The annual public board meeting for Abington Memorial Hospital in Pennsylvania has in some ways developed into a microcosm of the abortion-rights debate and the many issues that contribute to eroding access to the procedure, the Philadelphia Inquirer reports. Each year at its board meeting, Abington reviews its rules and allows for public discussion about its current policy positions, but “[f]or as long as anyone at Abington can remember,” abortion has been the sole topic dominating the board meetings, according to the Inquirer.

The hospital’s policy states that the facility “provides abortions to women who request them, to meet a legitimate community need, consistent with safe medical practice and the current laws of the nation and state, and as part of a full range of services that we provide to those who come to us and seek care.” The facility offers counseling services to all women considering abortion.

Every year, a few dozen abortion-rights opponents gather on one side of the board meeting, while a handful of abortion-rights advocates sit on the other side. This year, as in years’ past, the board listened to comments from every person in attendance and issued a decision maintaining its policy of offering abortions.

Clinics Perform Most Abortion Procedures

The Inquirer reports that nationwide, nearly 95% of abortions are performed in clinics, compared with 5% that are performed in hospitals. Nearly one-third of the more than 11,000 abortions in Pennsylvania last year occurred in four Planned Parenthood-affiliated clinics, while the number performed in hospitals has gradually declined each year.

Abortion-rights advocates say there are both benefits and drawbacks to the transition of abortion care into the clinic setting. Carol Petraitis, director of the Clara Bell Duvall Reproductive Freedom Project at the American Civil Liberties Union of Pennsylvania, said, “Moving it into clinic settings, there was control over the price and … how women were treated.”

Susan Schewel, executive director of the Women’s Medical Fund, said, “Abortion has been ghettoized because of the stigma, and it’s been separated out from routine health care for women.” She added, “And that’s not good for health of women and health of families. It should be integrated into routine ob-gyn care” (Vitez, Philadelphia Inquirer, 5/2).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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Teenagers are turning to alcohol and cigarettes to relieve school stress. This is the finding of a study presented at The British Psychological Society’s Division of Educational and Child Psychology annual conference.

The study carried out by psychologist Dr Pamela Taylor at Salford Local Authority looked at the stressors and coping strategies of 172 fifteen and sixteen year-olds facing their GCSE examinations.

Dr Taylor said: “Teenagers face many pressures at school – continuous achievement, examinations and having to make important decisions about their futures.”

Findings of the study indicate that the main stressors pupils experienced were the volume of coursework they were given, clashes with hand-in dates for assignments and teacher/pupil relationships. Although the majority of the pupils reported using adaptive coping strategies, such as listening to music, watching TV, sport and exercise or walking the dog, a number revealed that they engaged in forms of maladaptive coping such as drinking alcohol, smoking and taking drugs. Thirty percent drank alcohol to relieve stress, 16 percent smoked cigarettes and six percent used drugs.

Dr Taylor continued: “Over a quarter of these pupils reported suffering from high levels of school related stress. Our results illustrate how important it is to educate teenagers on the best ways to manage this stress, and highlight the dangers of using cigarettes, alcohol and drugs to cope.”

“The study also shows there is a need for secondary schools to tackle pupils’ school based problems and stressors, including time management, work-life balance and teacher/pupil relationships.”

The British Psychological Society Division of Educational and Child Psychology’s Annual Professional Development Event, runs from 7th – 9th January 2009 at Worsley Park Hotel and Country Club, Manchester.

The British Psychological Society Continue reading →

Long-term exposure to ground-level ozone, a major component of smog, is associated with an increased risk of death from respiratory ailments, according to a new nationwide study led by a researcher at the University of California, Berkeley.

The study, to be published in the March 12 issue of the New England Journal of Medicine, analyzed the risk of death for both ozone and fine particulate matter, two of the most prevalent components of air pollution. The study followed nearly 450,000 people for two decades and covered 96 metropolitan regions in the United States.

