officials are working on the basis that the 4% yearly savings will continue after 2015.
David Stout, of the NHS Confederation, which represents managers, said while the figures were good news they were probably down to the easier savings.
He said the "most challenging" actions, such as major changes to the way hospitals were run, still remained.
But David Flory, deputy chief executive of the NHS, said the financial figures were "encouraging and show the NHS continues to deliver the best care for patients while maintaining a healthy financial position".
But he added: "It is vital that the NHS does not take its eye off the ball - the NHS is performing well to meet future challenges, and must continue to do so."
http://www.bbc.co.uk/news/health-17541803
The UK Supreme Court has made a ruling which could allow thousands of insurance claims by families of people who died after exposure to asbestos.
The court placed insurance liability at the time an employee was exposed to asbestos, not when symptoms appeared.
Relatives of workers who died of the cancer mesothelioma want to make claims on policies dating from the 1940s.
One insurance firm in the case said the ruling was not its "favoured outcome" but welcomed the clarity it brought.
The Association of British Insurers welcomed the ruling, and blamed a small group of insurers for the legal battle.
The Supreme Court was asked to rule on the issue after judges in lower courts failed to agree.
Families had a success in 2008, when the High Court said firms' insurers at the time workers inhaled fibres were liable.
But two years later the Court of Appeal said that in some cases liability was triggered when symptoms developed - which could be decades after exposure.
Lawyers said the appeal court ruling had left victims' families facing "confusion and uncertainty".
The new ruling by a panel of five Supreme Court justices states that the disease can be said to have been "sustained" by an employee in the period when it was caused or initiated.
One of the judges, Lord Clarke, said: "The negligent exposure of an employee to asbestos during the [insurance] policy period has a sufficient causal link with subsequently arising mesothelioma to trigger the insurer's obligation."
Unite, the largest trade union in Britain and the Irish Republic, welcomed the ruling, which it said will affect "many of the 2,500 people who are diagnosed with mesothelioma each year".
Unite's challenge was on behalf of the family of Charles O'Farrell, a retired member who died of mesothelioma in 2003.
Commenting on the Supreme Court's decision, Unite general secretary Len McCluskey said: "It is a disgrace that insurance companies went to such lengths to shirk their responsibilities."
Mr O'Farrell's daughter, Maureen Edwards, said: "This is the right decision. I am delighted for all those families who have been awaiting this result.
"My dad worked all his life and was hoping to enjoy retirement before mesothelioma took him away.
"There was never any question about who was to blame - all this long battle was about was insurers wanting to get out of paying."
Nick Starling, director of general insurance and health at the Association of British Insurers, said: "The ABI and our members are committed to paying compensation as quickly as possible to people with mesothelioma who have been exposed to asbestos in the workplace.
"We have always opposed the attempt to change the basis on which mesothelioma claims should be paid, as argued by those who brought this litigation.
"Today's ruling by the Supreme Court has confirmed what most in the industry have always understood - that the insurer on cover when the claimant was exposed to asbestos should pay the claim, rather than the insurer on cover when the mesothelioma develops.
'Financial security'
"This case has been pursued by a small group of 'run-off' insurers acting independently and at odds with the views of the majority of the UK insurance industry. [A "run-off" company is an insurance firm which is no longer accepting new business.]
One of the four insurance companies which contested the proposal to date liability back to the time of exposure was Municipal Mutual Insurance Limited.
It issued a statement saying: "Whilst the ruling does not reflect MMI's favoured outcome, we welcome the clarity this judgment brings as it enables MMI to determine the extent of its liabilities and the available options for the future of MMI and its business.
"MMI participated in the joint action in order to determine the extent of the Company's insurance liabilities under policies it wrote in the period up to September 1992 (the date the Company ceased writing new insurance business).
"MMI has continued to compensate local authority employers for Mesothelioma claims, despite not being obliged to pay out claims until the outcome of the case was known. The underlying claimants (the victims of the disease) who have received compensation from MMI have been paid in full and have not been disadvantaged in any way by the fact that this case was brought."
A lawyer representing the lead claimant, Ruth Durham, said the judgement provided "clarity, consistency and comfort" for the families of thousands of mesothelioma victims.
