Contact: Amy Jenkins
University of Chicago Press Journals
ALEXANDRIA, Va. — US soldiers in Iraq do not carry the bacteria responsible for difficult-to-treat wound infections found in military hospitals treating soldiers wounded in Iraq, according to an article to be published electronically on Wednesday, May 16, 2007, in Infection Control and Hospital Epidemiology. The article will appear in the June issue of the journal.
Investigator Matthew E. Griffith, MD, (Brooke Army Medical Center at Fort Sam Houston, San Antonio, Texas) and colleagues found that drug-resistant strains of Acinetobacter calcoaceticus-baumannii complex are not present on the skin of uninjured soldiers in Iraq, as had been expected.
A. calcoaceticus-baumannii complex is an important cause of trauma-associated and hospital-acquired infection throughout the world, and multidrug-resistant strains of the bacteria have been infecting injured soldiers treated in US military hospitals in Iraq.
“We need to know where these infections are coming from,” explains Dr. Griffith. “One of the possibilities was that A. calcoaceticus-baumannii was on the soldiers’ skin before injury and simply traveled to the wound site to cause the infection. However, our research shows that this is not the case.”
Although the consequences of the outbreak A. calcoaceticus-baumannii infection in US military hospitals serving soldiers wounded in Iraq are well described, the source of the outbreak is unknown.
To determine whether A. calcoaceticus-baumannii complex is carried on the skin of healthy US Army soldiers, investigators cultured skin swab specimens from 102 active military soldiers stationed at a base in Iraq. The base is in an environment representative of all Iraqi environments with desert, irrigated farmland and an urban area nearby.
Several previous reports have described skin carriage of Acinetobacter species in healthy people. The carriage rates have been found to vary with climate and geography. These reports may not be generalizable to US Army soldiers in Iraq, which has an extremely dry climate.
“If skin carriage is not the source of A. calcoaceticus-baumannii complex infection, then the other possibility is that the bacteria contaminates the wounds after injury,” explains Dr. Griffith. “This could happen while an injured soldier is awaiting treatment or in the hospital during or after receiving medical care.”
“This observation refutes the concept that the bacterium is acquired prior to injury among soldiers deployed to Iraq,” Dr. Griffith says. “In addition, this observation adds to the ever growing body of evidence implicating nosocomial transmission as the cause of the ongoing military outbreak.”
Because of this and similar research, an increased emphasis on infection control has been put in place in the US military’s combat hospitals.
Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. Written by infection control practitioners and epidemiologists and guided by an editorial board composed of the nation’s leaders in the field, ICHE provides a critical forum for this vital information.
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Scientists have shown that a single 2.5mg dose of vitamin D may be enough to boost the immune system to fight against tuberculosis (TB) and similar bacteria for at least 6 weeks. Their findings came from a study that identified an extraordinarily high incidence of vitamin D deficiency amongst those communities in London most at risk from the disease, which kills around two million people each year.
The research, funded by the Wellcome Trust, the Department of Environmental Health at Newham Council and Newham University Hospital NHS Trust Respiratory Research Fund, is published online in the American Journal of Respiratory and Critical Care Medicine.
Whilst a diet of oily fish can provide some vitamin D, the main source of the body’s vitamin D comes from exposing the skin to sunlight. In Britain, however, the amount of sunlight is usually insufficient to make vitamin D in the skin between October and April, and much of the population becomes deficient during the winter and spring.
Researchers from Queen Mary’s School of Medicine and Dentistry, London, and the Wellcome Trust Centre for Research in Clinical Tropical Medicine, Imperial College London, studied patients at Newham University Hospital and Northwick Park Hospital in London who had been exposed to TB. They found that over 90% of such patients had a vitamin D deficiency.
Vitamin D was used to treat TB in the pre-antibiotic era, when special sanatoria were built in sunny locations, such as the Swiss Alps. But until now, no study has evaluated the effect of vitamin D supplementation on immunity to mycobacteria, the family of bacteria that cause TB.
