Offering option of initial HIV care at home increases use of ART
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LSTM Researchers found that offering adults in Malawi optional home initiation of care following HIV self-testing resulted in a significant increase in the proportion of adults initiating antiretroviral therapy compared with standard HIV care
LSTM Researchers found that offering adults in Malawi optional home initiation of care following HIV self-testing resulted in a significant increase in the proportion of adults initiating antiretroviral therapy (ART) compared with standard HIV care.
The results are part of a study that was funded by the Wellcome Trust and published in the July 23/30 issue of JAMA, which is HIV/AIDS themed and released early to coincide with the International AIDS Conference taking place in Melbourne, Australia next week.
In 2012 it was estimated that 35 million people worldwide were living with the human immunodeficiency virus (HIV). ART not only substantially reduces the risk of HIV transmission but also greatly reduces illness and death, which raises hopes that a high uptake of annual HIV testing and early initiation of ART could improve HIV prevention as well as care.
Sleep Loss Accelerates Brain Aging: Study
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Getting a good night’s sleep may help you stay sharp mentally as you age, a new study suggests.
Researchers at Duke-NUS Graduate Medical School Singapore have found that the less seniors sleep, the faster their brains age. These findings suggest sleep deprivation is a significant factor in cognitive decline, including dementia.
Past studies have demonstrated that sleep quality and duration can affect the cognitive functions of older adults, but the latest study suggests why.
The Duke-NUS study examined tracked 66 older Chinese adults, who underwent structural MRI brain scans measuring brain volume and tests of cognitive function every two years. Researchers also asked the seniors how well - and how long - they slept each night.
To advance care for patients with brain metastases: Reject five myths
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A blue-ribbon team of national experts on brain cancer says that professional pessimism and out-of-date “myths,” rather than current science, are guiding - and compromising - the care of patients with cancers that spread to the brain.
In a special article published in the July issue of Neurosurgery, the team, led by an NYU Langone Medical Center neurosurgeon, argues that many past, key clinical trials were designed with out-of-date assumptions and the tendency of some physicians to “lump together” brain metastases of diverse kinds of cancer, often results in less than optimal care for individual patients. Furthermore, payers question the best care when it deviates from these misconceptions, the authors conclude.
“It’s time to abandon this unjustifiable nihilism and think carefully about more individualized care,” says lead author of the article, Douglas S. Kondziolka, M.D., MSc, FRCSC, Vice Chair of Clinical Research and Director of the Gamma Knife Program in the Department of Neurosurgery at NYU Langone. The authors - who also say medical insurers help perpetuate the myths by denying coverage that deviates from them - identify five leading misconceptions that often lead to poorer care:
Poor quality of life may affect teens’ diabetes management
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In the years after being diagnosed with diabetes, adolescents struggling with social and psychological burdens of managing the disease are likely to do a worse job of controlling it, according to a new U.S. study.
Teens who reported a lower quality of life were more likely to have rising levels of hemoglobin A1c, a marker of elevated blood sugar over time and a sign of poor diabetes control.
“We need to intervene from a prevention standpoint,” said Korey Hood, a psychologist at the University of California, San Francisco and lead author of the study. “We need to do systematic screening of these psychosocial issues.”
Teens who are psychologically stressed are less likely to take care of themselves, which could explain the rise in A1c levels, added Michael Scharf, a psychiatrist at the University of Rochester Medical Center who was not involved in the study.
Study Explains How High Blood Pressure in Middle Age Affects Memory in Old Age
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High blood pressure in middle age plays a critical role in whether blood pressure in old age may affect memory and thinking, according to a study published in the online edition of the journal Neurology.
“Our findings bring new insight into the relationship between a history of high blood pressure, blood pressure in old age, the effects of blood pressure on brain structure, and memory and thinking,” said study author Lenore J. Launer, PhD, National Institute on Aging, part of the National Institutes of Health (NIH), Bethesda, Maryland.
For the study, 4,057 older participants free of dementia had their blood pressure measured in middle-age (mean age, 50 years). In late life (mean age, 76 years) their blood pressure was re-measured and participants underwent magnetic resonance imaging (MRI) scans that looked at structure and damage to the small vessels in the brain. They also took tests that measured their memory and thinking ability.
The study found that the association of blood pressure in old age to brain measures depended on a history of blood pressure in middle age. Higher systolic and diastolic blood pressure was associated with increased risk of brain lesions and tiny brain bleeds. This was most noticeable in people without a history of high blood pressure in middle age. For example, people with no history of high blood pressure in middle age who had high diastolic blood pressure in old age were 50% more likely to have severe brain lesions than people with low diastolic blood pressure in old age.