Helen Ashton from Irwin Mitchell said: "This judgment means that the thousands of people who are yet to be given the devastating news that they have the deadly illness will at least know that their families can get access to justice and receive the financial security they need.
"But the sad fact is that many victims of mesothelioma who have been awaiting the outcome of this appeal may not have lived long enough to know if their families will now receive the compensation they deserve."
She said asbestos-related disease caused more than 5,000 deaths every year.
The number of people affected by mesothelioma was still rising because of the time it can take for this illness to develop and was expected to peak around 2015, she added.
http://www.bbc.co.uk/news/world-17535887
A man who was given a face transplant after living for 15 years as a recluse is recovering well, US doctors say.
Richard Lee Norris is beginning to feel his face and is already brushing his teeth and shaving, according to the University of Maryland Medical Center.
Last week he was given what physicians say is the most extensive face transplant ever carried out, including new teeth, nose, tongue and jaw.
He has also regained his sense of smell, his doctors say.
The 37-year-old cut himself off from the rest of the world and wore a mask whenever he went outside after suffering horrific injuries in a gun accident.
The surgery was funded by the US Navy, which hopes the techniques will help casualties from Iraq and Afghanistan.
Surgeons who carried out the 36-hour operation said it was part of a series of transplant operations lasting 72 hours, using organs from one donor in five patients, including Mr Norris.
He lost his lips and nose in the accident, and only had limited movement of his mouth.
Lead surgeon Eduardo Rodriguez said Mr Norris would now get his life back.
"Our goal is to restore function as well as have aesthetically pleasing results," he said.
The US government estimates that 200 wounded troops might be eligible for face transplants.
The first face transplant was performed in France in 2005 on a woman who was mauled by her dog.
In 2010 surgeons in Spain carried out the world's first full-face transplant.
Face transplant surgery
http://www.bbc.co.uk/news/world-us-canada-17534646
Immediately giving someone having a heart attack a dose of glucose mixed with insulin and potassium (known as "GIK") could reduce their chance of cardiac arrest or dying by 50%, according to new research presented at the American College of Cardiology's 61st Annual Scientific Session in Chicago this week.
Dr Harry P. Selker, executive director of the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, led the study with co-principal investigator and project director Dr Joni Beshansky.
Selker told the press:
"Acute coronary syndromes represent the largest cause of death in this country. GIK is a very inexpensive treatment that appears to have promise in reducing those deaths and morbidity."
GIK contains glucose, to provide the heart with fuel when there is a reduced blood supply, and insulin to help move the glucose into the cells. Potassium is added because infusing glucose with insulin can cause potassium levels to become too low.
The trial, called the "IMMEDIATE Trial", is the first to show GIK is an effective treatment for use by paramedics in "real world community settings" said Selker, and as such may have important implications for how we treat heart attacks.
IMMEDIATE stands for Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care.
It is the first trial to give patients GIK at the very first signs of an impending heart attack, while they are still in the community, rather than waiting until they reach hospital and undergo diagnosis.
"When started immediately in the home or on the way to the hospital - even before the diagnosis is completely established - GIK appears to reduce the size of heart attacks and to reduce by half the risk of having a cardiac arrest or dying," said Selker.
He said previous trials using GIK have shown patchy results, probably because it was administered too late.
The treatment costs about $50.
The researchers trained paramedics working in 36 Emergency Medical Services systems in 13 cities around the US how to administer GIK to a patient after first establishing they were about to have or were in the throes of having a heart attack.
To decide whether GIK would be likely to help, the paramedics had to first use an electrocardiograph-based acute cardiac ischemia time-insensitive predictive (ACI-TIPI) instrument and interpret the accompanying thrombolytic predictive instrument decision support that prints patient-specific predictions on the top of the electrocardiogram.
From those predictions the paramedics could then decide whether patients were likely to benefit from GIK treatment.
Altogether, 911 patients took part in the study. They were randomly assigned to receive either GIK or a placebo.
The results showed that compared to patients treated with a placebo, those who received GIK straight after being diagnosed with acute coronary syndrome (a group of symptoms that indicates a heart attack is either about to happen or is already happening), were 50% less likely to experience cardiac arrest, where the heart stops beating, or die. This was in spite of the fact the GIK did not stop the heart attack from occuring.
