sábado, 30 de junio de 2012

Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus co-formulated efavirenz, emtricitabine, and tenofovir for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3 trial, analysis of results after 48 weeks : The Lancet

Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus co-formulated efavirenz, emtricitabine, and tenofovir for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3 trial, analysis of results after 48 weeks : The Lancet

The Lancet, Volume 379, Issue 9835, Pages 2439 - 2448, 30 June 2012

doi:10.1016/S0140-6736(12)60917-9

Cite or Link Using DOI

This article can be found in the following collections: Infectious Diseases (Anti-infective therapy, HIV/AIDS, Sexually transmitted infections)

Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus co-formulated efavirenz, emtricitabine, and tenofovir for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3 trial, analysis of results after 48 weeks

Dr Paul E Sax MD a

, Edwin DeJesus MD b, Anthony Mills MD c, Prof Andrew Zolopa MD d, Calvin Cohen MD e, David Wohl MD f, Prof Joel E Gallant MD f, Hui C Liu PhD g, Lijie Zhong PhD h, Kitty Yale BA h, Kirsten White PhD h, Brian P Kearney Pharm D h, Javier Szwarcberg MD h, Erin Quirk MD h, Andrew K Cheng MD h, for the GS-US-236-0102 study team

Summary

Background

The integrase inhibitor elvitegravir (EVG) has been co-formulated with the CYP3A4 inhibitor cobicistat (COBI), emtricitabine (FTC), and tenofovir disoproxil fumarate (TDF) in a single tablet given once daily. We compared the efficacy and safety of EVG/COBI/FTC/TDF with standard of care—co-formulated efavirenz (EFV)/FTC/TDF—as initial treatment for HIV infection.

Methods

In this phase 3 trial, treatment-naive patients from outpatient clinics in North America were randomly assigned by computer-generated allocation sequence with a block size of four in a 1:1 ratio to receive EVG/COBI/FTC/TDF or EFV/FTC/TDF, once daily, plus matching placebo. Patients and study staff involved in giving study treatment, assessing outcomes, and collecting and analysing data were masked to treatment allocation. Eligibility criteria included screening HIV RNA concentration of 5000 copies per mL or more, and susceptibility to efavirenz, emtricitabine, and tenofovir. The primary endpoint was HIV RNA concentration of fewer than 50 copies per mL at week 48. The study is registered with ClinicalTrials.gov, number NCT01095796.

Findings

700 patients were randomly assigned and treated (348 with EVG/COBI/FTC/TDF, 352 with EFV/FTC/TDF). EVG/COBI/FTC/TDF was non-inferior to EFV/FTC/TDF; 305/348 (87·6%) versus 296/352 (84·1%) of patients had HIV RNA concentrations of fewer than 50 copies per mL at week 48 (difference 3·6%, 95% CI −1·6% to 8·8%). Proportions of patients discontinuing drugs for adverse events did not differ substantially (13/348 in the EVG/COBI/FTC/TDF group vs 18/352 in the EFV/FTC/TDF group). Nausea was more common with EVG/COBI/FTC/TDF than with EFV/FTC/TDF (72/348 vs 48/352) and dizziness (23/348 vs 86/352), abnormal dreams (53/348 vs 95/352), insomnia (30/348 vs 49/352), and rash (22/348 vs 43/352) were less common. Serum creatinine concentration increased more by week 48 in the EVG/COBI/FTC/TDF group than in the EFV/FTC/TDF group (median 13 μmol/L, IQR 5 to 20 vs 1 μmol/L, −6 to 8; p<0·001).

Interpretation

If regulatory approval is given, EVG/COBI/FTC/TDF would be the only single-tablet, once-daily, integrase-inhibitor-based regimen for initial treatment of HIV infection.

Funding

Gilead Sciences.

AAV-Directed Persistent Expression of a Gene Encoding Anti-Nicotine Antibody for Smoking Cessation

Sci Transl Med 27 June 2012:
Vol. 4, Issue 140, p. 140ra87
Sci. Transl. Med. DOI: 10.1126/scitranslmed.3003611

Research Article

Addiction

AAV-Directed Persistent Expression of a Gene Encoding Anti-Nicotine Antibody for Smoking Cessation

+ Author Affiliations

¹Department of Genetic Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
²Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14850, USA.
³Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA.
⁴Departments of Chemistry and Immunology and Microbial Science, Scripps Research Institute, La Jolla, CA 92037, USA.
⁵Department of Cell and Developmental Biology, Weill Cornell Medical College, New York, NY 10065, USA.

