Don't Stress Over Anxiety: An Anxiety-Free Life With Dr. Jantz

Severe anxiety can leave its sufferers paralyzed with debilitating worry, uncontrollable fear and clinical depression. Although anxiety is the most common mental health problem in the U.S., many affected by anxiety don't know how to treat their problem or even how to seek help. Dr. Gregory L. Jantz, PhD, author of more than 25 self-help books and founder of The Center, has written a new book, "Overcoming Anxiety, Worry, and Fear," aimed at providing more than 40 million Americans with the anxiety help they need.

"Overcoming Anxiety, Worry, and Fear" is different than the many self-help books on the shelves today. Dr. Jantz' book offers a practical way for readers to deal with anxiety and not be paralyzed by everyday life and the foreboding future. His innovative whole-person approach to healing enables readers to first identify why they are anxious and then, through common sense and attention to the mind, body and spirit, directs them on a path for positive change and a more peaceful life.

Anxiety is a disease that often goes unrecognized and untreated. The following are some common mental and physical symptoms of excessive anxiety:

- Edginess, restlessness and inability to relax
- Irritability, fatigue and insomnia
- Difficulty concentrating and easily distracted
- Muscle tension and soreness
- Trembling and twitching
- Diarrhea and irritable bowel syndrome
- Shortness of breath, dizziness and headaches
- Uncontrollable worrying
- Sense of dread and doom

"Overcoming Anxiety, Worry, and Fear" is a great tool toward freedom from anxiety through emotional, physical, spiritual and intellectual healing. This is a must-read for anyone who is suffering, or who knows of someone suffering, from an anxiety disorder.

Source:
Dr. Gregory L. Jantz, PhD

Man Fined £10,000 For Illegal Sale Of Lifestyle Drugs, UK

A 27-year-old man from Uxbridge in northwest London was yesterday (26 May 2011) fined £10,000 at Southwark Crown Court for selling unlicensed medicines for erectile dysfunction.

Saranjit Bhambra pleaded guilty on 26 April 2011 to one offence of selling medicinal products that contain ingredients found in medicines that can only be supplied with a prescription or by a qualified pharmacist.

The Medicines and Healthcare products Regulatory Agency (MHRA) launched the investigation known as Operation Rome following a test purchase of a pack of four Tadil tablets from Bhambra's website.

The test purchase led to a search at a car mechanic's garage, where officers found evidence connected to an illegal online pharmacy supplying medicinal products including tadalafil and sildenafil. Both tadalafil and sildenafil are potent active ingredients and should only be taken when directed by a healthcare professional, who has access to a patient's individual records, and supplied through a registered pharmacy.

MHRA Head of Enforcement, Mick Deats, said: "While websites such as these may look professional, what we see behind the scenes tells a very different story.

"These unlicensed medicines were being sold from a mechanic's garage which means they risk additional contamination due to the unsanitary conditions in which they were stored.

"Anyone considering taking medication for erectile dysfunction (ED) should consult a healthcare professional so that the right diagnosis can be made as this could be a symptom of a more serious medical condition.

"The unlawful sale of medicines, including those to treat ED, poses a serious threat to public health and today's sentence reflects the nature and gravity of this crime."

Notes

1. Under the Medicines Act 1968 the penalty on indictment is a maximum of two years imprisonment and/or an unlimited fine.

2. Members of the public are advised that they should only take prescription-only medicines after an appropriate consultation with their GP. Only healthcare professionals can take into account risks and benefits associated with every medicine.

3. Unlicensed medicines have not been tested to European standards of safety, quality and efficacy.

Source:
MHRA

Tragara Pharmaceuticals' Apricoxib Reverses EMT, A Key Process For Cancer Progression And Metastasis

Tragara Pharmaceuticals, Inc. announced that apricoxib (Capoxigem®, TG01), its novel COX-2 inhibitor in development for select cancer types, demonstrated reversal of the epithelial-mesenchymal transition (EMT) in xenograft models of several types of solid tumors. These data results were presented at the 2011 American Society for Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium and the 2011 American Association for Cancer Research (AACR) Annual Meeting and demonstrate that apricoxib potently inhibits the activity of COX-2 and COX-2 derived prostaglandin E2 (PGE2), which in turn mediates EMT and the associated progression and metastasis of solid tumors.

"Reversal of EMT may provide several clinical benefits to patients with non-small cell lung cancer and pancreatic cancer," stated Sara Zaknoen, M.D., chief medical officer, Tragara Pharmaceuticals, Inc. "Patients may experience longer survival due to effects of EMT reversal on metastases and the cancer stem cell, and benefit from the reversal of resistance to drugs such as erlotinib."

Tragara has completed two phase II clinical trials of apricoxib. Results from the APRiCOT-L trial, a biomarker-based, phase II, randomized, placebo-controlled study of apricoxib in combination with erlotinib in non-small cell lung cancer, will be presented on June 6th at the ASCO meeting in Chicago. A second phase II study of apricoxib in combination with gemcitabine and erlotinib has completed enrollment and is currently being analyzed.

"COX-2 has been implicated in EMT, so we were gratified to see robust reversal of EMT resulting from apricoxib treatment in xenograft models of pancreatic, colon, and head and neck cancers," stated Francis Burrows, Ph.D., head of oncology biology, Tragara Pharmaceuticals, Inc. "This effect was associated with profound inhibition of metastasis in orthotopic cancer models but, interestingly, apricoxib-mediated EMT reversal also reduced proliferation and survival of tumor cells in the primary lesion, perhaps due to a reduction in levels of cancer stem cells which are thought to arise via EMT."

About Epithelial-Mesenchymal Transition (EMT) and COX-2

The epithelial-mesenchymal transition (EMT) is a developmental program resulting in a cellular shift from an epithelial phenotype to a motile, mesenchymal form that is essential for embryogenesis, tissue remodeling and tumor progression. Under the influence of oncogenic factors such as inflammatory cytokines, polarized epithelial cancer cells detach from their underlying basement membrane and progressively lose lineage-specific markers such as E-cadherin and acquire mesenchymal markers (e.g. vimentin) and the ability to invade and metastasize to new sites. Both EMT and hyperactivity of the COX-2 pathway are associated with poor prognosis in a range of solid tumor types. Many of the properties of solid tumor cells that have undergone EMT, including apoptosis resistance and heightened angiogenic and metastatic capacity, are also associated with chronic inflammation and overexpression of COX-2 and its catalytic product prostaglandin E2 (PGE2). Activation of the MAP kinase pathway by PGE2 induces the master regulators of EMT, the transcriptional repressors Snail and ZEB1 and also enhances TGFB-dependent EMT by blocking Smad signaling, suggesting that COX-2 derived PGE2 is a major driver of EMT in human cancer.
About Capoxigem® (apricoxib, TG01)

Capoxigem (apricoxib, TG01) is an oral, once-daily selective COX-2 inhibitor. It is being evaluated separately for the treatment of inflammation-related pain and cancer. In inflammation-related pain, Capoxigem modulates the cyclooxygenase pathway, reducing the production of inflammatory prostaglandins. A large phase IIa Proof-of-Concept and dose finding study in inflammation-related pain has been completed in the United States. Superiority to placebo and an active comparator was demonstrated; safety was comparable to the active comparator.

As an anti-cancer treatment, Capoxigem affects a number of different oncogenic signaling pathways, including the HIF-1, VEGF, VEGF-R and PDGF systems for angiogenesis; the EGFR, HER2/neu, Bcr/Abl for growth control and differentiation; the intrinsic and extrinsic pathways for apoptosis; and the integrin and metalloproteinase systems for tissue invasion and metastasis. Capoxigem also potently inhibits COX-2-derived PGE2 production, reversing the PGE2-dependent epithelial-mesenchymal transition (EMT) process and the associated progression and metastasis of solid tumors. In pre-clinical cancer models, Capoxigem has shown superiority to compounds with similar mechanisms of action and synergy in combination with cisplatin, trastuzumab, and pemetrexed.