And, for the first month afterwards, patients who received GIK were 40% less likely to experience cardiac arrest, die, or have to be hospitalized due to heart failure.
For patients experiencing ST-elevation heart attacks, which require immediate treatment, the effect was even more striking: those receivng GIK had a 60% reduced likelihood of cardiac arrest or death.
Giving GIK immediately also reduced the severity of heart tissue damage due to the heart attack.
In patients receiving placebo, 10% of the heart tissue was damaged, on average, compared to 2% for those who received GIK.
Plus, GIK did not appear to harm the 23% of patients whose suspected heart attacks turned out later to be false alarms.
Selker said more people die of heart attacks outside hospitals than inside them. He and his colleagues wanted to do something about that, and come up with something effective that can be used anywhere.
"Hundreds of thousands of people per year are dying out in the community; we wanted to direct our attention to those patients," he said.
The team are following up the study participants at six and 12 months to evaluate the long-term effects of GIK.
The National Heart, Lung and Blood Institute, which are part of the National Institutes of Health, funded the study.
source:http://www.medicalnewstoday.com/articles/243496.php
Rates of stroke and kidney failure in people with diabetes have surged in England, according to new analysis by Diabetes UK.
An audit of 1.9 million people with Type 1 and Type 2 diabetes found more than 13,000 had a stroke in 2009-10, a 57% rise from 2006-7.
And more than 7,000 had kidney failure, up 31% from 2006-7.
Barbara Young, chief executive of the charity, said the rates of the complications were "shocking".
Across the UK, 2.9 million people have diabetes, and another 850,000 are believed to have undiagnosed Type 2 diabetes.
A recent survey by the charity suggested almost a quarter of people with diabetes were unaware of having had their kidney function checked in the previous year, while 7% had not had their blood pressure checked.
Barbara Young said: "It is shocking that rates of strokes and kidney failure in people with diabetes are now at record levels and yet thousands of people are still not getting the health checks that can help prevent them.
"These figures are a reminder that all people with diabetes should have these checks every year, as this is the simplest and most effective way of reducing risk of complications such as stroke and kidney failure.
"We also need to get the message across to people with diabetes that they should demand these checks if they are not already getting them.
"Stroke and kidney failure are complications that hugely reduce quality of life for many people with diabetes, while the cost of treatment far exceeds that of the simple checks that can help prevent them developing in the first place."
source:http://www.bbc.co.uk/news/health-17487431
FRIDAY, March 23 (HealthDay News) -- In the past decade, the number of children receiving a diagnosis of attention-deficit hyperactivity disorder (ADHD) has risen by 66 percent, new research indicates.
In 2000, just 6.2 million physician office visits resulted in a diagnosis of ADHD. By 2010, that number had jumped to 10.4 million office visits.
"This study is really like a 10,000 foot aerial view of this issue," said study author Dr. Craig Garfield, an assistant professor of pediatrics and medical social sciences at Northwestern University in Chicago. "We looked at the trends in visits to doctors for ADHD over the last decade, and we were interested in overlaying some of the FDA's public health advisories and the introduction of new medications to see the effect on those trends."
The findings are published in the March/April issue of Academic Pediatrics.
ADHD is now a common condition in children and teenagers in the United States, according to background information in the study. The parent-reported incidence of the disorder is about 10 percent, or 5.4 million children. Symptoms of ADHD include an inability to focus, trouble controlling emotions and hyperactive behavior, according to the National Institute of Mental Health (NIMH).
Treatment for ADHD may include medications -- usually stimulant drugs -- and behavioral therapies, according to the NIMH. However, new medications -- and new health concerns -- altered treatment decisions over the decade studied.
In 2002, a nonstimulant medication, Strattera (atomoxetine), was approved for use in ADHD. In 2005, the U.S. Food and Drug Administration issued warnings that sudden death and suicidal thinking had been linked to Strattera. That same year, the FDA also expressed concern about a potential link between amphetamine-dextroamphetamine (Adderall) and cardiovascular risks, as well as adverse psychiatric symptoms. That same warning was extended to all approved ADHD medications in 2007, according to the study.
