[Press release] In search of a few good apps

In search of a few good apps.

New JAMA article suggests review and certification process for mHealth apps

BOSTON–While the Food and Drug Administration (FDA) has released guidelines for the regulation of mobile health (mHealth) apps that act as medical devices or as accessories to medical devices, the vast majority of mHealth apps remain unregulated and unevaluated. In a Viewpoint article, “In Search of a Few Good Apps”, published in JAMA on March 24, 214, co-authors, David Bates, MD and Adam Landman, MD of Brigham and Women’s Hospital (BWH) and Adam Powell, PhD, president of Payer+Provider Syndicate, call for the creation of mHealth (mobile health) app review and certification organizations to evaluate apps that are not regulated by the government.

“This article gives health care providers, patients, policymakers and mHealth app developers a perspective on how the issue of determining which apps are most useful might be addressed,” said Bates, who is Chief Quality Officer at BWH and chaired the Food and Drug Administration Safety and Innovation Act (FDASIA) Workgroup that made recommendations to the government about regulation of HIT and mobile apps. “Establishing an unbiased review and certification process is a key step in helping mHealth apps achieve their potential.”

The concept for this Viewpoint article was conceived by Landman and Powell after discussing their mutual concern about the lack of oversight over the accuracy, quality, and security of mHealth apps at the BWH Hackathon, an event sponsored by BWH’s Innovation Hub (iHub).

“Dr. Powell and I examined numerous mHealth apps and it was difficult to assess app credibility,” said Landman, Chief Medical Information Officer for Health Information Innovation and Integration and an emergency medicine physician at BWH. “The currently available reviews of mHealth apps have largely focused on personal impressions, rather than evidence-based, unbiased assessments of clinical performance and data security. With more rigorous certification criteria and unbiased accrediting bodies, both clinicians and consumers could be more confident in their selection and use of mHealth apps.”

In the article, authors describe the potential for multiple organizations to be created that could review and objectively certify mHealth apps for quality, accuracy, security and safety, similar to the role that Health On the Net Foundation (HON), a non-profit, non-governmental organization, plays in evaluating the quality of online medical content.

“People are increasingly turning to their smartphones for assistance in improving their health, but are having difficulty determining which apps are the securest and most effective. We hope that our article will instigate action that will enable clinicians and patients to make more effective use of mHealth apps,” said Powell, lead author of the article. “We foresee a potential future in which physicians will be able to confidently prescribe apps to their patient, and will have the tools that they need to interpret the resulting data. The establishment of an unbiased app certification and review process will play a key role in getting us there.”

 

Related articles

Wellocracy aims to help trackers choose and use health apps and devices

 

Related Resources

Free and low cost Health Apps sources include

• Health and Wellness Information Apps for locating information for personal health and wellness
• Health and Fitness Tracking Apps to help you enter and store your personal health and fitness information quickly

And these may be helpful when selecting health apps

• How to Choose A Better Health App (by LEXANDER V. PROKHOROV, MD, PHD at KevinMD.com on August 8, 2011) contains advice in the following areas

Set realistic expectations
Avoid apps that promise too much
Research the developers
Choose apps that use techniques you’ve heard of
See what other users say
Test apps before committing
iMedical apps has mobile medical app reviews and commentary by medical professionals. Most apps are about apps geared toward professionals and are not free.
The iMedical app forum now includes a medical librarian corner, with some patient/consumer apps

• iMedical apps has mobile medical app reviews and commentary by medical professionals. Most apps are about apps geared toward professionals and are not free.

[Press release] Alcohol’s role in traffic deaths vastly underreported: Study

Alcohol’s role in traffic deaths vastly underreported: Study.

PISCATAWAY, NJ – It’s no secret that drinking and driving can be a deadly mix. But the role of alcohol in U.S. traffic deaths may be substantially underreported on death certificates, according to a study in the March issue of the Journal of Studies on Alcohol and Drugs.

Between 1999 and 2009, more than 450,000 Americans were killed in a traffic crashes. But in cases where alcohol was involved, death certificates frequently failed to list alcohol as a cause of death.

Why does that matter? One big reason is that injuries are the leading cause of death for Americans younger than 45, according to the Centers for Disease Control and Prevention. And it’s important to have a clear idea of alcohol’s role in those deaths, explained Ralph Hingson, Sc.D., of the U.S. National Institute on Alcohol Abuse and Alcoholism.

“We need to have a handle on what’s contributing to the leading cause of death among young people,” Hingson said. What’s more, he noted, researchers need reliable data to study the effects of policies aimed at reducing alcohol-related deaths.

“You want to know how big the problem is, and if we can track it,” Hingson said. “Is it going up, or going down? And what policy measures are working?”

For the new study, I-Jen Castle, Ph.D., and a team led by Hingson focused on traffic deaths because, of all types of accidental fatalities, that’s where researchers have the best data. This is partly because many U.S. states—about half right now—require that fatally injured drivers be tested for blood alcohol levels, and nationwide about 70% of those drivers are tested.

Hingson’s team used a database maintained by the National Highway Traffic Safety Administration, called the Fatality Analysis Reporting System (FARS)—which contains the blood alcohol levels of Americans killed in traffic crashes. They compared that information with deaths certificate data from all U.S. states.

Overall, they found, death certificates greatly underreported the role of alcohol in traffic deaths between 1999 and 2009: Just over 3 percent listed alcohol as a contributing cause. But based on the FARS figures, 21 percent of those deaths were legally drunk.

