Eating Fish, Omega-3 Oils, Fruits And Veggies Lowers Risk Of Memory Problems

A diet rich in fish, omega-3 oils, fruits and vegetables may lower your risk of dementia and Alzheimer's disease, whereas consuming omega-6 rich oils could increase chances of developing memory problems, according to a new study.

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For the study, researchers examined the diets of 8,085 men and women over the age of 65 who did not have dementia at the beginning of the study. Over four years of follow-up, 183 of the participants developed Alzheimer's disease and 98 developed another type of dementia.

The study found people who regularly consumed omega-3 rich oils, such as canola oil, flaxseed oil and walnut oil, reduced their risk of dementia by 60 percent compared to people who did not regularly consume such oils. People who ate fruits and vegetables daily also reduced their risk of dementia by 30 percent compared to those who didn't regularly eat fruits and vegetables.

The study also found people who ate fish at least once a week had a 35-percent lower risk of Alzheimer's disease and 40-percent lower risk of dementia, but only if they did not carry the gene that increases the risk of Alzheimer's, called apolipoprotein E4, or ApoE4.

"Given that most people do not carry the ApoE4 gene, these results could have considerable implications in terms of public health," said study author Pascale Barberger-Gateau, PhD, of INSERM, the French National Institute for Health and Medical Research, in Bordeaux, France. "However, more research is needed to identify the optimal quantity and combination of nutrients which could be protective before implementing nutritional recommendations."

In addition, the study found people who did not carry the ApoE4 gene and consumed an unbalanced diet characterized by regular use of omega-6 rich oils, but not omega-3 rich oils or fish were twice as likely to develop dementia compared to those who didn't eat omega-6 rich oils, which include sunflower or grape seed oil. The study did not find any association between consuming corn oil, peanut oil, lard, meat or wine and lowering risk of dementia.

"While we've identified dietary patterns associated with lowering a person's risk of dementia or Alzheimer's, more research is needed to better understand the mechanisms of these nutrients involved in these apparently protective foods," said Barberger-Gateau.

Source : http://www.sciencedaily.com/releases/2007/11/071112163630.htm

Psychiatric Symptoms May Be First Sign of Undetected Cancer

For some cancer patients, the first manifestation of the disease is a psychiatric symptom. This was found to be particularly true for brain tumors and small-cell lung cancer (SCLC), according to a study in the June 15 issue of the International Journal of Cancer.

Within the first month following a first-time evaluation for a psychiatric symptom, Danish researchers found that the odds of being diagnosed with any type of malignancy were increased 2.61-fold. But for brain tumors, the incidence rate ratio was increased almost 19-fold.

"Our study illustrates the importance of making a thorough physical examination of patients with first-time psychiatric symptoms," said lead author Michael E. Benros, MD, from the University of Aarhus, in Denmark, and the Danish Cancer Society. "The overall cancer incidence was highest in persons older than 50 years of age admitted with a first-time mood disorder, where 1 out of 54 patients would have a malignant cancer diagnosed within the first year."

The highest risk was concentrated in the range of 50 to 64 years of age, he told Medscape Oncology. "The overall incidence of cancer was increased almost 4-fold and the incidence of brain tumors was increased 37 times."

Dr. Benros also noted that paraneoplastic neurological disorders have previously been reported in patients who subsequently were found to have small-cell lung cancer. "But our study is the first to indicate that this is also the case with psychiatric symptoms, where patients with SCLC had the highest incidence after patients with brain tumors," he said.

It is hypothesized that paraneoplastic neurological disorders are most often induced in patients with SCLC, as well as in non-SCLC but with less frequency, because patients with SCLC produce antibodies that react with both the tumor antigens and the nervous system, explained Dr. Benros. This is turn might induce both the paraneoplastic neurological disorders and the psychiatric symptoms.

"The etiology of paraneoplastic psychiatric disorders is also partly explained by the fact that lung cancer, especially SCLC, tends to have the highest risk of metastasis to the brain," he added. "These metastases could then induce psychiatric symptoms by direct pressure. SCLC can also stimulate ectopic hormone production, which might then induce psychiatric symptoms, but our study cannot provide any evidence regarding causal mechanisms."

High Incidence of Brain Tumors and Lung Cancer

In their study, Dr. Benros and colleagues investigated the possibility that psychiatric symptoms could be caused by an undetected malignancy or be part of a paraneoplastic syndrome. Using data from the Danish Psychiatric Central Register and the Danish Cancer Registry, the researchers evaluated the occurrence of psychiatric symptoms and cancer in 4,320,623 million individuals who were followed in the 10-year period from 1994 to 2003. During this time, 202,144 persons had a first-time psychiatric contact and 208,995 were diagnosed with cancer.