The researchers found that people living in areas with the highest concentrations of ozone, such as the Los Angeles metropolitan area and California’s Central Valley, had a 25 to 30 percent greater annual risk of dying from respiratory diseases compared with people from regions with the lowest levels of the pollutant. Those locations included the Great Plains area and regions near San Francisco and Seattle.

“This is the first time we’ve been able to connect chronic exposure to ozone, one of the most widespread pollutants in the world, with the risk of death, arguably the most important outcome in health impact studies used to justify air quality regulations,” said study lead author Michael Jerrett, UC Berkeley associate professor of environmental health sciences. “Previous research has connected short-term or acute ozone exposure to impaired lung function, aggravated asthma symptoms, increased emergency room visits and hospitalizations, but the impact of long-term exposure to ozone on mortality had not been pinned down until now.”

The study found that for every 10 parts-per-billion (ppb) increase in ozone level, there is a 4 percent increase in risk of death from respiratory causes, primarily pneumonia and chronic pulmonary obstructive pulmonary disease.

“World Health Organization data indicate that about 240,000 people die each year from respiratory causes in the United States,” said Jerrett. “Even a 4 percent increase can translate into thousands of excess deaths each year. Globally, some 7.7 million people die from respiratory causes, so worldwide the impact of ozone pollution could be very large.”

The findings come a year after the U.S. Environmental Protection Agency (EPA) strengthened its National Ambient Air Quality Standards for ground-level ozone from an annual average of 80 ppb to 75 ppb to reflect growing evidence of the harmful health effects of ozone. A group of leading scientists appointed to advise the EPA had actually recommended stricter health standards for ozone levels – from 60 to 70 ppb.

A month after the EPA released its new standards, a National Research Council report concluded that premature deaths related to ozone exposure of less than 24 hours are more likely among those with pre-existing diseases. The report called for more research on the link between mortality and ozone exposure over a period of weeks and years.

Ozone – gas made up of three oxygen atoms – forms a protective layer from the sun’s ultraviolet radiation when located in the Earth’s upper atmosphere. However, that same gas is toxic at ground level where it can be breathed by humans. Ground level ozone is formed through a complex chemical reaction in sunlight between nitrogen oxides (NOx), commonly spewed from vehicle exhaust, and industrial factory emissions.

The Intergovernmental Panel on Climate Change considers ground-level ozone, along with carbon dioxide and methane, to be one of the primary greenhouse gases in the Earth’s atmosphere.

“Ozone levels outdoors are not always highly correlated to ozone levels indoors, making it difficult to fully evaluate associations between ozone and health outcomes using ambient site monitors,” said study co-author C. Arden Pope III, professor of economics at Brigham Young University. “The reality is that most of us spend the majority of our time indoors. But this study suggests that repeated exposures to elevated ozone levels over time have cumulative effects on respiratory health.”

The new study analyzed data from 448,850 adults ages 30 and older enrolled in 1982 and 1983 in the American Cancer Society Cancer Prevention Study II.

The researchers correlated the information from that study with data from EPA air pollution monitors while controlling for potentially confounding factors such as a participant’s age, race, education, occupational exposures, smoking history and diet. The study also factored in other variables such as unemployment rates in the metropolitan and zip code area levels.

Ozone data were obtained from 1977 through 2000 between the months of April and September. Those months were chosen because ozone levels are typically higher when it’s warmer and because insufficient data was available during the cooler months.

Researchers included EPA measurements of fine particulate matter – particles equal to or smaller than 2.5 micrometers in diameter and typically found in smoke and haze – when they became available in 1999 and 2000. Because fine particle levels had already been linked to increased risk of premature death in previous studies, the researchers included them in the analysis to distinguish the effects of the two pollutants.

In an 18-year follow-up period, 48,884 of the people in the study died from cardiovascular causes such as heart disease and strokes, and 9,891 died from respiratory causes.

As has been observed in previous studies, the researchers found that fine particulate matter was linked to an increased risk of death from cardiovascular causes when analyzed alone and with ozone. The new finding was that the effects of ozone remained strongly linked to risk of death from respiratory problems, even after fine particle pollution was taken into account.