The picture varied widely from state to state. In some states—such as Maryland, Nevada, New Hampshire, and New Jersey—alcohol was rarely listed on death certificates. Certain other states did much better, including Delaware, Iowa, Kansas, and Minnesota. It’s not fully clear why alcohol is so often left off of death certificates. One reason could be the time it takes to get blood-alcohol test results back. Coroners or medical examiners usually have to file a death certificate within three to five days, Hingson’s team notes, but toxicology results might take longer than that.

The reasons for the wide variation among states aren’t known either. But Hingson said that’s an important question. “Some states have been pretty successful,” he noted. “What are they doing right?”

It doesn’t seem to be only a matter of passing laws: States that mandate alcohol testing for deceased drivers did not always do better when it came to reporting alcohol as a contributor on death certificates.

Whatever the reasons, Hingson said, the role of alcohol in injury deaths may be seriously underestimated on death certificates. And the situation is likely worse with other types of accidental deaths, such as falls, drug poisoning/overdoses, and drowning, for which there is no mandatory blood alcohol testing or other reporting systems.

Hingson said he thinks testing should be done in those cases as well.

[Press release] Obesity: Not just what you eat

Obesity: Not just what you eat.

Tel Aviv University research shows fat mass in cells expands with disuse

Over 35 percent of American adults and 17 percent of American children are considered obese, according to the latest survey conducted by the Centers for Disease Control and Prevention. Associated with diabetes, heart disease, stroke, and even certain types of cancer, obesity places a major burden on the health care system and economy. It’s usually treated through a combination of diet, nutrition, exercise, and other techniques.

To understand how obesity develops, Prof. Amit Gefen, Dr. Natan Shaked and Ms. Naama Shoham of Tel Aviv University’s Department of Biomedical Engineering, together with Prof. Dafna Benayahu of TAU’s Department of Cell and Developmental Biology, used state-of-the-art technology to analyze the accumulation of fat in the body at the cellular level. According to their findings, nutrition is not the only factor driving obesity. The mechanics of “cellular expansion” plays a primary role in fat production, they discovered.

By exposing the mechanics of fat production at a cellular level, the researchers offer insight into the development of obesity. And with a better understanding of the process, the team is now creating a platform to develop new therapies and technologies to prevent or even reverse fat gain. The research was published this week in the Biophysical Journal.

Getting to the bottom of obesity

“Two years ago, Dafna and I were awarded a grant from the Israel Science Foundation to investigate how mechanical forces increase the fat content within fat cells. We wanted to find out why a sedentary lifestyle results in obesity, other than making time to eat more hamburgers,” said Prof. Gefen. “We found that fat cells exposed to sustained, chronic pressure — such as what happens to the buttocks when you’re sitting down — experienced accelerated growth of lipid droplets, which are molecules that carry fats.

“Contrary to muscle and bone tissue, which get mechanically weaker with disuse, fat depots in fat cells expanded when they experienced sustained loading by as much as 50%. This was a substantial discovery.”

The researchers discovered that, once it accumulated lipid droplets, the structure of a cell and its mechanics changed dramatically. Using a cutting-edge atomic force microscope and other microscopy technologies, they were able to observe the material composition of the transforming fat cell, which became stiffer as it expanded. This stiffness alters the environment of surrounding cells by physically deforming them, pushing them to change their own shape and composition.

“When they gain mass and change their composition, expanding cells deform neighboring cells, forcing them to differentiate and expand,” said Prof. Gefen. “This proves that you’re not just what you eat. You’re also what you feel — and what you’re feeling is the pressure of increased weight and the sustained loading in the tissues of the buttocks of the couch potato.”

The more you know …

“If we understand the etiology of getting fatter, of how cells in fat tissues synthesize nutritional components under a given mechanical loading environment, then we can think about different practical solutions to obesity,” Prof. Gefen says. “If you can learn to control the mechanical environment of cells, you can then determine how to modulate the fat cells to produce less fat.”

The team hopes that its observations can serve as a point of departure for further research into the changing cellular environment and different stimulations that lead to increased fat production.

[Press release] Future generations could inherit drug and alcohol use

Future generations could inherit drug and alcohol use.

HUNTSVILLE, TX (3/20/14) — Parents who use alcohol, marijuana, and drugs have higher frequencies of children who pick up their habits, according to a study from Sam Houston State University.

The study, “Intergenerational Continuity of Substance Use,” found that when compared to parents who did not use substances, parents who used alcohol, marijuana, and other illicit drugs were significantly more likely to have children who used those same drugs. Specifically, the odds of children’s alcohol use were five times higher if their parents used alcohol; the odds of children’s marijuana use were two times higher if their parents used marijuana; and the odds of children’s other drug use were two times higher if their parent used other drugs. Age and other demographic factors also were important predictors of substance use.

HarmCausedByDrugsTable (Photo credit: Wikipedia) Source “Scoring drugs”, The Economist, data from “Drug harms in the UK: a multi-criteria decision analysis”, by David Nutt, Leslie King and Lawrence Phillips, on behalf of the Independent Scientific Committee on Drugs. The Lancet. 2010 Nov 6;376(9752):1558-65. d

“The study is rare in that it assesses the extent to which parent’s substance use predicts use by their children within age-equivalent and developmentally-specific stages of the life course,” said Dr. Kelly Knight of the College Criminal Justice’s Department of Criminal Justice and Criminology. “If a parent uses drugs, will their children grow up and use drugs? When did the parent use and when did their children use? There appears to be an intergenerational relationship. The effect is not as strong as one might believe from popular discourse, but when you measure it by developmental stage, it can provide important information on its impact in adolescence and early adulthood, specifically.”

