Significantly Worse Outcomes In Cancer Patients With Cognitive Impairment, UGA Study Finds

A new study published by researchers from the University of Georgia and the Moffitt Cancer Center in Tampa, Fla., has found that cancer patients with dementia have a dramatically lower survival rate than patients with cancer alone, even after controlling for factors such as age, tumor type and tumor stage.

But the study, published in the early online edition of the journal Critical Reviews in Oncology/Hematology, also argues that a diagnosis of dementia shouldn’t discourage the use of cancer screenings and appropriate cancer treatments.

“As the population ages and as treatments improve, we’re going to see more patients with both dementia and cancer,” said lead author Claire Robb, assistant professor in the UGA College of Public Health. “And right now there are no guidelines for oncologists as to how to treat these patients.”

Robb and her co-authors in the Senior Adult Oncology Program at Moffitt compared the outcomes of 86 cancer patients with cognitive impairment to a control group of 172 patients with cancer alone. They found that cancer patients with dementia survived an average of four fewer years.

Robb, who is also a researcher in the UGA Cancer Center, said that the reason for the disparity is unclear. She notes that the patients in both groups received similar treatment and that the survival gap persists even after controlling for age, tumor type and tumor stage.

But Robb pointed out that within the cognitively impaired group, there was a dramatic difference in survival time between those with mild cognitive impairment and those with moderate to severe impairment. People with mild cognitive impairment often have problems with thinking and memory yet can still live independently; those with moderate to severe dementia forget details about current events, lose awareness and have difficulty with basic tasks such as preparing meals or choosing proper clothing. The researchers found that while patients with moderate to severe dementia had an average survival time of eight months, those with mild dementia had an average survival time of nearly four and a half years.

“Some people would argue against treating patients with mild cognitive impairment because they’re going to have a shorter survival,” Robb said. “But, you know, 53 months – almost 4 and a half years – is a pretty significant amount of time to live.”

The patients in the UGA/Moffitt study generally received the same treatment regardless of cognitive status, but other studies have found that patients with dementia often receive fewer cancer screenings and undergo less aggressive treatment. One study found that physicians were significantly less likely to recommend a mammogram for a woman with dementia than without, while another found that patients with dementia were twice as likely to have colon cancer reported only after death. Another study of breast cancer patients found that those with dementia were 52 percent less likely to have the tumor removed surgically, 41 percent less likely to undergo radiation therapy, 39 percent less likely to undergo chemotherapy and nearly three times more likely to receive no treatment.

“The fact that cognitively impaired patients seen in our Senior Adult Oncology Program received treatments similar to unimpaired patients while epidemiologic data show a marked difference in treatment provides food for thought,” said study co-author Dr. Martine Extermann, associate faculty member at Moffitt. “Although this might reflect a referral bias in which those who volunteered to participate in the study are different from the general population, it might also indicate that such patients benefit from a specialized evaluation and management in a geriatric oncology program.”

Robb emphasized that she does not advocate overly aggressive treatment for patients who are in the late stages of dementia, but urges the creation of guidelines to help ensure that cognitively impaired cancer patients receive appropriate treatment.

“People have thought about the impact of the aging population on rates of cancer and dementia, but not much attention has been paid to what happens when the diseases coincide,” Robb said. “We’re going to be seeing more cases like these, and, if anything, I hope our research raises awareness of this situation.”

Source: Sam Fahmy

University of Georgia

Cheryl Gillan’s Autism Bill Passes Crucial Milestone

The Government has, for the first time, declared its support for what could be England’s first Autism Bill. The National Autistic Society (NAS) celebrated the move as a vital development for people with autism as Care Services Minister Phil Hope committed to enshrining in law a raft of new measures, via the Autism Bill, which could drive a dramatic improvement in local authority and NHS services for people with the condition.

Last night, MPs voted yes to the Government’s proposed blueprint and time scales to improve support and in a major development the Care Services Minister gave the forthcoming national adult autism strategy extra force by adding it to the Autism Bill. The Bill now awaits its third reading scheduled for the 19th June and with the support of the Government is likely to pass to the House of Lords.

Mark Lever, chief executive of the NAS said; “We are absolutely delighted that the Government is prepared to take decisive action to tackle the shocking lack of help which leaves people affected by autism feeling isolated, ignored and often at breaking point. The Autism Bill has passed a major and crucial hurdle on the road to becoming law but there’s still some way to go. Autism is a serious, lifelong and disabling condition, and without the right support it can have a profound and sometimes devastating effect on individuals and families so we will keep working with the Government to ensure the Autism Bill can deliver where it is really needed.”