Not surprisingly, highly populated regions such as the Los Angeles, Riverside and Houston areas, where the climate is sunny for much of the year and the air mass is relatively stable, had the highest average concentrations of ozone, ranging from 62.5 to 104 ppb. The regions with the lowest ozone levels had average concentrations of 33.3 to 53.1 ppb.

“Places like the Pacific Northwest and the Minneapolis St. Paul region are cooler and see more rain in the summer, which keeps the ozone levels in check,” said Jerrett. “Similarly, the San Francisco Bay Area’s infamous summertime fog blocks the sun and helps protect the region from high ozone levels.”

Because ozone formation depends on a complex interaction of multiple factors, it is challenging to regulate, the study authors said. “Our study for the first time presents evidence suggesting that long-term exposure to ozone and fine particle pollution have separate, independent effects on mortality, and that they seem to impact different parts of the body,” said Jerrett. “With this research, we now know that controlling ozone is not only beneficial for mitigating global warming, but that it could also have near-term benefits in the reduction of deaths from respiratory causes.”

Notes:

Other co-authors of the paper are Richard Burnett from Health Canada, the federal health department headquartered in Ottawa; Kaz Ito and George Thurston from the New York University School of Medicine; Daniel Krewski and Dr. Yuanli Shi from the University of Ottawa; and Eugenia Calle and Dr. Michael Thun from the American Cancer Society.

The Health Effects Institute, a non-profit research organization based in Boston, Mass., helped support this research.

An EPA list of where U.S. counties stand in compliance with the current federal ozone standards is available at epa/air/ozonepollution/pdfs/2008_03_design_values_2004_2006.pdf.

Source: Sarah Yang

University of California – Berkeley Continue reading →

Patients have a number of complaints about their physicians, and physicians have a number of complaints about their patients, according to a survey published in the February issue of Consumer Reports, the Washington Post reports. For the survey, the Consumer Reports National Research Center polled 39,000 subscribers to Consumer Reports and 335 primary care physicians selected at random from a national list. According to the survey, two-thirds of patients said that their physicians failed to disclose the cost of medications or office visits, and one-third said that their physicians failed to discuss the side effects of treatments. About 19% of patients said that they could not make appointments with their physicians within one week, and 7% said that their physicians did not return test results promptly, the survey found. The survey also found that patients referred to specific physicians by friends or family members reported a more positive experience than those not referred. Among physicians, 59% said that patients did not follow their advice “completely,” and one-third said that many of their patients are not specific about their symptoms, the survey found. A number of physicians also said that patients do not make appointments as early as they should, according to the survey. About 40% of patients said that they researched information about their conditions on the Internet, and 41% of physicians said that such patients were misinformed, the survey found. According to the survey, almost 80% of physicians said that their patients asked for prescription drugs they saw advertised on television, and 40% said that they oppose direct-to-consumer advertisements for medications (McClain, Washington Post, 2/6).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

As climate change is credited as one of the main drivers behind soaring food prices, the Global Crop Diversity Trust is undertaking a major effort to search crop collections – from Azerbaijan to Nigeria – for the traits that could arm agriculture against the impact of future changes. Traits, such as drought resistance in wheat, or salinity tolerance in potato, will become essential as crops around the world have to adapt to new climate conditions.

Climate change is having the most negative impact in the poorest regions of the world, already causing a decrease in yields of most major food crops due to droughts, floods, increasingly salty soils and higher temperatures.

Crop diversity is the raw material needed for improving and adapting food crops to harsher climate conditions and constantly evolving pests and diseases. However, it is disappearing from many of the places where it has been placed for safekeeping – the world’s genebanks. Compounding the fact that it is not well conserved is the fact that it is not well understood. A lack of readily available and accurate data on key traits can severely hinder plant breeders’ efforts to identify material they can use to breed new varieties best suited for the climates most countries will experience in the coming decades. The support provided by the Global Crop Diversity Trust will not only rescue collections which are at risk, but enable breeders and others to screen collections for important characteristics.