The study examined the patterns of substance use by families over a 27-year period. It documents substance use over time, giving a more complete understanding of when substance use occurs, when it declines, and the influence of parents in the process.

According to the National Survey on Drug Use and Health in 2011, about 22.6 million Americans age 12 years and older said they used illicit drugs in the last month. Other studies show that drug use is associated with reduced academic achievement, lower employment rates, poorer health, dependency on public assistance, neighborhood disorganization, and an increase in the likelihood of involvement in crime, criminal victimization and incarceration. The cost of drug use in this country from lost productivity, healthcare, and criminal justice is nearly $600 billion.

By plotting the life course of substance use within families, the study may be a valuable tool for the development of intervention programs. The study suggests that if substance use can be curtailed in adolescence, it may help to curb its prevalence in future generations.

The study also helps pinpoint the use of different illicit substances over the span of a lifetime, including its emergence in adolescence and when that use may decline. For example, marijuana and other drug use is most prevalent in adolescence and generally declines before or at age 24. Alcohol use continues to increase throughout adolescence and young adulthood, and then remains relatively steady over the lifetime.

These findings come from the National Youth Survey Family Study, which has collected data from three generations over a 27-year period. The analysis is based on 655 parents and 1,227 offspring from 1977 to 2004.

[Press release] Can ‘love hormone’ protect against addiction?

Can ‘love hormone’ protect against addiction?.

Addictive behavior such as drug and alcohol abuse could be associated with poor development of the so-called “love hormone” system in our bodies during early childhood, according to researchers at the University of Adelaide. The groundbreaking idea has resulted from a review of worldwide research into oxytocin, known as the “love hormone” or “bonding drug” because of its important role in enhancing social interactions, maternal behavior and partnership. This month’s special edition of the international journal Pharmacology, Biochemistry and Behavior deals with the current state of research linking oxytocin and addiction, and has been guest edited by Dr Femke Buisman-Pijlman from the University of Adelaide’s School of Medical Sciences. Dr Buisman-Pijlman, who has a background in both addiction studies and family studies, says some people’s lack of resilience to addictive behaviors may be linked to poor development of their oxytocin systems.

“We know that newborn babies already have levels of oxytocin in their bodies, and this helps to create the all-important bond between a mother and her child. But our oxytocin systems aren’t fully developed when we’re born – they don’t finish developing until the age of three, which means our systems are potentially subject to a range of influences both external and internal,” Dr Buisman-Pijlman says. She says the oxytocin system develops mainly based on experiences. “The main factors that affect our oxytocin systems are genetics, gender and environment. You can’t change the genes you’re born with, but environmental factors play a substantial role in the development of the oxytocin system until our systems are fully developed,” Dr Buisman-Pijlman says. IMAGE: This photo shows Dr. Femke Buisman-Pijlman from the University of Adelaide. She is the guest editor of the April 2014 edition of Pharmacology, Biochemistry and Behavior, which is focused on… Click here for more information. “Previous research has shown that there is a high degree of variability in people’s oxytocin levels. We’re interested in how and why people have such differences in oxytocin, and what we can do about it to have a beneficial impact on people’s health and wellbeing,” she says. She says studies show that some risk factors for drug addiction already exist at four years of age. “And because the hardware of the oxytocin system finishes developing in our bodies at around age three, this could be a critical window to study. Oxytocin can reduce the pleasure of drugs and feeling of stress, but only if the system develops well.” Her theory is that adversity in early life is key to the impaired development of the oxytocin system. “This adversity could take the form of a difficult birth, disturbed bonding or abuse, deprivation, or severe infection, to name just a few factors,” Dr Buisman-Pijlman says. “Understanding what occurs with the oxytocin system during the first few years of life could help us to unravel this aspect of addictive behavior and use that knowledge for treatment and prevention.”

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Big government — or good neighbors — can improve people’s health

Big government — or good neighbors — can improve people’s health.

Study explores connection between ideology, social capital and health

Lincoln, Neb., March 20, 2014 – The nation’s left-leaning citizens might be pleased by the findings of a new University of Nebraska study that finds those who live in liberal states tend to be healthier.

But conservatives could also take satisfaction in the same study’s conclusion that strong communities also foster better health.

“Some people might like the argument that liberal government automatically leads to healthier people, because it supports their worldview,” said Mitchel Herian, a faculty fellow with the university’s Public Policy Center and lead researcher on the new study. “But in the absence of a liberal government, you also see better levels of health if you have a strong community.”

The study, published in the March issue of the journal Social Science and Medicine, combined data from the 2010 Behavioral Risk Factor Surveillance System to measure health, a 2009 Gallup Healthways Survey to measure levels of social trust and a 2010 index that rates liberalism in state government. In all, the study involved data collected from more than 450,000 people from across the country.

It found that states with high levels of liberalism and those with high levels of social trust have higher levels of health and well-being.