The researchers performed a randomised control trial on a group of volunteers who were given either a 2.5mg supplement or a placebo. Samples of the volunteers’ blood were then tested in Dr Robert Wilkinson’s Wellcome Trust-funded laboratory at Imperial College, to see whether the supplement affected the immune system’s ability to withstand infection by mycobacteria.
“We found that a single large dose of vitamin D was sufficient to enhance a person’s immunity to the bacteria,” says Dr Adrian Martineau from Imperial College London, who co-ordinated the study. “This is very significant given the high levels of vitamin D deficiency in people at the highest risk of TB infection, and shows that a simple, cheap supplement could make a significant impact on the health of people most at risk from the disease.”
According to the Health Protection Agency, the incidence of TB in the UK is increasing, with around 8,000 new cases a year. Cases in the UK are predominantly confined to the major cities and about 40 per cent of all cases are in London. TB is also a major global problem: an estimated one-third of the world’s population – nearly two billion people – are infected. Nine million people a year develop the active disease worldwide, which kills two million each year.
“Most cases of TB in London arise from people who have already become infected with the bacteria but in whom it lies latent,” says Professor Chris Griffiths from Queen Mary’s School of Medicine and Dentistry. “Our results indicate that vitamin D supplementation may prevent reactivation of latent TB. Identifying people with latent TB and providing supplements could be an important strategy for tackling the disease.”
Treatment is both very cheap – about 60p per dose or 10p per week – and safe. Vitamin D supplements could be prescribed for patients with or at risk of latent TB through GP surgeries.
Dr Martineau points out: “Our work adds to the growing evidence that vitamin D may have a wide range of important health benefits, including preventing falls and fractures and reducing risk of cancer and diabetes, as well as boosting the immune system against infection. Population-wide supplementation needs to be considered by public health planners.”
“Milk and orange juice could be fortified with vitamin D, as in the US and Canada,” he says. “At present only margarine is supplemented in the UK, and recent studies show that this is not an effective way to prevent vitamin D deficiency.”
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Swedish researchers have found a way to increase the weight of people with Alzheimer’s, by improving communication and patient involvement, altering meal routines and providing a more homely eating environment
During the three-month study, published in the May issue of Journal of Clinical Nursing, 13 of the 18 patients in the intervention group put on weight, compared with just two of the 15 patients in the control group.
Patients who gained weight also displayed improved intellectual abilities.
“Weight loss is a common issue among people with dementia and in particular Alzheimer’s” explains lead researcher Anna-Greta Mamhidir from the Karolinska Institutet in Stockholm, Sweden.
“Meal environment, communication difficulties, loss of independence and confusion are just some of the factors that appear to contribute to this problem.
“Malnutrition can also lead to other serious issues, such as increased infection rates, delayed wound healing and increased risk of hip fractures.”
The aim of the study was to measure weight changes in patients with moderate and severe dementia and analyse whether providing staff training and a more supportive environment could lead to weight gain.
Two nursing home wards with similar staffing profiles and numbers of patients were selected. Both received meals from the same central kitchen.
The medical profiles of the two groups of patients were similar and drug regimes were unaltered during the study. Most of the patients had communication problems and memory loss and were physically dependent on staff.
Patients in the intervention group weighed between 31.5kg and 76kg at the start of the study, with an average weight of 55.9kg. By the end of the study this average had risen to 56.4kg.
When the team looked at individual patients they found that the largest weight gain in the intervention group was 7kg (15.4 pounds) and the smallest was 0.6kg (1.3 pounds).
Patients in the control group weighed between 45kg and 76.3kg at the start of the study, with an average weight of 62.5kg. This average fell to 58.4kg over course of the study.
Staff in the intervention group attended a one-week training course run by a psychologist and professor of nursing science. It comprised 20 hours of lectures and 18 hours of group discussion covering three key themes: delivering care in a way that promotes the patient’s integrity, how to communicate more effectively with patients with dementia and how to create a calmer and more homely environment.
During the study, the staff who had received training were asked to keep diary notes of any changes and they effect they had on patients. They also received support and encouragement from a research assistant, who spent most days on the ward, and a nurse researcher who visited the ward three to four times a week.
