Wednesday, September 30, 2009
Interventions to improve adherence to antiretroviral therapy such as peer support and electronic messaging are only partially effective, US investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.
Peer support improved adherence in the short-term, but was not associated with significant changes in either viral load or CD4 cell count, whereas electronic messaging had no effect on reported pill-taking, but did appear to improve laboratory markers.
Antiretroviral treatment can significantly improve the health and life expectancy of HIV-positive people. However, HIV treatment needs to be taken very rigorously and the best results are seen in patients who take all or nearly all of their doses. Many individuals do not achieve such high levels of adherence.
Investigators from Seattle designed a prospective, randomized, controlled trial to see if peer support, electronic messaging, or a combination of the two improved levels of adherence in both the short- and long-term in patients receiving antiretroviral therapy.
Their study ran between 2003 and 2007 and included 224 individuals.
“These findings suggest that receiving informational, emotional, and affirmational support from peers might promote adherence, but that effect did not persist when the support was discontinued. Ongoing social support, perhaps from individuals more integrated into participants’ lives, may hold greater promise in promoting and sustaining long-term adherence”, write the investigators.
They conclude, “Maintaining optimal adherence requires a set of complex and dynamic behaviors that may necessitate interventions of equal sophistication with personnel trained and dedicated to providing them on an ongoing basis.”
An RCT of peer support and pager messaging to promote antiretroviral therapy adherence and clinical outcomes among adults initiating or modifying therapy in Seattle, WA, United States.
Simoni, Jane M PhD et al
Journal of Acquired Immune Deficiency Syndromes published ahead of print September 23 2009. 10.1097/QAI.0b013e3181b9300c
Link to JAIDS abstract
You're not as different from Albert Einstein and Charles Darwin after all, at least when it comes to patterns of correspondence.
A new Northwestern University study of human behavior has determined that those who wrote letters using pen and paper -- long before electronic mail existed -- did so in a pattern similar to the way people use e-mail today.
The study, published Sept. 25 by the journal Science, demonstrates the similarity of these two seemingly different activities, with the underlying pattern of human activity linking letters and e-mails.
The researchers examined extensive letter correspondence records of 16 famous writers, performers, politicians and scientists, including Einstein, Darwin, Sigmund Freud, Karl Marx, and Ernest Hemingway, and found that the 16 individuals sent letters randomly but in cycles.
The same mathematical model the Northwestern team used in a previous study to explain e-mail behavior now has been shown to apply to the letter writers. This refutes the rational model, which says that people are driven foremost by responding to others.
No matter what their profession, all the letter writers behaved the same way. They adhered to a circadian cycle; they tended to write a number of letters at one sitting, which is more efficient; and when they wrote had more to do with chance and circumstances than a rational approach of writing the most important letter first.
"We are interested in identifying and understanding patterns of human behavior, in learning how we make choices," said Luís Amaral, professor of chemical and biological engineering in the McCormick School of Engineering and Applied Science. Amaral led the research. "There are patterns to how we spend our days, and these models of probability, of how people allocate their time to do certain tasks, can be applied to many different areas."
"People are not that rational," added Amaral, who also is an Early Career Scientist with the Howard Hughes Medical Institute. "If a doctor, for example, better understands how we make decisions, he or she may be able to get better compliance with a treatment if it is tied to something a person does with regularity."
The researchers studied correspondence that dated as far back as 1574 for philosopher Sir Francis Bacon and as recently, in the case of writer Carl Sandburg, as 1966. The letter data for the 16 individuals included a list of letters sent and, for each letter, the name of the sender, the name of the recipient and the date it was written.
On Universality in Human Correspondence Activity.R. Dean Malmgren, Daniel B. Stouffer, Andriana S. L. O. Campanharo, Luís A. Nunes Amaral
Science 25 September 2009 Vol. 325. no. 5948, pp. 1696 – 1700 DOI: 10.1126/science.1174562
Link to Science abstract
Although four million people are now receiving antiretroviral treatment in low and middle-income countries, another five million adults and children lack access to treatment, according to figures released today by United Nations agencies.
The report Towards universal access: scaling up priority HIV/AIDS interventions in the health sector is published by the World Health Organization, UNAIDS and UNICEF, and is the third annual review of international progress towards the goal of universal access to treatment and prevention by 2010.
Although more than a million people are estimated to have been enrolled into treatment programs during 2008 alone, the biggest annual increase since treatment scale-up began, only 42% of those in need of treatment in low and middle-income countries are currently being reached.
The report also reveals major gaps in two priority areas, the prevention of mother to child transmission and treatment of children.
The report estimates that 21% of pregnant women received an HIV test in 2008, and 45% received drugs to prevent mother to child transmission, of whom around one-third received only single-dose nevirapine, the least effective form of preventive treatment. Only one-third of those who tested positive were assessed for eligibility for antiretroviral treatment for their own health.
Although 38% of children with HIV in low- and middle-income countries in need of treatment received it, infant diagnosis continues to lag behind. In 41 reporting low- and middle-income countries only 15% of children born to HIV-infected mothers were tested for HIV within the first two months of life.
In 2008 just one percent of pregnant women living with HIV in North Africa and the Middle East received antiretroviral therapy for prevention of mother-to-child transmission.
While there is evidence of increased political commitment for HIV testing and counseling policies, with 90% of reporting countries having national policies in place, knowledge of status remains low; a median of less than 40% of people living with HIV are aware of their status.
The report highlights new data as well as acknowledgment of the dynamics of the epidemic among men who have sex with men, in particular in sub-Saharan Africa where same-sex relations are often considered taboo.
The authors note that population groups at high risk, for example, injecting drug users, sex workers and men who have sex with men, continue to face technical, legal and socio-cultural barriers in accessing health care.