The two factors – liberalism and social trust – are not interchangeable. People who live in a California city might have liberal political beliefs but mistrust their neighbors, Herian said, while those who live in a small Texas town might mistrust government but count on their neighbors.

To measure a state’s social capital, Herian and his colleagues used data from a survey that asked “If you lost a wallet or purse that contained $200 and it was found by a neighbor, do you think it would be returned with the money in it or not?”

To assess states’ political profiles, the study used an index that scores each of the 50 states on their relative liberalism vs. conservatism. The index is based upon factors such as interest group ratings of congressional members, voting records and election results in congressional races. It is designed not only to assess partisanship, but the extent to which politicians favor liberal social policy.

Health and well-being were measured with questions from the behavior risk survey that asked respondents to rate their health and to report how frequently poor physical or mental health prevents them from carrying out daily activities. The researchers also took smoking habits and body mass index into consideration.

Herian authored the study with psychologists Louis Tay of Purdue University, Ed Diener of the University of Illinois and UNL graduate student Joseph A. Hamm.

“Liberals argue for government programs and conservatives argue for individual responsibility,” Diener said. “When government programs are in place, people tend to be healthier. But when government programs are weaker, a person with lots of close ties and social capital can still be healthy. Their wife can get them to exercise, their friends can help them not drink too much, and their support for each other may directly affect their health. Loneliness is bad for health.”

The researchers said the study has implications for health policy at the state and local levels. Herian, who has studied how social trust influences public policy, said he expects to do more research on how to measure social trust.

Tay said the study shows two pathways to improving people’s health: Strong communities can provide good health outcomes, but government social programs also have a strong connection to good health and could be necessary to serve more fragmented and isolated communities.

Diener said the research demonstrates that good health is not just a matter of individuals “doing the right thing” like quitting smoking, exercising more and losing excess weight.

“Social factors have an influence, too,” he said. “It might be government programs, or it might be ‘social capital’ – having supportive others around us – that can influence our health beyond just each of us doing the right things.”

 

[Press release – new book] What’s behind near-death experiences — science, myth or miracle?

What’s behind near-death experiences — science, myth or miracle?.

New book Near-Death Experiences explores this controversial topic with historical reports and well-documented cases

In popular understanding, the expression “near-death experience” refers to the transition between the states of life and death. But how should such experiences be interpreted? Are they verifiable with scientific methods? If so, how can they be explained? Attempting to relate matters of scientific knowledge to subjective experience and the realm of belief is a difficult balancing act, and has led to a variety of approaches to the topic.

Near-Death Experiences by Birk Engmann scrutinizes the diverse views, and also myths, about near-death experiences and describes them from a scientific standpoint. Situated at the intersection of neuroscience, psychology, philosophy, and religious studies, his book will appeal to a broad audience of both scientists and general readers.

Engmann explains, “The multitude of views and models purporting explanation already indicates that near-death research is something of a tightrope walk between rationally explainable theories and the sphere of belief. There is an urgent need for a critical review, and indeed, one which examines the way the natural sciences can throw light on this matter. This is the main aim of my book.”

Near-Death Experiences provides explanations for the various experiences construed by some as proof of the supernatural. The author discusses this highly controversial topic, using interesting historical reports and recent well-documented cases.

Photographic illustration of a near-death-experience. (Photo credit: Wikipedia)

[Press release] Male, stressed, and poorly social

Male, stressed, and poorly social.

Stress undermines empathic abilities in men but increases them in women

Stress, this enemy that haunts us every day, could be undermining not only our health but also our relationships with other people, especially if we are men. In fact, stressed women apparently become more “prosocial”. These are the main findings of a study carried out with the collaboration of Giorgia Silani, from the International School for Advanced Studies (SISSA) of Trieste. The study was coordinated by the Social Cognitive Neuroscience Unit of the University of Vienna and saw the participation of the University of Freiburg.

“There’s a subtle boundary between the ability to identify with others and take on their perspective – and therefore be empathic – and the inability to distinguish between self and other, thus acting egocentrically” explains Silani. “To be truly empathic and behave prosocially it’s important to maintain the ability to distinguish between self and other, and stress appears to play an important role in this”.

Stress is a psycho-biological mechanism that may have a positive function: it enables the individual to recruit additional resources when faced with a particularly demanding situation. The individual can cope with stress in one of two ways: by trying to reduce the internal load of “extra” resources being used, or, more simply, by seeking external support. “Our starting hypothesis was that stressed individuals tend to become more egocentric. Taking a self-centred perspective in fact reduces the emotional/cognitive load. We therefore expected that in the experimental conditions people would be less empathic” explains Claus Lamm, from the University of Vienna and one of the authors of the paper.

More in detail…

The surprise was that our starting hypothesis was indeed true, but only for males. In the experiments, conditions of moderate stress were created in the laboratory (for example, the subjects had to perform public speaking or mental arithmetic tasks, etc.). The participants then had to imitate certain movements (motor condition), or recognise their own or other people’s emotions (emotional condition), or make a judgement taking on another person’s perspective (cognitive condition). Half of the study sample were men, the other half were women.

“What we observed was that stress worsens the performance of men in all three types of tasks. The opposite is true for women” explains Silani.

Why this happens is not yet clear. “Explanations might be sought at several levels”, concludes Silani. “At a psychosocial level, women may have internalized the experience that they receive more external support when they are able to interact better with others.