“We felt that this level of involvement in the project would make it easier for staff to accept and implement these new ideas” says Anna-Greta Mamhidir.
New pictures were placed on the dining room walls and staff worked with patients to print new patterns on curtains and tablecloths.
Patients’ rooms were given name plates, they were encouraged to have more private items in their rooms and staff wore brightly coloured clothes.
The prepared trays sent by the kitchen were replaced with serving bowls and patients were encouraged to help themselves.
No changes were made to the control ward.
Staff on the intervention ward noted in their diaries that the changes increased the contact between patients and staff and created a more pleasant atmosphere.
“Patients took part in activities, sat at the table together during mealtimes and served themselves food from bowls, encouraging them to be more independent and interact more with other patients” says Anna-Greta Mamhidir.
“The initiative was so successful that staff on the control ward were given the same training at the end of the study so that they could make the same improvements on their ward.”
Roger Watson, editor of Journal of Clinical Nursing, says that the research carried out by Mamhidir and colleagues makes a significant contribution to the field of food and dementia and has congratulated them for delving into what is a complex and difficult area.
“Societies are ageing and debates about food and old people and food and dementia – which are regular topics in the Journal – can only increase” he says.
“The current study shows a marked difference in weight change between the intervention and control groups and a strong link between weight gain and improved intellectual ability.
“I hope that it will stimulate further lines of enquiry as there is a vital need to improve nutrition among elderly patients, particularly those with Alzheimer’s and other forms of dementia.”
Notes to editors
Weight increase in patients with dementia and alteration in meal routines and meal environment after integrity promoting care. Mamhidir et al. Journal of Clinical Nursing.16, 987-996.
Founded in 1992, Journal of Clinical Nursing is a highly regarded peer reviewed Journal that has a truly international readership. The Journal embraces experienced clinical nurses, student nurses and health professionals, who support, inform and investigate nursing practice. It enlightens, educates, explores, debates and challenges the foundations of clinical health care knowledge and practice worldwide. Edited by Professor Roger Watson, it is published 10 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. http://www.blackwellpublishing.com/jcn
Blackwell Publishing is the world’s leading society publisher, partnering with 665 medical, academic, and professional societies. Blackwell publishes over 800 journals and has over 6,000 books in print. The company employs over 1,000 staff members in offices in the US, UK, Australia, China, Singapore, Denmark, Germany and Japan and officially merged with John Wiley & Sons, Inc’s Scientific, Technical and Medical business in February 2007. Blackwell’s mission as an expert publisher is to create long-term partnerships with our clients that enhance learning, disseminate research, and improve the quality of professional practice. For more information on Blackwell Publishing, please visit http://www.blackwellpublishing.com or http://www.blackwell-synergy.com.
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Contact: Alexander Storch
JAMA and Archives Journals
Small doses of the antioxidant coenzyme Q10 appear to increase blood levels of this naturally occurring compound in patients with Parkinson’s disease, but does not improve Parkinson’s disease symptoms, according to an article posted online today that will appear in the July 2007 print issue of Archives of Neurology, one of the JAMA/Archives journals.
Parkinson’s disease is a neurodegenerative disorder characterized by tremors and difficulty with walking or other movements. The biological mechanisms underlying the condition are not fully understood, but researchers suspect a malfunction of the mitochondria, parts of the cells that help convert food to energy, according to background information in the article. Coenzyme (CoQ10), an antioxidant sold as a dietary supplement, is also involved in mitochondrial processes. “Because of these functions, CoQ10 has attracted attention concerning neuroprotective actions in neurodegenerative disorders linked to mitochondrial defects or oxidative [oxygen-related] stress, such as Huntington’s disease and Parkinson’s disease,” the authors write. Previous studies indicate that high doses of CoQ10 (1,200 milligrams) may slow the deterioration associated with Parkinson’s disease.
Alexander Storch, M.D., of the Technical University of Dresden, Germany, and colleagues conducted a randomized clinical trial of a 300-milligram dose of CoQ10 in 131 patients with Parkinson’s disease who did not have changes in motor functions and were on stable treatment for their condition. Those assigned to the treatment group took 100 milligrams of CoQ10 three times daily for three months, followed by a two-month “washout” period. The researchers assessed Parkinson’s disease symptoms before treatment began, each month during treatment and again after the washout period. Blood tests were performed at the beginning of the study, after three months of treatment and after the washout period.