For their study, Garfield and his colleagues reviewed data from a national database from 2000 to 2010. They examined office visits for patients younger than 18.
In addition to finding a 66 percent increase in the number of office visits resulting in an ADHD diagnosis, they also found that more children were being treated for ADHD by child psychiatrists than by pediatricians. At the start of the study, about one in four children saw a psychiatrist for their condition. By the end of the study, more than one in three was visiting a psychiatrist for ADHD.
Despite possible concerns about safety, stimulant medications remain the mainstay of treatment. In 2000, 96 percent were treated with these medications, while 87 percent were receiving stimulant medication for their ADHD symptoms in 2010, the study found.
The use of Strattera, a nonstimulant drug, dropped from 15 percent in the year it was introduced (2002) to 6 percent by 2010. The use of other nonstimulant treatments, such as clonidine (Catapres/Kapvay/Nexiclon), guanfacine (Intuniv/Tenex) and Wellbutrin (buproprion), was relatively constant, but reached a high of 13 percent in 2010 following the introduction of extended-release Intuniv, the researchers found.
One previous study, published online last September in the American Journal of Psychiatry, found that about 2.8 million children were taking ADHD medications. Those authors said their use has risen gradually, likely because more teenagers are taking these medications.
The authors of the current study don't think there's suddenly been a dramatic rise in the number of children with ADHD, but instead believe that public awareness campaigns, media coverage of ADHD and advertisements for new medications are probably some of the driving factors behind the rise in diagnoses.
"There's more of an awareness on the part of the parents about this disease," said Garfield.
He said that the authors don't know why more people are taking their children to see psychiatrists for treatment, but said if the trend continues, parents may have trouble finding a doctor to care for their child's ADHD, given the shortage of psychiatrists.
Other experts agreed that the incidence of ADHD probably isn't going up that quickly. "I don't think these data reflect true prevalence. I think it's the total frequency of visits related to ADHD is going up," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park, N.Y.
"The American Academy of Pediatrics is encouraging pediatricians to play a more active role in the diagnosis and treatment of ADHD, so it's interesting to see that psychiatrists over time are now treating more," he said. "Pediatricians may be referring more, or as safety concerns have been raised by the FDA, it may be that families prefer to see a specialist."
source:http://health.usnews.com/health-news/news/articles/2012/03/23/adhd-diagnosis-rates-rose-sharply-in-past-decade?page=2
In terms of health, where you live can make a huge difference, according to a detailed study by the nonprofit Commonwealth Fund.
It looked at 43 indicators of health system performance in four major areas: access, prevention and treatments, costs and potentially avoidable hospital use, and health outcomes. The nation is broken down into 306 local health markets; their boundaries are determined by the service areas of local hospitals.
The list of the nation's top 10 local markets was dominated by Midwestern cities, according to the Fund's Scorecard on Local Health System Performance. Minnesota claimed four of the top spots, and California and Wisconsin each had two. Here are the top 10 local healthcare markets:
St. Paul, Minn.
Dubuque, Iowa
Rochester, Minn.
Minneapolis
Appleton, Wis.
Santa Rosa, Calif.
La Crosse, Wis.
St. Cloud, Minn.
Manchester, N.H.
San Mateo County, Calif.
"The report finds that access, quality, costs, and health outcomes all vary significantly from one local community to another," the Scorecard said, "often with a two- to threefold variation in key indicators between leading and lagging communities."
Cathy Schoen, a senior vice president at the Commonwealth Fund, says the report shows that a region's health system's performance reflects the importance of cooperation and communication among local health providers. Patients' medical literacy varies. They move in and out of different care settings and see multiple doctors and healthcare professionals. Their treatment needs and oversight can easily fall through the cracks.
Among the 43 indicators, Schoen mentioned nine that she felt deserved special attention.
1. Percent of adults ages 18–64 with health insurance: Best 94.6 percent; worst 46.8 percent. Top three: Boston; Springfield, Mass.; Worcester, Mass.
