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Health

Tip sheet for journalists: Equol, soy, menopause and bone health research published in Journal of Nutrition

The dietary supplement SE5-OH containing Natural S-equol, developed from soy, may be appropriate for women in menopause, based on results of recent clinical trials documenting its effectiveness and safety in relieving hot flushes and other symptoms of menopause. Nine articles on equol, soy, menopause, bone health and cancer research appear in a July 2010 supplement to the Journal of Nutrition and are summarized here. About SE5-OH containing Natural S-equol Soybeans contain a naturally occurring compound, the isoflavone called daidzein. Certain bacteria living within the human digestive tract can convert daidzein into S-equol [7-hydroxy-3-(4'-hydroxyphenyl)-chroman]. S-equol is thought to bind to the estrogen beta receptors, but further study is underway to confirm this hypothesis. Studies in Japan have documented an association in women between milder menopausal symptoms in those who naturally produce S-equol after eating soy compared to non-producers. The production of S-equol after soy consumption depends on the types of bacteria present in the large intestine and may be influenced by the amount of soy consumed. About 50 percent of Asians and 20 to 30 percent of North Americans and Europeans, who in general consume less soy than Asians, have the ability to produce equol. Pharmavite LLC, the makers of Nature Made® vitamins and minerals and a subsidiary of Otsuka Pharmaceutical Co., Ltd., is conducting and sponsoring clinical trials that examine the use of SE5-OH containing Natural S-equol in supplement form for the management of menopausal symptoms. JN Papers 1. Historical Overview of Soy and Isoflavone Research Messina reviews the past two decades of soy and isoflavone research, noting that largely because of research evaluating the anticancer effects of soyfoods sponsored by the US National Cancer Institute in the 1990s, interest in the role of soy and isoflavones in disease prevention greatly increased . Subsequently, isoflavones and soyfoods have been studied for their ability to lower cholesterol, their potential as alternatives to conventional hormone therapy, alleviate, as well as treat hot flashes and inhibit bone loss in postmenopausal women. "A Brief Historical Overview of the Past Two Decades of Soy and Isoflavone Research," Mark Messina, Ph.D., adjunct associate professor of nutrition at the Loma Linda University School of Public Health in California and of Nutrition Matters, Inc. in Port Townsend, Washington 2. Discovery and Chemistry of Equol The health benefits of soy-based diets may be greater in people who can produce S-equol after eating soy, than in non-producers. Equol exists in two mirror-image forms: S- equol and R-equol, but intestinal bacteria exclusively produce the S-equol from soy, which is known to have a select affinity for estrogen receptor beta. A man-made chemical process is needed to make R-equol, which binds more weakly with a preference for estrogen receptor alpha. Both forms of equol are of interest from a clinical and pharmacological perspective and are under development as nutraceutical and pharmacological agents. The authors state that wide range of biological activities these two equol forms possess warrants their investigation for the treatment of a number of hormone-related conditions involving conditions dependent on the female hormone estrogen and related to the male hormone androgen. "Equol: History, Chemistry and Formation," Kenneth D. R. Setchell, of Pathology and Laboratory Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center in Ohio, and Carlo Clerici of Clinica di Gastroenterologia ed Epatologia, at the Universita` degli Studi di Perugia University of Perugia in Italy 3. Biological Actions of Equol Equol exhibits a wide range of biological properties. This paper reviews previous research on how the body processes both equol forms, also called pharmacokinetics, and their biological actions. The authors note that if the theory that health benefits of soy-based diets are greater in equol-producers can be substantiated in studies, then for those adults who are unable to produce S-equol due to a lack of equol-producing bacteria in the intestine or some other factors, one option is to eat equol in the form of a nutraceutical. " Equol: Pharmacokinetics and Biological Actions," Kenneth D. R. Setchell, of Pathology and Laboratory Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center in Ohio, and Carlo Clerici of Clinica di Gastroenterologia ed Epatologia, at the Universita` degli Studi di Perugia University of Perugia in Italy 4. Equol Review by an Epidemiologist Lampe reviews the very limited body of a subset of research about equol, which includes animal studies involving S-equol, a mix of S- and R-equol or their "parental" compound, daidzein, and human epidemiologic studies of soy intake and equol production. "Emerging Research on Equol and Cancer," Johanna W. Lampe, of the Cancer Prevention Program, Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center in Seattle 5. Equol and Bone in Women and Mice Soybean isoflavones, including daidzein and genistein, can inhibit bone loss, depending on the dosage, according to a number of studies using animal model with osteoporosis, without causing notable effects on reproductive organs. Ishimi reports in this article data from a year-long study in postmenopausal Japanese women, in which 25 received a daily dose of daidzein and the isoflavone genistein , and 29 received a placebo. In the women in the isoflavone group who could produce S-equol, the percent change in bone loss at the total hip (a decrease of 0.46 percent) and at the hip intertrochanteric region (a decrease of 0.04 percent) was significantly lower (P< 0.05 for both) than that of the nonproducers (a decrease of 2.28 and 2.61, respectively.) Similarly the S-equol producers in the isoflavone group had significantly lower changes in their fat mass compared to nonproducers during the course of the study. The results suggest that using soy isoflavones to prevent bone loss and the accumulation of fat in women in early post-menopause may depend on an individual's equol-producing capacity. "Dietary Equol and Bone Metabolism in Postmenopausal Japanese Women and Osteoporotic Mice," Yoshiko Ishimi, of the National Institute of Health and Nutrition in Tokyo, Japan 6. Equol May Help to Reduce Bone Loss Estrogen produced in the body helps maintain dynamic bone with a high turnover rate. Menopause in women is associated with the body's stage when estrogen levels decrease. The reduction in production and circulating estrogen is associated with rapid bone loss. S-equol binds to estrogen receptor beta, in bone cells. A two-year randomized placebo-controlled trial that characterized postmenopausal women by their equol-producing status, showed that those who were equol producers had a 2.4 percent increase in the lumbar spine bone mineral density (BMD) compared with just 0.6 percent increase in the S-equol non-producers. Additional clinical studies have related women's equol producer status with changes in markers of bone turnover in response to treatments with soy isoflavones. "Equol, via Dietary Sources or Intestinal Production, May Ameliorate Estrogen Deficiency-Induced Bone Loss," Connie M. Weaver and LeeCole L. Legette, of the Department of Foods and Nutrition at Purdue University in Indiana 7. Cultural influences on assessing Menopausal Hot Flashes Hot flashes continue to be a troublesome problem for menopausal women the world over. After 50 years of research, Kronenberg reports that the specific cause and mechanism of hot flashes is still not understood, or how estrogen, the major pharmaceutical treatment, works to reduce hot flashes. Insights into the social and cultural complexities that may affect how and whether women report hot flashes and becoming more sophisticated in research tools, such as questionnaires, physiological monitors and brain imaging techniques, may yield more information. New aspects of hot flash research, including neuroimaging and the study of genetic differences, when combined with increasingly nuanced ways of asking questions of culturally distinct populations, provide challenges but rich complexity from which a better understanding of menopausal hot flashes will emerge. "Menopausal Hot Flashes: A Review of Physiology and Biosociocultural Perspective on Methods of Assessment," Fredi Kronenberg of the Clayman Institute for Gender Research at Stanford University 8. Equol Improves Menopausal Symptoms in Japanese Women Aso reports on three studies exploring the possible therapeutic role of the SE5-OH containing Natural S-equol supplement in treating menopausal symptoms in Japanese women. The studies indicated that a daily dose of 10 mg of SE5-OH containing Natural S-equol improved menopausal symptoms. In a confirmation study, menopausal women who were not equol producers who consumed 10 mg daily of the supplement for 12 weeks had significantly reduced severity and frequency of their hot flashes as well as a significant reduction in the severity of their neck or shoulder stiffness. The equol-ingesting group also showed trends of improvement in sweating and irritability. SE5-OH containing Natural S-equol appears to have a promising role as an alternative remedy in the management of women's menopausal symptoms. "Equol Improves Menopausal Symptoms in Japanese Women," Takeshi Aso, M.D., Ph.D., Professor Emeritus at the Tokyo Medical and Dental University in Japan. 9. Research Needs for Equol, Soy, and Menopause Research Barnes reported that research opportunities now exist to determine whether the effects of equol on menopausal symptoms, such as hot flashes, sleep disturbances, bone health, in equol producers can be extended to equol non-producers via supplements. It is recommended that future research be designed to avoid complications from differences of social culture, lifetime exposure to soy products, experimental techniques and other variables. "Cautions and Research Needs Identified at the Equol, Soy, and Menopause Research Leadership Conference," Stephen Barnes, Ph.D., of the Department of Pharmacology and Toxicology, and Helen Kim, PhD, director of 2-D Proteomics Laboratory, both at the University of Alabama at Birmingham. Making SE5-OH containing Natural S-equol Saga Nutraceuticals Research Institute of Otsuka Pharmaceutical Co., Ltd. developed SE5-OH containing Natural S-equol, which is created under current Good Manufacturing Practices using the equol-producing lactic acid bacterial strain Lactococcus 20-92 in a proprietary fermentation process patented by the Otsuka Pharmaceutical Co., Ltd. This process converts daidzein to Natural S-equol, steadily increasing the concentration of Natural S-equol until reaching a maximum concentration at 72 to 96 hours and decreasing daidzein by 95 percent. Following fermentation, the SE5-OH ingredient undergoes a sterilization process using heat denaturation that deactivates the bacteria. The process is designed to produce a product rich in Natural S-equol that can be used as a nutraceutical ingredient. For more information on the research on Natural S-equol, please visit the website www.naturalequol.com. About Pharmavite LLC: For almost 40 years, Pharmavite has earned and maintained the trust of healthcare professionals, consumers, and retailers by manufacturing high-quality vitamins, minerals, herbs and other dietary supplements that are safe, effective and science-based. Nature Made® is the number one selling dietary supplement brand in the food, drug, club and mass channels. The dietary supplement industry is regulated by the U.S. Food and Drug Administration and the Federal Trade Commission, as well as by government agencies in each of the 50 states. About Otsuka Pharmaceutical Co., Ltd.: Founded in 1964, Otsuka Pharmaceutical Co., Ltd. is a global healthcare company with the corporate philosophy: 'Otsuka-people creating new products for better health worldwide.' Otsuka researches, develops, manufactures and markets innovative and original products, with a focus on pharmaceutical products for the treatment of diseases and consumer products for the maintenance of everyday health. Otsuka is committed to being a corporation that creates global value, adhering to the high ethical standards required of a company involved in human health and life, maintaining a dynamic corporate culture, and working in harmony with local communities and the natural environment. Otsuka Pharmaceutical Co., Ltd. is a wholly owned subsidiary of Otsuka Holdings Co., Ltd., the holding company for the Otsuka Group. The Otsuka Group comprises 145 companies and employs approximately 39,000 people in 23 countries and regions worldwide. Otsuka and its consolidated subsidiaries earned ¥1,084.2 billion (approx. US $11.7 billion*) in annual revenues in fiscal 2009. Visit Otsuka Pharmaceutical Co., Ltd. at www.otsuka-global.com.