The Autism Bill is being championed through Parliament as a Private Member’s Bill led by Conservative MP Cheryl Gillan and was drafted by the NAS on behalf of a coalition of 15 other autism charities. She said; “I commend the Government on their commitment to transforming the lives of children and adults with autism via the support of Schools and Learners Minister, Sarah McCarthy-Fry and Care Services Minister, Phil Hope. Today is a real turning point for the thousands of people affected by autism who have been unable to get the help they desperately need and I look forward to working with the Government to make this vitally important Bill a reality.”

The Government’s measures come as the NAS I Exist campaign found that at least 1 in 3 adults with autism are experiencing serious mental health difficulties due to a lack of help. Under the Autism Bill the national adult autism strategy, due at the end of this year, will hold local authorities and NHS services legally responsible for providing support for adults with the condition and ensure they have clear routes to diagnosis, assessment and support. The NAS is, therefore, urging as many people affected by autism as possible to take part in the consultation for the strategy which closes on the 15th September.

This boost for adults with autism builds on a previous commitment by Sarah McCarthy-Fry MP to fulfil the Autism Bill’s original demands for better support for children via new regulations for Children and Young People’s Plans. In an important win for the wider disabled community these would legally require local authorities to collate and share data and information on children with disabilities with other agencies, which could see a huge sea change in disabled children’s services and ensure they get the support they need to fulfil their potential in adulthood.

Soure
The National Autistic Society

Cerebrospinal Fluid Study Reveals Potential New Gene Associated With Alzheimer’s Disease

A genomic study of cerebrospinal fluid (CSF) has added a new gene to the list of potential genetic contributors to Alzheimer’s disease, a national research team led by Indiana University School of Medicine scientists has reported.

The research team conducted a genome-wide analysis of potential CSF biomarkers that could be used for early detection of Alzheimer’s disease, using samples from 374 participants in the national Alzheimer’s Disease Neuroimaging Initiative (ADNI).

“This study was one of the first genome-wide analyses of biomarkers in cerebrospinal fluid, which has direct access to the brain and allows you to look at biochemical features that might be more directly tied to the disease,” said Andrew J. Saykin, Psy.D., Raymond C. Beeler Professor of Radiology and Imaging Sciences and director of the IU Center for Neuroimaging. The study was reported in the online edition of Neurology, the journal of the American Academy of Neurology.

In the genome-wide association study, researchers looked for genetic variations that could be related to CSF levels of three proteins – beta amyloid, tau and phosphorylated tau – that are linked to damage seen in brains of Alzheimer’s patients.

The primary novel finding was that a gene known as enhancer of polycomb homolog 2 (EPC2) was associated with total levels of the tau protein in the cerebrospinal fluid. This gene, which has not previously surfaced in other studies looking for Alzheimer-related markers, has been associated with a gene deletion syndrome that includes mental retardation, short stature and epilepsy.

EPC2 is also involved in the formation of a DNA structure, heterochromatin, that plays a role in the activation and control of gene activity. That process, called epigenetics, refers to the alteration of gene expression by factors beyond the instructions in the DNA itself, including environmental factors.

“The association of CSF tau and the EPC2 gene suggests a possible epigenetic mechanism that warrants follow-up in other samples. These epigenetic processes, in which genome function can be modified through interacting with the internal or external environment, are suspected of playing a role in neurodegenerative diseases such as Alzheimer’s,” said Dr. Saykin, who leads the Alzheimer’s Disease Neuroimaging Initiative genetics component.

The co-first authors of the study were Sungeun Kim, Ph.D., assistant research professor of radiology and imaging sciences, and Shanker Swaminathan, Ph.D. candidate in medical and molecular genetics, at IU School of Medicine, which is located on the campus of Indiana University-Purdue University, Indianapolis. Other investigators from IU include Li Shen, Ph.D., assistant professor of radiology and imaging sciences, Shannon L. Risacher, Ph.D. candidate in medical neuroscience, Kwangsik Nho, Ph.D., post doctoral fellow and Tatiana Foroud, Ph.D., P. Michael Conneally Professor of Medical and Molecular Genetics and director of the Hereditary Genomics Division.