"We have huge areas of the country where more than one in four or one in five adults are uninsured," Schoen says. Such communities tend to generate higher use of emergency rooms and poorer health outcomes. When people don't have health insurance, "it pulls down the quality of care in the entire community," she says.
2. Percent of adults age 50 and older who received recommended screening and preventive healthcare services: Best 58.8 percent; worst 26.0 percent. Top three: Arlington, Va.; Manchester, N.H.; Worcester, Mass.. Even the best markets could do a lot better, the Scorecard says.
3. Percent of Medicare beneficiaries who received at least one drug that should be avoided in the elderly: Best 11.4 percent; worst 44.0 percent. Top three: Bronx, N.Y.; East Long Island, N.Y.; White Plains, N.Y.
4. Percent of Medicare beneficiaries with dementia, hip/pelvic fracture, or chronic renal failure who received prescription in an ambulatory care setting that is contraindicated for that condition: Best 9.5 percent; worst 30.6 percent. Top three: Portland, Maine; Rochester, Minn.; Santa Cruz, Calif. "These two measures are signs that physicians are not always practicing evidence-based medicine and may not be up on the latest treatments," Schoen says. "It also can be a sign of patients seeing more than one physician and the physicians not talking to each other."
5. Hospital readmissions within 30 days of discharge as percent of all admissions among Medicare beneficiaries: Best 12.5 percent; worst 24.8 percent. Top three: Bend, Ore.; Ogden, Utah; Rapid City, S.D. There are several overlapping causes for high readmissions rates, Schoen says. Patients may have been discharged too early or left the hospital with an infection. They, their families, or their doctors may not have been given the proper care instructions.
6. Potentially avoidable emergency room visits among Medicare beneficiaries, per 1,000 beneficiaries: Best 129; worst 294. Top three: Everett, Wash.; Grand Junction, Colo.; Santa Cruz, Calif.. Because Medicare beneficiaries by definition have health insurance, the reasons for unnecessary visits tend to involve incorrect or confusing diagnoses by healthcare professionals or poor access and communications between providers and patients.
7. Potentially preventable mortality, deaths per 100,000 population: Best 51.5; worst 169.0. Top three: Boulder, Colo.; Everett, Wash.; Grand Junction, Colo. This measure includes conditions affecting people at different ages. For older patients, Schoen says, "even if they have a chronic condition, it shouldn't reach the stage" of causing a premature death if they receive proper care.
8. Percent of adults who smoke: Best 6.2 percent; worst 30.9 percent. Top three: Provo, Utah; San Mateo, Calif.; Santa Barbara, Calif.
9. Percent of adults ages 18–64 who are obese: Best 15.3 percent; worst 45.6 percent. Top three: Boulder, Colo.; Bridgeport, Conn.; San Francisco.
source:http://money.usnews.com/money/blogs/the-best-life/2012/03/23/how-good-is-your-communitys-healthcare
Funding for research into dementia is to be doubled by 2015 to try to make the UK a world leader in the field, David Cameron is due to announce.
The prime minister is expected to say in a speech that the level of diagnosis, understanding and awareness of dementia is "shockingly low."
Dementia is thought to affect around 800,000 people in the UK, with the cost to society estimated at £23bn.
In the next decade, the number with the disease is expected to top one million.
Continue reading the main story
“
Start Quote
Dementia is simply a terrible disease. And it is a scandal that we as a country haven't kept pace with it”
David Cameron
Prime Minister
Mr Cameron will set out plans to step up research into cures and treatments and to ensure that the health and social care systems are equipped to deal with the problem.
Overall funding for dementia research in 2010 totalled £26.6m. Under the plan for 2015, it will be £66m.
Mr Cameron will say: "One of the greatest challenges of our time is what I'd call the quiet crisis, one that steals lives and tears at the hearts of families, but that relative to its impact is hardly acknowledged.
"Dementia is simply a terrible disease. And it is a scandal that we as a country haven't kept pace with it.
"The level of diagnosis, understanding and awareness of dementia is shockingly low. It is as though we've been in collective denial."
The prime minister will say that the costs associated with the disease are already higher than those for cancer, heart disease or stroke.
"So my argument today is that we've got to treat this like the national crisis it is. We need an all-out fightback against this disease, one that cuts across society.