Climate engineering can’t erase climate change
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Tinkering with climate change through climate engineering isn’t going to help us get around what we have to do says a new report authored by researchers at six universities, including Simon Fraser University.
After evaluating a range of possible climate-altering approaches to dissipating greenhouse gases and reducing warming, the interdisciplinary team concluded there’s no way around it. We have to reduce the amount of carbon being released into the atmosphere.
“Some climate engineering strategies look very cheap on paper. But when you consider other criteria, like ecological risk, public perceptions and the abilities of governments to control the technology, some options look very bad,” says Jonn Axsen.
The assistant professor in SFU’s School of Resource and Environmental Management is a co-author on this study, which appears in the latest issue of the peer-reviewed journal Frontiers in Ecology and the Environment. It is the first scholarly attempt to rank a wide range of approaches to minimizing climate change in terms of their feasibility, cost-effectiveness, risk, public acceptance, governability and ethics.
Experts recommend blood, urine testing to diagnose rare adrenal tumors
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The Endocrine Society today issued a Clinical Practice Guideline (CPG) for the diagnosis and treatment of two types of rare adrenal tumors - pheochromocytomas and paragangliomas - that can raise the risk of cardiovascular disease and even death if left untreated.
The CPG, entitled “Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline,” appeared in the June 2014 issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society.
Pheochromocytomas are rare, usually noncancerous tumors that form inside the adrenal glands, while paragangliomas are similar tumors that develop outside the glands. The tumors cause the body to produce excess amounts of the hormones epinephrine - commonly known as adrenaline - and norepinephrine, which is involved in regulating blood pressure. Symptoms of these tumors include high blood pressure, episodic severe headaches, excess sweating, racing heart, feelings of anxiety and trembling.
Experts estimate between 0.1 and 1 percent of patients treated for high blood pressure have pheochromocytomas, according to the National Institutes of Health’s National Cancer Institute.
Stopping statins may benefit terminally ill patients
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People in the late stages of cancer and other terminal illnesses are not only unharmed by discontinuing statins for cholesterol management, they may benefit, according to a study presented Friday by researchers at Duke Medicine representing a national research network.
The finding addresses a thorny question in treating people with life-limiting illnesses: When, if ever, is it appropriate to discontinue medications prescribed for other conditions that will likely not lead to their death?
In an analysis presented at the American Society of Clinical Oncology annual meeting in Chicago, the researchers reported that discontinuing statins in patients with advanced illnesses resulted in improved overall quality of life, lower costs and no increased deaths. In fact, the patients who stopped taking statins appeared to live slightly longer.
“When you look at the number of medications people take when they are dying, it doubles in the last year of life,” said lead author Amy Abernethy, M.D., Ph.D., director of the Center for Learning Health Care at the Duke Clinical Research Institute and a member of the Duke Cancer Institute. Abernethy represented the Palliative Care Research Cooperative Group, a national research network focused on improving care for people with serious illnesses.
Scientists discover potential new target for cancer immunotherapy
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Scientists have found a way to target elusive cells that suppress immune response, depleting them with peptides that spare other important cells and shrink tumors in preclinical experiments, according to a paper published online by Nature Medicine.
“We’ve known about these cells blocking immune response for a decade, but haven’t been able to shut them down for lack of an identified target,” said the paper’s senior author, Larry Kwak, M.D., Ph.D., chair of Lymphoma/Myeloma and director of the Center for Cancer Immunology Research at The University of Texas MD Anderson Cancer Center.
The cells, called myeloid-derived suppressor cells (MDSCs), are found abundantly in the microenvironment around tumors. Created with other blood cells in the bone marrow, they interfere with activation and proliferation of T cells, the immune system’s attack cells. MDSCs have been shown in mouse models to accelerate cancer progression and metastasis.
“This is the first demonstration of a molecule on these cells that allows us to make an antibody, in this case a peptide, to bind to them and get rid of them,” Kwak said. “It’s a brand new immunotherapy target.”
To curb hepatitis C, test and treat inmates
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Problematic as it is for society, the high incarceration rate in the United States presents an important public health opportunity, according to a new “Perspective” article in the New England Journal of Medicine. It could make staving off the worst of the oncoming hepatitis C epidemic considerably easier.
Nearly 4 million Americans may be infected with the hepatitis C virus (HCV). Many of them don’t know they carry HCV, which can take decades to make them ill with cirrhosis, cancer, or liver failure. About a million people could die because of HCV by 2060, the authors wrote, and many who are saved will have required critical and costly treatments, including liver transplants.