Capoxigem added to erlotinib therapy in a clinically relevant subset of biomarker-selected patients with advanced refractory non-small cell lung cancer significantly prolonged time to progression, progression-free survival and overall survival in a phase II proof-of-concept study (APRiCOT-L). In clinical studies to date, Capoxigem has been well tolerated with a manageable side effect profile.

In addition to the APRiCOT-L study, a phase II study of Capoxigem in pancreatic cancer recently completed enrollment and an investigator initiated study of Capoxigem in NSCLC in combination with chemotherapy is currently underway in the United States.

Source: Tragara Pharmaceuticals, Inc

When Cancer Runs In The Family

5% to 10% of all breast cancers are monogenic in origin. In other words, there is a mutation of the genes BRCA1, BRCA2 or other high-risk genes. In this edition of Deutsches Arzteblatt International (Dtsch Arztebl Int 2011; 108(19): 323 - 30), Alfons Meindl of the Klinikum rechts der Isar (Munich) and coauthors report on new insights into the pathogenesis and treatment of hereditary breast and ovarian cancer and newly-discovered risk genes.

Meindl et al. evaluated data including those derived from the work of the German Consortium for Hereditary Breast and Ovarian Cancer. It was shown that if BRCA1 or BRCA2 is mutated, there is a breast cancer risk of up to 85% and an ovarian cancer risk of up to 50%. Another predisposing gene for breast and ovarian cancer is RAD51C. Like BRCA1 and BRCA2, it plays a central role in DNA repair and is mutated in approximately 1.5% to 4% of all families predisposed towards breast and ovarian cancer.

When there is evidence of a high-risk gene mutation, the authors recommend intensive risk-adjusted screening. Risk can be reduced by prophylactic bilateral removal of the breasts and ovaries. In the future, drug-based approaches to risk reduction may also be possible.

In Germany, breast cancer is the most common malignant disease in women and ovarian cancer the gynecological tumor with the highest mortality rate. There may be a hereditary cancer burden even if only two or more women, or one young woman, in a family develop the disease.

Sources: Deutsches Aerzteblatt International, AlphaGalileo Foundation.

Brain Circuitry Changes Growing Up Influence Moral Development

People's moral responses to similar situations change as they age, according to a new study at the University of Chicago that combined brain scanning, eye-tracking and behavioral measures to understand how the brain responds to morally laden scenarios.

Both preschool children and adults distinguish between damage done either intentionally or accidently when assessing whether a perpetrator had done something wrong. Nonetheless, adults are much less likely than children to think someone should be punished for damaging an object, especially if the action was accidental, said study author Jean Decety, the Irving B. Harris Professor in Psychology and Psychiatry at the University of Chicago and a leading scholar on affective and social neuroscience.

The different responses correlate with the various stages of development, Decety said, as the brain becomes better equipped to make reasoned judgments and integrate an understanding of the mental states of others with the outcome of their actions. Negative emotions alert people to the moral nature of a situation by bringing on discomfort that can precede moral judgment, and such an emotional response is stronger in young children, he explained.

"This is the first study to examine brain and behavior relationships in response to moral and non-moral situations from a neurodevelopmental perspective," wrote Decety in the article, "The Contribution of Emotion and Cognition to Moral Sensitivity: A Neurodevelopmental Study," published in the journal Cerebral Cortex. The study provides strong evidence that moral reasoning involves a complex integration between affective and cognitive processes that gradually changes with age.

For the research, Decety and colleagues studied 127 participants, aged 4 to 36, who were shown short video clips while undergoing an fMRI scan. The team also measured changes in the dilation of the people's pupils as they watched the clips.

The participants watched a total of 96 clips that portrayed intentional harm, such as someone being shoved, and accidental harm, such as someone being struck accidentally, such as a golf player swinging a club. The clips also showed intentional damage to objects, such as a person kicking a bicycle tire, and accidental damage, such as a person knocking a teapot off the shelf.

Eye tracking in the scanner revealed that all of the participants, irrespective of their age, paid more attention to people being harmed and to objects being damaged than they did to the perpetrators. Additionally, an analysis of pupil size showed that "pupil dilation was significantly greater for intentional actions than accidental actions, and this difference was constant across age, and correlated with activity in the amygdala and anterior cingulate cortex," Decety said.

The study revealed that the extent of activation in different areas of the brain as participants were exposed to the morally laden videos changed with age. For young children, the amygdala, which is associated the generation of emotional responses to a social situation, was much more activated than it was in adults.
In contrast, adults' responses were highest in the dorsolateral and ventromedial prefrontal cortex areas of the brain that allow people to reflect on the values linked to outcomes and actions.

In addition to viewing the video clips, participants were asked to determine, for instance, how mean was the perpetrator, and how much punishment should he receive for causing damage or injury. The responses showed a clear connection between moral judgments and the activation the team had observed in the brain.

"Whereas young children had a tendency to consider all the perpetrator malicious, irrespective of intention and targets (people and objects), as participants aged, they perceived the perpetrator as clearly less mean when carrying out an accidental action, and even more so when the target was an object," Decety said. When recommending punishments, adults were more likely to make allowances for actions that were accidental, he said. The response showed that they had a better developed prefrontal cortex and stronger functional connectivity between this region and the amygdala than children. Adults were better equipped to make moral judgments.

"In addition, the ratings of empathic sadness for the victim, which were strongest in young children, decreased gradually with age, and correlated with the activity in the insula and subgenual prefrontal cortex," which area areas associated with emotional behavior and automatic response to stresses, Decety said. Together, the results are consistent with the view that morality is instantiated by functionally integrating several distributed areas/networks.

The research was supported with a grant from the National Science Foundation. Joining Decety in writing the paper were Kalina Michalska, a postdoctoral scholar, and Katherine Kinzler, an assistant professor, both in the Department of Psychology.

Source: University of Chicago

Data Links Anesthesia Use And Learning Disabilities, ADHD

Infants and very young children who are exposed to anesthesia may experience higher rates of learning disabilities and cognitive difficulties than children who are not exposed to anesthesia, according to research and emerging data presented during the SmartTots: Pediatric Anesthesia Neurotoxicity panel at the International Anesthesia Research Society annual meeting in Vancouver, B.C.

"We want to impress upon people that there is a very reliable link between the animal and human data that is rapidly emerging," said panel moderator Dr. Vesna Jevtovic-Todorovic, M.D., Ph.D., M.B.A., Professor of Anesthesiology and Neuroscience at the University of Virginia Health System and SmartTots Scientific Advisory Board member.

Studies in nonhuman primates, including rhesus monkeys, have raised serious concerns about the effects of anesthesia on the developing nonhuman primate brain. Merle Paule, Ph.D., Director of the Division of Neurotoxicology at the National Center for Toxicological Research and SmartTots Scientific Advisory Board member, discussed his recent findings that a single 24-hour episode of ketamine anesthesia results in very long-lasting deficits in brain function in nonhuman primates. According to Dr. Paule, these findings provide proof-of-concept that general anesthesia during critical periods of brain development can result in subsequent functional deficits.

"Very clearly, the studies done by the folks at the National Center for Toxicological Research are extremely important. They can't be overrated because they show in a species similar to humans that there is an effect not only on the pathology in the brain, but also in behavior. And that effect is a lasting effect," said Randall Flick, M.D., M.P.H., Associate Professor of Anesthesiology and Pediatrics at the Mayo Clinic. Dr. Flick is also the Society for Pediatric Anesthesia representative on the SmartTots Affiliate Advisory Council.

Dr. Flick presented his findings from a recent study at the Mayo Clinic, which concluded that multiple exposures to anesthesia before the age of 2 years are a "significant risk factor" for the development of Attention Deficit Hyperactivity Disorder. A single exposure to anesthesia did not appear to have an effect, Dr. Flick said.

"[Our] most recent work suggests that even when you adjust for illness within the population, there appears to be an effect with multiple exposures to anesthesia," said Dr. Flick. Interestingly, the age of exposure, the cumulative length of exposure, and the number of anesthetics are critically important considerations. Children younger than 4 years who were exposed to anesthesia for 120 min and longer for at least two times are at high risk.