“Our crops must produce more food, on the same amount of land, with less water, and more expensive energy,” said Cary Fowler, Executive Director of the Global Crop Diversity Trust. “This, on top of climate change, poses an unprecedented challenge to farming. There is no possible scenario in which we can continue to grow the food we require without crop diversity. Through our grants we seek, as a matter of urgency, to rescue threatened crop collections and better understand and conserve crop diversity.”

Through a competitive grants scheme, the Trust will provide funding for projects that screen developing country collections – including wheat, chickpea, rice, barley, lentils, coconut, banana, maize, and sweet potato – for traits that will be essential for breeding climate-ready varieties. These projects involve 21 agricultural research institutions in Argentina, Bangladesh, Brazil, India, Israel, Mali, Nigeria, Niger, Pakistan, Papua New Guinea, Peru, the Philippines, South Africa, Sri Lanka, and Syria.

Scientists will be screening chickpea and wheat collections in Pakistan for traits of economic importance for farmers; characterizing rare coconuts in Sri Lanka for traits of drought tolerance and tolerance to other pests and diseases; screening for salinity tolerance in sweet potatoes in Peru; and identifying drought-tolerant bananas in India.

Much of the screening will take place within collections where many of the unique samples are at risk. Therefore, in addition to its efforts to bolster the development of climate-ready crops, the Trust will provide funding to save unique crop collections that are at risk of disappearing. Crop collections need to be re-grown at regular intervals, and fresh seed harvested and placed in seedbanks to ensure long-term conservation and availability. The Trust is working with more than 60 countries to “regenerate” unique collections of crops critical for food security, and to ensure that they are duplicated elsewhere for safety in a collection that meets international standards, as well as in the Svalbard Global Seed Vault.

Worldwide, there are a handful of crop collections that can be said to meet international standards. And even these few, despite their role in protecting the foundation of our food supply, lurch from one funding arrangement to the next without ever having any real long-term security. The Trust is now endowing these, the world’s most important collections, ensuring their conservation and availability for the future of agriculture. Crops already being safeguarded by the Trust’s pledge of financial security include banana, barley, bean, cassava, faba bean, forages, grass pea, lentil, pearl millet, rice, sorghum, taro, wheat and yam. These are housed in collections managed in trust for humanity at eight agricultural institutions that are supported by the Consultative Group on International Agricultural Research (CGIAR) and by the Secretariat for the Pacific Community.

“Secure funding on this sort of time-scale has been unheard of in this field. Crop collections are all too often amassed and then lost according to changing funding fashions and priorities,” said Daniel Debouck, Head of the Genetic Resources Unit at the International Center for Tropical Agriculture (CIAT), one of the agricultural institutions supported by the CGIAR. “Genebanking is not something you can turn on and off, and a shortfall in funding of just a few months can result in the permanent loss of unique varieties. We need to be sure that we will have sufficient funding year after year after year. The Trust is now providing that security.”

“The contents of our genebanks – some 1.5 million distinct samples – are the result of a 13,000-year experiment in the interaction between crops and environment, climate and culture,” said Fowler. “If we are wise enough to conserve these collections, we will have a treasure chest of the very traits that crops used in the past when they successfully adapted to new conditions – the traits they will need again in the future to adapt as climates and environments change.”

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The Global Crop Diversity Trust (croptrust/)

The mission of the Trust is to ensure the conservation and availability of crop diversity for food security worldwide. Although crop diversity is fundamental to fighting hunger and to the very future of agriculture, funding is unreliable and diversity is being lost. The Trust is the only organization working worldwide to solve this problem, and has already raised over $140 million. For further information, please visit: croptrust/.

Source: Jeff Haskins

Global Diversity Crop Trust Continue reading →

Sports Health is a bi-monthly publication that will publish its first issue in January 2009. It is aimed at physicians and allied health professionals who work with athletes.