Jul 8, 2010

Health

New way to conquer disease-causing nematodes in flies has implications for human diseases

A Science article published on July 9, 2010, describes the discovery of an alternative form of evolution that helps Drosophila flies conquer nematodes that sterilize them. Nematodes are among the most abundant, diverse and destructive parasites of plants and animals. The article, titled, "Adaptation via Symbiosis; Recent Spread of a Drosophila Defensive Symbiont", is by John Jaenike of the University of Rochester and his colleagues. In a video interview, Jaenike explains the results of this study and their implications for developing treatments for serious human diseases, including river blindness, caused by nematodes; about 17.7 million people worldwide are currently infected with river blindness. "The protection of an insect from a potent nematode parasite by a bacterial infection is of potential importance in both medicine and agriculture," says George Gilchrist, a program director at the National Science Foundation. "This study adds a new page to the catalogue of interactions between animals and bacteria." The Science study is also discussed in a press release from the University of Rochester.

Jul 8, 2010

Health

SNM cautions that Canada's Chalk River coming back online will not solve long-term isotope shortage

Reston, Va. -- SNM is optimistic that the anticipated recommencement of the Atomic Energy of Canada Limited (AECL)-run National Research Universal (NRU) reactor in Chalk River, Canada, will provide short-term relief to the isotope shortage that has been plaguing patients and the nuclear medicine community for more than one year. However, SNM cautions that the restart of this reactor will not solve the ongoing production and supply issues causing the crisis. "We are cautiously optimistic that NRU going back online will alleviate some of the most pressing concerns facing the nuclear medicine community," said Robert W. Atcher, Ph.D., M.B.A., chair of SNM's Domestic Isotope Availability Work Group and past president of the society. "However, this is not a magic bullet, and NRU coming back online will not solve this crisis. As the Canadian Nuclear Safety Commission (CNSC) staff are reported to have observed, gaps in the assessment of the reactor could have a serious impact on the reliability of the reactor's operation in the future." In a news conference held last month during SNM's Annual Meeting, Atcher asked Canadian officials to help put an end to this endemic crisis once and for all. "Several years ago, government and industrial parties in Canada assured the nuclear medicine community that Canada's MAPLE reactors could ensure the continued availability of Mo-99 in the U.S.," he said. In 2007, that project was canceled due to cost over-runs and technical problems. The NRU reactor at Chalk River was unexpectedly shut down in May 2009 after workers discovered a leak during a routine inspection. The NRU reactor supplied more than 35% of the world's supply of Molybdenum-99 (Mo-99) -- a critical medical isotope whose decay product, Technetium-99m (Tc-99m), is used for common imaging procedures to diagnose and detect heart disease, cancer and other conditions. More than 16 million procedures are conducted annually in the U.S. using that isotope. Over the past year, AECL announced additional repairs and maintenance issues that further delayed the start date of the NRU reactor. Coupled with scheduled outages at the High Flux Reactor (HFR) at Petten in the Netherlands -- the world's only other major reactor that produces Mo-99 -- many hospitals around the world were forced to either delay or cancel patient procedures. Of major long-term concern is that the Canadian government has announced previously that they intend to shut down isotope production at the NRU reactor permanently in 2016, which will create another, much longer shortage in the worldwide supply of Mo-99. "Creating and maintaining a sustainable delivery of radioisotopes is one of SNM's most critical priorities," said Dominique Delbeke, M.D., Ph.D., president of SNM. "We continue to work to advocate for a domestic supply of Mo-99 in the U.S. so that nuclear medicine physicians and technologists have a reliable supply of radioisotopes to perform critical imaging tests that patients need for high-quality care." At a hearing held July 7, the CNSC approved AECL's request to resume production of Mo-99 at its Chalk River facility. According to AECL officials, repairs have been completed and the reactor is ready to resume production. Production is expected to begin within 10 days of NRU coming back online. The reactor has to be refueled and brought back to power before isotope production can resume. "In addition to the impact that the shortage has had on the job market for nuclear medicine technologists and the impact on patients, the latest series of setbacks shows that the U.S. needs a reliable domestic isotope supply now more than ever before," added Atcher. The Canadian government's response to the recent expert panel report on what path to take after NRU is shut down has been to retreat to only providing radioisotopes for the Canadian region. This underscores the severity of the problem for the U.S. market, which comprises 50% of the world demand for Mo-99, Atcher noted. The American Medical Isotopes Production Act of 2009 (H.R. 3276), which would provide funding for the production of a domestic isotope supply, was approved by the U.S. House of Representatives this past fall. The bill is currently in the Senate. About SNM -- Advancing Molecular Imaging and Therapy SNM is an international scientific and medical organization dedicated to raising public awareness about what molecular imaging is and how it can help provide patients with the best health care possible. SNM members specialize in molecular imaging, a vital element of today's medical practice that adds an additional dimension to diagnosis, changing the way common and devastating diseases are understood and treated. SNM's more than 17,000 members set the standard for molecular imaging and nuclear medicine practice by creating guidelines, sharing information through journals and meetings and leading advocacy on key issues that affect molecular imaging and therapy research and practice. For more information, visit www.snm.org.