Greg Stratmann, M.D., Ph.D., Associate Professor of Clinical Anesthesia and Perioperative Care at the University of California, San Francisco, discussed whether anesthesia-induced cognitive decline is treatable. His group at the University of California, San Francisco found that in the rat model the ill effects of anesthesia on brain function, which are apparent later in life, can be overcome through environmental enrichment even when instituted 3 weeks after exposure to sevoflurane anesthesia.
According to Stratmann, "These findings support the concept that harnessing the brain's natural ability to adapt to functional demands can modify the course of anesthesia-induced cognitive decline in rats."

The current work builds on groundbreaking rodent studies by Dr. Jevtovic-Todorovic. Dr. Jevtovic-Todorovic authored a 2003 paper that demonstrated that common anesthetics, alone and in combination, caused massive damage in the brain of young rodents, manifested as a widespread nerve cell death. Importantly, the rodents suffered long-lasting cognitive impairment in learning and memory, which worsened as they aged.

The growing evidence that multiple exposures to anesthesia may have deleterious effects on developing human brains presents doctors and parents with a difficult and even frightening dilemma. Rarely is surgery optional for the youngest patients. Dr. Flick cautions that, absent more definitive data about the effects of anesthesia, deferring necessary surgery could cause children more harm.

"We need to understand if and how anesthesia changes brain function both in animals and in humans so that we can study the outcome we are most worried about -- cognitive function -- using clinically relevant models of anesthesia and possibly even surgery. We should not be tempted to change clinical practice unless we are certain that we need to and know exactly how to," said Stratmann.

At minimum, however, physicians should strive to minimize the length of time a child is sedated, as well as the number of trips to the operating room, suggests Dr. Jevtovic-Todorovic. If a surgery can be deferred until after the child is 4 years old, without causing serious harm to the child, the deferral may be warranted.

"The momentum of the data suggests that the concern is a potentially real one and the only way for us to reassure parents is to fund a substantial amount of research over the next several years," said Jevtovic-Todorovic.

This new data, coupled with previously reported animal studies, points to an urgent need for additional research to identify the mechanism of action, establish new guidelines for the use of existing anesthetics, and to develop a model that will ensure the safety of new anesthetics. SmartTots estimates that the necessary research could cost up to $40 million.

Source: SmartTots

Combination Niacin Does Not Improve Heart Attack And Stroke Risk

Niacin, also known as vitamin B3, when combined with statin only therapy for patients with heart and vascular disease does not lower heart attack and stroke risk - a finding which made the National Heart, Lung, and Blood Institute and Abbott Laboratories end a clinical trial 18 months early.

The trial, called AIM-HIGH, was aimed to see whether individuals with heart and vascular disease might have better outcomes if they added niacin to their statin treatment.

The study involved patients who were at risk of suffering a cardiovascular event, such as a stroke or heart attack, even though their low-density lipoprotein (LDL) levels were well controlled. These patients already had a history of cardiovascular disease, and high LDL and triglyceride levels.

Patients with high triglyceride and low HDL levels are known to have a higher risk of experiencing a cardiovascular event. Whether raising HDL levels might improve their outcomes has never been shown.

The trial, involving 3,414 American and Canadian patients, compared patients on statin therapy alone (1,696) to those on statins plus high-dose extended release niacin (1,718). The niacin patients did eventually have higher HDL cholesterol levels, as well as lower blood levels of triglycerides, compared to the statin-only patients.

However, their risk of having a stroke or a heart attack (fatal or non fatal) remained the same, as was their likelihood of having to be admitted to hospital. The study leaders added that the niacin combination patient's chances of requiring a revascularization procedure remained the same too.

All the study participants had a history of cardiovascular disease and had been taking statins to control their LDL levels before the trial began. They all had low HDL and high triglyceride levels - they had a higher-than-normal risk of experiencing future cardiovascular events.

The trial was to last from 2006 till 2012. Patients were aged 64 years (average). 34% of them had diabetes, more than half of them had had a heart attack before the study, 71% had high blood pressure, 81% had metabolic syndrome, and 92% had coronary artery disease.

Acting NHLBI Director, Susan B. Shurin, M.D., said:
"Seeking new and improved ways to manage cholesterol levels is vital in the battle against cardiovascular disease. This study sought to confirm earlier and smaller studies. Although we did not see the expected clinical benefit, we have answered an important scientific question about treatment for cardiovascular disease. We thank the research volunteers whose participation is key in advancing our knowledge in this critical public health area, and the dedicated investigators who conducted the study."
"The lack of effect on cardiovascular events is unexpected and a striking contrast to the results of previous trials and observational studies. The AIM-HIGH findings do not support the trial's hypothesis that, in the population studied, adding extended-release niacin to simvastatin in participants with well-controlled LDL cholesterol can provide additional clinical benefit."

Co-principal AIM-HIGH investigator, Professor William E. Boden, M.D., said:

"The results from AIM-HIGH should not be extrapolated to apply to potentially higher-risk patients such as those with acute heart attack or acute coronary syndromes, or in patients whose LDL cholesterol is not as well-controlled as those in AIM-HIGH."

It appears that the hope that medically raising good cholesterol (HDL) can reduce the risk of heart attack and stroke may be misplaced, according to the surprising results of this study. This trial may change the way millions of patients are treated, experts believe.

The results were surprising because several previous studies that followed up on patients for decades had indicated that those with high HDL cholesterol levels generally live longer and have fewer cardiovascular events compared to those with low HDL levels.

For some patients, there may be a silver lining around the disappointment with niacin. Niacin is not easy to take - it causes headaches and flushing. Many have endured the unpleasant side effects because doctors have told them it may save their lives. Knowing that that is not the case means that they can stop taking it without worrying about any health consequences.

Abbott Laboratories, the makers of niacin, a drug that brought in $927 million in sales last year, will be disappointed.

Abbott put $32 million towards the trial, while the US government gave $21 million.

Several other pharmaceutical companies that have been trying to develop HDL raising drugs will also be unhappy with the results.

Written by Christian Nordqvist

Patients With RA Receive Less Protection From Pandemic Influenza With H1N1 Vaccine

A Brazilian hospital-based study assessed responses to flu vaccines in 340 RA patients in regular follow-up compared to 234 healthy patients. Measures of protection obtained by vaccination (seroprotection rate (SP)) after immunization was over 20% lower for RA patients compared to healthy individuals (60.1% vs. 82.9% comparatively (p<0.001)). Tests to determine levels of detectable antibodies to microorganisms in the blood serum as a result of infection and immunization with the flu virus (seroconversion rate (SC)) showed a similar pattern with 53.4% of RA patients and 76.9% of healthy controls having antibodies present respectively (p<0.001).

"This study has highlighted that there are differences in the level of protection between the H1N1 vaccine and the seasonal influenza vaccine so healthcare professionals should not assume that immune response will be the same with different vaccines" said Professor A. Ribeiro of the University of Sao Paolo. "In planning for future pandemic outbreaks, healthcare professionals should consider specific immunization strategies to ensure this large population of patients are as fully protected as possible from the risk of contracting pandemic flu."

The vaccination's impact on disease activity (DAS28*) was also measured and nine patients (2.6%) reported worsening of symptoms with the mean disease activity score changing from 3.66 to 5.15 (p<0.05) after the H1N1 vaccination. No serious adverse events were seen across either patient group, although more subjects in the RA patient group reported more adverse events, 42% versus 30.8% with a rate of 140 events/100 patients versus 87/100 control group (p<0.005).

Notes:

* DAS28 (Disease Activity Score) is an index used by physicians to measure how active an individual's RA is. It assesses number of tender and swollen joints (out of a total of 28), the ethroycyte sedimentation rate (ESR, a blood marker of inflammation), and the patient's 'global assessment of global health'. A higher score indicates more active disease.