A total of 106 patients completed the full three months of the study—55 in the CoQ10 group and 51 in the placebo group. The compound was well tolerated overall, and the percentage of patients who experienced adverse effects—including viral infection, diarrhea and hearing loss—did not differ between the two groups. Blood levels of CoQ10 increased in the treatment group from an average of 0.99 milligrams per liter to an average of 4.46 milligrams per liter after three months.
“Although we demonstrated a significant increase in plasma levels of CoQ10 toward levels observed with high doses of standard CoQ10 formulations in Parkinson’s disease and other disorders, our study failed to show improvement of Parkinson’s disease symptoms and did not meet its primary or secondary end points,” which were changes on scales that measured Parkinson’s disease symptoms and their effects on physical and mental functioning, the authors write. “Our study further demonstrated that 300 milligrams per day of nanoparticular CoQ10 is safe and well tolerated in patients with Parkinson’s disease already taking various antiparkinsonian medications.”
“Since we did not find symptomatic effects of CoQ10 in Parkinson’s disease, our study does not support the hypothesis that restoring the impaired energy metabolism of the diseased dopaminergic neurons leads to symptomatic benefits in Parkinson’s disease,” the authors conclude. “Future studies will need to explore the protective effects of CoQ10 at the highest effective dose (equivalent to about 2,400 milligrams per day of a standard formulation) over a long treatment period and in a large cohort of patients both sufficient to clearly define the protective potential of this compound in Parkinson’s disease.”
(Arch Neurol. 2007;64:(doi:10.1001/archneur.64.7.nct60005). Available pre-embargo to the media at http://www.jamamedia.org.)
Editor’s Note: This study was supported by a grant from the Deutsche Parkinson-Vereinigung eV (German Parkinson Association), Neuss, Germany, and MSE Pharmazeutika GmbH, Bad Homburg, Germany. The co-enzyme Q10 and matching placebo were formulated and packaged without charge by MSE Pharmazeutika. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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JAMA and Archives Journals
A small pilot study suggests that testosterone treatment is safe, well tolerated and may reduce symptoms, slow brain degeneration and increase muscle mass in men with relapsing-remitting multiple sclerosis, the most common form of the disease, according to a report in the May issue of Archives of Neurology, one of the JAMA/Archives journals.
Multiple sclerosis is a progressive disease involving the immune and central nervous systems. MS and many other autoimmune diseases (in which the body attacks its own systems or tissues) are less common in men than in women, according to background information in the article. This is especially true during reproductive years. Sex hormones, including testosterone and estrogen, may be responsible for the difference. Testosterone has been shown to protect against an MS–like condition and other autoimmune diseases in animals.
Nancy L. Sicotte, M.D., of the David Geffen School of Medicine at UCLA, Los Angeles, and colleagues conducted a study of testosterone treatment in 10 men with relapsing-remitting MS, characterized by periods of neurologic symptoms (such as numbness or difficulty walking) followed by periods of remission. The men, who had an average age of 46, were enrolled in the study and then entered a six-month pre-treatment phase, during which symptoms were monitored but no therapies were administered. Then, each man applied 10 grams of a gel containing 100 milligrams of testosterone to his upper arms once daily for 12 months.
“One year of treatment with testosterone gel was associated with improvement in cognitive performance and a slowing of brain atrophy [deterioration],” the authors write. During the first nine months of the study—the period of time before the men began taking testosterone, plus the first three months of treatment, before it had time to take effect—brain volume decreased an average of -0.81 percent per year. In the second nine months, this decline slowed by 67 percent to an annual rate of -0.25 percent. “Because the protective effect of testosterone treatment on brain atrophy was observed in the absence of an appreciable anti-inflammatory effect, this protection may not be limited to MS, but may be applicable to those with non-inflammatory neurodegenerative diseases,” including amyotrophic lateral sclerosis or Lou Gehrig’s disease, the authors write.