Jul 8, 2010

Health

Electronic health records prime clinicians to provide progressive care to older adults

COLUMBIA, Mo. -- In 20 years, approximately 72 million older adults will reside in the United States, almost double the current number, according to the U.S. Administration on Aging. Potential issues are compounded by the projected shortage of health care workers needed to provide elder care. As part of the solution, an interdisciplinary team of University of Missouri researchers is refining electronic health record (EHR) technology to more efficiently meet increasing health care demands. The MU researchers are developing an EHR system that encompasses standard health assessments and those obtained through new technologies. The goal is to increase efficiency and accuracy, improve patient outcomes and reduce costs for long-term care. "As the use of emerging technologies increases along with the older population, maintaining complete and accurate patient information can be overwhelming," said Marilyn Rantz, professor in the MU Sinclair School of Nursing. "A comprehensive system that encompasses all measures, old and new, is the key to enhanced and efficient clinical decision making." The EHR is being tested at TigerPlace, an independent senior-living facility that helps residents age in place. According to the researchers' initial findings, use of the EHR system can enhance nursing care coordination and advance technology use and clinical research. "New technologies to passively monitor older adults' health are being developed and are increasingly commercially available," Rantz said. "The challenge remains to integrate clinical information systems with passive monitoring data, especially in long-term care and home health settings, in order to improve clinical decision making and ensure patient records are complete." Effective EHR systems display data in ways that are meaningful and quickly assessable for clinicians, Rantz said. With access to comprehensive data, clinicians can make more informed clinical decisions, better perform risk assessments and provide risk-reducing interventions. The study, "Developing a Comprehensive Electronic Health Care Records to Enhance Nursing Care Coordination, Use of Technology and Research," was published in the Journal of Gerontological Nursing. The research was supported by the U.S. Administration on Aging and the National Science Foundation. Project collaborators included researchers from the MU Sinclair School of Nursing, University Hospital, School of Medicine and the College of Engineering. For more information, visit the eldercare and rehabilitation technology Web site: http://eldertech.missouri.edu/

Jul 8, 2010

Health

Endoscopic ultrasound evaluation is associated with improved outcomes in pancreatic cancer patients

OAK BROOK, Ill. -- July 8, 2010 -- A new study has found that endoscopic ultrasound (EUS) is associated with improved outcomes in patients with localized pancreatic cancer, possibly due to the detection of earlier cancers and improved stage-appropriate management, including more selective performance of curative intent surgery. This is the first study to analyze a large population-based cancer registry and demonstrate that EUS evaluation is associated with improved pancreatic cancer survival. The study appears in the July issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE). Pancreatic cancer is common and highly lethal. The only chance of long-term survival in pancreatic cancer is if complete resection (surgical removal) can be performed. The symptoms of pancreatic cancer are non-specific and usually occur late in the course of the disease; less than 20 percent of patients have resectable disease at the time of diagnosis. Endoscopic ultrasound is considered to be one of the most accurate tests for detecting pancreatic masses and for the staging of pancreatic cancer. EUS has proven to have the highest sensitivity in detecting pancreatic tumors, especially when the results of other cross-sectional imaging modalities are inconclusive. It is equivalent and complementary to CT for staging pancreatic cancer and predicting vascular invasion and local resectability. Endoscopic ultrasound consists of a flexible endoscope which has a small ultrasound device built into the end. The ultrasound component produces sound waves that create visual images of the digestive tract which extend beyond the inner surface lining. EUS can be used to evaluate an abnormality below the surface such as a growth that was detected at a prior endoscopy or by X-ray. EUS is also used to diagnose diseases of the pancreas, bile duct, and gallbladder when other tests are inconclusive, and can be used to determine the stage of cancers. Tissue samples, using a fine needle aspiration technique (FNA), can be obtained in real time with EUS guidance should an abnormality be seen. "We hypothesized that undergoing EUS was associated with improved overall survival in pancreatic cancer patients, probably related to early pancreatic cancer detection and accurate preoperative staging by EUS and improved stage-appropriate treatment," said study lead author Saowanee Ngamruengphong, MD, Mayo Clinic Arizona, Scottsdale. "In this study, we analyzed the Surveillance Epidemiology and End Results (SEER) -- Medicare-linked database to study the association of undergoing EUS with overall survival in a cohort of patients with pancreatic adenocarcinoma and found that EUS is associated with improved survival in pancreatic cancer patients, most probably as a result of improved stage-appropriate management, including more selective performance of curative intent surgery and perioperative adjuvant therapy." Patients and Methods Using the SEER-Medicare database, researchers identified a total of 8,616 patients aged 65 and older with primary pancreatic cancer from January 1994 to December 2002 who fulfilled the inclusion and exclusion criteria. The study population was divided into two groups based on whether or not they underwent EUS evaluation. Group I consisted of patients who underwent EUS during the peridiagnostic period, Group II did not undergo EUS. Overall, 610 patients or 7.1 percent, underwent EUS for tumor evaluation and staging. Results There were more patients with early-stage disease in Group I than in Group II, 69.3 percent locoregional (localized and regional stage) disease in Group I vs. 36.2 percent in Group II. Curative-intent surgery, chemotherapy and radiation therapy were also performed more frequently in Group I. In patients with locoregional pancreatic adenocarcinoma, the median survival in Groups I and II were 10 months and 6 months respectively. The researchers found that receipt of EUS was an independent predictor of improved survival. Younger age at diagnosis, curative-intent surgery, chemotherapy and radiation therapy were also significantly associated with improved survival. The researchers noted that improved survival related to undergoing EUS in this study is likely due to many factors because EUS is purely a diagnostic imaging modality and carries no direct therapeutic impact. Therefore EUS evaluation may help identify patients who would most likely benefit from undergoing attempts at curative resection. On the other hand, EUS evaluation might help to identify patients with advanced or metastatic pancreatic cancer who would not benefit from curative resection and therefore avoid the morbidity and mortality related to unnecessary surgery. Researchers also looked at sociodemographic and geographic factors with undergoing EUS evaluation and found in multivariate analysis that younger age, white race, being married, locoregional disease, living in the Midwest region, and more recent year of diagnosis were significant predictors of undergoing EUS. The rate of EUS use in the study patients increased from .6 percent in 1994 to 13.1 percent in 2002. Although EUS evaluation is still performed in a minority of patients with pancreatic cancer, there is an increasing trend in the use of EUS in these patients. This may reflect increasing availability with dissemination of EUS technology from select academic centers to the community. In an accompanying editorial, Bryan G. Sauer, MD, MSc, and Vanessa M. Shami, MD, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, stated that they believe the study "provides further evidence of the value of EUS in pancreatic cancer. Although EUS is not currently used to treat cancer, its association with improved survival is most likely a surrogate for multiple factors that improve survival, such as earlier detection of cancer; more accurate staging; and multidisciplinary, stage-appropriate treatment. We believe that individuals with localized pancreatic masses should undergo EUS for diagnostic and staging purposes, so that stage-appropriate treatment can be pursued. Furthermore, we anticipate earlier detection of pancreatic cancer through improved imaging and effective screening." About the American Society for Gastrointestinal Endoscopy Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with more than 11,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area. About Endoscopy Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system.