Source:
Rory Berrie
European League Against Rheumatism

The Emotional And Mental Well-Being Of Patients With Sjogrens Syndrome Affected By Their Inability To Cry

The results of a Dutch study of 300 patients demonstrated that 22% of patients with Sjogren's syndrome were classified as clinically 'alexithymic' (experiencing difficulty identifying and describing emotions) compared to 12% of healthy controls. Subsequent results of the study showed that higher levels of alexithymia were moderately correlated with worse mental wellbeing in both groups (Pearson's correlation* (r) >= 0.32, p< 0.001), showing that there is a proven link between the two. Interestingly, in patients with Sjogren's syndrome, levels of emotion suppression also correlated with worse mental wellbeing in patients (r=-0.13, p=0.03), an effect that was seen less in the control group.

"Patients with Sjögren's syndrome experience chronic dryness of the eyes and mouth as well as other parts of the body, and thus have a hampered ability to cry. This may affect their ability to express their emotions and they often have to rely on words and facial expressions instead of tears as a result" said Ms. Ninke Van Leeuwen from Utrecht University. "We hope that the results of our study will drive further research to examine different psychological interventions that can benefit patients with Sjögren's syndrome who have emotional processing problems."

Validated questionnaires were used to assess the emotional processing, regulation and mental wellbeing of 300 patients with primary Sjögren's syndrome in the Netherlands area and 100 demographically matched healthy controls (mean age 56.8 years, 93% female). The questionnaires evaluated responses on the emotional processing styles including affect intensity (the strength of the emotions with which individuals respond to certain stimulus), alexithymia, cognitive reappraisal (the use of coping strategies for dealing with negative thoughts and feelings), expression and suppression of emotions and mental wellbeing.

Abstract Number: THU0527

*Pearson's correlation otherwise known as 'r' is a statistical term for the strength of an association. From 0.10-0.30, the association is considered weak, from 0.30-0.50 it is considered moderate and greater than 0.50 the correlation is considered strong.

Source:
Dimple Natali
European League Against Rheumatism

The Lungs Are Primed For Pneumonia By Aging, Obsolete Cells

Community-acquired pneumonia is the leading cause of infectious death among the elderly. Newly published research from The University of Texas Health Science Center San Antonio suggests why older people are vulnerable and offers a possible defense.

The researchers found that when it comes to aging and pneumonia, one bad apple can ruin the barrel. Lung cells that were supposed to die due to DNA damage - but didn't - were 5 to 15 times more susceptible to invasion by pneumonia-causing bacteria. These bad apples also increased the susceptibility of normal cells around them. The research was published Wednesday [May 25] in the journal Aging Cell.

Close to 1 billion adults worldwide are at risk for pneumonia. They include more than 800 million adults who are older than 65 and an estimated 210 million with chronic obstructive pulmonary disease (COPD).

Injurious effects

Both age and COPD are associated with senescent cells, which are unable to die due to dysregulated function. These cells have increased levels of proteins that disease-causing bacteria stick to and co-opt to invade the bloodstream. The cells also spew out molecules that increase inflammation, and make normal cells nearby do the same.

"Senescent cells prime the lungs for infection," said Pooja Shivshankar, Ph.D., research scientist in microbiology and immunology at the UT Health Science Center and first author on the study.

Controlling the inflammatory molecules' release could short-circuit pneumonia risk in the elderly, said the senior author, Carlos Orihuela, Ph.D., assistant professor of microbiology and immunology, also at the Health Science Center.

"We can't stop aging, but our findings suggest that preventing inflammation might be the next best thing," Dr. Orihuela said. "This opens up possibilities for anti-inflammatory drugs as treatments for pneumonia."

Mouse study

The scientists compared aged and young mice, all healthy. The older mice were found to have increased lung inflammation with higher levels of senescence markers; this was consistent with previous studies in the literature.

The lung cells in aged mice also proved to be more susceptible to infection by Streptococcus pneumonia, the bacterium that causes pneumonia. This was determined by increased levels of proteins to which the bacteria adhere and by testing bacterial adhesion to the lung cells.

Four different experiments - on senescent cells, on normal lung cells exposed to senescent cells, on aged mice and on young mice exposed to gene-damaging stress - revealed increased susceptibility to pneumonia infection.

"This potentially helps to explain why the elderly and individuals with COPD are predisposed to community-acquired pneumonia," Dr. Orihuela said.

Notes:

The scientists are in the Graduate School of Biomedical Sciences, the School of Medicine, and the Sam and Ann Barshop Institute for Longevity and Aging Studies at the UT Health Science Center San Antonio.

Cellular senescence increases expression of bacterial ligands in the lungs and is positively correlated with increased susceptibility to pneumococcal pneumonia. Pooja Shivshankar, Angela Boyd, Claude Le Saux, I-Tien Yeh, Carlos Orihuela. DOI: 10.1111/j.1474-9726.2011.00720.x

Source:
Will Sansom
University of Texas Health Science Center at San Antonio

IBio Announces Successful Production Of Critical Hookworm Vaccine Antigen

iBio, Inc. (NYSE AMEX: IBIO) today announced that its proprietary iBioLaunch™ Platform successfully expressed the hookworm-derived molecule known as NaAPR1M-74, which will be evaluated as a potential vaccine candidate for human hookworm disease.

The expression of this antigen represents a major breakthrough in the development of a human hookworm vaccine. Such a vaccine will provide significant public health benefit by preventing a parasitic disease that currently affects more than 576 million people worldwide and is a leading cause of anemia in the world's poorest countries. This accomplishment highlights the ability of iBioLaunch technology to overcome inherent limitations of other expression systems.

The success resulted from collaboration between iBio's research partner, the Fraunhofer Center for Molecular Biotechnology (FCMB), and the Sabin Vaccine Institute. Production of initial quantities of partially purified NaAPR1M-74 was completed last week at FCMB's pilot manufacturing facility employing the iBioLaunch Technology. This product was later transferred to Walter Reed Army Institute for Research (WRAIR) for final purification to formulate enough material to initiate Phase 1 clinical trials.

"We are very pleased with the success in expressing a pilot batch of this antigen in collaboration with iBio and FCMB," said Dr. Peter Hotez, President of Sabin Vaccine Institute. "It has been extremely difficult to produce this protein effectively, as evidenced by multiple prior unsuccessful attempts using traditional production systems."

"The expression of this complex protein with the iBioLaunch™ Platform not only moves us closer to a solution for hundreds of millions of people who suffer from hookworm, but also bodes well for other complex protein expression challenges," said Dr. Philip Russell, a member of the Board of Trustees of Sabin Vaccine Institute and member of the Board of Directors of iBio.

Clinical trials will be conducted by the Sabin Vaccine Institute's Human Hookworm Vaccine Initiative (HHVI). Established in 2000 with funding from the Bill & Melinda Gates Foundation and with additional support from the Dutch Ministry of Foreign Affairs and the Brazilian Ministry of Health, the HHVI is the first and only program that aims to reduce the prevalence of human hookworm infection through research and development, timely dissemination of results, innovation, and advocacy.

Source:
iBio, Inc.
Fraunhofer USA Center for Molecular Biotechnology
Sabin Vaccine Institute

Flu Vaccines Will Be Enough For Half The Population - So Who Should Get Them?

While the CDC is advising everyone to get a flu shot, vaccine makers say this is not necessarily true - some people may not need a repeat shot. Whoever is right, even with record production for this coming fall, only half the US population will be able to get vaccinated.

Vaccine makers say this season's shot will be a duplicate of last year's. This is because the same flu strains are circulating. If this is the case, young, healthy individuals may still be immune from last season's shot and may not need a booster.

It is inevitable that members of the public will become confused and frustrated with conflicting advice. Government health officials say that the protection offered by one season's shot can diminish rapidly -especially for frail, elderly people, as well as those with weakened immune systems.

Earlier this month, five vaccine makers said they plan to produce from 166 to 173 million flu vaccine doses for the coming influenza season, surpassing the previous record by 6 million.