+ Author Notes

↵* These authors contributed equally to this work.

↵†To whom correspondence should be addressed. E-mail: geneticmedicine@med.cornell.edu

Abstract

Current strategies to help tobacco smokers quit have limited success as a result of the addictive properties of the nicotine in cigarette smoke. We hypothesized that a single administration of an adeno-associated virus (AAV) gene transfer vector expressing high levels of an anti-nicotine antibody would persistently prevent nicotine from reaching its receptors in the brain. To test this hypothesis, we constructed an AAVrh.10 vector that expressed a full-length, high-affinity, anti-nicotine antibody derived from the Fab fragment of the anti-nicotine monoclonal antibody NIC9D9 (AAVantiNic). In mice treated with this vector, blood concentrations of the anti-nicotine antibody were dose-dependent, and the antibody showed high specificity and affinity for nicotine. The antibody shielded the brain from systemically administered nicotine, reducing brain nicotine concentrations to 15% of those in naïve mice. The amount of nicotine sequestered in the serum of vector-treated mice was more than seven times greater than that in untreated mice, with 83% of serum nicotine bound to immunoglobulin G. Treatment with the AAVantiNic vector blocked nicotine-mediated alterations in arterial blood pressure, heart rate, and locomotor activity. In summary, a single administration of a gene transfer vector expressing a high-affinity anti-nicotine monoclonal antibody elicited persistent (18 weeks), high titers of an anti-nicotine antibody that obviated the physiologic effects of nicotine. If this degree of efficacy translates to humans, AAVantiNic could be an effective preventative therapy for nicotine addiction.

Citation: M. J. Hicks, J. B. Rosenberg, B. P. De, O. E. Pagovich, C. N. Young, J.-p. Qiu, S. M. Kaminsky, N. R. Hackett, S. Worgall, K. D. Janda, R. L. Davisson, R. G. Crystal, AAV-Directed Persistent Expression of a Gene Encoding Anti-Nicotine Antibody for Smoking Cessation. Sci. Transl. Med. 4, 140ra87 (2012).

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People who walk a lot have lower risk of diabetes: MedlinePlus

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People who walk a lot have lower risk of diabetes

Thursday, June 28, 2012

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By Kerry Grens
NEW YORK (Reuters Health) - Among people with low physical activity and a high risk of diabetes, those who walk more throughout the day are less likely to actually get the blood sugar disorder, according to new research.
The study, published in the journal Diabetes Care, is part of a growing body of evidence that for people who get very little exercise, "even small amounts of activity will provide a really good return on their investment," said Catrine Tudor-Locke, who studies walking and health at Pennington Biomedical Research Center in Baton Rouge, Louisiana, and was not involved in the research.
Daily walking recommendations typically point to a minimum of 10,000 steps per day. Tudor-Locke said a good rule of thumb is that 2,000 steps equals about one mile.
Earlier studies, based on questionnaires, have shown that walking more is tied to a lower risk of diabetes. But few studies have used precise measures of how many steps people take each day, said Amanda Fretts, the lead author of the new report and a researcher at the University of Washington in Seattle.
To get a better sense of walking's potential benefits, Fretts and her colleagues asked more than 1,800 people to wear a pedometer on their hip for a week to tally the number of steps they typically took each day.
All of them came from native American communities in Arizona, Oklahoma and North and South Dakota that are known to have low physical activity levels and high rates of diabetes.
About a quarter of the group were considered to have very low activity, taking fewer than 3,500 steps a day, while half took fewer than 7,800 steps per day.
At the beginning of the study, none of the participants had diabetes. But after five years of follow-up, 243 people had developed the condition.
About 17 percent of the people in the lowest activity group developed diabetes, compared to 12 percent of the people who took more than 3,500 steps a day.
After taking into account people's age, whether they smoked and other diabetes risk factors, Fretts's team determined that people who walked the most were 29 percent less likely to develop diabetes than those who walked the least.
"Our finding wasn't surprising given that other studies have shown that even light activity is associated with a lower risk of diabetes," Fretts wrote in an email to Reuters Health.
The findings don't prove that walking more is responsible for the lower risk of diabetes, but Fretts offered some possible explanations for how walking might help.
"Increased physical activity may prevent weight gain and promote weight loss, a major determinant of diabetes risk," she told Reuters Health.
Indeed, when Fretts took into account how large people were, based on a measure called body mass index (BMI), she found that extra walking didn't provide any benefits to reducing people's diabetes risk.
"BMI is one of the plausible biological mechanisms by which physical activity (or walking) may lower diabetes risk - that is, walking may promote weight loss - and weight loss is a major factor related to diabetes risk," Fretts said.
Physical activity also has effects on inflammation, glucose and other molecules in the body that could help lower diabetes risk, said Fretts.
Tudor-Locke added that the potential benefits of moderate levels of walking are "only for those who are really inactive to begin with" and don't mean others should decrease their activity levels.
SOURCE: http://bit.ly/Lr2Pkb Diabetes Care, online June 20, 2012.
(This story corrects attribution in last paragraph)

