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Safety Of Shingles Vaccine Confirmed
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Improving Mood, Blood Sugar In Diabetes With Naturopathic Care
Labels: Blood, Diabetes, Improving, Naturopathic, Sugar
Could Home Births And Midwifery Units Save The NHS A Lot Of Money?, UK
Labels: Births, Could, Midwifery, Money, Units
How To Induce Damaged Heart Structural Cells To Become Functioning Heart Muscle
Labels: Become, Cells, Damaged, Functioning, Heart, Induce, Muscle, Structural
MS Drug Gilenya Positive Benefit-Risk Profile Following CHMP Review, Europe
Labels: BenefitRisk, Europe, Following, Gilenya, Positive, Profile, Review Editor's Choice
Main Category: Multiple Sclerosis
Also Included In: Regulatory Affairs / Drug Approvals
Article Date: 23 Apr 2012 - 11:00 PDT
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According to Novartis, the European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) has confirmed a positive benefit-risk profile for their once-a-day orally administered drug Gilenya (fingolimod).
In agreement with the CHMP, the company has updated their E.U. product information after the Article 20 review the EMA announced in January 2012, in order to offer further guidance to healthcare providers who want to initiate using Gilenya in MS patients. In the E.U., Gilenya is approved for the treatment of individuals with highly active relapsing-remitting MS, regardless of treatment with beta interferon, or in patients with rapidly evolving severe relapsing-remitting MS.
Gilenya is the first in a new class of sphingosine 1-phosphate receptor (S1PR) modulating compounds and has demonstrated superior efficacy over Avonex (interferon-beta-1a IM), a commonly prescribed treatment. In a pivotal head-to-head trial in patients with relapsing- remitting multiple sclerosis at one year, Gilenya achieved both its primary and secondary endpoints, i.e. a 52% relative reduction of the yearly relapse rate and a 40% relative reduction in the rate of brain atrophy.
A recent sub-analysis at one year revealed that in comparison to interferon-beta-1a (IM), Gilenya achieved a 61% relative reduction in the rate of yearly relapses in patient subgroups with highly active relapsing-remitting MS patients who previously received interferon therapy.
Gilenya has no label restrictions specific to treatment duration and was generally well tolerated during clinical trials with a manageable safety profile. Since February 2012, over 36,000 patients have been treated with Gilenya in clinical trials and in the post-marketing setting, which confirms Gilenya's long- term effectiveness and safety profile. 2,400 patients have been taking the drug for longer than two years.
The most common adverse events reported were cough, diarrhea, headache, liver enzyme elevations and back pain, whilst other side effects included a mild increase in blood pressure, transient, generally asymptomatic, heart rate reduction and atrioventricular block upon treatment initiation, macular edema, and mild bronchoconstriction.
Overall, the rates of infections, including serious events were similar in all treatment groups. However, patients treated with Gilenya reported a slightly higher rate of respiratory tract infections that consisted mainly of bronchitis. There were only a small number of reported malignancies in the clinical trial, with similar rates between the Gilenya and control groups.
All MS patients who start Gilenya therapy in the E.U. should have an electrocardiogram (ECG) and a blood pressure measurement before taking the first dose and after the six-hour first-dose monitoring period, in addition to having hourly measurements of their blood pressure and heart rate taken during this period. It is also recommended that patients' with symptomatic bradycardia (low heart rate) receive continuous ECG monitoring for at least six hours after taking the first dose, with those who had ECG abnormalities during the 6-hour monitoring period requiring extended monitoring, as well as those who had very low or their lowest measured heart rate at the six-hour time point.
The recommended label update in the E.U. also warns that Gilenya should not be used in patients who may be less tolerant of or tend to have a higher risk of developing a substantially slower or abnormal heart rate, due to certain underlying conditions or other medications taken at the same time.
Previous clinical trials have revealed insufficient knowledge about using Gilenya in such patients, but if these patients are to be treated, they would require overnight monitoring.
Patients who are already taking Gilenya are not affected by the new first-dose observation recommendations. However, should therapy be interrupted for longer than two weeks, patients should undergo the new recommended monitoring upon re-initiation of the treatment. Patients should not make any changes to any medications, including Gilenya, without first consulting with their doctor.
David Epstein, Division Head of Novartis Pharmaceuticals declares:
"We believe that Gilenya is a valuable treatment option for many patients with relapsing remitting MS, and we welcome the confirmation of the positive benefit-risk profile of the drug which also supports our continued belief of the blockbuster potential of Gilenya. MS is a devastating chronic disease that affects more than 2.1 million people worldwide, and patients need effective treatment options."
The EU will review the CHMP labeling recommendations, with a final decision expected in June 2012. In terms of any changes to the EU product information, Novartis will notify EU physicians via a Direct Healthcare Provider Communication (DHPC) by end of April 2012.
For the Gilenya information site, click here
Written By Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our multiple sclerosis section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:
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'MS Drug Gilenya Positive Benefit-Risk Profile Following CHMP Review, Europe'
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Heavier Baby Girls at Higher Risk for Diabetes, Heart Woes as Adults
Labels: Adults, Diabetes, Girls, Heart, Heavier, Higher
THURSDAY, March 29 (HealthDay News) -- Overweight female babies are at increased risk for cardiovascular disease and diabetes in adulthood, a new study suggests.
Researchers looked at more than 1,000 17-year-olds in Australia who had been followed since birth. The goal was to examine whether birth weight and body fat distribution in early childhood was associated with future health risk factors such as obesity, insulin resistance and high blood pressure.
The study found that teen girls with larger waist circumference, higher levels of insulin and triglycerides (a type of fat found in the blood), and lower levels of "good" HDL cholesterol were heavier from birth than other girls.
Birth weight and body fat distribution in early childhood seemed to have no impact on these risk factors in males, the authors noted.
The study will be published in the June issue of the Journal of Clinical Endocrinology & Metabolism.
"What happens to a baby in the womb affects future heart disease and diabetes risk when the child grows up," lead author Dr. Rae-Chi Huang of the University of Western Australia in Perth, said in a news release from the Endocrine Society.