Americans are taking flu shots in ever growing numbers; over the last ten months over 40% of the population has been vaccinated, compared to 30% in previous years.

The CDC (Centers for Disease Control and Prevention) has been aggressively promoting flu shots as a public health priority. It says everyone should be vaccinated, except for children under 6 months of age, individuals with egg allergies, and some other conditions. The emergence of swine flu in 2009 probably triggered another rush for shots.

US authorities have become more aggressive in promoting flu shots than their European counterparts.

Health authorities tend to use the changing flu strains argument when encouraging people to get vaccinated. As the same strains as last year are expected to be circulating this coming fall, many experts say that not everyone necessarily needs two consecutive years of shots.

The CDC says that at the best of times, flu shots are only about 70% effective. Repeat shots should be given to as many people as possible to protect a whole population, they say.

Studies do not seem to agree on how quickly a flu shot's protection starts to wane. According to the CDC, one's immunity drops by at least 66% over a year. Other studies suggest that in children protection last for up to three years, and at least one year in adults.

The truth is nobody, not even the experts, really know how long protection lasts.

If nobody is really sure, surely the best bet is to vaccinate as many people as possible.

Dificid (fidaxomicin) Approved For Clostridium Difficile-Associated Diarrhea

Dificid (fidaxomicin) has been approved by the FDA for CDAD (Clostridium difficile-Associated diarrhea). Clostridium Difficile, also known as C. difficile, a bacterium, causes diarrhea in humans, which can eventually lead to colitis and some serious intestinal complications. In severe cases the patient can die.

Contamination usually comes from an infected person who does not wash his/her hands after going to the toilet and then touches other people or surfaces, thus spreading the infection.

The FDA (Food and Drug Administration) evaluated safety and efficacy studies involving 564 individuals with CDAD. The studies compared Dificid with the antibiotic vancomycin, which is commonly used when treating CDAD. In both studies, both drugs had similar responses. However, more patients on Dificid had a sustained cure three weeks after treatment compared to those on vancomycin.

Edward Cox, M.D., M.P.H., director of the Office of Antimicrobial Products in the FDA's Center for Drug Evaluation and Research, said:

"In recent years, many in the infectious disease community have seen an increase in the number of cases of people with a C. difficile infection. Dificid is an effective new treatment option for patients who develop Clostridium difficile-associated diarrhea."

CDAD patients take Dificid twice daily for ten days. It is a macrolide antibacterial, as are Azithromycin, Clarithromycin, Dirithromycin, Erythromycin, Roxithromycin, and Telithromycin.

The FDA stresses that Dificid should only be used in proven or strongly suspected infections caused by C. difficile, otherwise its effectiveness might be undermined. It is also important to prevent drug-resistant bacteria from developing.

Dificid side effects included abdominal pain, diarrhea, headache, nausea and vomiting.

Elderly individuals, as well as hospital and nursing home patients, along with people on antibiotics for other infections are at risk of developing bacterial infection.

The best way to prevent CDAD is to wash your hands properly with soap and warm water.

Dicifid was developed and is marketed by Optimer Pharmaceuticals Inc, of San Diego, California.

Source: FDA

Written by Christian Nordqvist

View drug information on Clarithromycin.

The NHS Confederation's European Office has published the first detailed analysis of implications arising from an EU Directive which clarifies the rig

The Victoria Residential Care Home, Burnley, Lancashire is not meeting seven essential standards.

A Care Quality Commission inspection on the 14th March 2011 found that the home, Thursby Road, Burnley was not meeting seven of the sixteen essential safety requirements.

Providers of care services have a legal responsibility to make sure they are meeting all the essential standards of quality and safety.

The CQC report, which is published today on our website, highlights the regulator's concerns with seven areas the inspector looked at:

People should get safe and appropriate care that meets their needs and supports their rights

The provision of care does not meet this essential standard of quality and safety. People's care had not always been planned effectively and some risks had not been identified or assessed.

Food and drink should meet people's individual dietary needs

The provision of care does not meet this essential standard of quality and safety. People were provided with a choice of varied food in line with their preferences. However, people were not always provided with timely assistance to eat their meals.

People should be cared for in a clean environment and protected from the risk of infection

The provision of care does not meet this essential standard of quality and safety. There were no suitable arrangements in place to achieve and maintain appropriate standards of cleanliness and hygiene, as a consequence people experienced care in an unhygienic and unclean environment.

People should be given the medicines they need when they need them, and in a safe way

The provision of care does not meet this essential standard of quality and safety. The service does not fully protect people against the risks associated with the unsafe use and management of medication by means of the making of the appropriate arrangements for the recording, handling, administration and use of medicines.

People should be cared for in safe and accessible surroundings that support their health and welfare

The provision of care does not meet this essential standard of quality and safety. General repairs and maintenance of the premises were not undertaken in a way in which people's dignity and safety was maintained. Where work was being undertaken there were not adequate signs to direct people to other facilities and away from hazards.

People should be safe from harm from unsafe or unsuitable equipment

The provision of care does not meet this essential standard of quality and safety. People were not provided with suitable equipment to meet their needs. This meant the staff had to use inappropriate methods to move one person, which posed a serious risk to health and safety of the person and the staff.

There should be enough members of staff to keep people safe and meet their health and welfare needs

The provision of care does not meet this essential standard of quality and safety. There were less staff on duty, which had an impact on the amount of time staff could spend with people. The lack of a registered manager meant that staff lacked direction to provide safe and effective care.

Sue McMillan, Regional Director for CQC in the North West says, "The care at Victoria Residential Care Home has fallen far short of the standards people have a right to expect. We need to ensure that people living at the home are not at any immediate risk of harm.

"It is clear standards require significant further improvement so we will continue to monitor this service very closely to ensure these improvements are made and sustained."

Source:
Care Quality Commission

Challenges And Opportunities For The NHS Arise From New EU Law On Patient Mobility

The NHS Confederation's European Office has published the first detailed analysis of implications arising from an EU Directive which clarifies the rights of patients to receive healthcare in other European countries.

At a time when the Government is proposing to extend patient choice and diversify providers in the healthcare market, the publication looks at the significant implications the directive will have for NHS commissioners and providers.

The EU cross border healthcare directive, which clarifies the rights of patients travelling abroad for NHS-funded healthcare, will come into force in the UK in 2013.

This will be at a time when primary care trusts, who currently retain the power to make decisions on cross-border healthcare, will be winding down and the NHS will be in the middle of a £15-20 billion efficiency challenge.

In particular the briefing highlights that:

- a rise in waiting times for certain treatments in England could lead to an increased number of NHS patients seeking healthcare abroad;

- commissioners will need to have a clear, transparent list of which types of healthcare they do or do not fund. This will be especially important given the NHS is moving towards a system which will allow for greater variation at local level about what treatments patients are entitled to receive;

- providers will have opportunities to market themselves to foreign patients to help diversify their income, particularly given the current financial climate and the proposed removal of the private patient income cap.

Elisabetta Zanon, director of the NHS Confederation's European Office, said:

"There will be a substantial amount of change going on in the NHS over the next few years. Commissioners and providers will be implementing this Directive at a time of significant reorganisation and severe financial restraint.

"It is with these changes in mind that the full implications of this Directive should be considered. With a greater emphasis on patient choice and much more variety at local level on the treatments provided, how will commissioners ensure they are being fully transparent with patients about what they are entitled to?

"The Government's proposed removal of the private patient income cap will enable NHS Foundation Trusts to take full advantage of some of the opportunities which this Directive offers to market themselves to non-UK patients. How do we ensure that NHS trusts do not do this to the detriment of NHS patients?"

This briefing considers the challenges relating to cross-border healthcare the service will have to consider, understand and plan for in the coming two years, whatever the final structure of the reforms.

Notes

1. The NHS European Office monitors EU developments and influences them in the interest of the NHS. It is part of the NHS Confederation and funded by the strategic health authorities in England.