Jul 8, 2010

Brain & Behavior

1 in 5 preschoolers in the US demonstrates mental health issues when entering kindergarten

Washington, DC, 8 July 2010 -- Social competence and behavior problems that are evident at kindergarten and first grade are known to be strong predictors of a child's academic and social functioning. However, findings reported in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry suggest that psychosocial risk factors can be identified even earlier and can be observed during the transition from preschool to formal schooling. The article titled "Prevalence of DSM-IV Disorder in a Representative, Healthy Birth Cohort at School Entry: Sociodemographic Risks and Social Adaptation" Dr. Alice S. Carter and colleagues report on 1,329 healthy children born between July 1995 and September 1997 in the New Haven -- Meriden Standard Metropolitan Statistical Area of the 1990 Census. The researchers sought to determine the prevalence of psychiatric disorders in the early elementary school years and to examine the relationship between the sociodemographic and psychosocial risk factors and these disorders. The study sample was ascertained through birth records, and represents one of the first longitudinal studies to evaluate psychopathology in children within the United States as they negotiate the transition to school. One parent from each family of a subsample of 442 enriched for child psychopathology was interviewed using the Diagnostic Interview Schedule for Children -- Version IV (DISC IV) to determine the diagnosis. Parents were surveyed about sociodemographic factors, such as parental age and education, and poverty as well as psychosocial characteristics. Both parents and teachers of the children were surveyed about social competence. Dr. Carter and colleagues report that as children transition to formal schooling, approximately one in five (21.6%) will have a psychiatric disorder with impairment. The findings confirm that the prevalence of psychopathology during the transition to school age is not dissimilar to that documented for preschool-aged children. In addition, the risk of comorbidity (the risk of two or more disorders of any type) was 5.8%. Within the study cohort, the prevalence of externalizing disorders was 13.8% and 11.1% for internalizing disorders. Of those individuals who had more than one disorder, more than 60% had both an externalizing and an internalizing disorder. In the article, the researchers report, "Sociodemographic and psychosocial correlates included persistent poverty beginning in early childhood, limited parental education, low family expressiveness, stressful life events, and violence exposure. Finally, diagnostic status was significantly associated with poorer social competence and family burden." An accompanying editorial by Dr. Neil W. Boris of Tulane University can be found in the same issue of the Journal of the American Academy of Child and Adolescent Psychiatry. About the study, Dr. Boris states, "More than anything, Carter et al. remind us that young children are at significant risk for psychopathology just like older children. As children transition to school age, be on the lookout for problems." Commenting on the potential impact of their findings, Carter and colleagues observe, "Epidemological data on prevalence and risk co-incidence with disorders during the transition to school can and should inform conversations about psychosocial school readiness, early intervention, and prevention programming." Screening for psychopathology at the transition to school age is warranted and based on the impairment data of affected children early intervention seems appropriate. Cater and colleagues further state that, "intervention should also take into account the social context, not only within the school setting but also with respect to risk factors in the home and broader community." Notes to Editors This study was support by a grant to Dr. Carter from the National Institute of Mental Health (R01MH55278), the MRSA/MCHB LEND project (HERSA/MCHB T73MC00020l; Dr. David Helm, PI), and the Mental Health/Developmental Disabilities at Children's Hospital Boston (National Institute of Mental Health/National Institutes of Health R25 MH0171286; Dr. Kerim Munir, PI). The study is published in the Journal of the American Academy of Child and Adolescent Psychiatry and online at www.jaacap.com. This Release References: 1. Carter AS, Wagmiller RJ, Gray SAO, McCarthy KJ, Horwitz SM, Briggs-Gowan MJ. Prevalence of DSM-IV Disorder in a Representative, Healthy Birth Cohort at School Entry: Sociodemographic Risks and Social Adaptation. Journal of the American Academy of Child and Adolescent Psychiatry. 2010;49:686-698. 2. Boris NW. Minding the Transition to School. Journal of the American Academy of Child and Adolescent Psychiatry. 2010;49:635-636. To reach the author you may contact: Dr. Alice Carter at 617)287-6375 by email at [email protected]. For further information, please contact Rebecca Jensen, Managing Editor, JAACAP, [email protected] or 202.966.7300 x 112. About the Journal of the American Academy of Child and Adolescent Psychiatry The Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families. The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

Jul 8, 2010

Health

Functional MRI may predict response of hepatocellular carcinoma to chemoembolization