The research team also included collaborating scientists from the University of Pennsylvania School of Medicine; University of California, Irvine; The Translational Genomics Research Institute in Phoenix; Pfizer Inc.; University of California, San Diego; and the Mayo Clinic College of Medicine. Michael W. Weiner, MD, of the University of California, San Francisco and the Department of Veterans Affairs Medical Center, San Francisco, is the principal investigator of the ADNI.

The Alzheimer’s Disease Neuroimaging Initiative is funded by the National Institute on Aging (NIA), a component of the National Institutes of Health (NIH), with additional support from pharmaceutical and related industries and not-for-profit organizations including the Alzheimer’s Association. The initiative combines clinical, brain imaging (MRI and PET scans) and genetic data with other measurements including CSF and plasma to search for biomarkers that could be used for early diagnosis of Alzheimer’s disease and design of more efficient clinical trials.

Source:

IU School of Medicine

No-smoking Rules Not Common Enough For Asthmatic Children

Urban children with persistent asthma living in homes with smokers are 10 times less likely to be protected by a smoking ban in the home and car than asthmatic children living with no smokers, according to a new study (embargoed until 6 a.m. March 16) by researchers at the University of Rochester Medical Center.

The study, published in the March-April issue of Ambulatory Pediatrics, shows that the message has not reached every parent that any secondhand smoke exposure for children ??” especially those suffering from asthma ??” is detrimental to their health. Parents and caregivers may be trying to limit smoke exposure by smoking in a different room or by opening a window in the car, but these strategies aren’t very effective.

“Of course, the best case scenario is if the parents or guardians can quit smoking,” said lead author Jill Halterman, M.D., M.P.H., assistant professor at Golisano Children’s Hospital at Strong. “But that’s not always immediately possible. Another option is for parents to institute a “no-smoking” rule in the home and the car, and allow no exceptions to this rule. It is best if smokers always go outside to smoke, and this strategy may also help the parents to eventually quit.”

The study surveyed 231 parents of children with persistent and severe asthma at three Rochester pediatric practices. Almost half of the children lived with a smoker. Among all the families surveyed, only 64 percent had complete “no-smoking rules” for the home and car with no exceptions, and among the homes with smokers only 40 percent had such a rule. Children with severe asthma symptoms were no more likely to be protected by a no smoking rule than those with less severe symptoms.

Most caregivers surveyed said their health care providers asked them about smoke exposure in the home, but only 40 percent said they had been asked about exposure in the car ??” where concentration is higher than in the home ??” and few said they were offered resources to help them quit smoking.

“We, as health care providers, can do more to help parents understand better how to limit their children’s exposure to secondhand smoke. If parents are having trouble quitting, we can find them help. If caregivers want to limit their child’s exposure, we can talk about strategies to reducing exposure in the home and the car,” Halterman said.

Research for the study was funded by grants from Halcyon Hill Foundation and the Robert Wood Johnson Foundation’s Generalist Physician Faculty Scholars Program.

Contact: Heather Hare
heather_hareurmc.rochester
University of Rochester Medical Center

No-smoking Rules Not Common Enough For Asthmatic Children

Urban children with persistent asthma living in homes with smokers are 10 times less likely to be protected by a smoking ban in the home and car than asthmatic children living with no smokers, according to a new study (embargoed until 6 a.m. March 16) by researchers at the University of Rochester Medical Center.

The study, published in the March-April issue of Ambulatory Pediatrics, shows that the message has not reached every parent that any secondhand smoke exposure for children ??” especially those suffering from asthma ??” is detrimental to their health. Parents and caregivers may be trying to limit smoke exposure by smoking in a different room or by opening a window in the car, but these strategies aren’t very effective.

“Of course, the best case scenario is if the parents or guardians can quit smoking,” said lead author Jill Halterman, M.D., M.P.H., assistant professor at Golisano Children’s Hospital at Strong. “But that’s not always immediately possible. Another option is for parents to institute a “no-smoking” rule in the home and the car, and allow no exceptions to this rule. It is best if smokers always go outside to smoke, and this strategy may also help the parents to eventually quit.”

The study surveyed 231 parents of children with persistent and severe asthma at three Rochester pediatric practices. Almost half of the children lived with a smoker. Among all the families surveyed, only 64 percent had complete “no-smoking rules” for the home and car with no exceptions, and among the homes with smokers only 40 percent had such a rule. Children with severe asthma symptoms were no more likely to be protected by a no smoking rule than those with less severe symptoms.