From 1994 to 2003, a total of 4132 persons had a first-time psychiatric in- or outpatient contact and were subsequently diagnosed with cancer. Of this group, 1267 patients were diagnosed with cancer within the first year following their first-time psychiatric contact, and within this cohort, 145 persons had primary brain tumors.

The team observed that there was an increased overall incidence rate ratio of cancer during the initial 3-month period following a first-time psychiatric contact. During the first month, the incidence rate ratio of overall cancer was 2.61 (95% CI, 2.31 – 2.95), for brain tumors 18.85 (95% CI, 14.52 – 24.48), and for lung cancer 2.98 (95% CI, 2.16 – 4.12). The specific incidence rate ratio for SCLC was 6.13 (95% CI, 3.39 – 11.07).

In general, the increased incidence rates for most cancers decreased to a nonsignificant level within the first 3 months. The exception was for brain tumors, for which the incidence rate ratio remained significantly elevated during the first 9 months following a first-time psychiatric contact.

"Future studies should address a possible screening of subgroups of psychiatric patients with first-time symptoms," said Dr. Benros. "Psychiatric disorders with onset after the age of 50 could be an indication for brain imaging and, if they are smokers, patients could be examined for antibodies such as anti-Hu, but a more formal analysis of costs and benefits was beyond the scope of our study."

Source : http://www.medscape.com/viewarticle/705450?src=mpnews&spon=34&uac=133298AG

Final Analysis Shows HPV Vaccine Is Effective and Safe

The final results of a large phase 3 trial have confirmed that a bivalent vaccine is highly effective at protecting against human papillomavirus (HPV) types 16 and 18. Licensed under the name Cervarix and manufactured by GlaxoSmithKline, the vaccine was effective at providing protection against cervical intraepithelial neoplasia grade 2+ (CIN2+) lesions associated with HPV-16 and HPV-18, as well as lesions that were associated with nonvaccine types HPV-31, HPV-33, and HPV-45.

These 5 HPV types are responsible for about 82% of all cervical cancers, researchers say, in a report published online July 7 in the Lancet.

This is 1 of 2 vaccines against HPV that are now commercially available, the other being Gardasil (Merck). At present, only Gardasil is marketed in the United States, while Cervarix is awaiting approval there. But both vaccines are marketed in many other countries worldwide, including most of Europe.

The 2 vaccines also differ in the range of HPV subtypes they target — Cervarix is active against HPV 16 and 18, while Gardasil is active against HPV 6, 11, 16, and 18.

But even though both HPV vaccines appear to be effective at reducing precancerous lesions and have the potential to substantially reduce the incidence of cervical cancer, current approaches are too limited, argue the authors of an accompanying editorial.

Cannot Be Limited to Women

The only efficient way to control the spread of HPV is to "vaccinate the other half of the sexually active population: boys and men," write the editorialists, Karin Michels, PhD, from Harvard Medical School, in Boston, Massachusetts, and Harald zur Hausen, DSc, MD, from the German Cancer Research Center, in Heidelberg, Germany. Dr. zur Hausen was awarded the 2008 Nobel Prize in Physiology or Medicine for his discovery of human papilloma viruses causing cervical cancer.

The primary public-health goal of immunization programs is to halt the spread of infection and ultimately disease, and the current targets for the HPV vaccines are girls and young women who have not yet become sexually active. But while this program will reduce cervical-cancer incidence in a couple of decades, they note, "this subgroup of the population at risk is too small to limit the spread of the virus."

The editorialists point out that infection with oncogenic HPV types goes beyond cervical cancer, as they are also a primary cause of anal cancer and contribute to a substantial proportion of penile, oropharyngeal, and tonsillar cancers, all of which are predominant in men.

"Women have shouldered responsibility for contraception since its inception," they write. "The goal to eradicate sexually transmitted carcinogenic viruses can be jointly carried by women and men and could be accomplished within a few decades."

Lead author of the latest study, Jorma Paavonen, MD, a professor of obstetrics and gynecology at the University of Helsinki, in Finland, agrees. "Vaccinating both girls and boys is important to produce so-called herd immunity, which protects the population as a whole and may ultimately lead to eradication of the high-risk oncogenic HPV types."

He added that there is an ongoing randomized phase 4 community trial in Finland that is evaluating the HPV vaccine in both sexes, and more than 30,000 participants have already been enrolled.