The current global economic crisis not only highlights the obstacles to attaining universal access but also threatens to reverse progress made. Program budgets will be cut or eliminated and this would mean increasing morbidity and mortality, increasing transmission risks, increased antiretroviral resistance leading to increased burden on health systems and a reversal of economic and social gains.
According to the authors opportunities do exist within this climate. For example, they point to the high levels of commitment pledged to attaining universal access; the increase in access to testing and counseling as well as the emerging evidence on the effects of antiretroviral treatment for prevention of HIV, and they stress that “The hard-won gains of recent years are fragile and call for renewed commitment by all stakeholders.”
Towards universal access: scaling up priority HIV/AIDS interventions in the health sector.
WHO, UNICEF, UNAIDS September 2009.
Link to the Report
Tuesday, September 29, 2009
— An Indiana University study published in the September issue of the International Journal of Sexual Health found that women who feel more positively about women's genitals find it easier to orgasm and are more likely to engage in sexual health promoting behaviors, such as having regular gynecological exams or performing vulvar self-examinations.
"These are important findings about body image," said Debby Herbenick, associate director of the Center for Sexual Health Promotion in the School of Health, Physical Education and Recreation. "Our culture often portrays women's genitals as dirty and in need of cleaning and grooming. Some women may have had greater exposure to such negative messages or may be more susceptible to their impact."
Herbenick's study created a scale for measuring men's and women's attitudes toward women's genitals. Such a scale, she wrote in the study, could be useful in sex therapy, in medical settings to help better understand decision-making that goes into gynecological care and treatment, and in health education settings involving women and their sexual health. The study also found that men had more positive attitudes about women's genitals than women.
"Women are often more critical about their own bodies -- and other women's bodies -- than men are," Herbenick said. "What we found in this study is that men generally feel positive about a variety of aspects of women's genitals including how they look, smell, taste and feel."
Herbenick, also a sexual health educator for The Kinsey Institute for Research in Sex, Gender and Reproduction, offers the following suggestions regarding the findings:
- Body image. Parents might consider how they can help their daughters to feel more positively about their bodies, such as by teaching them accurate names for their body parts, including their genitals (e.g., "vulva" rather than "down there") and responding in supportive ways to their self-exploration. "Rather than saying, 'don't touch down there -- it's dirty,' parents might let their children know that it's OK for them to touch their genitals, but in private spaces such as their own bedroom or the bathroom," Herbenick said.
- Advertisements and marketing. Health educators might consider ways that they can teach women and men about their bodies in positive, sex-positive ways by openly discussing how some products or marketing campaigns make people feel about their bodies.
"Our study builds on previous research that demonstrates that the mind and body are highly connected in regard to sex," said Herbenick. "When women feel more positively about female genitals, they likely feel more relaxed in their own skin, more able to let go and thus more likely to experience pleasure and orgasm."
The Development and Validation of a Scale to Measure Attitudes Toward Women's Genitals
Debra L. Herbenick..
International Journal of Sexual Health, 2009; 21 (3): 153 DOI: 10.1080/19317610903149692
Link to IJSH abstract
HIV/AIDS is up to five times more prevalent in American prisons than in the general population. Adherence to treatment programs can be strictly monitored in prison. However, once prisoners are released, medical monitoring becomes problematic. A new study by Dr. Nitika Pant Pai – an Assistant professor of Medicine and a medical scientist at the Research Institute of the McGill University Health Center, Montreal – suggests the majority (76%) of inmates take their antiretroviral treatment (ART) intermittently once they leave prison, representing a higher risk to the general population.
"Over a period of 9 years, we studied 512 HIV positive repeat offender inmates from the San Francisco County jail system," says Dr. Pant Pai. "Our results show that only 15% continuously took their ART between incarcerations or after their release." According to the study, published in the journal PLoS ONE, these figures highlight a lack of effectiveness on the part of medical monitoring services for these people outside prison.
"Taking ART intermittently is a problem because it depletes the CD4 count - the immunizing cells that fight infection – and increases the probability of developing resistance to the virus," says Dr. Pant Pai. "The risk for rapid disease progression becomes higher and presents a risk for public health transmission of HIV to their partners." According to the study those on intermittent therapy were 1.5 times more likely to have higher virus load than those on continuous therapy; those who never received therapy were 3 times more likely to have a higher VL.
"The optimal solution for treating patients and controlling the HIV/Aids epidemic in the USA is to ensure continuous therapy," explains Dr. Milton Estes, medical director of Forensic AIDS Project, San Francisco. "To achieve this we must work on various aspects of the prisoner's lives, such as marginalization, psychiatric problems and drug use, both before and after their departure from prison." According to Dr. Jacqueline Tulsky, senior author of the study, "This research highlights the need to examine ART policies inside and outside correctional settings with a view to establishing effective lifelong management of HIV in prisoners."
"This research is the first observational study in American prisons to evaluate the impact of antiretroviral treatment (ART) over a nine year period. It demonstrates the need for effective community transition and prison release programs to optimize ART given in jails," explains Dr. Pant Pai.
The Impact of Antiretroviral Therapy in a Cohort of HIV Infected Patients Going in and out of the San Francisco County Jail
Nitika Pant Pai, Milton Estes, Erica E. M. Moodie, Arthur L. Reingold, Jacqueline P. Tulsky
PLoS ONE published 22 Sep 2009 | doi:10.1371/journal.pone.0007115
Link to PLoS ONE article
Men who use Viagra and other erectile dysfunction drugs are four times more likely to experience condom breakage than other men, American researchers report in the September issue of Sexually Transmitted Infections. However a separate study conducted by the same team did not find the same association, which would need to be confirmed by other research.