In addition, lean body mass (muscle mass) increased an average of 1.7 kilograms (about 3.74 pounds) during the treatment phase. Participants did not report any adverse effects, there were no abnormalities in blood tests taken during the trial and the men’s prostate examination results remained stable.
“Overall, in this first trial of testosterone treatment in men with relapsing-remitting MS, the treatment was shown to be safe and well tolerated,” the authors conclude. “In addition, exploratory findings reported herein suggest a possible neuroprotective effect of testosterone treatment in men, which warrants further investigation.”
(Arch Neurol. 2007;64:683-688. Available pre-embargo to the media at http://www.jamamedia.org.)
Editor’s Note: This study was supported by grants from the National Multiple Sclerosis Society, the General Clinical Research Centers at Harbor-UCLA Medical Center, the Sherak Family Foundation and the Skirball Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Contact: Emma Dickinson
BMJ Specialty Journals
Prospective study of dietary patterns and chronic obstructive pulmonary disease among US men
A Mediterranean diet halves the chances of developing progressive inflammatory lung disease (COPD), reveals a large study, published ahead of print in Thorax.
COPD (chronic obstructive pulmonary disease) is an umbrella term for chronic progressive lung disease, such as emphysema and bronchitis. It is expected to become the third leading cause of death worldwide by 2020, with cigarette smoking the primary factor in its development.
The researchers tracked the health of almost 43,000 men, who were already part of the US Health Professionals Follow up Study. This began in 1986 and involved more than 50,000 US health care professionals aged between 40 and 75, who were surveyed every two years.
They were asked questions about lifestyle, including smoking and exercise, diet and medical history. Dietary intake was assessed in detail every four years.
Eating patterns fell into two distinct categories: those who ate a diet rich in fruit, vegetables, whole grains and fish (Mediterranean diet); and those who ate a diet rich in processed foods, refined sugars, and cured and red meats (Western diet).
Between 1986 and 1998, 111 cases of COPD were newly diagnosed.
The Mediterranean diet was associated with a 50% lower risk of developing COPD than the Western diet, even after adjusting for age, smoking, and other risk factors.
And men who ate a predominantly Western diet were more than four times as likely to develop COPD, even after taking account of other influential factors.
The higher the compliance with a Mediterranean diet, the lower was the risk of developing COPD over the 12 year period.
Conversely, the higher the compliance with the Western diet, the higher was the risk of developing COPD.
Global Health Vision
UC Irvine neurobiologist Hans Keirstead and his research team today launched a project to develop stem cell lines that genetically match human patients. These lines would allow scientists to better study conditions ranging from diabetes to Parkinson’s disease, and they would provide the basis for potential patient-specific stem cell treatments.
Contact: Jennifer Fitzenberger
University of California – Irvine
A glucosamine-like dietary supplement has been found to suppress the damaging autoimmune response seen in multiple sclerosis and type-1 diabetes mellitus, according to University of California, Irvine health sciences researchers.
National Institutes of Health, National Multiple Sclerosis Society, Juvenile Diabetes Research Foundation, Wadsworth Foundation, Canadian Institutes for Health Research
Contact: Tom Vasich
University of California – Irvine
Contact: Emily Butler
Kennedy Krieger Institute
(Baltimore, MD) — The Interactive Autism Network (IAN)—the first national online autism registry spearheaded by the Kennedy Krieger Institute—has registered an unprecedented number of individuals and families living with autism. Never before have researchers been offered access to such a large pool of family-provided data on this puzzling disorder. In only one month, IAN (www.IANproject.org) has achieved significant milestones:
More than 13,000 registered participants
Representation in all 50 states as well as the District of Columbia, American Samoa, Northern Mariana Islands, Guam, Marshall Islands and Palau
Diverse family registration, including: six sets of triplets, 37 sets of identical twins and 157 sets of fraternal twins
Researchers from institutions across the country have already begun to access IAN data to:
Supplement and enhance current research studies
Compare and validate existing research results obtained from smaller sample sizes
Explore hypotheses for future research and search for parallels among individuals with autism and their families in a way that was not previously possible
“In one short month, IAN has become the country’s largest pool of autism data,” said Dr. Paul Law, Director, Interactive Autism Network at the Kennedy Krieger Institute in Baltimore, Maryland. “The fact that IAN has already become a vital resource for researchers, so early in its lifespan, bodes extremely well for the potential of this project, and ultimately, to the pursuit of answers in autism.”