Latest Results

The latest results, from a 3-year follow-up of women participating in the Papilloma Trial Against Cancer in Young Adults (PATRICIA), show the vaccine to be highly immunogenic, generally well tolerated, and effective against HPV-16 or HPV-18 infections and associated precancerous lesions, the researchers note.

Efficacy against CIN2+ associated with HPV types 16 and 18 was 92.9% (96.1% CI, 79.9% – 98.3%) in the primary analysis and 98.1% (95% CI, 88.4% – 100%) in an additional analysis, in which probable causality to HPV type was assigned in lesions infected with multiple oncogenic types.

The final analysis was event-driven, meaning that there were enough end points to show efficacy during this follow-up. "Also, the efficacy was even stronger when we used a CIN3+ end point, which is the immediate precursor of invasive cervical cancer," he told Medscape Oncology. "This and the Kaplan-Maier curves show that the efficacy gets stronger over time and does not wear off."

A total of 18,644 women between the ages of 15 and 25 years, residing in 14 countries, were included in PATRICIA. Participants were randomized to receive either the HPV vaccine or a control hepatitis-A vaccine. The analyses were conducted in several cohorts:

• According-to-protocol cohort for efficacy (ATP-E), which consisted of women who met eligibility criteria, complied with the trial protocol, and received all 3 doses of study vaccine (vaccine=8093; control=8069).
• Total vaccinated cohort (TVC), which included all women receiving at least 1 vaccine dose, regardless of their baseline HPV status; this represents the general population, including those who are sexually active (vaccine=9319, control=9325).
• Total vaccinated cohort-naive (TVC-naive), consisting of women with no evidence of oncogenic HPV infection at baseline; this represents women before sexual debut (vaccine=5822; control=5819).

All of the participants received vaccinations at months 0, 1, and 6, and the mean follow-up was 34.9 months after the third dose. The primary-end-point analysis was conducted in the ATP-E cohort, in participants who were seronegative at month 0 and HPV DNA negative at months 0 and 6 for the HPV type considered in the analysis.

Efficacy Observed for Vaccine and Nonvaccine Oncogenic Types

At the final analysis, there were a total of 60 confirmed cases of CIN2+, of which 33 (55%) contained DNA from nonvaccine oncogenic HPV types in addition to HPV-16 or HPV-18. Within this group, 12 CIN3+ lesions containing HPV-16/18 DNA, including 3 cases of adenocarcinoma in situ, were detected. Only 2 of these cases were found in the vaccine group, while the other 10 were detected among the controls.

Neither this trial nor any of the other trials have shown any safety signals.

Vaccine efficacy against CIN2+, irrespective of HPV DNA in lesions, was 30.4% in the TVC and 70.2% in the TVC-naive groups. The researchers also noted that efficacy against CIN3+ was 33.4% in the TVC cohort and 87.0% in the TVC-naive cohort.

The efficacy against CIN2+ associated with 12 nonvaccine oncogenic types was 54.0% in the ATP-E group. Since several lesions were coinfected with HPV-16/18, a post hoc analysis was conducted excluding these lesions, showing an efficacy of 37.4% against CIN2+ lesions associated exclusively with nonvaccine types. These 2 analyses suggest that the true vaccine efficacy against CIN 2+ associated with 12 nonvaccine oncogenic HPV types is between 37% and 54%, the authors note.

The authors also observed that the vaccine substantially reduced the number of colposcopy referrals and cervical-excision procedures in both the TVC and TVC-naive cohorts.

In general, the safety profile was generally similar to that of the control vaccine. "Neither this trial nor any of the other trials have shown any safety signals," said Dr. Paavonen. "All existing evidence shows that the prophylactic HPV vaccine is safe."

The study was funded by GlaxoSmithKline Biologicals. Several of the study authors have reported financial relationships with GlaxoSmithKline and/or Merck; the disclosures are listed in the paper. The editorialists declare no conflicts of interest.

Lancet. Published online July 7, 2009.

Source : http://www.medscape.com/viewarticle/705560?sssdmh=dm1.497244&src=nldne

Implementation of a Pediatric Medical Emergency Team

Transition From a Traditional Code Team to a Medical Emergency Team and Categorization of Cardiopulmonary Arrests in a Children's Center

Hunt EA, Zimmer KP, Rinke ML, et al
Arch Pediatr Adolesc Med. 2008;162:117-122

Summary

Medical emergency teams (METs) have been implemented in adult hospital care in order to identify patients who are experiencing clinical deterioration before they reach the point of arrest. As such, these teams are often more multidisciplinary than traditional "code teams," and they are designed to empower care providers, including nurses, to get quick evaluation of any patient about whom they are worried.