“The comprehensive care of athletes requires a diverse team of professionals, including athletic trainers, physical therapists, primary care physicians and orthopaedic surgeons,” said Edward M. Wojtys, MD, Sports Health Editor-in-Chief. Dr. Wojtys is a professor of Orthopaedic Surgery and Chief of the Sports Medicine Service, and Medical Director of MedSport, all at the University of Michigan. “Our goal with this publication is to improve the care and rehabilitation of athletes.”

Sports Health features associate editors from each of the collaborating organizations. Editor-in-chief Dr. Wojtys was nominated by AOSSM. Dr. George Davies of SPTS is the co-founder and previous co-editor of the Journal of Orthopaedic and Sports Physical Therapy. Dr. Matthew Gammons of AMSSM is the primary care sports physician at the Killington Medical Clinic and the Vermont Orthopaedic Clinic where he currently works with patients incurring a variety of sports-related injuries. He also serves as one of the team physicians for the U.S. Ski and Snowboard teams. Dr. Riann Palmieri-Smith of NATA is an Assistant Professor in Athletic Training, Movement Science and Orthopaedics at the University of Michigan and has served as a Section Editor for the Journal of Athletic Training in the Pathology, Physiology, and Biodynamics section.

“SAGE is pleased to be partnering again with AOSSM, for whom we currently publish the American Journal of Sports Medicine. We are also pleased to be working for the first time with such prestigious organizations as the AMSSM, NATA and SPTS in the launch of this important new journal,” said Jayne Marks, SAGE Vice-President, Global Business Development. “The publication of Sports Health helps solidify SAGE’s position as a leading publisher of high-quality, cutting-edge information for medical professionals and researchers.”

Sports Health: A Multidisciplinary Approach. Vol. 1, Issue 1. Jan. 2009. Bi-monthly. ISSN: 1941-7381. E-ISSN: 1941-0921. 2009 subscription pricing: $125 individual. $325 institution. Sports Health is a benefit of membership for members of the AOSSM, AMSSM and SPTS, and an option of membership for members of the NATA.

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SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets. Since 1965, SAGE has helped inform and educate a global community of scholars, practitioners, researchers, and students spanning a wide range of subject areas including business, humanities, social sciences, and science, technology, and medicine. A privately owned corporation, SAGE has principal offices in Los Angeles, London, New Delhi, and Singapore. sagepub/

The American Orthopaedic Society for Sports Medicine (AOSSM) is a world leader in sports medicine education, research, communication, and fellowship and includes the top national and international orthopaedic sports medicine specialists. (sportsmed/)

The American Medical Society for Sports Medicine (AMSSM) is a multi-disciplinary organization of physicians whose members are dedicated to education, research, collaboration and fellowship within the field of Sports Medicine. (amssm/)

The National Athletic Trainers’ Association (NATA) is the professional membership association for certified athletic trainers and others who support the athletic training profession. (nata/)

The Sports Physical Therapy Section (SPTS) is a component member of the American Physical Therapy Association, which provides a common forum for members with an interest in sports physical therapy. (spts/)

Source: Andrea Rulfo

SAGE Publications Continue reading →

Two years after CDC recommended routine HIV testing for people ages 13 to 64, several studies presented at a recent conference indicate that the recommendations generally are not being followed, the Washington Post reports (Brown, Washington Post, 11/21). According to the Baltimore Sun, researchers at the Forum for Collaborative HIV Research — based at the George Washington University School of Public Health — said on Thursday during the conference that HIV testing is a significant step to ending the epidemic in the U.S. About 1.1 million people are living with HIV in the U.S. and one in five is unaware of his or her status. The researchers also said that people who are unaware that they are HIV-positive are responsible for transmitting 50% to 70% of new sexually transmitted infection cases. John Bartlett, chief of infectious diseases at Johns Hopkins University School of Medicine and a co-chair of the meeting, said the high number of people unaware of their HIV status should be a “call to action that the test will be offered on a more regular basis” (Brewington, Baltimore Sun, 11/21).