Early knowledge of hepatocellular carcinoma (HCC) response to transcatheter arterial chemoembolization (TACE) is crucial for determining treatment success, timing of repeat treatment, and patient prognosis. Currently, magnetic resonance imaging (MRI) is used 1-3 mo after treatment to evaluate anatomical tumor response, based upon changes in tumor size and contrast-agent enhancement. Alternatively, diffusion-weighted imaging (DWI) can be used as a functional imaging technique to depict thermally induced motion of water molecules. The extent of water mobility within biological tissues can be quantified by a parameter called the apparent diffusion coefficient (ADC). Recently, ADC values have been shown to change within days to weeks after therapy, which is earlier than changes seen by conventional HCC anatomical size assessment. However, no studies to date have reported the intra-procedural characteristics of ADC and whether these values can predict future tumor response at the time of chemoembolization. A research article to be published on July 7, 2010 in the World Journal of Gastroenterology addresses this question. The research team led by Professor Reed A Omary, from Department of Radiology, Northwestern University, Chicago, used functional magnetic resonance imaging (MRI) to measure changes in tumor activity at the time of treatment, and compared them to tumor structural changes on conventional MRI at standard 1- and 3-mo follow-up periods. Their results suggest that patients whose intra-procedural ADC values increase or decrease by > 15% are more likely to have a favorable anatomical tumor response 1 mo later. This result is encouraging because early knowledge of HCC response after initial therapy is essential to revise prognosis and guide future therapy. Use of DWI and ADC mapping in conjunction with traditional anatomical imaging evaluation could further improve tumor response interpretation and subsequent treatment planning. At present, MR/Interventional radiology suites permit the acquisition of immediate quantitative functional imaging changes, in both tumor perfusion and now diffusion. Which of these two functional parameters is more effective as an intra-procedural biomarker to tailor HCC therapy awaits verification by future studies. Reference: Chung JC, Naik NK, Lewandowski RJ, Deng J, Mulcahy MF, Kulik LM, Sato KT, Ryu RK, Salem R, Larson AC, Omary RA. Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization. World J Gastroenterol 2010; 16(25): 3161-3167 http://www.wjgnet.com/1007-9327/full/v16/i25/3161.htm Correspondence to: Reed A Omary, MD, MS, Professor of Radiology and Biomedical Engineering, Vice Chair of Research, Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave., Suite 1600, Chicago, IL 60611, United States. [email protected] Telephone: +1-312-6953774 Fax: +1-312-9265991 About World Journal of Gastroenterology World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2009 IF: 2.092. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

Jul 8, 2010

Health

Legalizing marijuana in California would lower the price of the drug and increase use

Legalizing the production and distribution of marijuana in California could cut the price of the drug by as much as 80 percent and increase consumption…

Jul 8, 2010

Health

Decline in international medical graduates exacerbates shortage of general surgeons

CHICAGO (July 7, 2010) -- A decline in the number of international medical graduates (IMGs) is threatening patient access to quality surgical care, according to a new study in the June issue of the Journal of the American College of Surgeons. For years, a flat supply of new U.S.-educated medical school graduates in the specialty of general surgery has created a strong need for IMGs, graduates of medical schools located outside the U.S. and Canada. The study reveals that a decline in IMGs practicing general surgery in the U.S. is creating a "crisis of urgency" as demand for general surgeons continues to grow. Rural areas are particularly threatened by this trend. In 2005, IMGs represented 17.4 percent of all general surgeons; now they represent only 14.8 percent. Meanwhile, since 2005, the total number of rural surgeons has declined nearly 40 percent to 998, according to researchers. By 2020, the growth of the U.S. population and proportion of people older than 65 years of age will create a greater demand for healthcare resources, including surgeons. In 2020, it is estimated that the supply of general surgeons will fall short of the demand by 1,875. "We are currently unable to fill our general surgery residencies with U.S. medical school students," said Kyla P. Terhune, MD, a general surgical resident at Vanderbilt University School of Medicine, Nashville, Tenn. "In the 2009 residency match, if every U.S. senior medical student had been matched to a first-year position in any field, only 70 percent of available positions would have been filled. These shortages can have a lasting impact on patient access to care, particularly in trauma and critical care situations." While IMGs have long been relied upon to meet the growing need for general surgeons, the number of IMGs in practice is declining. This decline, along with inadequate numbers of trainees in domestic surgery programs, has created a critical gap. To help address future demands, 108 of the 126 existing medical schools (86 percent) are increasing class size, with a projected expansion of allopathic (conventional or Western medicine) graduates by 5,000 each year through 2020. In this study, an assessment of the National Resident Matching Program's 2009 Main Residency Match showed 22,427 total positions in all specialties offered at a postgraduate year (PGY)-1 level. However, only 15,638 senior students enrolled in U.S. allopathic medical schools submitted rank lists (the process in which applicants bid for or "rank" their preferred residency programs) for those positions. And while the number of U.S. seniors submitting rank lists in 2009 increased by 919 from 2005, the number of senior medical students submitting for general surgery spots actually decreased by 72 applicants. On a positive note, there is recent evidence that this year more seniors are interested in general surgery; even so, this country remains dependent on a dwindling pool of IMGs. Recently, the Physician Workforce Enhancement Act of 2009 was introduced to alleviate some of these workforce shortages by providing loans to eligible hospitals to help establish residency training programs. Preference would be given to rural and small urban areas, and programs would be limited to particular specialties, including family medicine, internal medicine, general surgery, and others. This legislation makes an attempt to increase the number of residency positions, a process that may lead to more qualified general surgeons in the future. But delays in passing the legislation and residency application trends means additional general surgery residents are likely to be IMGs. "We cannot provide for our citizens through our own medical education system," said Dr. Terhune. "This study shows us that we must acknowledge the importance of IMGs -- and the fact that we have become too reliant on them to meet the growing demand for all specialties, including general surgery." This cross-sectional study revealed that compared with their non-IMG counterparts, IMGs were older (52 ± 8 years versus 47 ± 8 years; p< 0.001), more likely to be male (93 percent vs. 82 percent; p< 0.001), and more likely to be further out of training (46 percent versus 28 percent ≥ 20 years out of training; p< 0.001). In terms of geographic distribution, there were 2,216 IMGs in urban cores (15 percent of general surgeons in these areas); 223 IMGs in large rural areas (12 percent of general surgeons in these areas); and 163 IMGs in small rural areas (16 percent of general surgeons in these areas). IMGs include both U.S. citizens and non-citizens who have trained abroad. The Educational Commission for Foreign Medical Graduates requires IMGs to complete four years of education at a medical school listed in the International Medical Education Directory and to obtain passing scores on the same licensing examinations that are given to U.S. graduates. About the American College of Surgeons The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 77,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

Jul 7, 2010

Health

Society of Interventional Radiology advances global definition of specialty, benefits patients