This means that the more they need help – and are thus stressed – the more they apply social strategies. At a physiological level, the gender difference might be accounted for by the oxytocin system. Oxytocin is a hormone connected with social behaviours and a previous study found that in conditions of stress women had higher physiological levels of oxytocin than men”.

[Press release] Honey is a new approach to fighting antibiotic resistance: How sweet it is!

Honey is a new approach to fighting antibiotic resistance: How sweet it is!.

DALLAS, March 16, 2014 — Honey, that delectable condiment for breads and fruits, could be one sweet solution to the serious, ever-growing problem of bacterial resistance to antibiotics, researchers said here today.

Medical professionals sometimes use honey successfully as a topical dressing, but it could play a larger role in fighting infections, the researchers predicted. Their study was part of the 247th National Meeting of the American Chemical Society (ACS), the world’s largest scientific society.

The meeting, attended by thousands of scientists, features more than 10,000 reports on new advances in science and other topics. It is being held at the Dallas Convention Center and area hotels through Thursday.

Honey Reclamation Program (Photo credit: The Rocketeer)

“The unique property of honey lies in its ability to fight infection on multiple levels, making it more difficult for bacteria to develop resistance,” said study leader Susan M. Meschwitz, Ph.D. That is, it uses a combination of weapons, including hydrogen peroxide, acidity, osmotic effect, high sugar concentration and polyphenols — all of which actively kill bacterial cells, she explained. The osmotic effect, which is the result of the high sugar concentration in honey, draws water from the bacterial cells, dehydrating and killing them.

In addition, several studies have shown that honey inhibits the formation of biofilms, or communities of slimy disease-causing bacteria, she said. “Honey may also disrupt quorum sensing, which weakens bacterial virulence, rendering the bacteria more susceptible to conventional antibiotics,” Meschwitz said. Quorum sensing is the way bacteria communicate with one another, and may be involved in the formation of biofilms. In certain bacteria, this communication system also controls the release of toxins, which affects the bacteria’s pathogenicity, or their ability to cause disease.

Meschwitz, who is with Salve Regina University in Newport, R.I., said another advantage of honey is that unlike conventional antibiotics, it doesn’t target the essential growth processes of bacteria. The problem with this type of targeting, which is the basis of conventional antibiotics, is that it results in the bacteria building up resistance to the drugs.

Honey is effective because it is filled with healthful polyphenols, or antioxidants, she said. These include the phenolic acids, caffeic acid, p-coumaric acid and ellagic acid, as well as many flavonoids. “Several studies have demonstrated a correlation between the non-peroxide antimicrobial and antioxidant activities of honey and the presence of honey phenolics,” she added. A large number of laboratory and limited clinical studies have confirmed the broad-spectrum antibacterial, antifungal and antiviral properties of honey, according to Meschwitz.

She said that her team also is finding that honey has antioxidant properties and is an effective antibacterial. “We have run standard antioxidant tests on honey to measure the level of antioxidant activity,” she explained. “We have separated and identified the various antioxidant polyphenol compounds. In our antibacterial studies, we have been testing honey’s activity against E. coli, Staphylococcus aureus and Pseudomonas aeruginosa, among others.”

[Press release] Three-quarters of people with seasonal and pandemic flu have no symptoms

 

English: Influenza positive tests reported to CDC by US WHO/NREVSS collaborating laboratories, national summary, 2008-2009: subtypes and percent positive tests (Photo credit: Wikipedia)

Three-quarters of people with seasonal and pandemic flu have no symptoms.

Around 1 in 5 of the population were infected in both recent outbreaks of seasonal flu and the 2009 H1N1 influenza pandemic, but just 23% of these infections caused symptoms, and only 17% of people were ill enough to consult their doctor.

These findings come from a major new community-based study comparing the burden and severity of seasonal and pandemic influenza in England over 5 years, published in The Lancet Respiratory Medicine journal.

“Reported cases of influenza represent the tip of a large clinical and subclinical iceberg that is mainly invisible to national surveillance systems that only record cases seeking medical attention”, explains lead author Dr Andrew Hayward from University College London, UK.

“Most people don’t go to the doctor when they have flu. Even when they do consult they are often not recognised as having influenza. Surveillance based on patients who consult greatly underestimates the number of community cases, which in turn can lead to overestimates of the proportion of cases who end up in hospital or die. Information on the community burden is therefore critical to inform future control and prevention programmes.”*

The Flu Watch study tracked five successive cohorts of households across England over six influenza seasons between 2006 and 2011. The researchers calculated nationally representative estimates of the incidence of influenza infection, the proportion of infections that were symptomatic, and the proportion of symptomatic infections that led to medical attention.

Participants provided blood samples before and after each season for influenza serology, and all participating households were contacted weekly to identify any cases of cough, cold, sore throat or ‘flu-like illness”. Any person reporting such symptoms was asked to submit a nasal swab on day 2 of illness to test for a variety of respiratory viruses using Real-Time, Polymerase Chain Reaction (RT-PCR) technology.

The results show that on average 18% of the unvaccinated community were infected with influenza each winter season—19% during prepandemic seasons and 18% during the 2009 pandemic. But most (77%) of these infections showed no symptoms, and only around 17% of people with PCR-confirmed influenza visited their doctor. Compared with some seasonal flu strains, the 2009 pandemic strain caused substantially milder symptoms.