2. The full briefing on the implications of the EU directive can be found here.

Source:
The NHS Confederation

U.S., Russia Reaffirm Commitment To Eradicate Polio At G8 Summit

At the G8 Summit in Deauville, Presidents Obama and Medvedev recognized the collaborative efforts already underway between the United States and Russia to eradicate polio globally, and pledged to continue that cooperative until the eradication objective is finally achieved.

In January of this year, the U.S. government and the government of the Russian Federation, through the U.S. Agency for International Development (USAID), the U.S. Department of Health and Human Services (HHS), and the Ministry of Health and Social Development of the Russian Federation (MOHSD), signed a Protocol of Intent on Cooperation for the Global Eradication of Polio.

"By working together, the United States and Russia can have a much greater impact on global development challenges like the eradication of polio," says USAID's Deputy Assistant Administrator Jonathan Hale.

The 'reset' policy of the Obama Administration, in conjunction with the work of the Health Working Group of the U.S.-Russia Bilateral Presidential Commission, is presenting opportunities for even closer and deeper dialogue and collaboration in the health sector, both within our two countries and globally. Areas of collaboration include providing technical assistance for polio surveillance; participating in and monitoring of polio immunization campaigns; providing technical assistance on polio clinical diagnoses, case management and rehabilitation; and advocacy and resource mobilization.

The first activities to implement the protocol are a joint immunization monitoring mission planned for Tajikistan and Kyrgyzstan May 23-27, 2011. These missions are being planned in cooperation with the Ministries of Health of the two countries and with the World Health Organization. The goal of joint immunization and monitoring missions is to identify strengths and gaps in current immunization campaigns, provide suggestions for improvement, and identify threats to regional spread of the disease or certification.

The U.S. is the largest bilateral donor to the Global Polio Eradication Initiative. Polio eradication is part of USAID's more comprehensive effort to reduce morbidity, mortality and disability due to vaccine-preventable diseases.

Source:
USAID

Statement From HHS Deputy Secretary Bill Corr On Retrospective Review Of Existing Rules

Earlier this year, President Obama outlined his plan to create a 21st-century regulatory system that is simpler and smarter and that protects the health and safety of the American people in a pragmatic and cost-effective way. He called for a change in culture to incorporate ongoing review of regulations into our operations. We can target rules already on the books to increase flexibility and remove regulations that are out-of-date, unnecessary, excessively burdensome, or in conflict with other rules.

Today, the Department of Health and Human Services released its Preliminary Plan for Retrospective Review of Existing Rules based on a comprehensive inventory of each agency's existing, significant regulations. The Plan highlights regulations already being modified or streamlined and identifies additional candidates for further review.

For example:

- The Centers for Medicare & Medicaid Services (CMS) is working to address conflicting requirements between Medicaid and Medicare that potentially create barriers to high quality, seamless, and cost-effective care for dual eligible beneficiaries. By improving coordination and partnering with states, we can improve access, quality, and cost of care for people who depend on both programs.

- The Secretary is reviewing and updating the methods and criteria used to identify Health Professional Shortages and Medically Underserved Areas. The previous criteria were last established in 1978. Establishing more consistent and comprehensive criteria will allow the Department to more effectively serve some of our most vulnerable populations.

- And we are looking for opportunities to incorporate modern technology into our regulations in a way that increases flexibility for states and businesses while improving people's lives. For example, the Agency for Children and Families is encouraging states' child support programs to use cost-effective technologies like electronic signature and document storage; the Food and Drug Administration is also going paperless with its adverse events reporting requirements for medical devices; and CMS is working to reduce the barriers to telemedicine to provide better access to care.

Today's report highlights many more opportunities for reform. At HHS, we do not believe regulatory review is a process you can just engage in from time to time. We have redoubled our long-standing effort and commitment to making regulatory review an integral part of our operations and culture.

As our work continues in the months and years to come, we will rely on key principles like transparency, public participation, clear priorities, and informed analysis to guide our efforts. We have a responsibility to balance the health and safety of all Americans and our commitment to promoting economic growth, job creation, and innovation. Today's plan is a key step in fulfilling the responsibility.

Source:

Minister Kathleen Lynch Opens The Sonas aPc Conference, Ireland

Kathleen Lynch, T.D., Minister of State with responsibility for Older People, today (May 26th 2011), officially opened the third Annual Sonas aPc Conference. The title of the Conference is Living with Dementia: Activity for Meaningful Lives There were over 300 delegates at the gathering which was addressed by a range of national and international experts on innovative new methods of enhancing the lives of those suffering from dementia.

Sonas aPc provides training for those who care for older people with dementia or intellectual disabilities. The training enables them to carry out therapeutic communication activities. The aim of Sonas is to activate each individual's potential for communication whatever that potential might be.

Minister Lynch also presented awards to three nursing homes who had achieved excellence in implementing the Sonas programme. These were St John's Community Hospital, Enniscorthy, St Joseph's Cluny, and Marymount Care Centre, Lucan.

Speaking at the conference Minister Lynch said; "Sonas is constantly championing new and innovative therapies, to ensure that people with dementia continue to live their lives to the full. To our worthy winners I am happy to say that these awards recognise your commitment to the Sonas philosophy and I offer you my warmest congratulations."

The Minister added; "The Government is aware of the challenges that Alzheimers and dementia will pose for us. The programme for Government commits us to developing a national strategy by 2013. This will support the delivery of long-term care services having regard to future demographic development and the resulting increase in demand for long-term care. The policy will be developed on the basis of the best evidence available from national and international sources".

Source:
Department of Health and Children, Ireland

Alzheimer's Society Comment On Care Quality Commission Inspection, UK

The Care Quality Commission (CQC) has identified major failings in the first 12 of its 100 reports into the quality of elderly care in hospitals in England. The report identified three hospitals as failing to meet essential standards required by law. Failings included people not being given adequate assistance to eat and drink, not being given enough fluids and failing to involve patients in their own care.

Alzheimer's Society comment:
'It is unacceptable that in one in four hospitals are robbing people of their dignity and complicating health problems. People with dementia occupy a quarter of hospital beds. With the right training and support, good care is possible. However, Alzheimer's Society research shows the majority of people with dementia leave hospital in worse health than when they arrived.'
'This could all be stopped and hundreds of millions could be saved if we invest in more appropriate services and training. For too long poor dementia care has been costing lives and money. The CQC must crack down on hospitals that fail to meet standards.'

Source:
Alzheimer's Society

The Availability Of Substance Abuse Treatment Facilities Offering Counseling Services In Asian Languages Varies By Region

A new report shows that only 2-percent (291) of the nation's 13,513 substance abuse treatment facilities provide counseling services in various Asian languages. The report also showed that the proportion of facilities offering these services varied by geographic region. The report issued today by the Substance Abuse and Mental Health Services Administration (SAMHSA), in conjunction with Asian American and Pacific Islander Heritage Month, brings attention to the counseling services being offered in Chinese, Hmong, Korean, Tagalog or Vietnamese, and the benefit to the community.

According to the report, the percentage of facilities offering counseling services in these languages ranged from a high of 4-percent (162 facilities) in the west to a low of 1- percent (22 facilities) in the south.

In terms of the language services offered, Tagalog was the most commonly provided Asian language service provided in facilities located in the west (63 facilities) while Chinese language services were the most commonly provided by facilities located in the other regions of the country -- northeast (25 facilities), midwest (17 facilities) and south (9 facilities).

"SAMHSA estimates half a million Asian American adults need substance abuse treatment and language should not be a barrier to care," said SAMHSA Administrator, Pamela S. Hyde, J.D. "Offering services that build on cultural strengths and the language spoken by the client are essential to helping people overcome behavioral health problems and achieving recovery."

SAMHSA Spotlight: Availability of Asian Language Substance Abuse Treatment Counselors Varies by Region, was developed as part of SAMHSA's strategic initiative on data, outcomes, and quality - an effort to inform policy makers and service providers on the nature and scope of behavioral health issues. The report is based on data from the 2009 National Survey of Substance Abuse Treatment Services (N-SSATS). N-SSATS is an annual census of substance abuse treatment facilities that provides data on the location and characteristics of alcohol and drug abuse treatment services throughout the United States.