In the first study, the researchers used newspaper and internet advertisements to recruit a convenience sample of 440 men who used condoms for vaginal sex. The self-completion questionnaire focused on the most recent occasion they had sex.
Just under one in ten of the men had used an erectile dysfunction drug on that occasion. For 12% of these men the condom broke, compared to 5% of men who didn’t use an erectile dysfunction drug.
Men reporting a longer duration of intercourse were also more likely to report condom breakage. However, in multivariate analysis, which controls for the skewing effect of other factors, erectile dysfunction drug use remained significant - users were four times more likely to report condom breakage (adjusted odds ratio 4.04, 95% confidence interval 1.06 - 15.41).
The researchers suggest that as Viagra and related drugs increase swelling during an erection, it is plausible that condoms become more tight-fitting. They say that users of these drugs may need to be advised to use condoms that are large enough for an enhanced erection. Moreover, users should be made aware that having sex for longer is associated with condom breakage.
However the same team of researchers published a separate study earlier this year in the Journal of Sexual Medicine, which did not find the same association.
In this study, a different group of 705 men were recruited via a website selling sexual paraphernalia. Although most men were heterosexual, some were reporting on anal sex. Men who used recreational drugs were excluded.
Once again, the men were asked about the last time they used a condom for penetrative sex. Seven per cent of men reported using an erectile dysfunction drug.
Condom breakage was rarely reported in this sample, and was no more commonly reported by erectile dysfunction drug users.
On the other hand, users were actually more likely to report the condom slipping off or erection problems during sex. The researchers concluded from this that while Viagra and similar drugs may improve men’s erections, they do not always eliminate all erection problems, especially those associated with condom use.
The researchers believe that their studies highlight the importance of further research into the implications of using erectile dysfunction drugs.
Is phosphodiesterase type 5 inhibitor use associated with condom breakage?
R Crosby, W L Yarber, S A Sanders, C A Graham
Sexually Transmitted Infections 85:404-405, 2009. doi:10.1136/sti.2009.036012
Link to STI abstract
Do phosphodiesterase type 5 inhibitors protect against condom-associated erection loss and condom slippage?
Stephanie A. Sanders, Robin R. Milhausen, Richard A. Crosby, Cynthia A. Graham, William L. Yarber
Journal of Sexual Medicine volume 6 issue 5 p1451-1456, published on line 27April 2009. DOI: 10.1111/j.1743-6109.2009.01267.x
Link to JSM abstract
The Vatican has lashed out at criticism over its handling of its pedophilia crisis by saying the Catholic church was "busy cleaning its own house" and that the problems with clerical sex abuse in other churches were as big, if not bigger.
In a defiant and provocative statement, issued following a meeting of the UN human rights council in Geneva, the Holy See said the majority of Catholic clergy who committed such acts were not pedophiles but homosexuals attracted to sex with adolescent males.
The statement, read out by Archbishop Silvano Tomasi, the Vatican's permanent observer to the UN, defended its record by claiming that "available research" showed that only 1.5%-5% of Catholic clergy were involved in child sex abuse.
He also quoted statistics from the Christian Scientist Monitor newspaper to show that most US churches being hit by child sex abuse allegations were Protestant and that sexual abuse within Jewish communities was common.
He added that sexual abuse was far more likely to be committed by family members, babysitters, friends, relatives or neighbors, and male children were quite often guilty of sexual molestation of other children.
The statement said that rather than pedophilia, it would "be more correct" to speak of ephebophilia, a homosexual attraction to adolescent males.
Rabbi Joseph Potasnik, head of the New York Board of Rabbis, said: "Comparative tragedy is a dangerous path on which to travel. All of us need to look within our own communities. Child abuse is sinful and shameful and we must expel them immediately from our midst."
In 1997, more than seven hundred children in Japan reportedly suffered an epileptic attack while watching an episode of a popular cartoon. This was later diagnosed as a case of photosensitive epilepsy (a kind of epilepsy caused by visual stimulus) triggered by a specific segment of the cartoon containing a colorful flickering stimulus. Recently in 2007, the animated video footage promoting the 2012 London Olympics faced similar complaint from some viewers.
Because of the widespread usages of television and video games, it is important to detect the crucial visual parameters in triggering an epileptic attack. Common guidelines are available on specific visual parameters of the stimuli like spatial/temporal frequency, stimulus contrast, patterns etc. However, despite the ubiquitous presence of colorful displays and materials, very little is known about the relationship between color-combinations (chromaticity) and photosensitivity. Further it is also not precisely known how the patients' brain responses differ from healthy brains against such colorful stimuli.
In a study published in the journal PLoS ONE on September 25, researchers led by Joydeep Bhattacharya at Goldsmiths, University of London, investigated brain rhythms of photosensitivity against combinational chromatic flickering in nine adult controls, an unmedicated patient suffering from photosensitive epilepsy, two age-matched controls, and another medicated patient.
Their results show that when perturbed by potentially epileptic-triggering stimulus, healthy human brain manages to maintain a non-deterministic, possibly a chaotic state with a high degree of disorder, but an epileptic brain represents a highly ordered state which making it prone to hyper-excitation. Further their study has found how complexities underlying brain dynamics could be modulated by certain color combinations more than the other, for example, red-blue flickering stimulus causes larger cortical excitation than red-green or blue-green stimulus.
Dr. Bhattacharya said, "These findings support the 'decomplexification hypothesis': a healthy brain is more 'complex' than a pathological brain."
However, he added, "It is important to extend the research with larger number of patients to find at what extent these statistical and complexity measures applied in the present paper would have diagnostic potential."
Other researchers in the team are Mayank Bhagat, Chitresh Bhushan, Goutam Saha from the Indian Institute of Technology (Kharagpur, India), Katsumi Watanabe from the University of Tokyo, and Shinsuke Shimojo from the California Institute of Technology.