The study indicates that primary-care surveillance greatly underestimates the extent of infection and illness in the community. The rate of influenza across all winter seasons was on average 22 times higher than rates of disease recorded by the Royal College of General Practitioners Sentinel Influenza-Like Illness Surveillance Scheme.

According to Dr Hayward, “Despite its mild nature, the 2009 pandemic caused enormous international concern, expense, and disruption. We need to prepare for how to respond to both mild and severe pandemics. To do this we need more refined assessments of severity, including community studies to guide control measures early in the course of a pandemic and inform a proportionate response.”

Writing in a linked Comment, Dr Peter William Horby from the Oxford University Clinical Research Unit in Vietnam says, “In view of the undoubtedly high rates of subclinical influenza infection, an important unanswered question is the extent to which mild and asymptomatic influenza infections contribute to transmission…A large number of well individuals mixing widely in the community might, even if only mildly infectious, make a substantial contribution to onward transmission.”

He concludes, “Surveillance of medically attended illnesses provides a partial and biased picture, and is vulnerable to changes in consulting, testing, or reporting practices. As such, it is clear that reliable estimates of the infection and clinical attack rates during the early stages of an influenza epidemic requires the collection of standardised data across the whole range of disease severity, from the community, primary care, and secondary care.”

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Major ‘third-hand smoke’ compound causes DNA damage — and potentially cancer

Major ‘third-hand smoke’ compound causes DNA damage — and potentially cancer.

Major ‘third-hand smoke’ compound causes DNA damage — and potentially cancer

DALLAS, March 16, 2014 — Leftover cigarette smoke that clings to walls and furniture is a smelly nuisance, but now research suggests that it could pose a far more serious threat, especially to young children who put toys and other smoke-affected items into their mouths. Scientists reported today that one compound from this “third-hand smoke,” which forms when second-hand smoke reacts with indoor air, damages DNA and sticks to it in a way that could potentially cause cancer.

Their talk was one of more than 10,000 presentations at the 247th National Meeting & Exposition of the American Chemical Society (ACS), the world’s largest scientific society, taking place here through Thursday.

Bo Hang, Ph.D., who presented the research, said that although the idea of third-hand smoke made its debut in research circles just a few years ago in 2009, evidence already strongly suggests it could threaten human health.

“The best argument for instituting a ban on smoking indoors is actually third-hand smoke,” said Hang, a scientist at Lawrence Berkeley National Laboratory (LBNL).

Researchers have found that many of the more than 4,000 compounds in second-hand smoke, which wafts through the air as a cigarette is smoked, can linger indoors long after a cigarette is stubbed out. Based on studies led by Hugo Destaillats, Ph.D., also at LBNL, these substances can go on to react with indoor pollutants such as ozone and nitrous acid, creating brand-new compounds, some of which may be carcinogenic.

One of those compounds goes by the acronym NNA. Hang’s research has shown that NNA, a tobacco-specific nitrosamine, locks onto DNA to form a bulky adduct (a piece of DNA bound to a cancer-causing chemical), as well as other adducts, in lab test tubes. Other large compounds that attach to DNA tend to cause genetic mutations. NNA also breaks the DNA about as often as a related compound called NNK, which is a well-studied byproduct of nicotine and a known potent carcinogen. This kind of DNA damage can lead to uncontrolled cell growth and the formation of cancerous tumors.

Just as it took years to establish the cancer-causing effects of first-hand smoke that is inhaled as a person breathes in directly from the cigarette, making the connection between third-hand smoke or NNA and cancer could take a long time, Hang said. But early research into its nature, exposure and health effects is compelling enough that a research consortium dedicated to investigating third-hand smoke was formed in California in 2010. That consortium helped fund Hang’s work on NNA-induced DNA damage, which he said could eventually be used as biomarkers to identify people who have been exposed to third-hand smoke.

The biggest potential health risk is for babies and toddlers, he noted. As they crawl and put their hands or toys in their mouths, they could touch, swallow or inhale compounds from third-hand smoke. Their small size and early developmental stage make them more vulnerable than adults to the effects of environmental hazards.

…

[News item] Health-care professionals should prescribe sleep to prevent, treat metabolic disorders, experts argue — ScienceDaily

Health-care professionals should prescribe sleep to prevent, treat metabolic disorders, experts argue — ScienceDaily.

Date:
March 24, 2014
Source:
The Lancet
Summary:
Evidence increasingly suggests that insufficient or disturbed sleep is associated with metabolic disorders such as type 2 diabetes and obesity, and addressing poor quality sleep should be a target for the prevention — and even treatment — of these disorders. Addressing some types of sleep disturbance — such as sleep apnea — may have a directly beneficial effect on patients’ metabolic health, say the authors. But a far more common problem is people simply not getting enough sleep, particularly due to the increased use of devices such as tablets and portable gaming devices.

…

Addressing some types of sleep disturbance — such as sleep apnea — may have a directly beneficial effect on patients’ metabolic health, say the authors. But a far more common problem is people simply not getting enough sleep, particularly due to the increased use of devices such as tablets and portable gaming devices.
Furthermore, disruption of the body’s natural sleeping and waking cycle (circadian desynchrony) often experienced by shift workers and others who work outside daylight hours, also appears to have a clear association with poor metabolic health, accompanied by increased rates of chronic illness and early mortality.

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[News item] Ruling with an iron fist could make your child pack on pounds — ScienceDaily

Ruling with an iron fist could make your child pack on pounds — ScienceDaily.