"We found that female babies are particularly prone to this increased risk, and females who are at high risk of obesity and diabetes-related conditions at age 17 are showing increased obesity as early as 12 months of age," Huang said.
Huang said the findings are important because there are increasing rates of obesity and gestational diabetes among pregnant women in Western nations. This means a rise in the number of overweight female babies.
"Our results can be applied to public health messages targeting both maternal health and measures in early infancy regarding the prevention of childhood obesity and its consequences," Huang said.
Although the study showed an association between early obesity and increased risk of diabetes and cardiovascular disease, it did not prove a cause-and-effect relationship.
-- Robert Preidt 
Copyright © 2012 HealthDay. All rights reserved. SOURCE: The Endocrine Society, news release, March 29, 2012
Treating Gum Disease May Help Diabetics Avoid Complications
Labels: Avoid, Complications, Diabetics, Disease, Treating
FRIDAY, March 23 (HealthDay News) -- Treating gum disease in people with diabetes reduces their medical costs and hospitalizations, new research shows.
The three-year study included diabetes patients with gum (periodontal) disease who were randomly selected either to receive periodontal therapy or no treatment (control group).
Those in the treatment group underwent periodontal therapy in the first year and their gum health was maintained for the following two years. The patients in the control group had incomplete periodontal therapy before the study and did not receive regular periodontal maintenance during the study.
The total annual per-patient cost of hospital admissions, doctor visits and overall medical care was an average of more than $1,800 lower in the treatment group than in the control group. The patients in the treatment group had 33 percent fewer hospital admissions.
The study was to be presented Friday at the annual meeting of the American Association for Dental Research, in Tampa, Fla.
"There have been emerging links between oral infections and systemic diseases such as diabetes, which is increasingly prevalent in our population," lead researcher Marjorie Jeffcoat, professor and dean emeritus of the University of Pennsylvania School of Dental Medicine in Philadelphia, said in an association news release.
"My research team and I had looked at other data sets and we knew that health care costs could be reduced, but we wanted to look at the hospitalizations and see how those could be reduced," Jeffcoat said. "This study provided direct insight as to how lower hospitalizations could be achieved through periodontal therapy, and we will further this study by analyzing other chronic diseases and conditions such as heart attacks, strokes and pregnancy with pre-term birth."
Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.
It's also important to note that although the study showed an association between better gum care and lowered health costs for diabetics, it didn't prove that healthier gums directly resulted in fewer hospitalizations or lowered costs.
-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCE: American Association for Dental Research, news release, March 23, 2012
Make Weight Loss a Family Affair
Labels: Affair, Family, Weight 
Study: Overweight Kids Lose Weight When Their Parents Do
By Denise Mann
WebMD Health News
Reviewed by Louise Chang, MD
April 6, 2012 -- Want to get your overweight child to lose weight, but don't know how?
Do the same thing yourself.
This is the main finding from a new study of 80 overweight or obese children and their parents. When parents lost weight, their kids did, too. For each one unit decrease in the parent's body mass index or BMI, children lost one quarter of a BMI unit.
"That is a lot of weight on a child," says researcher Kerri N. Boutelle, PhD. She is an associate professor of pediatrics and psychiatry at University of California-San Diego and Rady Children's Hospital, also in San Diego.
Since 1970, the rate of childhood obesity in the U.S. has tripled. About 1 in 3 children in America are overweight or obese. As a result, obesity-related diseases and conditions normally only seen in adults are increasingly diagnosed in kids.
To find out what helps children lose weight and what doesn't, Boutelle and colleagues looked at a number of factors. These included a parent's weight loss, changes in foods served at home, and parenting style such as setting limits on behavior.
The researchers divided the families into two groups. In one group, parent and child attended separate sessions in a five-month weight loss program that included dietary changes, exercise, behavioral change skills, and parenting skills. In the other group, parents were the only ones who participated in the weight loss program.
"The only thing that was associated with weight loss was parental weight loss," Boutelle says.
The average BMI of parents in the study was obese, but not all the parents in the study were overweight. The findings may have been even more dramatic if all the parents were overweight or obese, Boutelle says.
"Children look up to their parents," she says. "It is not fair to tell a child to lose weight if you don't do it yourself."
It has to be a team effort.
Her message to parents? "Walk your own talk."
Nazrat Mirza, MD, is a pediatrician at the Obesity Institute at Children's National Medical Center in Washington, D.C. "This study reaffirms the role of the parent and the fact that changes need to be made in the home environment to be sustainable."
Studies have shown that only targeting parents for weight loss has trickle-down effects on kids. "The parents lose weight and the children do, too."
This makes perfect sense. "Parents are the role models for the children, they buy the food for the household, and set activity levels," Mirza says. "This is where the changes need to take place."
As a pediatric cardiologist, Steven Lipshultz, MD, often sees kids who have risk factors for heart disease largely due to their weight. He is professor and chairman of pediatrics at the University of Miami Miller School of Medicine.
If the parents are overweight and not on board, these children won't lose weight or make and maintain heart-healthy changes. "Less than 15% will go in the right direction, and we have to bring them in for a 12-week program that meets three times a week to encourage them to stay on track."
The new study "confirms good common sense."
The findings appear in Obesity.
SOURCES: Boutelle, K.N. Obesity, published online March 15, 2012. Kerri N. Boutelle, PhD, associate professor, pediatrics and psychiatry, University of California, San Diego; Rady Children's Hospital, San Diego. Nazrat Mirza, MD, pediatrician, Obesity Institute, Children's National Medical Center, Washington, D.C. Steven Lipshultz, MD, professor and chairman of pediatrics, University of Miami Miller School of Medicine, Miami, Fla. Let's Move Campaign: "Learn the Facts."©2012 WebMD, LLC. All Rights Reserved.
Migraines - Many Treatments Work, But Few Use Them
Labels: Migraines, Treatments Editor's Choice
Academic Journal
Main Category: Headache / Migraine
Article Date: 23 Apr 2012 - 21:00 PDT
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Although several preventive migraine treatments are very effective for many patients, few sufferers use them, according to new American Academy of Neurology guidelines. The guidelines have been published in the journal Neurology and will be presented tomorrow at the American Academy of Neurology's 64th Annual meeting in New Orleans.