Investigating Neuromagnetic Brain Responses against Chromatic Flickering Stimuli by Wavelet Entropies.
Mayank Bhagat, Chitresh Bhushan, Goutam Saha, Shinsuke Shimjo, Katsumi Watanabe, Joydeep Bhattacharya
PLoS ONE, 2009; 4(9): e7173 DOI: 10.1371/journal.pone.0007173
Link to PLoS ONE article
Monday, September 28, 2009
Doses of efavirenz can be safely reduced in patients who have high blood concentrations of the drug, Dutch investigators report in the October 1st edition of the Journal of Acquired Immune Deficiency Syndromes. Reducing the dose of the drug meant that patients were less likely to discontinue treatment with efavirenz due to side-effects, and reducing the dose of the drug did not increase the risk of viral load becoming detectable.
Efavirenz (Sustiva, also in the combination pill Atripla) is one of the drugs recommended for first-line antiretroviral treatment. The drug has a potent anti-HIV effect, is easy to take and has a mild side-effect profile.
However, a proportion of individuals who start treatment with efavirenz report central nervous system side-effects. These can include problems sleeping, vivid dreams, and depression. Although such side-effects are often mild and transient, a small number of patients discontinue treatment with efavirenz because of them.
There is some evidence that such side-effects are more likely to occur if a patient has high blood concentrations of efavirenz.
Investigators from the Netherlands therefore undertook a 48-week study to see if patients with high concentrations of efavirenz in their blood could safely reduce their daily dose of the drug, and if such dose reductions meant that an individual was less likely to discontinue their treatment with efavirenz.
“This study demonstrated that therapeutic drug monitoring-guided efavirenz dose reduction may prevent toxicity-induced discontinuations in patients with high plasma concentrations”, comment the investigators.
They add, “we did not observe any detrimental effect of dose reduction on virological response.”
They conclude, “our study demonstrates that therapeutic drug monitoring-guided dose reduction can be considered in patients who have high efavirenz plasma concentrations. Dose reduction does not negatively affect virological efficacy and may prevent toxicity-induced discontinuations.”
Efavirenz dose reduction is safe in patients with high plasma concentrations and may prevent efavirenz discontinuations.
van Luin, Matthijs PharmD et al.
Journal of Acquired Immune Deficiency Syndromes 52: 240-45, 2009. DOI: 10.1097/QAI.0b013e3181b061e6
Link to JAIDS abstract
Five genetic regions have been identified that are unique to the most virulent strain of Clostridium difficile (C. difficile), the hospital superbug. Researchers writing in BioMed Central's open access journal Genome Biology studied the genome of the bacterium, looking for genes relating to motility, antibiotic resistance and toxicity.
Brendan Wren from the London School of Hygiene & Tropical Medicine worked with a team of researchers at The Wellcome Trust Sanger Institute to compare the genomes of three strains of the bacterium, the hypervirulent '027' strain, an historic, non-epidemic 027 strain and one less related and also non-epidemic '630' strain.
He said: "C. difficile is the most frequent cause of nosocomial diarrhea worldwide. In the past five years a new group of highly virulent C. difficile strains has emerged to cause outbreaks of increased severity in North America and Europe. Several studies have shown that patients infected with these '027' strains have more severe diarrhea, higher mortality and more recurrences. This study provides genetic markers for the identification of 027 strains and offers a unique opportunity to explain their emergence."
The researchers found that the 027 strains had considerable genetic differences compared to the non-epidemic 630 strain, which may relate to the observed phenotypic difference in virulence. Additionally, five genetic regions appear to have accumulated over the last 20 years in the modern day epidemic 027 strain, compared to its historic counterpart.
According to Wren, "The observed gene differences between these strains might individually or collectively explain why modern 027 strains are more likely to be epidemic and could explain the higher case-fatality ratio and persistence associated with infection by these strains."
Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium.
Richard A Stabler et al
Genome Biology 10:R102 25 September 2009 doi:10.1186/gb-2009-10-9-r102
Link to Genome Bio abstract
Antibiotic resistance has been a significant problem for hospitals and health-care facilities for more than a decade. But despite the need for new treatment options, there have been only two new classes of antibiotics developed in the last 40 years.
Now a promising discovery by McMaster University researchers has revealed an ideal starting point to develop new interventions for resistant infections.
Eric Brown, a professor and chair of the Department of Biochemistry and Biomedical Sciences, and a team of researchers from the Michael G. DeGroote Institute for Infectious Disease Research have identified a novel chemical compound that targets drug-resistant bacteria in a different way from existing antibiotics. The discovery could lead to new treatments to overcome antibiotic resistance in certain types of microorganisms.
"Everyone reads the headlines about drug-resistant bugs, it's a big problem," said Brown, who holds the Canada Research Chair in Antimicrobial Research. "Really what we're trying to do is understand whether or not there are new ways to tackle this problem."
The research team, which included biochemists and chemists from McMaster University, used high-throughput screening to uncover the new class of chemical. The approach allows scientists to look for small molecules that kill bacteria as well as examine the molecular mechanisms and pathways they exploit.
Existing antibiotics destroy bacteria by blocking production of its cell wall, DNA or protein. The new McMaster-discovered compound, MAC13243, is directed at blocking a particular step in the development of the bacteria's cell surface, which until now has not been recognized as a target for antibiotics.
"We're excited about finding a new probe of a relatively uncharted part of bacterial physiology," Brown said. "It's a new way of thinking about the problem. Who knows, could this chemical become a drug? Anything's possible. But at the very least we've advanced the field and created some tools that people can use now to try to better understand this pathway."