“We know this is going to come crashing down on us,” said lead author Dr. Josiah D. Rich, professor of medicine and epidemiology at Brown University and director of the Center for Prisoner Health and Human Rights at The Miriam Hospital. “It’s already starting to come crashing down. The next 10 to 20 years are going to be ugly.”
The single best setting for fighting the epidemic is U.S. prisons and jails, where more than 10 million people cycle through each year. In part because a major means of HCV transmission is through injection drug use, a large portion of the nation’s infected population passes through the criminal justice system. In the journal, for example, Rich and his coauthors estimate that one in six inmates is infected and one in three infected Americans ends up locked up for at least a little time in their lives.
Study finds hazardous flame retardants in preschools
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A new study of preschools and day care centers finds that flame retardants are prevalent indoors, potentially exposing young children to chemicals known to be hazardous.
The study, to appear online Thursday, May 15, in the journal Chemosphere, was led by researchers at the University of California, Berkeley, and funded by the California Air Resources Board. Although many infants and young children spend up to 50 hours per week in day care, the study authors noted that this paper represents the first systematic review of flame retardants in early child care settings.
The researchers covered 40 child care centers serving 1,764 children in Monterey and Alameda counties. The facilities were located in a mix of urban, rural and agricultural areas. The researchers collected air and floor dust samples when the children were present, and tested for 14 different PBDEs, or polybrominated diphenyl ethers, and four non-PBDE flame retardants, including tris phosphate compounds.
The study found both PBDEs and tris phosphate compounds in 100 percent of the dust samples collected. Median levels of PBDEs were somewhat lower than those found in homes in other studies, but median levels of chlorinated tris were similar to or higher than household levels found in other studies.
Access to electronic health records may influence care
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Unlike medical records kept in paper charts, electronic health records (EHR) provide numerous access points to clinicians to review a patient’s medical history. A new study has found access to electronic health records in acute care situations may influence the care given to that patient, and in some cases, failure to review the EHR could have adversely affected the medical management. The findings are reported in the May 2014 edition http://content.healthaffairs.org/content/33/5/800.abstract of Health Affairs. John L. Ulmer, M.D., professor of radiology and chief of neuroradiology at the Medical College of Wisconsin (MCW), is the corresponding author. Co-authors are Michael J. Franczak and Madeline Klein, former research assistants at MCW; Flavius Raslau, M.D., assistant professor of radiology at the University of Kentucky College of Medicine; Jo Bergholte, program manager at MCW; and Leighton P. Mark, professor of radiology at MCW.
In the study, three neuroradiologists at Froedtert & the Medical College Froedtert Hospital analyzed 2,000 head CT scans that had been ordered by emergency department physicians. For each exam, the neuroradiologists compared the medical information generated by the emergency department physicians to the additional information retrieved by interpreting radiologists who had access to EHR patient data.
The interpreting radiologists found that in many of the cases, the additional data in the EHR would have a significant impact on the interpretations of the head CT scans.
Cholesterol drug users may use pills as a license to overeat
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People who take the common cholesterol-lowering drugs known as statins may feel a false sense of security and eat a bit more, according to a new study.
Researchers found that U.S. adults taking statins in 1999-2000 were eating fewer calories than people not taking the drugs, but statin users were eating about the same amount as non-users by 2009-2010.
“We believe that physicians need to reemphasize the importance of a healthy lifestyle to statin-users,” Dr. Takehiro Sugiyama told Reuters Health in an email.
He is the study’s lead author from the University of Tokyo in Japan.
Study ties breathing problems, asthma to bone loss
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People with asthma-related breathing problems may be at increased risk for bone loss, according to a new study.
The study examined the records of more than 7,000 adults in Seoul, Korea, and found those with a certain characteristic of asthma had significantly lower bone density in a region of their spine than those without asthma symptoms.
The characteristic, called airway hyperresponsiveness, means the airways in the lungs are particularly sensitive, and it doesn’t take much to trigger an asthma attack.
However, both men and women with airway hyperresponsiveness were still in the normal range for overall bone density, on average. And researchers couldn’t say whether the asthma symptoms or the bone loss came first or what linked the two.
Arkansas to appeal ruling on abortion restriction law
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Arkansas Attorney General Dustin McDaniel said on Friday he would appeal a federal judge’s decision striking down a state law that bans most abortions starting at 12 weeks of pregnancy, one of the most stringent such statutes in the United States.
U.S. District Judge Susan Webber Wright ruled last month that the Arkansas law violated the U.S. Supreme Court decision that a woman has the right to an abortion until the fetus is viable outside the womb, which medical experts say is around the 23-to-24-week mark
A number of states have recently enacted restrictive bans on abortion, including North Dakota, Arizona and Texas, setting off a round of court battles.