Author Stephen D. Silberstein, MD, FACP, FAHS, of Jefferson Headache Center at Thomas Jefferson University in Philadelphia and a Fellow of the American Academy of Neurology, said:
"Studies show that migraine is underrecognized and undertreated. About 38 percent of people who suffer from migraine could benefit from preventive treatments, but only less than a third of these people currently use them."
Preventive treatments are generally administered daily to prevent migraine attacks from ever occurring, or to lessen their severity and length of duration if they do.
Silberstein said:
"Some studies show that migraine attacks can be reduced by more than half with preventive treatments."
All evidence related to migraine prevention was reviewed before the guidelines were made.
The following prescription medications were found to be effective in preventing migraine attacks, or at least reducing their severity and/or duration: divalproex sodium (an seizure medication)sodium valproate (an seizure medication) topiramate (an seizure medication)metoprolol (beta blocker)propranolol (beta blocker)timolol (beta blocker)The guidelines say that doctors should offer these medications for the prevention or reduction in frequency or severity of migraine attacks.The guidelines say that Lamotrigine, a seizure medication, does not prevent migraine.
According to the guideline, herbal preparation Petasites (butterbur) can effectively prevent migraine attacks.The following were also found to be effective: NSAIDs (nonsteroidal anti-inflammatory drugs)
FenoprofenIbuprofenKetoprofenNaproxen and naproxen sodiumSubcutaneous histamine
Complementary treatments
MagnesiumMIG-99 (feverfew) RiboflavinEven though patients do not require a prescription for these OTC medications and complementary therapies, Dr. Silberstein said that patients should still visit their doctor for their scheduled follow-up appointments.
Silberstein said:
"Migraines can get better or worse over time, and people should discuss these changes in the pattern of attacks with their doctors and see whether they need to adjust their dose or even stop their medication or switch to a different medication. In addition, people need to keep in mind that all drugs, including over-the-counter drugs and complementary treatments, can have side effects or interact with other medications, which should be monitored."
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
S.D. Silberstein, S. Holland, F. Freitag, et al.
Neurology 2012;78;1337. DOI 10.1212/WNL.0b013e3182535d20
"Update: NSAIDs and Other Complementary Treatments for Episodic Migraine Prevention in Adults"
S.D. Silberstein, S. Holland, F. Freitag, et al.
Neurology 2012;78;1346. DOI 10.1212/WNL.0b013e3182535d0c
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23 Apr. 2012.
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'Migraines - Many Treatments Work, But Few Use Them'
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Genes Pinpointed for Common Childhood Obesity
Labels: Childhood, Common, Genes, Obesity, Pinpointed
Study Suggests Genes Play a Role in Early Life Weight Gain
By Brenda Goodman, MA
WebMD Health News
Reviewed by Louise Chang, MD
April 8, 2012 -- An international team of researchers says they've found at least two new gene markers that appear to increase the risk for common childhood obesity.
Little is known about the gene markers, which sit on chromosomes 13 and 17. But they are positioned close to and within genes that are thought to be involved in how the gut functions.
What's more, the markers do not appear to be active in obese adults, leading researchers to conclude that they exert their influence within the first years of life.
"We see a clear genetic signature to childhood obesity, showing that there's more than just an environmental component to the disease," says researcher Struan F.A. Grant, PhD, associate director of the Center for Applied Genomics at The Children's Hospital of Philadelphia, at a news conference.
The study is published in the journal Nature Genetics.
The discovery of a genetic component to childhood obesity does not mean a child who inherits these gene markers is fated to be fat.
Instead, the new markers help explain why obesity runs in families. They may also help explain why some kids, given the roughly the same diets and patterns of physical activity as their peers, may pack on pounds while others stay relatively slim.
"If we can understand how inherited risk factors change susceptibility to obesity -- what's different about the biology of people who are resistant to obesity vs. those who are susceptible -- we would get clues for new therapies or interventions that could be safer and more effective than what is currently available," says researcher Joel Hirschhorn, MD, PhD, director of the Center for Basic and Translational Obesity Research at Children's Hospital Boston, in an email.
"It's very, very exciting," says Nancy Copperman, MS, RD, director of public health initiatives for the North Shore-LIJ Health System in Great Neck, N.Y.
For the study, researchers took a new look at genetic information collected from more than 5,500 obese children and 8,300 normal-weight kids in the U.S., Canada, Europe, and Australia.
Advanced gene mapping techniques pinpointed seven markers that were more common in the obese children than in the lean kids. Those risk areas had also previously been linked to adult obesity.
In addition, they identified two new risk areas that appeared to be unique to childhood obesity. One area was near a gene on chromosome 13. The other was within a gene on chromosome 17. In addition, they found a degree of evidence to support the possible role of two other gene markers.
Assuming the genes act on their own, researchers say inheriting the marker near the gene on chromosome 13 would increase a child's odds of becoming obese by 22%. A child with the other marker would have a 14% increased risk of obesity.
At least three newly identified genes seem to work in the digestive system.
The protein compound made by one of the genes, for example, is known to turn off the body's defenses against H. pylori bacteria, which are a cause of stomach ulcers. H. pylori infection, researchers note, is more common in obese people.
In a news conference, Karen Winer, MD, a medical officer at the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), called the study "groundbreaking work" because it involved the largest collection of genetic material ever compiled to investigate common childhood obesity. The NICHD funded the study.
Previous gene studies had focused on extreme childhood obesity, which is usually associated with defects in a single determining gene, like the inherited Prader-Willi syndrome.
"Common obesity is a very complex disease -- not only genetic or environmental (high-fat diet, inactive lifestyle) -- but an interaction between these two factors," says William S. Garver, PhD, an assistant professor in the department of biochemistry and molecular biology at the University of New Mexico Health Sciences Center in Albuquerque.
Garver studies genes related to obesity, but he was not involved in the research.
"It is likely that most common obesity genes interact with an environmental factor or other 'modifying genes' to promote weight gain," he says in an email to WebMD.