Reuters Health

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Small Babies Can Be Sign of Heart Problems in Mother: MedlinePlus

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Small Babies Can Be Sign of Heart Problems in Mother

Researchers say some women with low birthweight babies have type of heart dysfunction

By Mary Elizabeth Dallas

Thursday, June 28, 2012

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THURSDAY, June 28 (HealthDay News) -- Women who give birth to small babies may have abnormal heart function and be at risk for long-term heart problems, researchers report.
The study involved 29 women with a condition known as fetal growth restriction (when fetuses are smaller than 90 percent of other fetuses for their gestational age), 25 women with preeclampsia (high blood pressure during pregnancy) and 58 women with normal pregnancies.
"Women whose pregnancies are affected by fetal growth restriction are known to have high risk of cardiovascular disease and death in the decades to come," study author Dr. Basky Thilaganathan, director of the Fetal Maternal Medicine Unit at St. George's University of London, said in a news release. "Clinicians should be aware of the maternal susceptibility to heart strain and failure in these pregnancies. Lifestyle changes and medical interventions earlier in life could help these women reduce their risk of future cardiovascular disease and death."
The women had their blood pressure taken and underwent echocardiograms (ultrasounds of the inside of the heart) and electrocardiograms (a measure of the electrical activity of the heartbeat) as well as other tests of heart function.
Researchers said some women with small babies may have a heart condition which causes the heart to work less efficiently in it's diastolic, or relaxation phase. This condition increases their risk for heart failure, they noted.
The authors also found women who give birth to smaller than average babies had a higher body mass index on average than other women. They argued this could be one reason for their abnormal heart function.
"Our findings help clarify how this risk develops so these women can be identified and receive preventative treatment," concluded Thilaganathan.

The study was published June 26 in Hypertension.

SOURCE: American Heart Association, news release, June 26, 2012

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Appendectomies no threat to fertility, study says: MedlinePlus

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Appendectomies no threat to fertility, study says

Thursday, June 28, 2012

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By Frederik Joelving
NEW YORK (Reuters Health) - Getting an appendectomy doesn't seem to hurt a woman's chance of having babies, according to a new study that contradicts long-held beliefs among fertility experts.
In fact, UK researchers found women who'd had their appendix removed were more likely to get pregnant later on than women who hadn't had the common surgery.
Dr. Alan B. Copperman, who heads the division of reproductive endocrinology at Mount Sinai Medical Center in New York and was not involved in the new work, called the results "reassuring."
"We always assume that appendectomy is a risk factor for infertility," he told Reuters Health. "This study showed us it wasn't necessarily the appendectomy that put patients at risk."
Still, he warned, "I would not conclude that your fertility is enhanced by appendectomy."
The procedure is one of the most common surgeries in the U.S. and is usually done to treat appendicitis, a potentially life-threatening inflammation of the appendix.
One in 14 people nationally will have appendicitis at some point in their life. It most commonly occurs in young people age 10 to 30.
Ruptured appendixes and bad pelvic infections after appendectomies are known to increase the risk of infertility. Some reports have also suggested the appendectomy itself might hurt a woman's fertility, presumably because it could leave scar tissue sticking to the fallopian tubes, snagging the egg on its way to the uterus.
"A lot of patients thought they would become infertile after appendicectomy (appendectomy)," said Dr. Sami Shimi, a surgeon at the University of Dundee in Scotland, who worked on the new study. "But when I looked at the reports supporting this, they were really weak."
He and his colleagues decided to do a bigger study, using a limited patient database. They were taken aback by the results.
"I was completely surprised that patients who had had an appendicectomy or appendicitis were more fertile, they had more subsequent pregnancies," Shimi told Reuters Health. "And I thought, OK, I have done something wrong here."
So the team tapped into one of the world's largest digital repositories of medical records from primary care, the General Practice Research Database from the UK.
Out of more than 76,000 women who'd undergone an appendectomy, 39 percent had a first pregnancy in the decade following the procedure, according to results published in the journal Fertility and Sterility.
The rate for twice as many women who hadn't had the surgery was only 28 percent. Although the follow-up time was slightly shorter for this group, the fertility gap remained after accounting for age, birth control use, number of previous hospitalizations and other factors.
But Copperman cautioned against making too much of that finding.
"When you go back and retrospectively look at even really large databases, you wonder whether there are confounding factors or biases that cloud the results," he said.
Shimi and his colleagues are still scratching their heads over the strange finding and are currently working to find out if it's a real biological phenomenon or if there is something unique about women who get appendectomies.
For now, Shimi said, what seems certain is that women shouldn't fret about fertility problems if they need an appendectomy.
"That fear is unfounded," the researcher said.
SOURCE: http://bit.ly/L2v0eB Fertility and Sterility, online June 7, 2012.