This study evaluated historical data from one institution before and after implementation of a pediatric MET. The outcome of interest was the rate (per 1000 patient-days and per 1000 discharges) of cardiopulmonary or respiratory arrests before and after implementation of the pediatric MET.

Organizing the MET had several aspects that differed from previous code team approaches, including the fact that nurses were supported in their first-responder roles. Security guards and chaplains were on the team to handle family members so that nurses could be more involved in the MET evaluation and stabilization of the patients.

Perhaps the most significant change was the addition of a pediatric pharmacist to the MET. (There was no pharmacist on the code team.) Part of the implementation of the MET involved defining a set of criteria for which an MET could be called, and these ranged from "respiratory distress" to "worried family member," giving a lot of discretion to nursing when ordering an MET intervention. Education of all personnel to their new roles was also completed.

There were no differences in the number of patients admitted during the year pre-MET and the year post-MET implementation, and patient severity of illness was similar as well. The MET was activated more often than traditional code teams at a rate of 1.8 calls per 1000 patient-days compared with 1.1 calls per 1000 patient-days for code team activation.

The study authors found a 51% reduction in rate of respiratory arrest and cardiopulmonary arrest after MET implementation, but the difference was not statistically significant (95% confidence interval [CI] for the incidence rate ratio was 0.18-1.20). The rate of reduction in respiratory arrest alone almost reached statistical significance (incidence rate ratio 0.27, 95% CI 0.05-1.01).

The study authors concluded that implementation of the pediatric MET was associated with no change in rate of cardiopulmonary arrest but was associated with a reduced rate of respiratory arrest on the ward units.

Viewpoint

This article is very valuable for providing a road map of how to implement a change in emergency response in a children's hospital. However, the process also points out one of the biggest difficulties of quality improvement research. With such a multifaceted intervention (change in criteria and environment for activating the team, addition of a pharmacist, and education of all providers as to new roles -- to name just a few), it would be very difficult to determine which portion of the change provided the benefit. As more hospitals implement pediatric METs as a method to respond to emergencies, it will be interesting to see outcomes at other institutions.

Source : http://www.medscape.com/viewarticle/575965

CPR Chest Compression Depth Guidelines in Children May Need Revision

The chest compression depth recommended in cardiopulmonary resuscitation (CPR) guidelines for pediatric patients do not appear to be optimal and may be excessive, according to studies in the July issue of Pediatrics.

The studies used computed tomography reconstruction to estimate chest compression depths that would be optimal for infants and children up to 8 years old during cardiopulmonary resuscitation. Current guidelines in that age group call for compressions of one third to one half the external anterior-posterior chest depth.

Dr. Matthew Braga at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and co-authors blame low rates of survival among children who experience cardiac arrest on unproven targets for pediatric chest compressions that are based on extrapolation from adults and animal models.

To provide direct experimental data, Dr. Braga's team examined pediatric chest CT scans previously performed to measure individual chest depths in 14 age groups between birth and 8 years.

Results show that "the current recommendations of one third to one half external anterior-posterior chest depth are not ideal and may not be attainable or safe for all children."

For example, a one-half chest compression in 3- to 12-month-olds would theoretically result in 25% having no residual internal depth, causing harm to structures being compressed. The authors estimate that the same would be true for 21% of 1- to 3-year-olds, and 8% of 3- to 8-year-olds.

According to Dr. Braga and associates, "Use of a constant chest compression depth target of 38 mm would be expected to be adequate for > 98% of 1 to 8-year-old children, with > 10 mm of residual chest depth."

Dr. Matthew Huei-Ming Ma and associates at National Taiwan University Hospital, Taipei, take a similar tack, using chest CT scans of 36 infants and 38 children ages 1 to 8.

They observed that accurate depths of chest compression at the lower half of the sternum and the internipple line revealed no significant difference. Therefore, they maintain, "because guidelines should be modified and simplified for ease of use by either the layperson or health care provider, it is not necessary to provide two choices in the pediatric resuscitation guidelines in the future."

Dr. Ma's team also observed that compression depths according to current guidelines were similar to or even higher than recommended compression depths for adults.

"More scientific debate is needed on this issue for further revision of pediatric CPR guidelines," they conclude.

Pediatrics 2009;124:e69-e74.

Source : http://www.medscape.com/viewarticle/705045?sssdmh=dm1.492967&src=nldne