There's still a lot to be learned about the genetic components of childhood obesity. Taken together, Grant says all the markers known to be associated with the condition probably still only account for 5% to 10% of a person's genetic risk.
SOURCES: Bradfield, J. Nature Genetics, April 8, 2012. News release, Nature Genetics. Karen Winer, MD, a medical officer in the Endocrinology, Nutrition and Growth Branch, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, Md. Struan F.A. Grant, PhD, associate director, The Center for Applied Genomics, The Children's Hospital of Philadelphia, Pennsylvania. Joel Hirschhorn, MD, PhD, director, center for basic and translational obesity research, Children's Hospital Boston, Massachusetts. Nancy Copperman, MS, RD, director of public health initiatives, North Shore-LIJ Health System, Great Neck, N.Y. William S. Garver, PhD, assistant professor, department of biochemistry and molecular biology, The University of New Mexico Health Science Center, Albuquerque, N.M.©2012 WebMD, LLC. All Rights Reserved.
Males With Mutated BRCA1 Breast Cancer Gene Have Higher Prostate Cancer Risk
Labels: BRCA1, Breast, Cancer, Higher, Males, Mutated, Prostate Editor's Choice
Academic Journal
Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology; Genetics
Article Date: 23 Apr 2012 - 13:00 PDT
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Men who carry the mutated BRCA1 gene have a four times greater chance of developing prostate cancer than other males, researchers from the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust reported in the British Cancer Journal. The mutated BRCA1 is found in people with a family history of not only breast cancer, but ovarian cancer as well.
Men with the mutated BRCA1 gene are also more susceptible to the very aggressive form of prostate cancer. The authors explained that hopefully, their findings may have an impact on the potential screening and treatment procedures for patients with prostate cancer.
If patients who have the mutated BRCA1 gene were detected early, doctors would then be able to monitor them for prostate cancer from a younger age, which would result in prompter and more targeted treatment if the malignancy developed.
In Great Britain, more than 50% of prostate cancer cases are diagnosed in males over the age of 70 years, making age the main risk factor. In this study, however, out of 913 men who underwent screening, three-quarters of the ones carrying the mutated BRCA1 gene had a prostate cancer diagnosis before reaching 64 years of age, indicating clearly that the presence of the faulty gene might serve as an early warning for individuals with a higher risk of developing the disease at a younger age.
Prostate cancer kills 10,000 men every year in the UK; 37,000 new diagnoses are made annually. Prostate cancer, the most common male cancer worldwide, is more common in the United Kingdom than lung cancer. The authors explained that low awareness contributes to the current number of deaths in the country.
Previous studies have shown that 70% of adult males do not know anything about prostate cancer and what its signs and symptoms are. Better awareness could save thousands of lives annually, they added.
Prostate Action Chief Executive, Emma Malcolm, explained:
"Early detection of prostate cancer can vastly improve the chances of successful treatment but at the moment there isn't an effective way of screening for the disease. We've long known about the link between breast cancer and prostate cancer and this research confirms the likelihood of men developing prostate cancer from the inherited faulty BRCA1 gene.Once gene testing becomes faster and cheaper we may be able to identify those men at a higher risk of prostate cancer and monitor them from an early age."
Author Professor Ros Eeles, said:
"Until now there has been some doubt as to whether mutations in the BRCA1 gene increase the risk of prostate cancer. This large study has shown that men with prostate cancer have a 1 in 200 chance of having an alteration of this gene and men with this alteration have a 3.8 fold increased risk of developing the disease. This translates as nearly 9% risk of prostate cancer by the age of 65.The important thing about this result is that there are drugs that can target specific defects that occur with the BRCA1 mutation and this kind of result can open up the possibility of targeted medicines based on genetics."
Science information manager at Cancer Research UK, Josephine Querido, said:
"We suspected that men who inherited a faulty copy of the BRCA1 gene had a higher risk of prostate cancer, and this study shows us exactly how much this increases their risk. This will help doctors find the best way to monitor these men and select the right treatments for them.Research like this will lead to new opportunities for preventing, diagnosing and treating the disease."
Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
D Leongamornlert, N Mahmud1, M Tymrakiewicz, E Saunders, T Dadaev, E Castro, C Goh, K Govindasami, M Guy, L O'Brien, E Sawyer, A Hall, R Wilkinson, D Easton, D Goldgar, R Eeles and Z Kote-Jarai
British Journal of Cancer 19 April 2012. doi: 10.1038/bjc.2012.146 Please use one of the following formats to cite this article in your essay, paper or report:
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23 Apr. 2012.
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'Males With Mutated BRCA1 Breast Cancer Gene Have Higher Prostate Cancer Risk'
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Diabetes Groups Issue New Guidelines on Blood Sugar
Labels: Blood, Diabetes, Groups, Guidelines, Issue, Sugar By Serena Gordon
HealthDay Reporter
THURSDAY, April 19 (HealthDay News) -- Type 2 diabetes is a complex metabolic disorder, and treating the disease often requires a personalized, multi-pronged approach, say new expert guidelines on treating high blood sugar levels, issued Thursday.
The recommendations are a joint effort by the American Diabetes Association and the European Association for the Study of Diabetes.
"We're making a lot of progress in managing type 2 diabetes," said Dr. Vivian Fonseca, president of medicine and science for the American Diabetes Association. "The new guidelines are more patient-centered. The message is to choose an appropriate [blood sugar] goal based on the patient's current health status, motivation level, resources and complications."
"It is very possible to manage type 2 diabetes well and keep blood sugar under good control," he noted. "It's important that patients have a discussion with their doctor about what their [blood sugar] goals should be, and what is the best treatment or treatments to get them to that goal."
The new guidelines are scheduled to be published in the June issue of Diabetes Care, but were released online ahead of publication on April 19.
Fonseca said the new guidelines were necessary because the management of type 2 diabetes is becoming increasingly complex; there is a widening array of medications available to treat the disease, and new research studies are constantly being released highlighting both the benefits and the risks of current treatments.
The biggest change in the new guidelines is an emphasis on a patient-centered approach to treatment. For example, the blood sugar goal for someone who's young, healthy and motivated to manage type 2 diabetes will be lower than it is for someone who's elderly and has additional health problems.