Reuters Health

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More visits from hospice may allow death at home: MedlinePlus

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More visits from hospice may allow death at home

Thursday, June 28, 2012

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By Andrew M. Seaman
NEW YORK (Reuters Health) - Very ill patients who prefer to die at home are more likely to do so if they get frequent visits from hospice nurses and doctors, according to a new report.
The findings highlight the importance of hospices, which provide specialized care to very sick or terminally ill patients and offer them the opportunity to remain at home if they want to.
"Frankly, it's one of the things hospices offer that hospitals can't," said Dr. David Casarett, chief medical officer at the Penn-Wissahickon Hospice at the University of Pennsylvania in Philadelphia.
"People want to be home," he told Reuters Health. "That's where they feel comfortable and it's a matter of dignity."
In the Journal of Clinical Oncology, Casarett and his colleagues write that the majority of cancer patients die in a hospital even though most would prefer to do so at home.
"Most people now have an option, so it's really important for people to achieve that option," said Donna Wilson, a professor at the University of Alberta in Canada, who was not involved with the new study.
More and more people in developed countries are dying at home compared with in the 1990s and 2000s, when the rate of dying in hospitals peaked among terminally ill patients, said Wilson.
She told Reuters Health that, at least in Canada, people moved away from dying at hospitals partly because they were afraid of the aggressive tests and treatments. At the same time, the availability of hospice and pain management services increased.
"A study like this can really be very helpful to waking people up to what we should do," said Wilson, who added that there will be more dramatic shifts in home deaths as baby boomers continue to age.
"I think people want to spend time at home and we need a health care system that allows them to do it," added Casarett.

FREQUENT VISITS
To see what factors were linked to a person's chance of dying at home, Casarett and his colleagues looked at information collected between October 2008 and June 2011 for cancer patients in hospices in Florida, Pennsylvania and Wisconsin.
From the patients' medical records, the researchers knew where more than 5,800 of them wanted to die. About three-quarters wanted to die at home, whereas the rest typically preferred to die at a nursing home, a hospice unit or a hospital.
Of the people who started care at home and said they wanted to die there, 1,735, or 55 percent, did so.
The researchers found three factors that were tied to people's chance of dying at home. Specifically, married people and those who had made their preference clear in advance directives were more likely to die at home. The same was true for people who had daily visits from the hospice for the first four days of their care.
The results don't necessarily prove that frequent visits by themselves up the chances of dying according to one's preferences, but the researchers felt that was likely.
"The main finding for us was the issue of being able to show that more visits really do help," said Casarett. "It's not really rocket science - it's common sense in a way. But, from a policy perspective, it's important."
That's because they help hospices that struggle for funding make their case.
The researchers caution, however, that some of the patients in the study may have changed their mind on where they wanted to die after they were asked at the beginning of their hospice care.
Hospice care varies in price, but may be covered by Medicare, Medicaid and private insurances.
SOURCE: http://bit.ly/N3tjY4 Journal of Clinical Oncology, online June 25, 2012.