Date:
March 19, 2014
Source:
American Heart Association
Summary:
Kids whose parents are demanding but not emotionally responsive are about one-third more likely to be obese than kids whose parents set healthy boundaries, are affectionate and discuss behavior. Researchers compared kids whose parents are generally affectionate, have reasonable discussions about behavior with their child and set healthy boundaries (authoritative) with those whose parents were strict about limits without much dialogue or affection (authoritarian).

[News story] Commonly used pain relievers have added benefit of fighting bacterial infection — ScienceDaily

Commonly used pain relievers have added benefit of fighting bacterial infection — ScienceDaily.

Summary:
Some commonly used drugs that combat aches and pains, fever, and inflammation are also thought to have the ability to kill bacteria. New research reveals that these drugs, better known as nonsteroidal anti-inflammatory drugs, act on bacteria in a way that is fundamentally different from current antibiotics. The discovery could open up new strategies for fighting drug-resistant infections and ‘superbugs.’

…

“We discovered that some anti-inflammatory drugs used in human and veterinary medicine have weak antibiotic activity and that they exert this secondary activity by preventing bacteria from copying their DNA, which they need to do in order to multiply,” explains senior author Dr. Aaron Oakley of the University of Wollongong, in Australia. The researchers analyzed three NSAIDs: bromofenac, carprofen, and vedaprofen. The more commonly known NSAIDs, which include aspirin, ibuprofen, and naproxen, were not tested.

…

Top 100 Selling Drugs of 2013

Top 100 Selling Drugs of 2013.

Hypothyroid medication levothyroxine (Synthroid, AbbVie) was the nation’s most prescribed drug in 2013, whereas the antipsychotic aripiprazole (Abilify, Otsuka Pharmaceutical) had the highest sales, at nearly $6.5 billion, according to a new report from research firm IMS Health on the top 100 selling drugs in the United States.

Following levothyroxine as most prescribed were the cholesterol-lowering drug rosuvastatin (Crestor, AstraZeneca), the proton-pump inhibitor esomeprazole (Nexium, AstraZeneca), and the antidepressant duloxetine (Cymbalta, Eli Lilly).

Rounding out the top 10 most prescribed drugs in 2013 (in order) were the asthma drugs albuterol (Ventolin, HFA) and fluticasone propionate/salmeterol (Advair Diskus, GlaxoSmithKline), the antihypertensive valsartan (Diovan, Novartis), the attention deficit drug lisdexamfetamine dimesylate (Vyvanse, Shire), the antiepileptic pregabalin (Lyrica, Pfizer), and the chronic obstructive pulmonary disease drug tiotropium bromide (Spiriva, Boehringer Ingelheim).
Table 1. Top 100 Drugs by Sales
Rank Drug (brand name) Sales, 2013
1 Abilify $6,460,215,394
2 Nexium $6,135,667,614
3 Humira $5,549,996,855
4 Crestor $5,310,818,889
5 Cymbalta $5,219,860,418
6 Advair Diskus $5,121,312,668
7 Enbrel $4,681,201,645
8 Remicade $4,098,233,242
9 Copaxone $3,697,182,238
10 Neulasta $3,580,364,758
11 Rituxan $3,288,614,045
12 Lantus Solostar $3,005,681,663
13 Spiriva Handihaler $2,998,207,542
14 Atripla $2,856,818,557
15 Januvia $2,843,496,907
16 Avastin $2,688,414,938
17 Lantus $2,556,825,619
18 Oxycontin $2,534,909,675
19 Lyrica $2,415,254,835
20 Epogen $2,280,696,834
21 Celebrex $2,237,658,764
22 Truvada $2,235,712,145
23 Diovan $2,169,819,482
24 Herceptin $1,938,804,857
25 Gleevec $1,896,982,614
26 Lucentis $1,859,463,484
27 Namenda $1,856,822,750
28 Vyvanse $1,743,115,521
29 Zetia $1,710,526,476
30 Symbicort $1,563,242,161
31 Levemir $1,547,629,745
32 Suboxone $1,450,554,130
33 Novolog Flexpen $1,377,221,614
34 Novolog $1,349,403,122
35 Avonex $1,240,754,136
36 Seroquel Xr $1,226,532,019
37 Viagra $1,196,812,385
38 Alimta $1,192,134,813
39 Humalog $1,184,189,487
40 Nasonex $1,137,402,455
41 Victoza 3-Pak $1,104,811,637
42 Cialis $1,086,355,583
43 Gilenya $1,059,346,323
44 Flovent Hfa $1,050,009,900
45 Procrit $1,030,419,958
46 Isentress $1,014,678,055
47 Xarelto $996,441,091
48 Prezista $992,087,940
49 Janumet $987,663,598
50 Stelara $965,072,892
51 Neupogen $958,807,372
52 Orencia $957,680,500
53 Renvela $955,330,199
54 Reyataz $934,879,388
55 Vesicare $933,311,254
56 Dexilant $916,401,204
57 Tecfidera $879,673,483
58 Humalog Kwikpen $879,632,962
59 Synthroid $858,725,708
60 Vytorin $858,576,112
61 Lunesta $851,791,226
62 Pradaxa $836,573,805
63 Benicar $832,276,970
64 Evista $823,647,433
65 Xolair $821,783,471
66 Aranesp $809,245,700
67 Prevnar 13 $806,129,346
68 Sensipar $786,320,942
69 Xgeva $785,725,436
70 Invega Sustenna $779,834,172
71 Zytiga $775,269,249
72 Avonex Pen $768,655,140
73 Synagis $767,786,422
74 Betaseron $767,648,290
75 Xeloda $754,133,787
76 Ventolin Hfa $745,629,470
77 Zyvox $726,184,205
78 Afinitor $721,629,719
79 Gardasil $710,208,856
80 Zostavax $705,140,729
81 Incivek $701,317,408
82 Sandostatin Lar $697,961,265
83 Aciphex $683,359,951
84 Benicar Hct $681,353,719
85 Bystolic $681,318,227
86 Treanda $679,052,250
87 Focalin Xr $660,161,202
88 Erbitux $648,984,405
89 Tamiflu $641,134,799
90 Tarceva $640,597,157
91 Pristiq $632,619,542
92 Complera $630,039,312
93 Cubicin $628,034,439
94 Velcade $621,800,823
95 Strattera $616,604,042
96 Viread $599,074,197
97 Stribild $598,844,153
98 Welchol $573,939,710
99 Combivent Respimat $573,179,772
100 Xifaxan $569,762,570
Source: IMS National Prescription Audit, IMS Healt