FAIRFAX, Va. -- The Society of Interventional Radiology, with the support of 41 international societies representing 10,000 interventional radiology doctors, has issued the first global statement defining interventional radiology -- one designed to benefit medical treatment for individuals. The statement addresses the evolution, impact and future direction of this minimally invasive specialty, emphasizing the worldwide availability of this specialized medical care. The statement, the result of more than two years of collaborative work, is being co-published in August as a "Special Communications" in SIR's Journal of Vascular and Interventional Radiology and in the Cardiovascular and Interventional Radiological Society of Europe's journal. "Until now, there has been no single document -- no blueprint -- defining interventional radiology that has had broad international support. It was time for interventional radiology to organize itself, worldwide, as a single family," said SIR President James F. Benenati, M.D., FSIR, who represents the U.S. organization of nearly 4,500 doctors, scientists and allied health professionals dedicated to improving health care through minimally invasive treatments. Interventional radiologists offer the least invasive and most advanced treatment options for major health problems (including cancer, cardiovascular and venous disease, spine fractures, stroke and uterine fibroids), but many may not be aware of these advances, he noted. In the United States, IR is a recognized subspecialty with its own board certification exam, and IR is defined by its strong tradition of innovation and adaptation. However, the need for a universal statement became evident because there are countries where interventional radiology may not be recognized formally as a "real" specialty or subspecialty, explained Benenati. "Continuously increasing numbers of patients are being treated by interventional radiologists -- without the need for open invasive surgery, without the need for a scalpel. When you have an inclusive, multinational document that represents more than 10,000 doctors worldwide, it is hard to deny their existence," added Benenati, an interventional radiologist and medical director for the Noninvasive Vascular Laboratory at Baptist Cardiac & Vascular Institute in Miami, Fla. "Interventional radiology is a unique specialty distinct from all other radiologic, medical and surgical specialties. While IR has been helping patients for more than 40 years, it is still a relatively new specialty; however, it has become integral to the delivery of health care worldwide," said the SIR president. The "Global Statement Defining Interventional Radiology" puts into writing the basic elements of IR that apply to interventional radiologists anywhere in the world. It stresses that IR doctors "provide patient evaluation and management relevant to image-guided interventions in collaboration with other physicians or independently." The collaborative statement evolved over time, with input from IRs from nearly every continent. Work on the collaborative statement began two years ago by John A. Kaufman, M.D., FSIR, FCIRSE, then SIR president, and his European counterpart, Jim A. Reekers, M.D., FCIRSE, FSIR, then president of CIRSE. It was important to include input from as large a representation of interventionalists as possible to make sure the statement was universally useful, said Kaufman, professor at the Dotter Interventional Institute, Oregon Health & Science University, Portland, Ore. "Every country will find that what they do is a little different, but the goal is a document backed by interventional radiology societies all over the world stating, 'This is what constitutes the specialty of interventional radiology,'" he noted. "We expect that the document will be translated and published widely throughout the world," said Kaufman. Intentionally brief, the "Global Statement Defining Interventional Radiology" details that IRs have expertise in diagnostic imaging and radiation safety, in image-guided minimally invasive procedures and techniques as applied to multiple diseases and organs, in the evaluation and management of patients suitable for the image-guided interventions included in the scope of IR practice and in continual invention and innovation of new techniques, devices and procedures. The unified statement defines and identifies the common features of IR. It provides background and outlines common elements found in the specialty, including clinical practice and scope, training, certification, research, practice quality and professionalism. Besides SIR, the final statement is endorsed by CIRSE, Austrian Society of Interventional Radiology, Brazilian Society of Interventional Radiology and Endovascular Surgery, British Society of Interventional Radiology, Bulgarian Society of Interventional Radiology, Canadian Interventional Radiology Association, CardioVascular and Interventional Radiology Section Within the Singapore Radiological Society, Cardiovascular and Interventional Society of Turkey, Chinese Society of Interventional Radiology, Croatian Society of Radiology, Czech Society of Interventional Radiology, Danish Society of Interventional Radiology, Dutch Society of Interventional Radiology, Egyptian Society of Interventional Radiology, Finnish Society of Interventional Radiology, Georgian Association of Cardiovascular and Interventional Radiology, German Society of Interventional Radiology and Minimally Invasive Therapy, Hellenic Society of Interventional Radiology, Hong Kong Society of Interventional Radiology, Hungarian Society of Cardiovascular and Interventional Radiology, IberoAmerican Society of Interventionism, Indian Society of Vascular and Interventional Radiology, Interventional Radiology Section, Polish Medical Society of Radiology, Interventional Radiology Society of Australasia, Irish Society of Interventional Radiology, Israeli Society of Interventional Radiology, Japanese Society of Interventional Radiology, Korean Society of Interventional Radiology, Pan Arab Interventional Radiology Society, Philippine Society of Vascular and Interventional Radiology, Portuguese Section of Interventional Radiology of the Portuguese Society of Radiology and Nuclear Medicine, Section of Cardiovascular and Interventional Radiology of the Royal Belgian Radiological Society, Seldinger Society of Vascular and Interventional Radiology, Sezione di Studio della SIRM di Radiologia Vascolare ed Interventistica, Sociedad Argentina de Radiologia, Society of Interventional Onco-Radiology, Spanish Society of Vascular and Interventional Radiology, Swiss Society of Cardiovascular and Interventional Radiology, Taiwanese Radiological Society, Thai Society of Vascular and Interventional Radiology and the Working Group of Cardiovascular and Interventional Radiology of the Slovak Radiological Society. Interventional radiologists are responsible for much of the medical innovation and development of minimally invasive treatments that are commonplace today. From the invention of angioplasty and the catheter-delivered stent, which were both first used to treat peripheral arterial disease in the legs, to cardiac catheterization, drug-coated stents, balloon angioplasty, catheter delivery systems and clot-removing devices of today -- these vascular specialists continue to shape and change the medical landscape and improve patient care. IR treatments offer less risk, less pain and less recovery time than traditional surgery. For more information about the Society of Interventional Radiology and minimally invasive treatments, visit online at www.SIRweb.org. About the Society of Interventional Radiology Interventional radiologists are physicians who specialize in minimally invasive, targeted treatments. They offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. They use X-ray, MRI and other imaging to advance a catheter in the body, such as in an artery, to treat at the source of the disease internally. As the inventors of angioplasty and the catheter-delivered stent, which were first used in the legs to treat peripheral arterial disease, interventional radiologists pioneered minimally invasive modern medicine. Today, interventional oncology is a growing specialty area of interventional radiology. Interventional radiologists can deliver treatments for cancer directly to the tumor without significant side effects or damage to nearby normal tissue. Many conditions that once required surgery can be treated less invasively by interventional radiologists. Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery. Visit www.SIRweb.org.

Jul 7, 2010

Health

HIV prevention strategy key to curbing epidemic and cutting long-term treatment costs