Ranjana Pathania, a former postdoctoral fellow in the Brown lab and now an assistant professor at the Indian Institute of Technology Roorkee, is the lead author of the study. The research also involved collaborators in McMaster's Department of Biochemistry and Biomedical Sciences and Department of Chemistry and Chemical Biology.
Chemical genomics in Escherichia coli identifies an inhibitor of bacterial lipoprotein targeting
Ranjana Pathania, et al
Nature Chemical Biology published on line 27 September 2009 doi:10.1038/nchembio.221 Article
Link to Nature Chem Biol abstract
Middle aged men who smoke, have high blood pressure and raised cholesterol levels can expect a 10–15 year shorter life expectancy from age 50 compared with men without these risk factors.
The Oxford University study published in the British Medical Journal reports data from the Whitehall study, in which the health of 19,000 male civil servants has been followed for almost 40 years since 1970, when they were aged 40–69.
'We’ve shown that men at age 50 who smoke, have high blood pressure and high cholesterol levels can expect to survive to 74 years of age, while those who have none of these risk factors can expect to live until 83,’ says Dr Robert Clarke of the Clinical Trial Service Unit at the University of Oxford, who led the research team.
Dr Clarke says: ‘The results give people another way of looking at heart disease risk factors that can be understood more readily. If you stop smoking or take measures to deal with high blood pressure or body weight, it will translate into increased life expectancy.
'It also provides support for existing public health policies. Bans on smoking in public places, efforts to lower saturated fats and salt, combined with medications for those at high risk of cardiovascular disease, when taken together will result in substantial improvements in life expectancy across the population.
Life expectancy in relation to cardiovascular risk factors: 38 year follow-up of 19,000 men in the Whitehall study
Robert Clarke, Jonathan Emberson, Astrid Fletcher, Elizabeth Breeze, Michael Marmot, and Martin J Shipley
BMJ 2009;339:b3513, doi: 10.1136/bmj.b3513 (Published 17 September 2009)
Link to BMJ abstract
A meta-analysis has found that, compared to the general population, HIV-positive individuals have an increased risk of several non-AIDS-defining cancers. The research, which is published in the online edition of the Journal of Acquired Immune Deficiency Syndromes, showed that HIV-positive individuals had an increased risk of several infection-related cancers, as well as malignancies that are related to smoking.
However, the authors were unable to say if HIV per se increased the risk of such cancers, or if “confounding by unadjusted cancer risk factors may be responsible for the apparent elevated incidence”.
Cervical cancer, Kaposi’s sarcoma and non-Hodgkin’s lymphoma are all AIDS-defining cancers. Research suggests that people with HIV may also have an increased risk of developing several other cancers. A previous meta-analysis of seven studies showed that these cancers were often related to viral infections.
US investigators have now conducted a further meta-analysis including six additional studies. The investigators stratified their results to see if gender, a previous AIDS diagnosis and antiretroviral exposure affected the risk of non-AIDS-defining cancers.
Cigarette smoking appears to have been the underlying cause of many of the cancers, especially for women.
The investigators conclude, “this study found an increased SIR for many types of non-AIDS cancers.” However, “it remains unclear whether HIV-infected individuals are truly at a greater risk of non-AIDS-defining cancers, or if confounding by unadjusted cancer risk factors may be responsible for the apparent elevated increase.”
A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals
Shiels, Meredith S PhD, MHS et al.
Journal of Acquired Immune Deficiency Syndromes published on line 2009 DOI: 10.1097/QAI.0b013e3181b327ca.
Link to JAIDS abstract
The results of the RV 144 HIV vaccine trial should be treated with caution until further data are presented, US advocacy organization Treatment Action Group said on Friday, following the announcement that the combination of vaccines used in the study resulted in a 31.2% reduction in the risk of HIV infection.
“Based on the limited amount of information that has been released, it appears that the statistical significance [of the result] hangs on very few cases of HIV infection. TAG urges caution in interpreting the findings until more detailed information is available,” the group stated in a press release.
Further results from the study will be presented at the International AIDS Vaccine conference in Paris, October 19th-22nd.
Data on the immunological correlates of protection from infection in study participants will be amongst the subjects reported, but investigators have warned that due to the small number of infections in the study, they will have limited ability to carry out sub-group analyses to determine the effects of gender, risk group or other variables on the risk of infection.
Trial investigators have also warned that the results should not be over-interpreted. In a conference call with journalists on Thursday, Dr Antony Fauci emphasized that the vaccine construct used in the study, which used the viral envelope proteins from subtype B and E in order to stimulate antibody production, had been tailored to the types of HIV most commonly circulating in Thailand.
Quite different vaccines would need to be constructed for other regions of the world if the approach tested in this study were eventually deemed to be worth investigating in wider studies.
Link to Treatment Action Group press release
Sunday, September 27, 2009
Chronic sleep deprivation in a mouse model of Alzheimer's disease makes Alzheimer's brain plaques appear earlier and more often, researchers at Washington University School of Medicine in St. Louis report online this week in Science Express.
They also found that orexin, a protein that helps regulate the sleep cycle, appears to be directly involved in the increase.
Neurodegenerative disorders like Alzheimer's disease and Parkinson's disease often disrupt sleep. The new findings are some of the first indications that sleep loss could play a role in the genesis of such disorders.
"Orexin or compounds it interacts with may become new drug targets for treatment of Alzheimer's disease," says senior author David M. Holtzman, M.D., the Andrew and Gretchen Jones Professor and chair of the Department of Neurology at the School of Medicine and neurologist-in-chief at Barnes-Jewish Hospital. "The results also suggest that we may need to prioritize treating sleep disorders not only for their many acute effects but also for potential long-term impacts on brain health."