According to the Post, the studies show that the most common reasons for not following CDC’s recommendations are misconceptions by clinicians that the tests take too much time, as well as an unwillingness by health insurers to pay for the tests. Kevin Fenton — director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention — said, “Reimbursement is a major barrier to routine testing.” The Post reports that testing a patient who receives an initial saliva test, followed by a blood test for confirmation if possible, costs about $80 to $120 if the patient is charged (Washington Post, 11/21).

The Sun also reports that a continuing stigma associated with HIV/AIDS is contributing to a lack of widespread testing. Richard Rothman, associate professor in Johns Hopkins University’s Department of Emergency Medicine, said 2006 data show that emergency departments tested patients at a rate of 3.2 tests per 1,000 visits. “There are many missed opportunities in recognizing patients earlier in the course of their illness,” he said (Baltimore Sun, 11/21). Veronica Miller, executive director of the forum, said that HIV/AIDS is a “life-threatening disease that is so grossly underdiagnosed and undertreated in this country.” She said that about 5% of patients presenting with serious illness are routinely tested for HIV in hospital EDs. For example, at John H. Stroger Jr. Hospital of Cook County in Chicago, about 2,000 people who went to the ED and were ill enough to be admitted were offered HIV tests. Slightly less than 1% tested HIV-positive, and more than 90% had CD4+ T cell counts less than 200, one of the factors that leads to an AIDS diagnosis (Washington Post, 11/21).

According to the AP/Indianapolis Star, 11 states have changed their laws to no longer require special consent for HIV testing, which is a “key step to making an HIV test part of the standard battery that patients expect.” People living with HIV are “mostly likely” to be found in EDs because many are uninsured and have low incomes, the AP/Star reports. Bartlett said that routine HIV testing in patients who are not critically ill is given in no more than 100 of the U.S.’s 5,000 EDs, adding that about 40% of pregnant women and their infants who should be tested for HIV are not. “Those are what we call missed opportunities,” he said (Neergaard, AP/Indianapolis Star, 11/20).

The studies also show that if routine HIV testing were implemented in the U.S., HIV detection could occur at earlier stages in many people (Washington Post, 11/21). Miller said that it is “crucial to understand how important routine HIV testing is at every level of American society so everyone knows their status; it’s the first step in controlling the HIV epidemic” (Tasker, Miami Herald, 11/20). Bartlett said HIV testing today is “much better, it’s much easier, it’s much cheaper. The treatment is really great now.” CDC’s Bernard Branson said the agency “find[s] people are very receptive to being tested, and there was concern about that before.” He added that “people are taking the recommendations to heart and implementing them as much as was feasible for them.” According to the AP/Star, data from the studies presented on Thursday indicate that more than 80% of ED patients were “amenable” to HIV tests and that most ED staff were opposed to administering the tests. This is “[p]resumably because [EDs] are so busy, and there is confusion on how much HIV counseling is needed,” the AP/Star reports. There are no nationwide data on the impact of the new guidelines, according to Branson (AP/Indianapolis Star, 11/20).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

UroToday- In a report in the January, 2008 issue of the British Journal of Urology International, Dr. Sengupta and associates from the Mayo Clinic assess the risk of progression and death among patients with pathologically insignificant tumors after radical prostatectomy (RP) for prostate cancer (CaP). Insignificant CaP was defined as a pre-surgical PSA Continue reading →

A study led by researchers at the University of Southern California (USC) found that men who took a daily folic acid supplement of 1 mg daily had more than twice the risk of prostate cancer compared with men who took a placebo.

The finding came from a secondary analysis of the Aspirin/Folate Polyp Prevention Study (AFPP), a placebo-controlled randomized trial to determine the impact of aspirin and folic acid on colon polyps in men and women who were at high risk for the disease. The results appear in the March 10 online issue of the Journal of the National Cancer Institute.