"We did it with cancer in the 70s. With HIV in the 80s and 90s. We fought the stigma, stepped up to the challenge and made massive in-roads into fighting these killers.
"Now we've got to do the same with dementia. This is a personal priority of mine, and it's got an ambition to match.
"That ambition: nothing less than for Britain to be a world leader in dementia research and care."
"Drastic costs"
Shirley Cramer, acting chief executive of Alzheimer's Research UK, said Mr Cameron's announcement was an "important step" in recognising and solving the challenge presented by dementia.
"David Cameron's announcements are a turning point in our battle to defeat dementia," she said.
"Of course, investment must continue to increase if we are to avert the drastic economic costs of dementia that lie in wait.
"Alzheimer's Research UK looks forward to working with the government to ensure that this new funding achieves what is so desperately needed - new treatments and therapies."
Jeremy Hughes, chief executive of the Alzheimer's Society, said the announcement would mark an "unprecedented step" towards making the UK a world leader in tackling dementia.
"Doubling funding for research, tackling diagnosis and calling for a radical shift in the way we talk, think and act on dementia will help to transform lives," he added.
"There are currently 800,000 people with dementia, yet too many are not able to live well with the condition. The PM is leading the way, but from Plymouth to Preston, from the boardroom to bus drivers, we all have a role to play."
Sir Mark Walport, director of the Wellcome Trust, said: "Rising to this challenge will require excellence in medical research, so we can better understand the biology of dementia and use that insight to improve diagnosis and treatment.
But local council leaders warned there was a "very real crisis" in the provision of care for the elderly and vulnerable.
David Rogers, chairman of the Local Government Association's community wellbeing board, said: "We now need politicians to transcend political point-scoring and wake up to the ticking demographic time bomb this country is facing.
"There needs to be urgent action to ensure the way we offer support to older people is fairer, simpler and fit for purpose in order to truly meet the needs of the most vulnerable members of our society."
source:http://www.bbc.co.uk/news/health-17507678
Nearly one in seven people are diagnosed with a sinus infection each year. Although sinus infections are the fifth leading reason for antibiotic prescriptions, 90 to 98 percent of cases are caused by viruses, which are not affected by antibiotics. Used inappropriately, antibiotics foster the development of drug-resistant superbugs.
"There is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, so many physicians prescribe antibiotics 'just in case,'" said Anthony W. Chow, MD, chair of the guidelines panel and professor emeritus of infectious diseases at the University of British Columbia, Vancouver. "However, if the infection turns out to be viral - as most are - the antibiotics won't help and in fact can cause harm by increasing antibiotic resistance, exposing patients to drug side effects unnecessarily and adding cost."
The guidelines - the first developed by IDSA on this topic - provide specific characteristics of the illness to help doctors distinguish between viral and bacterial sinus infections. A sinus infection, called acute rhinosinusitis, is inflammation of the nasal and sinus passages that can cause uncomfortable pressure on either side of the nose and last for weeks. Most sinus infections develop during or after a cold or other upper respiratory infection, but other factors such as allergens and environmental irritants may play a role.
The guidelines recommend treating bacterial sinus infections with amoxicillin-clavulanate versus the current standard of care, amoxicillin. The addition of clavulanate helps to overcome antibiotic resistance by inhibiting an enzyme that breaks down the antibiotic. The guidelines also recommend against using other commonly used antibiotics, including azithromycin, clarithromycin and trimethoprim-sulfamethoxazole, due to increasing drug resistance.
The recommendation to use amoxicillin-clavulanate instead of amoxicillin is a major shift from older guidelines developed by other organizations. Dr. Chow notes that this recommendation was made due to increases in antibiotic resistance as well as the common use of pneumococcal vaccines, which have changed the pattern of bacteria that cause sinus infections.
The IDSA guidelines use the new GRADE system (Grading of Recommendations Assessment, Development and Evaluation), which is designed to more clearly assess the quality of evidence and strength of recommendations. The new IDSA guidelines note that randomized controlled trials referenced in previous guidelines often don't differentiate between bacterial and viral cause of infection, and therefore may not provide the best recommendations.