Blood sugar goals are usually expressed in terms of hemoglobin A1C levels (HbA1C). HbA1C, often just referred to as A1C, is a measure of long-term blood sugar control. It gives an estimate of what the average blood sugar level has been for the past two to three months. A1C is expressed as a percentage, and in general, the goal for people with type 2 diabetes is to lower their A1C levels below 7 percent. Someone without diabetes generally has levels below 5.6 percent, according to the American Diabetes Association.
In the past, the below-7-percent goal was applied to most people with type 2 diabetes. But, the new guidelines note that more stringent goals, such as keeping A1C between 6 and 6.5 percent, might be appropriate for someone who has a long life expectancy, no history of heart disease and who hasn't experienced significant low blood sugar levels (hypoglycemia). Low blood sugar levels can be a potentially dangerous side effect of many diabetes treatments.
The new guidelines suggest that blood sugar targets should be looser (A1C between 7.5 and 8 percent) for people who are older than 65 or 70, because they're more at risk of having complications from hypoglycemia, as well as being more at risk of side effects from taking multiple medications.
Lifestyle changes remain an important part of any type 2 diabetes management plan in the new guidelines. The recommendations are to lose 5 percent to 10 percent of body weight, and to participate in modest exercise for at least two-and-a-half hours each week.
The medication metformin is also recommended as a first-line treatment for people with type 2 diabetes. Metformin works by making the body more receptive to the hormone insulin. Metformin therapy should begin as soon as someone is diagnosed with type 2 diabetes, unless they have a near-normal A1C and are highly motivated to make lifestyle changes, according to the guidelines. In such a case, doctors may choose to follow up with the patient in three to six months to see if the lifestyle changes have been effective. If not, metformin should be started.
The guidelines also recommend adding another drug to metformin therapy if blood sugar levels aren't under control after three months on metformin alone. Again, this is an area where the patient needs to be considered and consulted. Each additional treatment option has its own risks and benefits. Talk to your doctor about which might be right for you.
"The new guidelines take a patient-centered view: Treat the patient and not the blood sugar. The type of medication should be tailored to the pathophysiology of the patient," explained Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City.
"I feel that we need to have combination therapy much earlier in the disease, but the issue is that we don't have research data on combination therapy, and we need studies to know what are the best combinations. But, I believe it's important to be aggressive early in the disease to prevent complications," Zonszein said.
And, he added, although the current guidelines only cover the treatment of high blood sugar, it's also important to remember to control cholesterol and high blood pressure in people with type 2 diabetes.
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Vivian Fonseca, M.D., president, medicine and science, American Diabetes Association; Joel Zonszein, M.D., director, clinical diabetes center, Montefiore Medical Center, New York City; June 2012 Diabetes Care
CT Scans Deliver More Radiation to Obese People: Study
Labels: Deliver, Obese, People, Radiation, Scans, Study By Randy Dotinga
HealthDay Reporter
FRIDAY, April 13 (HealthDay News) -- Obese and overweight patients who undergo CT scans are exposed to much more radiation than people of normal weight, researchers say.
The challenge for heavier people is that more radiation is needed to scan their bodies, a radiation specialist said.
"One has to customize the dose based on patient size, increase the power of the X-rays and the quantity that are going inside," said Dr. Dushyant Sahani, director of CT imaging services at Massachusetts General Hospital and an associate professor of radiology at Harvard Medical School.
Nearly 60 percent of U.S. adults are overweight or obese, according to the study. As obesity-related health challenges surface, so do orders for medical scans, the authors said. Because radiation can cause cancer and other ill effects, researchers have been concerned about the risks of exposure derived from medical imaging.
However, Sahani, who was not involved in the study, said the excess body fat of extra-large patients absorbs much of the radiation, meaning that they may face no extra danger.
"Fat is not as sensitive to undergoing any bad changes as the other tissues," said Sahani.
Even if an obese patient gets twice the radiation as a smaller person of the same age, the risk of radiation damage would be higher for the smaller person, he said.
The study authors, all from the Rensselaer Polytechnic Institute in Troy, N.Y., launched their research to better understand how radiation in CT scans affect the bodies of heavier people. Statistics about their radiation haven't been previously available, the study authors said. "We want to fill this gap," said study lead author Aiping Ding, a research associate at the institute.
CT scans are used to create images that divide the body's organs into sections, or slices. Sahani said, "They produce a detailed anatomic picture, as if someone's body has been actually sliced."
In the new study, the researchers created 10 computerized male and female "phantoms" that represented people of various body types, ranging from normal to morbidly obese. (Previous research using phantoms had mostly looked at average-sized people).
The researchers then calculated how much radiation would enter the bodies during CT scans. In some cases, the dose that reached organs was as much as 57 percent higher in the obese patients.
"We want to tell people that obese patients receive high doses and that we can use our phantom to quantify the specific dose for the patient," Ding said. "Our study can be a good reference for radiologists."
What should patients do with this information? Ding suggests that they ask their radiologist about the risk they face when they undergo a CT scan. Patients are at especially high risk at hospitals that take multiple CT scans of individual patients in a day, Ding said.
The study appeared recently in the journal Physics in Medicine & Biology.
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Dushyant Sahani, M.D., director of CT imaging services, Massachusetts General Hospital, and associate professor of radiology, Harvard Medical School, Boston; Aiping Ding, Ph.D., research associate, Rensselaer Polytechnic Institute, Troy, N.Y.; April 6, 2012, Physics in Medicine & Biology
Cervical Screening Rates Low In Some Groups
Labels: Cervical, Groups, Rates, Screening Editor's Choice
Main Category: Cervical Cancer / HPV Vaccine
Also Included In: Women's Health / Gynecology
Article Date: 23 Apr 2012 - 10:00 PDT
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According to a study published in the Journal of Public Health, women who are young, non-Caucasian or live in areas of socioeconomic deprivation are less likely to attend cervical screening.
Cervical cancer is the second most common cancer in women, with around 400,000 new cases and 250,000 deaths each year. In 2008, 25,000 of the 54,800 European women who were diagnosed with cervical cancer died from the disease. 2,500 of these new cases and 830 deaths were in the UK.