[Report] Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014

Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse (OEI-03-13-00030) 03-03-2014.

….
More than half of Part D plan sponsors did not report data on potential fraud and abuse between 2010 and 2012. Of those sponsors that did report data, more than one-third did not identify any incidents for at least one of their reporting years. In total, sponsors reported identifying 64,135 incidents of potential fraud and abuse between 2010 and 2012. Sponsors’ identification of such incidents varied significantly, from 0 to almost 14,000 incidents a year.

CMS requires sponsors to conduct inquiries and implement corrective actions in response to incidents of potential fraud and abuse; however, 28 percent of Part D plan sponsors reported performing none of these actions between 2010 and 2012. Although CMS reported that it conducted basic summary analyses of the data on potential fraud and abuse, it did not perform quality assurance checks on the data or use them to monitor or oversee the Part D program.
WHAT WE RECOMMEND
We recommend that CMS (1) amend regulations to require sponsors to report to CMS their identification of and response to potential fraud and abuse; (2) provide sponsors with specific guidelines on how to define and count incidents, related inquiries, and corrective actions; (3) review data to determine why certain sponsors reported especially high or low numbers of incidents, related inquiries, and corrective actions; and (4) share sponsors’ data on potential fraud and abuse with all sponsors and law enforcement. CMS did not concur with the first recommendation, partially concurred with the second and fourth recommendations, and concurred with the third recommendation.

 

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[Press release] Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2012 | Full Text Reports…

Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2012 | Full Text Reports….

This report presents detailed tables from the 2012 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, education, current employment status, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates (frequencies and percentages) are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions.

 

 

[Press release] Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence | Full Text Reports…

Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence | Full Text Reports….

Background
Internet addiction (IA) is considered as one of behavioral addictions. Although common neurobiological mechanisms have been suggested to underlie behavioral addiction and substance dependence, few studies have directly compared IA with substance dependence, such as alcohol dependence (AD).

Methods
We compared patients with IA, AD, and healthy controls (HC) in terms of the Five Factor Model of personality and with regard to impulsiveness, anger expression, and mood to explore psychological factors that are linked to aggression. All patients were treatment-seeking and had moderate-to-severe symptoms.

Results
The IA and AD groups showed a lower level of agreeableness and higher levels of neuroticism, impulsivity, and anger expression compared with the HC group, which are characteristics related to aggression. The addiction groups showed lower levels of extraversion, openness to experience, and conscientiousness and were more depressive and anxious than the HCs, and the severity of IA and AD symptoms was positively correlated with these types of psychopathology.

Conclusions
IA and AD are similar in terms of personality, temperament, and emotion, and they share common characteristics that may lead to aggression. Our findings suggest that strategies to reduce aggression in patients with IA are necessary and that IA and AD are closely related and should be dealt with as having a close nosological relationship.

[News article]Stop Looking For ‘Hardwired’ Differences In Male And Female Brains | Popular Science

Stop Looking For ‘Hardwired’ Differences In Male And Female Brains | Popular Science.

Excerpt

…many supposed psychological differences between the sexes are as illusory as the physical ones. In 2005, Janet Hyde, a researcher at the University of Wisconsin-Madison, analyzed data from studies of apparent sex differences in traits such as aggression, social ability, math, and moral reasoning. Nearly four fifths of the traits showed only a minor or negligible difference between men and women.

In the rare cases where actual psychological differences exist, they cannot be attributed to innate neurology alone. Everything in the brain is a combination of nature and nurture. Culture comes into play, which affects behavior, which then affects the brain. From birth (and even in the womb), a baby is labeled as a girl or boy and treated a certain way as a result. For example, a 2005 study of 386 birth announcements in Canadian newspapers showed that parents tend to say they’re “proud” when it’s a boy and “happy” when it’s a girl. Anne Fausto-Sterling, a biologist at Brown University, has shown that mothers talk to infant girls more than infant boys. This could partly explain why girls tend to have better language skills later on. “Some differences end up fairly entrenched in adult human beings,” Fausto-Sterling says. “But that doesn’t mean that you were born that way or that you were born destined to be that way.”

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