Holtzman's laboratory uses a technique called in vivo microdialysis to monitor levels of amyloid beta in the brains of mice genetically engineered as a model of Alzheimer's disease. Amyloid beta is a protein fragment that is the principal component of Alzheimer's plaques.
Jae-Eun Kang, Ph.D., a post-doctoral fellow in Holtzman's lab, noticed that brain amyloid beta levels in mice rose and fell in association with sleep and wakefulness, increasing in the night, when mice are mostly awake, and decreasing during the day, when they are mostly asleep.
A separate study of amyloid beta levels in human cerebrospinal fluid led by Randall Bateman, M.D., assistant professor of neurology and a neurologist at Barnes-Jewish Hospital, also showed that amyloid beta levels were generally higher when subjects were awake and lower when they slept.
To confirm the link, Kang learned to use electroencephalography (EEG) on the mice at the Sleep and Circadian Neurobiology Laboratory at Stanford University with researchers Seiji Nishino, M.D., Ph.D., and Nobuhiro Fujiki, M.D., Ph.D. The EEG readings let researchers more definitively determine when mice were asleep or awake and validated the connection: Mice that stayed awake longer had higher amyloid beta levels.
"This makes sense in light of an earlier study in our lab where John Cirrito, Ph.D., showed that increases in synaptic activity resulted in increased levels of amyloid beta," Holtzman notes. "The brain's synapses may generally be more active when we're awake."
Depriving the mice of sleep caused a 25 percent increase in amyloid beta levels. Levels were lower when mice were allowed to sleep. Blocking a hormone previously linked to stress and amyloid beta production had no effect on these changes, suggesting that they weren't caused by the stress of sleep deprivation, according to Holtzman.
Researchers elsewhere had linked mutations in orexin to narcolepsy, a disorder that is characterized by excessive daytime sleepiness. The brain has two kinds of receptors for orexin, which is also associated with regulation of feeding behavior.
When Holtzman's group injected orexin into the brains of the mice, mice stayed awake longer, and amyloid beta levels increased. When researchers used a drug called almorexant to block both orexin receptors, amyloid beta levels were significantly lower and animals were awake less.
Miranda M. Lim, M.D., Ph.D., a neurology resident and post-doctoral researcher in Holtzman's lab, performed long-term behavioral experiments with the mice. She found that three weeks of chronic sleep deprivation accelerated amyloid plaque deposition in the brain. In contrast, when mice were given almorexant for two months, plaque deposition significantly decreased, dropping by more than 80 percent in some brain regions.
"This suggests the possibility that a treatment like this could be tested to see if it could delay the onset of Alzheimer's disease," says Holtzman.
Holtzman notes that not only does the risk of Alzheimer's increase with age, the sleep/wake cycle also starts to break down, with older adults progressively getting less and less sleep. Investigators are considering epidemiological studies of whether chronic sleep loss in young and middle-aged adults increases risk of Alzheimer's disease later in life.
Holtzman also plans to learn more of the molecular details of how orexin affects amyloid beta.
"We would like to know if there are ways to alter orexin signaling and its effects on amyloid beta without necessarily modifying sleep," he says.
Additional studies will address the questions of whether increased amyloid beta during wakefulness is connected to increased synaptic activity and whether some aspect of sleep lowers amyloid beta levels independent of synaptic activity.
Amyloid ß dynamics are regulated by orexin and the sleep-wake cycle.
Jae-Eun Kang, Miranda M. Lim, Randall J. Bateman, James J. Lee, Liam P. Smyth, John R. Cirrito, Nobuhiro Fujiki, Seiji Nishino, and David M. Holtzman
Science Express Published online September 24 2009; 10.1126/science.1180962
Link to Science abstract
Coming Out in Middle School
Benoit Denizet-Lewis, a contributing writer for the magazine, is the author of “America Anonymous: Eight Addicts in Search of a Life.” His new book, “American Voyeur,” a collection of his writing, will be published in January.
This article gives unusual insights to the teens coming out in what is a remarkably different time:
“His dad would give him up for adoption if he knew he was gay.”
Though most adolescents who come out do so in high school, sex researchers and counselors say that middle-school students are increasingly coming out to friends or family or to an adult in school. Just how they’re faring in a world that wasn’t expecting them — and that isn’t so sure a 12-year-old can know if he’s gay — is a complicated question that defies simple geographical explanations. Though gay kids in the South and in rural areas tend to have a harder time than those on the coasts, I met gay youth who were doing well in socially conservative areas like Tulsa and others in progressive cities who were afraid to come out.
What is clear is that for many gay youth, middle school is more survival than learning — one parent of a gay teenager I spent time with likened her child’s middle school to a “war zone.”
A middle-school counselor in Maine summed up the view of many educators I spoke to when she conceded that her school was “totally unprepared” for openly gay students. “We always knew middle school was a time when kids struggle with their identity,” she told me, “but it was easy to let anti-gay language slide because it’s so imbedded in middle-school culture and because we didn’t have students who were out to us or their classmates. Now we do, so we’re playing catch up to try to keep them safe.”
There is a growing consensus among parents and middle-school educators that something needs to be done to curb anti-gay bullying, which a 2008 study at an all-male school by researchers at the University of Nebraska and Harvard Medical School found to be the most psychologically harmful type of bullying.
"I certainly don’t believe school districts should force a sexual agenda on the community,” says Finn Laursen, the executive director of the Christian Educators Association International, “but we can’t just put our heads in the sand and ignore the kind of harassment that’s going on.”