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Nicotine Patch Sharpens Memory in Those With Mild Cognitive Impairment | Fisher Center for Alzheimer's Research Foundation

Nicotine Patch Sharpens Memory in Those With Mild Cognitive Impairment

Many people use a nicotine patch to help kick the smoking habit. But wearing a nicotine patch may also help to sharpen memory and thinking skills in those with mild cognitive impairment, a new study suggests.
Memory problems are a hallmark of mild cognitive impairment, a condition that sometimes progresses to full-blown Alzheimer’s. And nicotine is known to sharpen cognitive skills. Smokers who are given the drug, for example, do better on tests requiring attention skills. Some studies have suggested that nicotine – by patch or through injections – can boost memory in people with Alzheimer’s as well.
To test whether nicotine helps people with mild cognitive impairment, or MCI, researchers recruited 67 men and women with the condition. All were nonsmokers, and their average age was 76. Some wore a nicotine patch for six months, and others were a lookalike dummy patch. They were then given tests of memory and thinking.
Those who got the nicotine patch scored higher on tests of memory that required them to remember lists of words or what they read. They were also better able to pay attention and had faster reaction times. Those wearing the placebo patch, by contrast, did worse on these tests after six months. The patch, which was given at a dose of 15 milligrams per day, also appeared to be safe, with few side effects.
The researchers note that nerve cells involved in attention contain receptors for nicotine, which may in part explain the findings. People with Alzheimer’s disease show diminished nicotine receptors, though in those with MCI, the receptors are often intact.
One interesting finding was that nicotine appeared to have greater benefit in those who carried the APOE-E4 gene. People with this gene are at increased risk of developing Alzheimer’s, though carrying the gene does not mean you will get the disease.
Still, experts caution that it’s too soon to recommend that those with MCI start wearing a nicotine patch to help keep the memory sharp. The study was relatively small, so larger tests would need to be conducted to confirm the findings. It’s also not known how the patch might affect smokers or former smokers with memory problems. And one study in mice suggested that nicotine could lead to increased production of tau, a protein that builds up in the brains of those with Alzheimer’s.
Still, the scientists believe that the results provide strong justification for further research into the effects of nicotine on those with memory problems. They note that nicotine or similar drugs could be “a promising strategy to ameliorate symptoms of MCI and slow progression to dementia.”
By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.
Source: P. Newhouse, MD: K. Kellar, PhD; P. Aisen, MD; et al: “Nicotine Treatment of Mild Cognitive Impairment: A 6-Month Double-Blind Pilot Clinical Trial.” Neurology 2012, Vol. 78, pages 91-101.

How Crossword Puzzles May Keep Alzheimer’s Away | Fisher Center for Alzheimer's Research Foundation

How Crossword Puzzles May Keep Alzheimer’s Away

Reading, writing, doing crossword puzzles and solving challenging puzzles may be linked to a lower risk of Alzheimer’s disease. Now a new study shows how mental stimulation may protect the brain.
The study, from researchers at the University of California, Berkeley, used brain scans and an imaging agent called Pittsburgh compound B to measure changes in the brains’ of test subjects. Pittsburgh compound B binds to beta-amyloid, a toxic protein that builds up in the brains of those with Alzheimer’s and is the main component of the brain plaques that characterize the disease.
The study, published in the Archives of Neurology, included 65 healthy older volunteers whose average age was 76, along with 10 seniors who had Alzheimer’s disease. Ten young people in their 20s and 30s served as controls.
Participants were asked about how often they engaged in mentally demanding activities like reading books or newspapers, writing letters or e-mails, going to the library and playing games. As part of the questionnaire, they were asked to rate how often they did these activities – ranging from every day or almost every day, to once a year or less – during five different periods of their lives: at age 6, 12, 18, 40 and currently.
The researchers found that the more often someone engaged in mentally stimulating activities, the less buildup of beta-amyloid they were likely to have in the brain.
“We report a direct association between cognitive activity and Pittsburgh compound B uptake, suggesting that lifestyle factors found in individuals with high cognitive engagement may prevent or slow deposition of beta-amyloid, perhaps influencing the onset and progression of Alzheimer’s disease,” the researchers write.
Engaging in mentally challenging tasks in the early and middle years seemed to be especially important for preventing the accumulation of beta-amyloid plaque, the researchers found. The brains of seniors who engaged in mentally stimulating activities most often were comparable to those of young people in the control group. Older people with the least cognitive stimulation, on the other hand, had brains that more closely resembled those of people with Alzheimer’s.
The study participants were also asked about how often they engaged in physical activities like cycling, waking, dancing or doing yoga in the previous two-weeks. Other studies have shown a link between physical activity and staying mentally sharp in old age, though that association was not demonstrated in this study. Those who were more physically active, though, tended to participate in mentally challenging tasks.
The authors note that Alzheimer’s is a complex disease, with many factors contributing to its onset and course. “Cognitive activity is just one component of a complex set of lifestyle practices linked to Alzheimer’s disease risk that may be examined in future work,” they concluded.
By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.
Source: Susan M. Landau; Shawn M. Marks; Elizabeth C. Mormino; et al: “Association of Lifetime Cognitive Engagement and Low β-Amyloid Deposition.” Archives of Neurology online doi:10.1001/archneurol.2011.2748