Increasing highly active antiretroviral therapy (HAART) treatment for people with HIV/AIDS will provide significant cost savings over a relatively short period of time, according to a formal economic analysis led by researchers at the BC Centre for Excellence in HIV/AIDS (BC-CfE) at Providence Health Care and the University of British Columbia (UBC). The analysis of HAART coverage in British Columbia, published recently in AIDS, the official journal of the International AIDS Society (IAS), is the first comprehensive economic evaluation of the net benefit of HAART in the province. HAART lowers viral load, stopping HIV from progressing to AIDS in individuals and helping to prevent HIV transmission. The study's key finding shows that while expanding HAART use is cost-effective for individual patients, the benefits become exponentially greater when HAART's ability to prevent HIV transmission is considered. The economic analysis demonstrated that increasing HAART treatment coverage from the current estimated 50 per cent to 75 per cent of all clinically eligible British Columbians (HIV-infected individuals with CD4 cell counts below 350 cells/ ul) would deliver a net benefit of US$900 million over 30 years. "The study findings make the point that expansion of HAART is not just a medical or ethical imperative, it is a very smart financial investment in terms of its potential to improve public health," said Dr. Julio Montaner, director of the BC-CfE, president of the IAS, and one of the authors of the study. "HIV continues to be a global health concern and the lifetime costs of treating individuals with HIV are substantial. Therefore, HAART's potential to prevent new HIV infections is an important element of the overall strategy to minimize the economic burden on the health care system of treating HIV," added Montaner, who is also a professor and Chair in AIDS Research at the University of British Columbia. The study, Expanding access to HAART: a cost-effective approach for testing and preventing HIV, provides the first analysis that incorporates the impact of HAART on prevention based on real data. The study was undertaken from a taxpayer perspective. Only direct medical costs such as antiretroviral and non-antiretroviral medications, hospitalizations, physician visits and laboratory tests were considered. The study was based on high-quality population-based data for B.C. Researchers expect that the findings can be accurately applied to other areas with similar healthcare systems. Within B.C., the sub-populations most affected by HIV are hard-to-reach, marginalized groups such as sex trade workers, injection drug users and men who have sex with men. Prevention of new infections among these HIV-vulnerable groups must be a priority in order to meaningfully curb the growth of the epidemic. In this context, the study findings lend further credence to the BC-CfE-pioneered Seek and Treat strategy. The B.C. government recently invested in a $48-million, four-year pilot project in Prince George and Vancouver's Downtown Eastside to extend HAART treatment to all people in medical need living with HIV. The Seek and Treat program will improve access to HIV/AIDS treatment and care among hard-to-reach populations. The program is currently being evaluated as part of the BC-CfE's innovative research program, Seek and Treat for the Optimal Prevention of HIV/AIDS (STOP HIV/AIDS). The Seek and Treat strategy has increasingly gained acceptance internationally, with pilot projects being implemented in some U.S. cities. Seek and Treat is central to the BC-CfE's work in turning the tide against the epidemic. Seek and Treat aims to engage people into appropriate care, including HIV testing and antiretroviral treatment, as soon as medically indicated. The BC-CfE's research has conclusively shown that appropriate use of antiretroviral treatment halts the progression of HIV infection to AIDS and death and dramatically reduces the chances of HIV transmission. With the support of the B.C. government, the BC-CfE is currently evaluating further strategies and undertaking a wide variety of scientific studies and economic analyses to harness the full potential of antiretroviral treatment in the province. This work is being closely followed by international agencies, including UNAIDS and WHO, as it provides unique insights into the most efficient ways to deal with the global HIV pandemic. In the absence of an HIV vaccine or cure, Seek and Treat, as proposed by the BC-CfE, provides an innovative option to help HIV-infected individuals live full and fulfilling lives, prevent HIV transmission and curtail the human suffering and economic costs of HIV infection. For a full copy of the study, Expanding access to HAART: a cost-effective approach for testing and preventing HIV, and other studies related to Seek and Treat released by the BC-CfE, please visit http://www.cfenet.ubc.ca/our-work/initiatives/seek-and-treat. About the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE): The B.C. Centre for Excellence in HIV/AIDS (BC-CfE) is Canada's largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. Based at St. Paul's Hospital, Providence Health Care, a teaching hospital of the University of British Columbia, the BC-CfE is dedicated to improving the health of British Columbians with HIV through developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses. About UBC The University of British Columbia is one of Canada's largest and most prestigious public research and teaching institutions. UBC is consistently ranked among the world's 40 best universities, one of only two Canadian universities in this category. UBC consistently attracts more than $450 million per year in research funding from government, non-profit organizations and industry through 7,000 grants. It is ranked within the top 10 North American universities in terms of the number of U.S. life sciences patents and the quality of activity generated from those patents, including spin-off company creation.

Jul 7, 2010

Health

NOSCAR announces first NOTES transoral and transvaginal gallbladder removals performed as part of US multicenter human trial

OAK BROOK, Ill., July 7, 2010 -- The Natural Orifice Surgery Consortium for Assessment and Research® (NOSCAR®), a joint effort of the American Society for Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), announces the completion of the first transoral and transvaginal cholecystectomies (gallbladder removal) using Natural Orifice Translumenal Endoscopic Surgery® (NOTES®) in a multicenter human trial in the United States. Santiago Horgan, MD, at the University of California, San Diego School of Medicine, removed the gallbladder of a patient through the mouth and John Romanelli, MD, Baystate Medical Center in Springfield, Mass., removed the gallbladder of a patient through the vagina as part of the NOSCAR® human trials. NOTES® is performed by using the patient's natural openings for surgery. These human trials are the first in the world comparing oral and transvaginal NOTES® to traditional laparoscopy. "NOSCAR congratulates Drs. Horgan and Romanelli for these major accomplishments. These are the first NOTES transoral and transvaginal cholecystectomies in a U.S. multicenter human trial and are a big step forward in the evolution of this revolutionary procedure," said Michael L. Kochman, MD, NOSCAR Research Subcommittee co-chair. Cholecystectomy or gallbladder removal is one of the most common surgeries in the U.S.; approximately 750,000 are performed annually. This study uses the mouth or vagina as routes to the gallbladder. Rather than making up to five incisions in the abdominal wall, tools are passed down the mouth and through a hole created in the stomach (transgastric) or through the vagina (transvaginal). Dr. Horgan opted to make a tiny incision in the stomach, requiring no stitches, to pass a camera and to inflate the abdomen for optimal safety and visibility. The actual gallbladder removal was performed entirely through the mouth. Dr. Romanelli also made a small vaginal incision for similar reasons as Dr. Horgan, to ensure the safety of the procedure. He extracted the gallbladder through the vagina. "We are excited to announce the completion of the first transoral and transvaginal cholecystectomies in the NOTES human trials. UCSD and Baystate Medical Center are at the forefront of NOTES research and their participation in these human trials is providing invaluable knowledge that is taking NOTES to the next level," said Steven D. Schwaitzberg, MD, NOSCAR Research Subcommittee co-chair. The human trials were announced last summer and began earlier this year. The prospective multicenter trial compares NOTES cholecystectomy versus conventional laparoscopic cholecystectomy. NOSCAR has granted funds to selected institutions to conduct these trials. Institutions participating in the trial have demonstrated a strong commitment to developing the basic science that forms the foundation of NOTES and have already performed human NOTES cases under an Institutional Review Board protocol; approximately 200 patients will be enrolled in the clinical trial. Until now, NOSCAR research efforts have focused on basic research. Continuing research commitments from industry partners Ethicon Endo-Surgery, Olympus America Inc., Stryker Medical and KARL STORZ Endoscopy-America are providing funds to support the human study in this emerging transdisciplinary therapy. ACI, a Clinical Research Organization based in Pennsylvania, has been retained to provide data collection and report preparation services for the study. About NOSCAR Natural Orifice Translumenal Endoscopic Surgery® (NOTES®) might represent the next major advancement in minimally invasive therapy. To address this emerging technology, a working group consisting of expert laparoscopic surgeons from SAGES and a group of expert interventional endoscopists representing ASGE have joined together as the Natural Orifice Surgery Consortium for Assessment and Research® (NOSCAR®). The growing capabilities of therapeutic flexible endoscopy have ushered in a new era in treatment of gastrointestinal conditions. Refinements in laparoscopic surgery have progressed to the point that complex surgical procedures, such as gastric bypass, can now be performed in a minimally invasive fashion. These trends have set the stage for the development of even less invasive methods to treat conditions in both the gut lumen and in the peritoneal cavity. It seems feasible that major intraperitoneal surgery may one day be performed without skin incisions. The natural orifices may provide the entry point for surgical interventions in the peritoneal cavity thereby avoiding abdominal wall incisions. For more information, visit www.noscar.org. About the Society of American Gastrointestinal and Endoscopic Surgeons The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) was founded in 1981 to foster, promote, support and encourage academic, clinical and research achievement in gastrointestinal endoscopic surgery. SAGES members are general and colorectal surgeons who perform endoscopy and laparoscopy as part of their practice as well as surgical residents, fellows, and other allied health personnel. The Society has grown from fewer than 50 original members to more than 5,500 from every state and over 80 countries. Visit www.sages.org for more information. About the American Society for Gastrointestinal Endoscopy Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with more than 11,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area. Media Contacts: Barbara Connell NOSCAR 630-570-5616 [email protected] Anne Brownsey ASGE 630-570-5635 [email protected]