Still, the younger they are when they come out, the more that youth with same-sex attractions face an obstacle that would be unimaginable to their straight peers. When a 12-year-old boy matter-of-factly tells his parents — or a school counselor — that he likes girls, their reaction tends not to be one of disbelief, dismissal or rejection. “No one says to them: ‘Are you sure? You’re too young to know if you like girls. It’s probably just a phase,’ ” says Eileen Ross, the director of the Outlet Program, a support service for gay youth in Mountain View, Calif. “But that’s what we say too often to gay youth. We deny them their feelings and truth in a way we would never do with a heterosexual young person.”
All of this fluidity, confusion and experimentation can be understandably disorienting for parents and educators. Is an eighth grader who says he’s gay just experimenting? Could he change his mind in a week, as 13-year-olds routinely do with other identities — skater, prep, goth, jock — they try on for a while and then shed for another? And if sexuality is so fluid, should he really box himself in with a gay identity? Many parents told me they especially struggled with that last question.
Johnny said his mom has made it very clear that he’s not allowed to bring a boyfriend over to the house. “She’s like, ‘O.K., I accept you, but you better not bring any of those people around,’ ” he told me.
That’s one of about 50 “rejecting behaviors” identified by Caitlin Ryan of San Francisco State University, who has spent the last eight years studying the link between family acceptance or rejection of gay children and their mental health in early adulthood. (Ryan found that teenagers in “rejecting families” were significantly more likely to have attempted suicide, used drugs and engaged in unprotected sex than those who were raised in accepting families.)
As I listened to them bicker, I couldn’t help remembering what Ritch Savin-Williams, the professor of developmental psychology at Cornell, told me the first time we spoke: “This is the first generation of gay kids who have the great joy of being able to argue with their parents about dating, just like their straight peers do.”
Saturday, September 26, 2009
A comparison of breast milk samples from Denmark and Finland revealed a significant difference in environmental chemicals which have previously been implicated in testicular cancer or in adversely affecting development of the fetal testis in humans and animals.
This finding is published in the International Journal of Andrology.
In recent years a worldwide increase in testicular cancer has been noticed, but the cause remains unknown. In some countries, such as Denmark the prevalence of this disease and other male reproductive disorders, including poor semen quality and congenital genital abnormalities is conspicuously high; while in Finland, a similarly industrialized Nordic country, the incidences of these disorders are markedly lower. In the UK, almost 2,000 men are diagnosed with testicular cancer every year, and in the US this number is over 8,000. There is a wide variation in incidence rates of testicular cancer around the globe, and the reasons behind the observed trends are unexplained.
Environmental endocrine disrupting chemicals (EDCs) are commonly found in fatty foods, paints, plasticizers, pesticides, and the byproducts of industrial processes, and in recent studies an association has been shown between some of these agents and male reproductive problems. To investigate whether EDCs could be related to such great differences in reproductive disorders between closely related countries, Konrad Krysiak-Baltyn and colleagues from Denmark, Finland, and Germany measured levels of 121 chemicals in 68 breast milk samples from Denmark and Finland to compare exposure of mothers to EDCs.
With so many chemicals, they used sophisticated, bioinformatics tools to interpret the complex data, and the results showed a clear distinction between the countries.
"We were very surprised to find that some EDC levels, including some dioxins, PCBs and some pesticides, were significantly higher in Denmark than in Finland," said Professor Niels Skakkebaek, a senior member of the research team, based at the University Department of Growth and Reproduction, Rigshospitalet, Denmark. "Our findings reinforce the view that environmental exposure to EDCs may explain some of the temporal and between-country differences in incidence of male reproductive disorders."
"In spite of the findings, I would strongly urge women, including Danish mothers, to continue with breast feeding, which has many beneficial effects for the child," added Skakkebaek.
Country-specific chemical signatures of persistent environmental compounds in breast milk
K. Krysiak-Baltyn et al.
International Journal of Andrology, 2009; DOI: 10.1111/j.1365-2605.2009.00996.x
Link to IJA abstract
— Adolescent depression and anxiety disorders are two distinct psychiatric disorders, according to Dr. William W. Hale III (a researcher of the Langeveld Institute for the Study of Education and Development in Childhood and Adolescence at Utrecht University) in a recent publication in the Journal of Child Psychology and Psychiatry.
Hale and his colleagues conducted a five-year, longitudinal study of secondary school adolescents. Every year the depressive and anxiety disorder symptoms of the adolescents were measured. Hale and his colleagues concluded that while adolescent anxiety and depression were strongly related to one another, that adolescent depression and anxiety disorder symptoms are in fact best classified as two distinct disorders.
These conclusions are of importance for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) that is planned for publication in 2012. Adolescent depression and anxiety disorders are presently classified in the revised fourth edition of the DSM (DSM-IV-TR), however it has been suggested that these two disorders be given a joint classification in the DSM-V. Hale argues that the present-day classification of adolescent depression and anxiety disorders be preserved in the DSM-V.
One factor or two parallel processes? Comorbidity and development of adolescent anxiety and depressive disorder symptoms.
William W. Hale III, Quinten A.W. Raaijmakers, Peter Muris, Anne van Hoof, Wim H.J. Meeus.
Journal of Child Psychology and Psychiatry, 2009; 50 (10): 1218 DOI: 10.1111/j.1469-7610.2009.02115.x
Link to JCPP abstract
— Parents say that honesty is the best policy, but they regularly lie to their children as a way of influencing their behavior and emotions, finds new research from the University of Toronto and the University of California, San Diego.
Surprisingly little scholarship has been published on the subject of parental lying, so Gail Heyman, professor of psychology at UC San Diego, Diem Luu, a former UCSD student, and Kang Lee, professor at the University of Toronto and director of the Institute of Child Study at OISE, set out to explore the under-researched phenomenon. They asked U.S. participants in two related studies about parents lying to their children – either for the purpose of promoting appropriate behavior or to make them happy.