Source:
Substance Abuse and Mental Health Administration (SAMHSA)

FDA To Make Enforcement And Compliance Activities Accessible Online

The U.S. Food and Drug Administration today announced that it is disclosing more information about inspections and court actions, and now has a web portal on its enforcement activities as part of Phase II of the agency's Transparency Initiative. These actions are being taken to make FDA's enforcement and compliance-related activities more accessible, downloadable, and searchable online.

The information includes a summary of the most common Inspectional Observations of objectionable conditions or practices made during inspections and a searchable Inspections Database that includes the names and addresses of inspected facilities, inspection dates, type of FDA-regulated products involved, and final inspectional classification.

By the end of 2011, FDA will also begin to disclose additional information about FDA evaluations of filers, expand disclosure of Untitled Letters, and in appropriate situations, support industry efforts during a food recall to inform consumers of products that are not subject to the recall.

Access to this information about FDA's enforcement and compliance activities will provide the following to the public and regulated industry:

- More information about company practices that may jeopardize public health, as well as about companies that have had satisfactory FDA inspections

- Information about recall and enforcement activities that will help consumers make decisions about products

- Information about inspection results, which can be expected to create a greater incentive to bring practices into compliance with the law

- Information about food products that are not subject to a particular recall, which can help reduce consumer confusion.

FDA Commissioner Margaret A. Hamburg M.D. launched FDA's Transparency Initiative in June 2009 in response to the Obama administration's commitment to openness in government. After holding public meetings and inviting written comments, FDA issued a report proposing 21 actions to increase disclosures about agency activities. The actions announced today stem directly from that effort and are among the first of the proposals to be implemented.

Source:
U.S. Food and Drug Administration

Large Outbreak Of Haemolytic Uraemic Syndrome Caused By E. Coli In Germany - Important Advice For Travellers

The Health Protection Agency (HPA) is aware that Germany is currently experiencing a large outbreak of haemolytic uraemic syndrome (HUS), which is a serious complication from verocytotoxin-producing E. coli (VTEC) infection that requires hospitalisation. Since the second week of May, there have been reports of approximately 214 cases of HUS and two people are reported to have died.

The outbreak is mainly affecting adults - almost 70 per cent of who are female. The cases are occurring mainly in northern Germany, but there are also reports from southern and eastern Germany.

This strain of VTEC infection suspected in this outbreak is O104 which is a rare strain of the infection and seldom seen in the UK.

England has so far seen two cases in German nationals with compatible symptoms. Other European countries have also seen cases of HUS and bloody diarrhoea among returning travellers.

The German authorities believe that a food source of infection is likely, and, early studies implicate raw tomatoes, cucumbers and lettuce. Although it is not clear whether one or more of these food items are associated with the outbreak, as a precaution they are advising people in Germany against eating raw tomatoes, cucumbers and lettuce, especially in the north of the country, until further notice.

The HPA and the National Travel Health Network and Centre (NaTHNaC) advises anyone travelling to Germany to follow the advice from the German authorities. In addition, returning travellers with illness including bloody diarrhoea should seek urgent medical attention and make sure they mention any recent travel history.

The public health organisation in Germany investigating the outbreak also recommend following the standard food and water hygiene advice.

Dr Dilys Morgan, head of the gastrointestinal, emerging and zoonotic infections department at the HPA, said: "The HPA is actively monitoring the situation very carefully and liaising with the authorities in Germany, the European Centre for Disease Control (ECDC) and the World Health Organization (WHO) as to the cause of the outbreak.

"We are keeping a close watch for potential cases reported in England and are working with colleagues in the devolved administrations to recommend they do the same. In addition we are in the process of alerting health professionals to the situation and advising them to urgently investigate potential cases with a travel history to Germany."

The HPA is also working closely with the Department of Health and the Food Standards Agency. The FSA is monitoring the situation closely and if there are any implications for food distributed in the UK they will provide an update.

Notes

1. In this outbreak many more people are suspected to have bloody diarrhoea, which can be serious, or milder forms of the infection which are usually self limiting and clears within seven days. The public health organisation investigating the outbreak in Germany is the Robert Koch Institute.

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2. Haemolytic Uraemic Syndrome (HUS) is a serious complication from verocytotoxin-producing E. coli (VTEC) infection that affects the blood, kidneys and in severe cases, the central nervous system. It is a serious illness that requires treatment in hospital and can be fatal.

3. The number of severe cases of HUS in a short period is very unusual and the affected age groups in this outbreak are not typical - HUS is a more common complication from E. coli infection in children.

4. Escherichia coli (commonly referred to as E coli) bacteria usually cause diarrhoea which settles within seven days without treatment. There are many strains of the infection. Occasionally, serious kidney and blood complications can occur, such as HUS.

5. Most people normally carry harmless strains of E. coli in their intestine. Both the harmless strains and the strains that cause diarrhoea are acquired primarily through ingestion of contaminated food or water. Person-to-person and animal-to-human transmission is through the oral-faecal route.

6. Good hygiene is very important in preventing person-to person spread and small children should be supervised with hand washing after using the toilet and before eating.

7. Verocytotoxin- producing E. coli (VTEC) O104 is a rare serogroup and further testing of samples is needed to confirm this as the cause of the outbreak. Reports from Germany refer to the VTEC cases as cases of Shiga-toxin producing E. coli (STEC). VTEC is also sometimes called Entrohaemorrhagic E. coli (EHEC).

8. Healthcare professionals and members of the public can find more information about travel health (including country specific advice) by logging onto the National Travel Health Network and Centre (NaTHNaC) website.

Source:
Health Protection Agency

New Clues To How Humble Painkiller Stifles Cancer Growth

Cancer Research UK scientists have shed light on how a common class of painkillers - which includes ibuprofen - may interact with a key protein that fuels the growth of many different types of cancer, according to a study published in the journal Chemical Communications today (Thursday).

Ibuprofen is one of several profens - a particular group of non-steroidal anti-inflammatory drugs (NSAIDs) - being investigated for their ability to prevent cancer.

The University of Bath research team* carried out an analysis of drugs in the same class as ibuprofen and discovered that they are all processed by the body in exactly the same way - through a protein called AMACR, which converts the drug into its active form.

AMACR is overactive in almost all prostate cancers, some bowel cancers and several other types of cancer and is thought to fuel the growth of the disease by boosting the cell's energy supply.

So understanding how drugs like ibuprofen might alter AMACR activity could help scientists better understand how they are able to block cancer growth.

Lead author Dr Matthew Lloyd, said: "Our study is the first to test other drugs in the same family as ibuprofen systematically and show that they're all processed by the same protein in the body. Some early laboratory studies have suggested that high doses of ibuprofen can halt the growth of prostate cancer cells, but the reasons for this aren't well understood.

"Understanding more about how this protein is acting in cells and what molecules it interacts with could provide important clues to how this process works, hopefully opening up new avenues of research for treating prostate cancer in the future."

Dr Julie Sharp, senior science information manager at Cancer Research UK, said: "This research is part of an international effort to understand how drugs like ibuprofen could prevent, or slow down, the development of cancer. But there are risks as well as benefits and long term use of these drugs can have side effects, such as bleeding and stomach ulcers. Understanding more about how these drugs work on a molecular level is a crucial step in being able to develop better targeted drugs with fewer side effects in future."

References

Woodman et al., Chiral inversion of 2-arylpropional-CoA esters by human alpha-methyylacyl-CoA racemase 1A (P504S) - a potential mechanism for the anti-cancer effects of ibuprofen (2011), Chemical Communications, DOI: 10.1039/ClCC10763A.

Source:
Cancer Research UK

Most Authoritative Report On Colorectal Cancer And Diet Ever Conducted: Links With Meat, Fiber Confirmed

The most comprehensive and authoritative report on colorectal cancer risk ever published has concluded that red and processed meat increase risk of the disease and found that the evidence that foods containing fiber offer protection against colorectal cancer has become stronger.