The researchers state that strategies to improve cervical screening attendance among young, non-Caucasian women, and those living on low incomes need to be developed and implemented, in order to address this disparity.
The researchers, Ji Young Bang, Ghasem Yadegarfar, Michael Soljak and Azeem Majeed, set out to identify general practice and socioeconomic factors linked to cervical screening in England, using data on 26,497,476 women, registered with 7,970 practices in 152 English Primary Care Trusts (PCT).
The Quality and Outcomes Framework (QOF) is a UK system that allows for general participating practices to be monitored in terms of their achievements. For their study, the researchers obtained data on staffing levels, socioeconomic status and QOF Indicators from the QOF system, between 2008 and 2009.
Furthermore, using data from the 2007 Information Center for Health & Social Care Database, the researchers calculated the number of female patients per full-time general practitioner, in a population of 100,000.
The Index of Multiple Deprivation (IMD) score was obtained from the 2004 Department of Communities and Local Government (DCLG) IMD database. The IMD calculates the degrees of socioeconomic deprivation based on education, health, housing, employment, income, and crime.
The team also included the proportion of female patients aged 25 to 49 years and 50 to 64 years that were registered with practices since 2008, as well as the estimated number of patients of different ethnicities.
In both PCTs and practices, the researchers found that women aged 25 to 49, ethnic women and those living in areas of socioeconomic deprivation were significantly less likely to attend cervical screening.
In addition, women aged 50 to 64 years, overall QOF score and the records/information score were significantly positively associated with cervical screening coverage, but only at practice level.
The median range for cervical screening at a practice level was 83.5% (0 to 100%), and ranged from 65.8% to 85.8% at a PCT level.
The study outcome has established which groups of women could gain major benefits by improving their attendence for cervical screening. It furthermore confirms findings of other research that have also identified insufficient screening attendance in young, non-Caucasian women that are socioeconomically deprived.
According to earlier studies, the reason why non-Caucasian women have lower cervical screening attendance may be due to lack of knowledge about the cervical screening program.
Bang explained:
"To improve cervical screening, a system for educating these individuals and improving knowledge of the service provided needs to be instituted.More organized practices may be better at monitoring and delivering health care to the local population, resulting in the implementation of policies that can deliver positive results in increasing cervical screening. To improve cervical screening a multifaceted approach is needed that includes patients, physicians, individual practices and policy makers.
Performance indicators, such as cervical screening coverage, can be substantially influenced by population factors such as age, ethnicity, and socioeconomic status.
Using crude performance data to determine the quality of care provided by general practices and PCTs can be misleading. This is an important issue as the UK government has announced this year that the general practice performance data will be made available publicly in the near future."
Bang concludes:
"Our study illustrates that population and health system characteristics remain important influences on participation in preventative interventions such as cervical screening, even in a health system that offers free of charge access to universal healthcare.Also, in the 21st century, more than twenty years after the start of cervical screening in England, socioeconomic, ethnic, and age-related disparities still exist. To improve cervical screening in England, efforts should focus on implementing and developing strategies for improving cervical screening attendance in the young, socioeconomically disadvantaged and ethnic minority women."
Written By Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Ji Young Bang, Ghasem Yadegarfar, Michael Soljak and Azeem Majeed
Journal Of Public Health , April 2012, doi: 10.1093/pubmed/fds019 Please use one of the following formats to cite this article in your essay, paper or report:
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23 Apr. 2012.
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Ultra-Long-Acting Insulin Degludec, Two Phase 3 Studies Published
Labels: Degludec, Insulin, Phase, Published, Studies, UltraLongActing
Obese Workers' Health Care Costs Top Those of Smokers
Labels: Costs, Health, Obese, Smokers, Those, Workers
FRIDAY, April 13 (HealthDay News) -- Obese workers have even higher health costs than smokers, a new study finds.
Researchers examined data from more than 30,000 Mayo Clinic employees and retirees who had continuous health insurance from 2001 to 2007.
The analysis revealed that both obesity and smoking were associated with higher health care costs. Average yearly health costs were $1,275 more for smokers than nonsmokers and $1,850 more for obese people than those with normal weight.
Health care costs for morbidly obese people were up to $5,500 more a year than for normal weight people.
The additional health care costs associated with obesity appeared to be lower after the researchers adjusted for other accompanying health problems, but "this may lead to underestimation of the true incremental costs, since obesity is a risk factor for developing chronic conditions," wrote James Moriarty and colleagues at the Mayo Clinic in Rochester, Minn.
Employers are looking at ways to reduce health care costs -- such as quit-smoking and fitness programs -- and this study showed that both obesity and smoking led to persistently higher health care costs during the seven years examined by the researchers, the study authors said.
The study was published in the March issue of the Journal of Occupational and Environmental Medicine.
-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCE: Journal of Occupational and Environmental Medicine, news release, April 3, 2012
American Lung Association New Guidance On Lung Cancer Screening
Labels: American, Association, Cancer, Guidance, Screening Editor's Choice
Main Category: Lung Cancer
Article Date: 23 Apr 2012 - 19:00 PDT
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In the United States, lung cancer kills more people than any other cancer and has a five year survival rate of only 15%. With that in mind, the American Lung Association released updated guidelines on screening for lung cancer, based on research from the National Cancer Institute National Lung Cancer Screening Trial (NLST).
The NLST has found in its recent work that low-dose computed tomography (CT) reduced lung cancer deaths by up to 20%, when compared to standard chest X-Rays. The NLST findings have already been put into effect to some extent, but The American Lung Association's Lung Cancer Screening Committee, chaired by Jonathan Samet, M.D., M.S., from the University of Southern California, highlights this information to both the public at large and the physicians treating them.
The Lung Association recommends that those between the ages of 55 and 74, with a history of smoking to a level of 30 pack years (that is a pack a day for 30 years), whether they have a history of lung cancer or not, should be screen with CT scans. There are unknown risks associated with the CT screening.