"These are the first evidence-based rhinosinusitis guidelines using the GRADE system," said Thomas M. File Jr., MD, co-author of the guidelines and chair of the Infectious Disease Section at Northeast Ohio Medical University, Rootstown, Ohio. "Health care providers face difficulties when treating sinus infections, and these guidelines provide the best recommendations available. The guidelines are transparent, clearly stating the level of evidence for each recommendation and pointing out where we need more research."
The IDSA rhinosinusitis guidelines contain a number of other recommendations, including:
How to tell the difference - The guidelines note a sinus infection is likely caused by bacteria and should be treated promptly with antibiotics if:
symptoms last for 10 days or more and are not improving (previous guidelines suggested waiting seven days); or
symptoms are severe, including fever of 102 or higher, nasal discharge and facial pain lasting 3-4 days in a row; or
symptoms get worse, with new fever, headache or increased nasal discharge, typically after a viral upper respiratory infection that lasted five or six days and initially seemed to improve.
Shorter treatment time - Most guidelines to date have recommended 10 days to two weeks of antibiotic treatment for a bacterial infection. However, the IDSA guidelines suggest five to seven days of antibiotics is long enough to treat a bacterial infection without encouraging resistance. The IDSA guidelines still do recommend children receive antibiotic treatment for 10 days to two weeks.
Avoid decongestants and antihistamines - Whether the sinus infection is bacterial or viral, decongestant and antihistamines are not helpful and may make symptoms worse. Nasal steroids can help ease symptoms in people who have sinus infections and a history of allergies.
Saline irrigation may help- The guidelines note nasal irrigation using a sterile solution - including sprays, drops or liquid - may help relieve some symptoms. However, the guidelines note this may not be helpful in children because they are less likely to tolerate the discomfort of the therapy.
To ease symptoms of a sinus infection, Dr. File said he recommends patients take acetaminophen for sinus pain, use saline irrigation and drink plenty of fluids.
The voluntary guidelines are not intended to take the place of a doctor's judgment, but rather support the decision-making process, which must be individualized according to each patient's circumstances.
source:http://www.medicalnewstoday.com/releases/243186.php
An order to move, living beings need muscles, and, more specifically, skeletal muscles that are controlled by the nervous system. Skeletal muscles are composed of cylindrical muscle fibres with a multitude of peripheral nuclei. Until now, little was known about the mechanism used to position nuclei on the edge of muscle fibres. A team of French-American researchers has tried to better understand the reasons behind nuclei layout.
Edgar Gomes and his team of collaborators have identified the mechanism involved in positioning nuclei in muscle fibres.
The researchers identified (in Drosophila and mice) two proteins involved in positioning the nuclei: protein Kif5B, which belongs to the kinesin family (molecular motor), and protein MAP7, which is used to move different organelles in cells.
This result was achieved by mutating MAP7 and Kif5b protein-coding genes in the Drosophila and by studying the development of the embryo. In this case, they observed that the nuclei were not correctly aligned in the muscle fibres.
"MAP7 is required to position nuclei in muscle fibre in Drosophila and in mammals" states Edgar Gomes, Inserm researcher. The research team succeeded in describing the nuclei-positioning mechanism in fibres, which involved the MAP7 protein and its interaction with the molecular motor: kinsin Kif5b. They demonstrated that a mutation of these proteins did not affect muscle extension or its attachment to the skeleton: only the position of the nuclei was affected.
By making both proteins interact together, Edgar Gomes' team suggest that MAP7 binds with Kif5b to encourage nuclei positioning. "Furthermore, these proteins act together, both physically and genetically, and their physical bond is required for correct nuclei positioning. Our results show that they are required for the muscle to function correctly" underlines Edgar Gomes.
Muscular diseases lead to weaknesses in the fibres and can be associated with a cellular nuclei alignment failure. Edgar Gomes and his team have demonstrated that by correctly replacing the nuclei, the muscle recovers its functions. "We suggest that by correcting muscular positioning faults in patients suffering from myopathies, these patients may see improvements in their muscular functioning" concludes Edgar Gomes.
source:http://www.medicalnewstoday.com/releases/243185.php