Extra weight comes with more knee pain, stiffness: MedlinePlus

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Extra weight comes with more knee pain, stiffness

Thursday, June 28, 2012

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By Natasja Sheriff
NEW YORK (Reuters Health) - People who put on weight are more likely to develop knee pain than those who stay the same or lose weight, says a new study.
People who shed pounds saw only a modest improvement in knee pain, however, researchers from Monash University in Melbourne, Australia, found.
"Preventing weight gain, almost no matter what weight you start out at, is going to be the key to preventing knee problems," said Dr. Susan Bartlett, who has studied joint pain and obesity at McGill University in Montreal, Canada, and was not involved in the study.
Knee pain is one of the most common forms of joint pain, affecting around 18 percent of U.S. adults, according to the Centers for Disease Control and Prevention. Although the causes of the problem vary - from overuse and repetitive movement in athletes, to chronic conditions like arthritis - studies have pointed to a link between knee pain and weight gain.
Previous research has linked overweight to a higher risk of the joint disease osteoarthritis, but this is the first report to look at the role extra weight might play in knee pain, the Australian researchers say.
For the new study, they recruited 250 people ages 25 to 60 with no history of knee surgery, injury or knee joint disease. More than three quarters were women, and many were obese.
When the researchers checked in with participants two years after the study began, around a fifth had dropped out. Of the 196 people who remained, more than half had maintained their weight, while 14 percent had put on weight - about 7 kilograms, or 15 pounds, on average - and 30 percent had lost weight.
For every kilogram gained, pain scores went up by 1.9 points on a 500-point scale. Stiffness worsened by 1.4 points (on a 200 point scale), and function by 6.1 points (on a 1,700 point scale).
The study can't show with certainty that the extra pounds caused the pain, although researchers say that's likely to be the case.
"The changes might be small, but if you can put enough of these changes together, it makes the difference between having symptoms that interfere with life, and keeping them more manageable," Bartlett told Reuters Health.
The link between weight gain and pain was strongest in obese people, who experienced a 59-point increase in pain when they put on weight compared to just 6.4 points in non-obese people.
People who shed weight during the study did experience some improvement in knee pain, by 22.4 points on average. Weight loss, however, only led to a small improvement in function of 9.8 points in obese people.
In their report, published in the journal Arthritis Care and Research, Stephanie Tanamas from Monash University and colleagues say previous studies have suggested weight loss can improve knee problems. While their findings bear that out to some extent, a large drop in weight may be needed to see a benefit, the researchers add.
Bartlett did point to one limitation, however. A lot of people, especially those who lost weight, may have lost larger amounts of weight and then regained it, which may have influenced the results.
Still, she said, the study shows there is a lot of value in preventing weight gain in the first place and to some degree in losing extra pounds if you have knee problems.
"Losing weight if you are obese, and you already have arthritis, should help with symptoms and functions, but you won't be able to completely undo the effects of weight gain," Bartlett said.
SOURCE: http://bit.ly/N0rMX5 Arthritis Care and Research, online June 5, 2012.