Edelman, M.D., chief medical officer of the American Lung Association reminds that :
"Never starting smoking and quitting smoking still remains the best way to prevent lung cancer .. Additionally, it is also important for people to have their homes tested for radon, as radon exposure can increase the risk of lung cancer."
The report also reminds medical centers to refer patients to specialist facilities that can better undertake and diagnose the CT scans, and also promote and advertise the option of lung cancer screening for long term smokers to patients.
The American Lung Association says it hopes to save lives with its new strategy and vows to continue to fight for clean air and reduced tobacco smoking.
Written by Rupert Shepherd
Copyright: Medical News Today
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23 Apr. 2012.
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Obesity's Health Costs Double Earlier Estimates
Labels: Costs, Double, Earlier, Estimates, Health, Obesitys
THURSDAY, April 12 (HealthDay News) -- A new study finds that obesity accounts for nearly 21 percent of U.S. health care spending, which is more than twice as high as previous estimates.
The findings strengthen the case for government intervention to prevent obesity, said the researchers from Cornell University in Ithaca, N.Y.
The researchers found that an obese person's medical costs are $2,741 a year higher (in 2005 dollars) than if they were not obese. That works out to $190.2 billion a year nationally, or 20.6 percent of total U.S. health spending.
Previous estimates had put the cost of obesity at $85.7 billion a year, or 9.1 percent of total health spending.
"Historically, we've been underestimating the benefit of preventing and reducing obesity," study author John Cawley, a professor of economics and policy analysis and management at Cornell, said in a university news release.
"Obesity raises the risk of cancer, stroke, heart attack and diabetes," Cawley said. "For any type of surgery, there are complications [for the obese] with anesthesia, with healing. Obesity raises the costs of treating almost any medical condition. It adds up very quickly."
The study was published recently in the Journal of Health Economics.
-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCES: Cornell University, news release, April 9, 2012
Troubled Homes May Fuel Obesity in Girls
Labels: Girls, Homes, Obesity, Troubled 
By Jenifer Goodwin
HealthDay Reporter
MONDAY, April 16 (HealthDay News) -- Little girls from troubled homes are more likely to be obese at age 5 than girls from happier ones, new research shows.
However, researchers did not find that same association between boys' weight and difficult family situations.
In the study, researchers looked at data on more than 1,600 preschoolers from the Fragile Families and Child Wellbeing Study, which tracks the health and well-being of children born to mostly low-income, single-mother families. About half were black, 27 percent were Hispanic and 22 percent were white.
When their children were aged 1 and 3 years, mothers were asked about six stressors: domestic violence, depression, drug abuse, housing insecurity, food insecurity (meaning that their household didn't always have enough nutritious food to eat) and whether the child's father was in prison. Children's height and weight were measured at age 5.
At 5 years old, 17 percent of the children were obese, defined as having a body-mass index in the 95th percentile or above, or being heavier than 95 percent of their peers for their height.
Girls whose mothers reported experiencing two or more stressors when their daughter was age 1 were twice as likely to be obese at age 5. If the mother reported experiencing two or more stressors when the daughter was age 3, the girl was also about twice as likely to be obese.
Researchers found a trend toward a similarly high risk of obesity if the mothers reported experiencing stressors when their daughter was aged 1 and 3, however the results were not statistically significant. Researchers believe that doesn't mean there isn't a link, just that this sample wasn't big enough to show it.
The results suggest that pediatricians and others trying to stem the childhood obesity epidemic need to consider the family dynamics and home environment, rather than just the girl's weight.
"For families who are experiencing all these stresses, obesity is one more thing and may not be as high a priority as other things," said study author Shakira Suglia, an assistant professor in the department of epidemiology at Columbia University, in New York City. "Particularly for girls, when you're seeing these patients coming in as obese children at age 5, there is probably more going on than what they're eating and what their physical activity is. ... There are other things going on in the family environment that need to be addressed to improve the health of the child."
The study is published in the May issue of Pediatrics.
There are several explanations thought to be behind the stress-obesity connection, said Christina Bethell, a professor in the pediatrics department at Oregon Health & Science University and director of the Child and Adolescent Health Measurement Initiative.
"The connection between stress, health behaviors and obesity is profound and many say that to deal with obesity, first we have to deal with psychosocial issues and stress," said Bethell.
There may be a direct relationship, in that kids who are stressed because of difficult home life may be more prone to eat highly caloric foods. Studies have suggested in adults that stress prompts people to reach for "comfort foods," Suglia said.
But there may be indirect effects as well. Mothers who are stressed, or who are dealing with worries such as violence or serious economic instability, may not be as emotionally available to their kids, Suglia said, and may put kids in front of the TV or feed them junk food to keep them occupied as they try to deal with their own problems.
Economic instability may mean families can't afford or believe they can't afford to buy fresh produce, lean cuts of meat and other nutritious foods, she added.
Prior research has found stress caused by domestic violence and poverty is associated with greater risks of cardiovascular disease in adults.
An open question, however, is why there wasn't an association with obesity and troubled homes in boys. There are several possible explanations, Suglia said.
"It's possible that girls internalize things differently. Other studies have shown they do act differently in being exposed to stress. Girls tend to internalize more, and to have more depressive behaviors," Suglia said.
Boys are generally more physically active than girls even at a young age, so all of their running and jumping may help ward off obesity longer. Boys and girls also develop differently, so it's possible that girls are picking up more on maternal worries while boys are paying less attention, making them less vulnerable to it, Suglia said.
"In the domestic violence literature, we've found that girls identify more with the mom more than the boys," Suglia said.
But none of these are proven explanations. Indeed, researchers found that girls who grew up with these psychosocial risk factors were more likely to be obese than kids from more peaceful homes, but not that a difficult home life caused the obesity.