"This report shows that colorectal cancer is one of the most preventable cancers," said Elisa Bandera, MD, PhD, who served on the World Cancer Research Fund/American Institute for Cancer Research's Continuous Update Project (CUP) Expert Panel that authored the report. "AICR has estimated that about 45 percent of colorectal cancer cases could be prevented if we all ate more fiber-rich plant foods and less meat, drank less alcohol, moved more and stayed lean. That's over 64,000 cases in the US every year."


The report, released today as part of WCRF/AICR's groundbreaking Continuous Update Project, has examined the links between colorectal cancer risk and diet, physical activity and weight, and updated the colorectal cancer findings of the charity's 2007 Expert Report.


A systematic review of the evidence was carried out by WCRF/AICR-funded scientists at Imperial College London, who added 263 new papers on colorectal cancer to the 749 that had been analyzed as part of the 2007 Report. An independent CUP Expert Panel then analyzed the totality of evidence and made new judgments.


Meat Link Remains Convincing


For red and processed meat, findings from 10 new cohort studies were added to the 14 included in the 2007 Report. The CUP Expert Panel concluded that there is convincing evidence that both red and processed meat increase colorectal cancer risk.


AICR recommends that people limit consumption to 18 ounces (cooked weight) of red meat a week - roughly the equivalent of five or six small portions of beef, lamb or pork - and avoid processed meat. (The report showed that ounce for ounce, consuming processed meat increases risk twice as much as consuming red meat.)


Evidence of Fiber's Protective Role Upgraded


The CUP Expert Panel also concluded that the evidence showing that foods containing dietary fiber reduce colorectal cancer risk has become stronger since the publication of the 2007 report. They considered the evidence sufficient to strengthen the conclusion that foods containing fiber are protective from "probable" to "convincing".


The analysis for fiber added seven more studies to the existing eight from the 2007 Report; the CUP Expert Panel noted that the evidence has become much more consistent.


This reaffirms AICR's recommendation for people to eat a plant-based diet, including foods containing fiber, such as whole grains, fruits, vegetables and beans.


Evidence on Activity, Body Weight, Alcohol Still ConvincingThe experts concluded that studies published since 2007 added to the evidence that maintaining a healthy weight and being physically active are both convincingly linked to lowering colon cancer risk, while a healthy weight is linked to lower rectal cancer risk. The CUP Expert Panel also affirmed that carrying excess fat especially around the waist is a convincing cause of colorectal cancer. There is also convincing evidence that alcohol consumption increases colorectal cancer risk in men and it also probably increases risk in women.

Dr. Alan Jackson, Chair of the WCRF/AICR CUP Expert Panel, said: "Our review has found strong evidence that many cases of colorectal cancer are not inevitable and that people can significantly reduce their risk by making changes to their diet and lifestyle.

"Because our judgments are based on more evidence than ever before, the public can be confident that this represents the best advice available on preventing colorectal cancer.

"There has been a lot of debate over the last few years about the strength of evidence that red and processed meat increase risk of cancer. We hope our review can help give clarity to those people who are still confused about the strength of the evidence.

"On meat, the clear message that comes out of our report is that red and processed meat increase risk of colorectal cancer and that people who want to reduce their risk should consider cutting down the amount they eat."

CUP Expert Panel member Dr. Elisa Bandera added: "Many people feel confused about cancer prevention because it can seem like a new study is published every week that suggests something either causes or prevents cancer.

"But the CUP takes the latest scientific findings and adds them to the existing body of evidence in a systematic way that ensures our advice takes the latest research into account. This means people can be confident that AICR's recommendations represent the most up-to-date, evidence-based information on cancer prevention available."

Notes

-- The CUP report on colorectal cancer contains the judgments of the WCRF/AICR Continuous Update Project Expert Panel. It is chaired by Dr. Alan Jackson of the University of Southampton and the other members are: Dr. Elisa Bandera of the Cancer Institute of New Jersey; Dr. Stephen Hursting of the University of Texas; Dr. David Hunter of Harvard University; Dr. Anne McTiernan of the Fred Hutchinson Cancer Research Center; Dr. Hilary J Powers of the University of Sheffield; Dr. Ricardo Uauy of Instituto de Nutricion y Tecnologia de los Alimentos in Chile and the London School of Hygiene and Tropical Medicine; and Dr. Steven H Zeisel of the University of North Carolina. Dr. Arthur Schatzkin, of the National Cancer Institute, served on the CUP Expert Panel until his death in 2010. Professor Elio Riboli of Imperial College London is a panel observer, Dr. John Milner of the National Cancer Institute is an advisor.

-- The CUP Expert Panel made judgments on the strength of the evidence following a systematic review of the evidence by a team of scientists at Imperial College London led by Dr Teresa Norat.

-- The CUP central database is a unique and valuable resource for researchers. Once WCRF/AICR updates the evidence on all cancers, the CUP database will be made accessible to the world's scientific community.

-- The full WCRF/AICR CUP Expert Panel report.

-- The timing of the CUP Expert Panel report's publication coincides with the publication in the journal PLoS One of the Imperial College team's systematic review of the evidence on red and processed meat and colorectal cancer.

-- Following an analysis of the Imperial College team's report, the CUP Expert Panel concluded that there is convincing evidence that red meat; processed meat; excess body fat; and abdominal fatness (fat carried around the waist) increase risk of colorectal cancer.

-- The CUP Expert Panel concluded there is convincing evidence that regular physical activity reduces risk of colorectal cancer. They also concluded that foods containing dietary fiber, such as fruits, vegetables, whole grains and beans, reduce risk of colorectal cancer. The panel also judged that garlic probably reduces risk of colorectal cancer.

-- The CUP Expert Panel concluded that there is convincing evidence that alcohol increases colorectal cancer risk in men. For women, it probably increases risk.

-- The CUP Expert Panel judged that milk probably reduces colorectal cancer risk, but AICR does not make a recommendation regarding dairy foods because the evidence for overall cancer risk remains unclear.

-- The evidence also shows that dietary supplements containing calcium probably reduce colorectal cancer risk, but when this finding is weighed against the totality of evidence on diet and cancer, AICR still recommends looking to whole foods to get the nutrients we need, instead of relying on supplements for cancer protection.

-- Red meat refers to beef, pork and lamb. If a person eats 3.5 ounces of red meat every day (24.5 ounces per week), their risk of colorectal cancer will be 17% higher than someone who eats no red meat. If they eat 7.0 ounces of red meat every day (49 ounces per week), their risk will be 34% higher, and so on. The evidence shows that there is very little increase in risk for people who keep their intake of red meat to less than 18 ounces per week

-- Processed meat is meat preserved by smoking, curing, salting, or by the addition of preservatives. Examples include ham, bacon, pastrami and salami, as well as hot dogs and sausages. If a person eats 3.5 ounces of processed meat every day (24.5 ounces per week), their risk of colorectal cancer will be 36% higher than someone who eats no processed meat. If they eat 7.0 ounces of processed meat every day (49 ounces per week), their risk will be 72% higher.

-- There are set criteria that the evidence must meet for the CUP Expert Panel to be judged "convincing." The evidence must be robust enough for it to be thought highly unlikely to be modified in the foreseeable future as new evidence accumulates. All the following are also generally required:

-- Evidence from more than one study type;

- No substantial unexplained heterogeneity within or between study types or in different populations relating to the presence or absence of an association, or direction of effect;

- Good quality studies to exclude with confidence the possibility that the observed association results from random or systematic error, including confounding, measurement error, and selection bias;

- Presence of a plausible biological gradient ('dose response') in the association. Such a gradient need not be linear or even in the same direction across the different levels of exposure, so long as this can be explained plausibly;

- Strong and plausible experimental evidence, either from human studies or relevant animal models, that typical human exposures can lead to relevant cancer outcomes.

Source:
American Institute for Cancer Research (AICR)