Reuters Health

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Smallest, Largest Fetuses at Higher Risk of Stillbirth: MedlinePlus

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Smallest, Largest Fetuses at Higher Risk of Stillbirth

Problems with placenta to blame for small babies, while maternal diabetes, obesity can mean large babies

By Mary Elizabeth Dallas

Thursday, June 28, 2012

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Stillbirth

THURSDAY, June 28 (HealthDay News) -- Fetuses at the extremes of weight -- either very small or very large -- have a greater risk of being stillborn than babies of more average weight, a new study indicates.
Researchers from St. Michael's Hospital in Ontario examined records of about 767,000 live births and nearly 4,700 stillbirths that occurred in Ontario between 2002 and 2007. Stillbirth is typically defined as a fetus that dies at the 23rd week of gestation or later and weighing at least 1.1 pounds, though this research included fetuses that died at 20 weeks or later.
About 19 percent of stillbirths occurred in fetuses below the tenth percentile for weight, meaning they are smaller than 90 percent of fetuses.
The smallest fetuses faced an even bigger risk. Being among the smallest 1 percent put fetuses at a nearly 10 times higher risk of stillbirth than average weight babies, or those in the 40th to 60th weight percentiles.
Very large fetuses also faced some added risks. About 1 percent of stillbirths occurred among fetuses in the top 1 percent for weight.
"In this study of all registered live-born and stillborn infants in Ontario, extreme underweight and overweight states confer the highest risk of stillbirth," study authors Drs. Joel Ray and Marcelo Urquia, said in a hospital news release.
Small fetuses are often due to a faulty placenta, while maternal diabetes and obesity often leads to very large fetuses. The rate of stillbirth in industrialized countries is about six per 1,000.

The study was published June 25 in the Journal of Perinatology.

SOURCE: St. Michael's Hospital, news release, June 25, 2012

HealthDay

Eating Vegetables May Protect Pancreas, Study Suggests: MedlinePlus

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Eating Vegetables May Protect Pancreas, Study Suggests

4 servings a day cut risk of acute pancreatitis by 44% compared to 1 helping, researchers say

By Randy Dotinga

Thursday, June 28, 2012

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THURSDAY, June 28 (HealthDay News) -- A vegetable-heavy diet could help prevent acute pancreatitis, a new study suggests.
The pancreas, which is located behind the stomach, releases digestive enzymes to break down food. Acute pancreatitis is a potentially life-threatening disease that occurs when those enzymes begin to eat the pancreas itself.
For the study, researchers at the Karolinska Institute in Stockholm, Sweden, examined 80,000 Swedish adults for 11 years after they answered questions about their diets in 1997. The goal of the research was to gain a better understanding of a possible connection between antioxidant levels, which are affected by diet, and an increased risk of acute pancreatitis.
Over the 11 years, 320 participants developed cases of acute pancreatitis that weren't connected to gallstones, which are a common cause of the disease.
On average, those surveyed ate almost two servings of fruit a day and about 2.5 servings of vegetables.
The investigators found that the risk of acute pancreatitis didn't seem to have anything to do with how much fruit people ate. Vegetables, however, appeared to be an important factor, Viktor Oskarsson and colleagues reported in the study, which was published online June 28 in the journal Gut.
After adjusting their statistics for various factors, the researchers found that those who ate more than four servings of vegetables a day were 44 percent less likely to develop acute pancreatitis than those who ate less than one serving of vegetables a day.
Overweight people and those who consumed more than one alcoholic drink per day appeared to get the most positive benefit from eating a lot of vegetables, the findings indicated.
Overall, however, acute pancreatitis -- at least the kind that's not caused by gallstones -- was rare. Although vegetables appeared to have a protective effect, few people developed the condition overall, even if they ate few vegetables.
The researchers suspect antioxidants in vegetables helped prevent the condition, while fructose in fruits may weaken the protective effect.
Although the study uncovered an association between vegetable consumption and a reduced risk of acute pancreatitis, it did not prove a cause-and-effect relationship.