Copyright © 2012 HealthDay. All rights reserved. SOURCES: Shakira Suglia, Sc.D., assistant professor, department of epidemiology, Mailman School of Public Health, Columbia University, New York City; Christina Bethell, Ph.D., MBA, MPH, professor, school of medicine, Oregon Health & Science University and director, Child and Adolescent Health Measurement Initiative; May 2012 Pediatrics
Forehead And Scalp Successfully Reattached
Labels: Forehead, Reattached, Scalp, Successfully Editor's Choice
Main Category: Cosmetic Medicine / Plastic Surgery
Also Included In: Dermatology
Article Date: 23 Apr 2012 - 10:00 PDT
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Surgeons at the Buncke Clinic at California Pacific Medical Center, part of the Sutter Health network, successfully performed an extremely rare surgery reattaching the forehead and scalp of a 22-year-old Stockton woman. This type of surgery has only been successfully performed a few times in the world.
The patient, Sonya Dominguez, was at her workplace when her hair was caught in machinery. Dominguez was airlifted to CPMC, via helicopter, where Buncke Clinical surgeons performed the 7 hour surgery using a technique called microsurgery. This technique allowed the surgeons to repair small nerves and blood vessels with sutures thinner than human hair.
Lead surgeons on the procedure, Dr. Brian Parrett and Dr. Bauback Safa, explained:
"By repairing six blood vessels with the microscope as an aid, we were able to successfully restore the blood supply and replant the completely amputated forehead and scalp.The patient's scalp hair began to grow back within days after the surgery and she was able to go home after just one week."
Sonya Dominguez said:
"I put my trust in their hands. Without them, I probably wouldn't be here."
Gregory Buncke, M.D., head of the Buncke Clinic and chief of plastic surgery at CPMC, explained:
"Microsurgery offers hope to patients who, until recently, had few options. The difference it can make in a person's life is remarkable. If this type of surgery had not been available to this young woman, she would have had extensive and permanent disfigurement.
Patients come to use from all over the world for microsurgery. We reattach and reconstruct limbs and other body parts that have been crushed or blown up in accidents. In addition, every week we perform reconstructive surgeries for cancer patients, in particular those with breast cancer and head and neck cancers."
By continually perfecting their microsurgery techniques, these surgeons are currently able to repair severely damaged areas that, in the past, were untreatable.
Microsurgery requires highly specialized surgical skills, over 6 years of training after medical school, as well as the availability of well-trained and experienced microsurgical nurses and anesthesiologists.
Written By Grace Rattue
Copyright: Medical News Today
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23 Apr. 2012.
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'Forehead And Scalp Successfully Reattached'
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Health Tip: Diabetics, Avoid Too Much Salt
Labels: Avoid, Diabetics, Health
(HealthDay News) -- High-sodium foods can contribute to high blood pressure, which is a major risk factor for stroke and heart attack. The issue is compounded for people with diabetes, who are already at greater risk of heart attack and stroke.
The American Diabetes Association suggests these healthier choices that can help you cut down on salt:
Choose fresh fruits and fresh vegetables over packaged offerings.Opt for dried versions of legumes, beans and peas instead of canned varieties.Look for whole-grain foods that aren't packed with sodium, including whole-grain barley, popcorn, brown and wild rice and quinoa.Choose seeds and nuts that aren't salted.-- Diana Kohnle Copyright © 2012 HealthDay. All rights reserved.
Want to Lose Weight? Skip Trendy Diets
Labels: Diets, Trendy, Weight
Study: Biggest Losers Eat Less Fat and Exercise More
By Denise Mann
WebMD Health News
Reviewed by Laura J. Martin, MD
April 10, 2012 -- Here's what doesn't really work well if you want to lose weight: "diet" foods, non-prescription weight loss supplements, and liquid or fad diets.
So what does work? Eat less fat, get more exercise, join a weight loss program, and ask your doctor about prescription weight loss pills.
It may seem boring, even a bit old-fashioned. But it works, says a new study in the April 10 issue of the American Journal of Preventive Medicine.
The study set out to find out what successful dieters are doing to shed unwanted pounds and keep them off.
"People actually are losing 5% to 10% of their body weight or more using tried-and-true methods," says study author Jacinda M. Nicklas, MD, MPH. She is a clinical research fellow at Beth Israel Deaconess Medical Center in Boston.
The study included information on more than 4,000 obese people who took part in the National Health and Nutrition Examination Survey. Of these, 63% said they had tried to lose weight. Forty percent said they lost 5% or more of their body weight, and 20% said they lost 10% or more of their excess body weight.
Several trends emerged among the biggest losers. Those who exercised more and ate less fat lost more weight. Those who joined commercial weight loss programs, such as Weight Watchers or Jenny Craig, were more likely to have lost 10% or more of their body weight, the study showed. Use of prescription weight loss medications was also associated with weight loss, but only a small number of people in the study used these drugs.
The study did not include specifics on how much the participants exercised or how they changed their diets.
The results are mostly in line with what Nicklas tells her weight loss patients. She typically advises them to cut calories, but not necessarily trim fat. "I do like them to exercise more, especially for weight loss maintenance," she says. "Joining a program improves accountability and encourages shared knowledge among members."
Scott Kahan, MD, MPH, says that what works for one person doesn't always work for the next. He is the director of the National Center for Weight and Wellness in Washington, D.C. "The most important thing is to actually look for something that works for you, and this will be different for each person," he says. "Some people do well with low-fat diets because it includes the foods that they love and are satisfying. For other people, a low-carb plan may work better," he says. "It has to be individualized or it is just not going to be sustainable."
The new study "does provide good support to the recommendations of eating less and exercising more," Connie Diekman, RD, says in an email. She is the director of university nutrition at Washington University in St. Louis.
The researchers relied on self-reported information, which isn't always 100% accurate. Still, "the fact that the most commonly used techniques for losing weight were changes in behaviors, not special products or diets, gives inspiration to others who want to lose weight but feel they need something special to do that," Diekman says.
And "another positive outcome of this study is that obese subjects were able to lose weight, a fact that many often feel is not achievable," she says.
SOURCES: Jacinta M. Nicklas, MD, MPH, clinical research fellow, Beth Israel Deaconess Medical Center, Boston. Connie Diekman, RD, director, university nutrition, Washington University, St. Louis. Nicklas, J.M. American Journal of Preventive Medicine, 2012, study received ahead of print. Scott Kahan, MD, MPH, director, National Center for Weight and Wellness, Washington, D.C.©2012 WebMD, LLC. All Rights Reserved.