IAN has become successful in registering families largely due to the tight knit nature of the autism community and the outpouring of support from parents. Testimonials continue to echo the great need for and tremendous potential of IAN.
“What better opportunity to help our children, to help each other and to learn more about autism. We have been given the power to DO SOMETHING to combat autism. Go to the website, accept this responsibility & watch us change the future of this heartbreaking disorder.”
Posted on CNN.com Health Blog by an IAN participant
IAN is funded by a grant from Autism Speaks, a non-profit organization dedicated to increasing awareness about the growing autism health crisis and raising funds for critical autism research.
About the Kennedy Krieger Institute
Internationally recognized for improving the lives of children and adolescents with disorders and injuries of the brain and spinal cord, the Kennedy Krieger Institute in Baltimore, MD serves more than 12,000 individuals each year through inpatient and outpatient clinics, home and community services and school-based programs. Kennedy Krieger provides a wide range of services for children with developmental concerns mild to severe, and is home to a team of investigators who are contributing to the understanding of how disorders develop while pioneering new interventions and earlier diagnosis. For more information on Kennedy Krieger Institute, visit http://www.kennedykrieger.org.
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Contact: Amy Molnar
John Wiley & Sons, Inc.
While one in four cancer survivors participates in a support group after diagnosis, use of support groups varies considerably by cancer type, and few survivors receive referrals to such programs from their physicians, according to a new study. Published in the June 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study finds that cancer survivors are more likely to attend a support group compared to people with other chronic conditions, but there is little active support for such use by treating physicians. Utilization among cancer survivors differs depending on factors such as gender, age, health insurance and other co-morbid conditions.
The psychosocial burden of cancer is well recognized but seems to be poorly managed by many physicians. Support groups for a variety of cancers and other chronic conditions are widely available across the United States. They often are the only mental care and external disease information resource cancer patients have. While previous studies have shown about one in five women with early stage breast cancer use support services in the year following treatment (18 percent), little is known regarding participation in support groups and support group use among patients with different types of cancer and for cancer survivors.
Dr. Jason Owen of Loma Linda University in Loma Linda, California and co-investigators sought to comprehensively characterize how patients with different types of cancers and other chronic medical conditions use support groups and who uses them. The study team analyzed survey data from 9,187 participants (1,844 with cancer and 4,951 with other chronic health problems).
Dr Owen and his team found that only one in seven (14 percent) patients with a non-cancer, chronic medical condition accessed support groups while almost one in four (23 percent) cancer patients did. Only 11 percent of cancer patients used a cancer-specific support group. Patients with blood malignancies and breast cancer were more likely to report participation in a support group compared to those with lung and skin cancers.
Interestingly, predictors of use were similar across various cancer sites and included female gender, Caucasian race, higher education level, and symptoms of depression or anxiety. Younger age and urban residence did not predict support group use. While physical functional status did not predict use among cancer patients, it did among patients with other chronic conditions.
Dr. Owen also found that while physicians passively supported patient use of support groups, only one in ten cancer patients in this study had received a physician recommendation.
Dr. Owen concludes, “This study sheds light on which individuals with cancer use these services.” This study will help clinicians recognize the importance of support groups for cancer patients. “Assistance in identifying and accessing support groups, should be a standard of care for all patients receiving curative, follow-up, or palliative care for cancer,” Dr. Owen recommends.
Article: “Use of Health-Related and Cancer-Specific Support Groups Among Adult Cancer Survivors,” Jason E. Owen, Michael S. Goldstein, Jennifer Lee, Nancy Breen, Julia H. Rowland, CANCER; Published Online: May 14, 2007 (DOI: 10.1002/cncr.22719); Print Issue Date: June 15, 2007.
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