Folic acid (folate) is a B vitamin found in many vegetables, beans, fruits and whole grains. While evidence of its ability to reduce neural tube defects in infants while taken by the mother before or during pregnancy has been well documented, its effects on other conditions are unclear.

“We know that adequate folate levels are important in the prevention of several cancer types, cardiovascular and neurological diseases,” says lead author Jane Figueiredo, Ph.D., assistant professor of preventive medicine at the Keck School of Medicine of USC. “However, little has been known about its role in prostate cancer. Our objective was to investigate the relationship between folic acid supplements and dietary folate and risk of prostate cancer.”

The AFPP study was conducted between 1994 and 2006 and found that aspirin reduced the risk of colon polyps while folic acid had a negative effect and increased the risk of advanced and multiple polyps. The first analysis did not address the impact of folic acid supplements on prostate cancer risk. Previous observational studies have been inconsistent. Some studies suggest that increased folate in the diet or in supplements might actually lower the risk of prostate cancer, and others have suggested no effect or even a potential harmful effect.

In the secondary analysis, researchers looked at prostate cancer incidence among 643 men who were randomly assigned to 1 mg daily folic acid supplements or placebo in the AFPP study and who enrolled in an extended follow-up study. The estimated prostate cancer risk was 9.7 percent at 10 years in men assigned to folate, compared with 3.3 percent in men assigned to placebo.

By contrast, dietary folate intake and plasma folate showed a trend toward reduced risk of prostate cancer, although the difference did not reach statistical significance. It remains unclear why dietary and circulating folate among non-multivitamin users may be inversely associated with risk, Figueiredo says.

“The synthetic form of folate, folic acid, found in supplements, is more bioavailable compared to folate from dietary sources and we know the amount of folate available is critical,” she says. “Adequate levels of folate may be beneficial, but too much folate is unlikely to be beneficial.”

Alternatively, these results may be due to chance, and replication by other studies is needed, she notes.

“These findings highlight the potentially complex role of folate in prostate cancer. The possibility of different effects from folic acid-containing supplements versus natural sources of folate definitely merits further investigation.”

The study was supported by the National Cancer Institute and the National Institutes of Health.

Jane C. Figueiredo, Maria V. Grau, Robert W. Haile, Robert S. Sandler, Robert W. Summers, Robert S. Bresalier, Carol A. Burke, Gail E. McKeown-Eyssen, John A. Baron. “Folic Acid and Risk of Prostate Cancer: Results From a Randomized Clinical Trial.” Journal of the National Cancer Institute. Doi: 10.1093/jnci/djp019.

University of Southern California Health Sciences
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Nicotine withdrawal can cause dangerous agitation in intensive care patients. Researchers writing in BioMed Central’s open access journal Critical Care found that, compared to non-smokers, agitated smokers were more likely to accidentally remove tubes and catheters, require supplemental sedative, analgesic or anti-psychotic medications, or need physical restraints.

Damien du Cheyron, from Caen University Hospital, France, worked with a team of researchers to study the effects of nicotine withdrawal in 44 smokers and 100 non-smokers in the hospital’s intensive care unit, finding that agitation was twice as common in smokers than controls. He said, “Agitation was significantly more common in smokers than in non-smokers. These results suggest the need to be aware of nicotine withdrawal syndrome in critically ill patients, and support the need for improved strategies to prevent agitation or treat it earlier”.

None of the smokers in the study were allowed nicotine replacement therapy (NRT) during the study period. According to du Cheyron, “NRT remains a controversial topic in intensive care and has been associated with mortality. Due to the serious consequences of withdrawal-induced agitation, including sedation and physical restraint, we suggest that the use of nicotine replacement therapy should be tested by a well-designed, randomized controlled clinical trial in the ICU setting”.

Notes

The effect of carbon dioxide on near-death experiences in out-of-hospital cardiac arrest survivors: a prospective observational study
Zalika Klemenc-Ketis, Janko Kersnik and Stefek Grmec
Critical Care (in press)

Source:
Graeme Baldwin

BioMed Central Continue reading →