SOURCE: BMJ, news release, June 27, 2012

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Job Worries for Parents May Mean Poorer Nutrition for Kids: MedlinePlus

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Job Worries for Parents May Mean Poorer Nutrition for Kids

Study found family meals suffered as work pressures increased

Thursday, June 28, 2012

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THURSDAY, June 28 (HealthDay News) -- The more work-related stress parents experience, the more likely their children are to eat unhealthy meals, a new study shows.
"Who would have thought that a child's nutrition is affected by [parents] worrying about their jobs?" said Katherine Bauer, a researcher and assistant professor of public health at Temple University's Center for Obesity Research and Education. Bauer conducted the research while at the University of Minnesota.
The research is published in the current issue of the journal Social Science & Medicine.
Bauer and her colleagues used data from a study of more than 3,700 parents of teens living in a Midwestern metropolitan area. Only 64 percent of fathers and 46 percent of mothers were employed full time.
Those mothers employed full time had fewer meals as a family, served more fast-food meals and encouraged their teens to eat healthy less often, the researchers found. They had lower fruit and vegetable intake and spent less time on food preparation than moms who worked part time or who were not employed.
The fathers' only difference by employment status was that full-time workers had fewer hours of food preparation than those who worked part time or were not employed.
Mothers spent more hours on food preparation than fathers, no matter their employment status, Bauer said.
Parents with high stress levels were more likely to have fast food for family meals, less likely to encourage their children to eat healthy and more likely to eat fewer servings of fruits and vegetables a day.
Mothers with high stress levels served an average of four family meals a week, while those with low stress levels served 5.5 meals. Fathers with high stress levels had 4.1 family meals weekly; those with low stress levels had 5.7 family meals a week.
The findings were not surprising to Dr. Alice Lichtenstein, professor of nutrition science and policy at Tufts University in Boston.
"Work stress can affect many areas of daily life, including meal times and quality," she said.
The solution? Bauer said children should learn to help prepare and cook meals. The entire family also can help with grocery shopping.
Lichtenstein agreed. "Teaching both parents and children how to take advantage of quick, easy, healthy and common food items we are fortunate to have in the marketplace can ease the load on any one member of the family," she said.
"No one wants to have to go out shopping after a tiring day, whether it be work, classes or after-school activities," Lichtenstein continued. "A little advance planning can ensure the components of a quick, healthy meal are on hand."
Her suggestions: Stock the freezer with frozen vegetables and lean sources of protein, such as chicken or shrimp. You can make a variety of healthy stir-fry dishes that can be assembled quickly. Also have on hand fresh salad greens and tofu.
"The other important part of the equation is ensuring that everyone in the household feels confident pitching in, whether it be tearing up lettuce leaves and setting the table for younger children or cutting and cooking for older household members," Lichtenstein said. "The key is to have the basic ingredients and the knowledge to use them for meal preparation."

SOURCES: Katherine Bauer, Ph.D., researcher and assistant professor, public health, Temple University Center for Obesity Research and Education, Philadelphia; Alice Lichtenstein, D.Sc., Gershoff Professor of Nutrition Science and Policy, director and senior scientist, Cardiovascular Nutrition Laboratory, Tufts University, Boston; June 22, 2012, Social Science & Medicine

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Health Tip: Help Cool a Temper Tantrum: MedlinePlus

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Health Tip: Help Cool a Temper Tantrum

Offer praise when the child calms down

By Diana Kohnle

Thursday, June 28, 2012

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(HealthDay News) -- When your child's outburst becomes a temper tantrum, especially in a public place, some parents don't know how to react.
The Cleveland Clinic offers these suggestions:

Stay calm and if possible, ignore your child's tantrum.
When your child starts to calm down, offer plenty of praise and positive reinforcement.
Help distract your child and encourage calming down by putting the child in time out.
Explain that you understand the child's feelings and frustrations.
Teach your child healthy ways of managing anger and frustration.
Be a good role model by handling your own frustrations in a calm manner.

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Health Tip: Have Heart Palpitations?: MedlinePlus

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Health Tip: Have Heart Palpitations?

Get them checked by a doctor

By Diana Kohnle

Thursday, June 28, 2012

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Heart Diseases

(HealthDay News) -- Heart palpitations are sensations that your heart isn't beating in its regular rhythm. In some cases, they can indicate a serious cardiovascular problem such as an irregular heartbeat. In other cases, they can be relatively harmless.
The U.S. National Heart Lung and Blood Institute says any new or unexpected heart palpitations should be checked by a doctor. They could be caused by:

A serious heart problem, such as an irregular heartbeat (medically called an arrhythmia).
Conditions including dehydration, fever, thyroid problems, anemia, low blood pressure or low blood sugar.
Strong emotions, such as anxiety, stress or fear.
Intense exercise or physical activity.
Changes in hormone levels due to pregnancy, menstruation or menopause.
Certain foods, alcoholic beverages. medications or supplements.

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