Jul 7, 2010

Health

Research: Schwartz Center Rounds encourage compassionate health care and better teamwork

Boston, MA - Caregivers who participated in a program where attendees discuss medical cases that were complex for psychosocial and emotional reasons were more likely to be attentive to the psychosocial and emotional aspects of patient care. The program also enhanced their beliefs about the importance of empathy. These were a couple of the most significant findings of a study that recently appeared in Academic Medicine. The study looked at the effects of Schwartz Center Rounds - case-based facilitated discussions at which caregivers discuss the psychosocial and emotional challenges of their jobs. Held at 195 health care facilities in 31 states, the Rounds provide a safe and confidential forum where clinicians share their job-related experiences, fears, dilemmas, joys and concerns with one another. The researchers conducted retrospective surveys of attendees at six sites offering Schwartz Center Rounds for at least three years and prospective surveys of attendees at 10 Rounds sites before the program began and after at least seven Rounds sessions were conducted. "We know that good caregiver-patient relationships, communication and "whole-person" knowledge of patients have been correlated with improvements in clinical and functional status, adherence, patient trust and reduced malpractice suits," said lead author Beth A. Lown, MD, a faculty member at Mt. Auburn Hospital and an assistant professor of medicine at Harvard Medical School. "The Rounds foster deeper, more meaningful relationships with patients, yielding significant benefits for everyone involved." Respondents to the retrospective survey also reported: Better teamwork, including greater appreciation of the roles and contributions of colleagues Decreases in perceived stress Improvements in the ability to cope with the psychosocial demands and emotional difficulties of care "The finding that the Rounds encourage better teamwork should be very intriguing to anyone interested in care quality because collaboration plays an important role in the causation and prevention of adverse events," said Dr. Lown. Researchers also reported that for participants in the prospective survey of newer Rounds hospitals, the greater the number of Rounds attended, the greater: the impact on that caregiver's insights into the psychosocial aspects of care their focus on the effects of illness on patients' lives and families their level of compassion The study also revealed that Rounds benefit departments and hospitals as a whole, particularly by encouraging a culture of teamwork. Rounds have spurred programmatic changes at host hospitals, including greater use of palliative care teams and changes in nursing care in the ICU. The study's co-author is Colleen F. Manning, director of research at Goodman Research Group, Inc. About the Kenneth B. Schwartz Center The Kenneth B. Schwartz Center is an autonomous, nonprofit organization with a mission to support and advance compassionate health care in which caregivers, patients and their families relate to one another in a way that provides hope to the patient, support to caregivers, and sustenance to the healing process. The Center's most successful and fastest growing program, the Schwartz Center Rounds, are held at 195 sites in 31 states. For more information on the Schwartz Center, visit www.theschwartzcenter.org

Jul 7, 2010

Health

York U autism-related study discovers how drug interferes with neuronal cell function

TORONTO, July 7, 2010 − A York University study has shown for the first time how the drug misoprostol, which has been linked to neurodevelopmental defects associated with autism, interferes with neuronal cell function. It is an important finding because misoprostol is similar in structure to naturally-occurring prostaglandins, which are the key signaling molecules produced by fatty acids in the brain. Past clinical studies have shown an association between misoprostol and severe neurodevelopmental defects including autism symptoms. Those studies looked at cases in Brazil in which women misused the drug early in pregnancy in unsuccessful attempts to terminate their pregnancies. The York study examined mouse neuronal cells to discover how the drug actually interferes at a molecular level with prostaglandins, which are important for development and communication of cells in the brain. "Early in the first trimester of pregnancy, neuronal cells reach out to communicate with one another," says Dorota Crawford, an assistant professor in the School of Kinesiology & Health Science in York's Faculty of Health. "Our study shows that misoprostol interferes with this process by increasing the level of calcium ions in neuronal extensions, which reduces the number and length of these extensions. It prevents the cells from communicating with each other. If changes in prostaglandin level alter the development or differentiation of cells, it may have a physiological impact." Crawford and Javaneh Tamiji, who undertook the research for her master's thesis in the Neuroscience Graduate Diploma Program at York, co-authored a study published online in the journal Biochemical and Biophysical Research Communications: "Prostaglandin E2 and misoprostol induce neurite retraction in Neuro-2a cells." There is no indication that women in Canada are misusing misoprostol to terminate pregnancies, and in fact the drug is used safely for other purposes such as treatment and prevention of gastrointestinal ulcers. However, during early neuronal development the drug misoprostol or other environmental factors such as infections or inflammations, which can also increase the level of prostaglandins, may interfere with normal brain function, says Crawford. Crawford and Tamiji focused on the drug misoprostol because they had evidence from the clinical studies of the neurotoxic effects of the drug. They used misoprostol and the naturally occurring prostaglandins side by side in their study and found that both compounds produced the same effects on neuronal cell function. The study shows that misoprostol interferes with the prostaglandin pathway in a dose-dependent manner -- in other words, the higher the dose, the greater the problems created. "What that indicates to us is whether it is infection that will activate it, or whether it is the drug, it will cause the same effect," says Crawford. Now that it has been shown that misoprostol affects interaction between cells, the next step will be to do animal studies on mice to examine the physiological impacts on particular parts of the brain, she says. Crawford's lab is one of very few in the world that has adopted a multidisciplinary approach to the study of autism spectrum disorders, using molecular techniques to understand the link between causative biological factors (genes and environment) and the behavioural expression. This release is posted on the York University Media Relations website at: http://www.yorku.ca/mediar/archive/Release.php?Release=1894 York University is the leading interdisciplinary research and teaching university in Canada. York offers a modern, academic experience at the undergraduate and graduate level in Toronto, Canada's most international city. The third largest university in the country, York is host to a dynamic academic community of 50,000 students and 7,000 faculty and staff, as well as 200,000 alumni worldwide. York's 10 Faculties and 28 research centres conduct ambitious, groundbreaking research that is interdisciplinary, cutting across traditional academic boundaries. This distinctive and collaborative approach is preparing students for the future and bringing fresh insights and solutions to real-world challenges. York University is an autonomous, not-for-profit corporation. Media Contact: Janice Walls, Media Relations, York University, 416 736 2100 x22101/ [email protected]

Jul 7, 2010