In one of the studies, many parents reported they told their young children that bad things would happen if they didn't go to bed or eat what they were supposed to. For example, one mother said she told her child that if he didn't finish all of his food he would get pimples all over his face. Other parents reported inventing magical creatures. One explained, "We told our daughter that if she wrapped up all her pacifiers like gifts, the 'paci-fairy' would come and give them to children who needed them...I thought it was healthier to get rid of the pacifiers, and it was a way for her to feel proud and special."
In the other study, the researchers surveyed college students' recollections about their parents' lying and obtained similar results: parents often lie to their children even as they tell them that lying is unacceptable.
The researchers refer to this practice as "parenting by lying." "We are surprised by how often parenting by lying takes place," said Lee. "Moreover, our findings showed that even the parents who most strongly promoted the importance of honesty with their children engaged in parenting by lying."
Though Heyman thinks that there are occasions when it is appropriate to be less than truthful with a child – "telling a two-year-old you don't like their drawing is just cruel," she said – she urges parents to think through the issues and consider alternatives before resorting to the expedient lie.
"Children sometimes behave in ways that are disruptive or are likely to harm their long-term interests," said Heyman. "It is common for parents to try out a range of strategies, including lying, to gain compliance. When parents are juggling the demands of getting through the day, concerns about possible long-term negative consequences to children's beliefs about honesty are not necessarily at the forefront."
Parenting by lying
Gail D. Heyman, Diem H. Luu, Kang Lee
Journal of Moral Education Volume 38, Issue 3 September 2009 , pages 353 – 369 DOI: 10.1080/03057240903101630
Link to JME abstract
Friday, September 25, 2009
Bill & Melinda Gates Foundation statement (September 24, 2009)
The Bill & Melinda Gates Foundation launched the Living Proof Project: U.S. Investments in Global Health are Working, a multi-year awareness campaign to highlight the extraordinary success of the U.S. government’s efforts to improve health around the world.
The Living Proof Project will show that U.S-supported initiatives to fight malaria, AIDS, and other diseases are saving and improving the lives of millions of people in poor and developing countries – and as a result, empowering them to lead more productive lives. The campaign kicked off today with a new web site (www.livingproofproject.org) and advertisements in Washington, DC that highlight compelling success stories in global health.
“We want to show Americans that their investments in global health are working,” said Bill Gates, co-chair of the Gates Foundation. “We should all be proud that U.S.-funded health programs are saving millions of lives and bringing new hope to poor and developing countries.”
Nontuberculous mycobacteria (NTM) are environmental organisms found in both water and soil that can cause severe pulmonary (lung) disease in humans. Pulmonary NTM is on the rise in the United States, according to a large study of people hospitalized with the condition.
A research team led by epidemiologists from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, analyzed hospital discharge records of patients in 11 states whose combined total population represents 42 percent of the country. They reviewed database records spanning 1998 to 2005, and identified more than 16,475 hospitalizations associated with pulmonary NTM in people without AIDS. Before the widespread availability of combination antiretroviral therapy, pulmonary NTM disease was a common opportunistic infection among people with AIDS infection; in this study, the researchers limited their analysis to non-AIDS NTM disease.
Of the 11 states studied, Florida, New York and California had 62 percent of the pulmonary NTM hospitalizations. The scientists chose these states to compare trends by geographic area. They found the annual prevalence of disease increased significantly among men and women in Florida (3.2 percent per year for men and 6.5 percent per year for women) and among women in New York (4.6 percent per year). There were no significant changes in California. Whether these geographic differences in prevalence are a result of exposure to NTM, or increased concentrations of mycobacterium in certain environments, or both, is not clear. However, previous studies have found high disease prevalence in the southeastern United States, particularly along the coastal regions of the Atlantic and Gulf coasts.
Study results show pulmonary NTM has increased in certain geographic areas of the United States, and while overall prevalence is higher in women, prevalence increases for both sexes in the fifth or sixth decade of life. Further research is needed to define the prevalence of the disease in nonhospitalized people in regions throughout the United States and to determine risk factors for disease susceptibility, including genetic and environmental factors.
Hospitalizations for nontuberculous mycobacteria-associated lung disease, United States, 1998-2005.
Megan E. Billinger et al.
Emerging Infectious Diseases, 2009; (published ahead of print) DOI: 10:3201/eid510.090196
Link to EID article [pdf]
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- Jack Dee - Emergency services
- 'Great Britain' for Dummies
- Good Weather For Air Strikes
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- You’ve always had mail
- Millions receiving ART --- millions more
- ‘feel more positively about female genitals’
- Five times more HIV/AIDS in American prisons and w...
- Viagra & condoms
- The Jews are worse . . . anyway, it’s the Gays
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- HIV smoking risk increase
- RV 144 HIV vaccine trial – ‘caution’
- Pat Bagley - Salt Lake Tribune
- just some titles
- New Rules
- Sleep Loss & Alzheimer's
- Coming Out
- Mitchell and Webb
- Environmental endocrine disrupting chemicals
- depression and anxiety - distinct
- "parenting by lying."
- Murder at the Manor
- Rachel Maddow
- Something is working!
- Pulmonary NTM spreading?
- "dose dumping"
- Bacteria Is Spread?
- Worst Person - "The Dumbest Man On The Planet!"
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- majority hide at work
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- Smoking bans reduce heart attacks
- Walking after spinal-cord injury
- Keeping a virus circulating
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- God Shuffled His Feet
- Rachel Maddow
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- Would I Lie To You?
- Pat Bagley - Salt Lake Tribune
- flu exposure pathways
- Tobacco and marijuana may reduce levels . . .
- HIV's ability to mutate
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- Lewis Black
- The Solipsist
- Al Murray
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