Most caregivers surveyed said their health care providers asked them about smoke exposure in the home, but only 40 percent said they had been asked about exposure in the car ??” where concentration is higher than in the home ??” and few said they were offered resources to help them quit smoking.

“We, as health care providers, can do more to help parents understand better how to limit their children’s exposure to secondhand smoke. If parents are having trouble quitting, we can find them help. If caregivers want to limit their child’s exposure, we can talk about strategies to reducing exposure in the home and the car,” Halterman said.

Research for the study was funded by grants from Halcyon Hill Foundation and the Robert Wood Johnson Foundation’s Generalist Physician Faculty Scholars Program.

Contact: Heather Hare
heather_hareurmc.rochester
University of Rochester Medical Center

New Study Compares Avian Flu With A Notorious Killer From The Past

In the waning months of the First World War, a lethal virus known as the Spanish flu (influenza A, subtype H1N1), swept the United States, Europe and Asia in three convulsive waves. The year was 1918. The ensuing pandemic claimed up to 100 million victims, most of whom succumbed to severe respiratory complications associated with rapidly progressing pneumonia. Many died within days of the first symptoms.

In a new study, Carole Baskin, formerly assistant research professor at Arizona’s Biodesign Institute, currently with Science Foundation Arizona, and an interdisciplinary team of collaborators, compared the recent avian strain known in the scientific community as H5N1, with genetic ressortants of the 1918 virus – source of the most severe influenza pandemic in recorded history. The results, which appear in the latest issue of the Proceedings of the National Academy of Science, are sobering. H5N1 was found to replicate profusely within the first 24 hours, causing severe damage to respiratory tissues while sending the host’s innate immune response into a lethal overdrive, reminiscent of the trajectory of the original 1918 virus.

The threat of an avian flu pandemic hasn’t gone away and emergency preparedness efforts may be inadequate to deal with the scope of such a pandemic, were one to occur. “In order to come up with vaccines and therapies, you have to understand the disease,” Baskin stresses. “That’s why I think this type of pathogenesis study is so important.”

Although H5N1 is not readily communicable between humans, it has nevertheless killed over 400 people to date as a result of human-avian interactions, primarily in Vietnam, Thailand, China, Egypt and Indonesia, according to the World Health Organization. The mortality rate for those stricken with highly pathogenic avian influenza (HPAI) H5N1 is 63 percent. Should a series of modifications allow the virus to pass from person to person, the consequences for humankind could be catastrophic.

In the new study, Baskin and colleagues examine the host-pathogen responses to a common influenza virus and two ressortant strains of the 1918 H1N1 virus, each containing HA and NA – key surface antigens closely linked to the 1918 strain’s potent virulence. The effects of these strains on host tissues and gene expression was compared with those of a 2004 Vietnam isolate of the Highly Pathogenic Avian Influenza (HPAI) H5N1. In a non-human primate model of the disease, the avian virus was found to significantly outpace not only run-of-the-mill influenza but even the highly virulent 1918 ressortants, in terms of its relentless pathogenicity.

Ressortant viruses occur when different influenza subtypes or strains simultaneously infect the same host. A shuffling and exchange of genetic material between two or more such viruses can occur under these conditions, giving rise to new viral forms which share genetic characteristics with each parent strain but may also possess novel attributes, including heightened virulence. (Researchers borrow this ressortant technique from nature in order to create deactivated viral strains for use in yearly influenza vaccines.)

The perfect storm

Unlike typical seasonal flu which poses the greatest threat to juveniles, elderly and those with compromised immunity; the 1918 flu reserved the worst of its wrath for healthy young adults with robust immune systems. In the case of the avian H5N1 virus, statistics of human fatalities reveal a similar trend. In both cases, the highly pathogenic strains replicate rapidly and induce a massive transcription of genes associated with the innate immune response, the body’s first line of defense for combating viral challenges.

The group sought to compare the 1918 flu strain with H5N1 through a systems biology approach, pioneered by Dr. Baskin’s mentor, Michael G. Katze, Ph.D. at the University of Washington. Using this strategy, respiratory tissue was analyzed with high-throughput technologies of functional genomics, proteomics and transcriptomics to measure gene expression and regulation in fine-grained detail. Such techniques have opened a new window onto the genetic underpinnings of infectious disease.

A large number of these genes code for cytokines and chemokines – immunomodulating agents which include interleukins, interferons and other factors involved with the host’s innate inflammatory response to infection. The result of this overwhelming transcription induction, shown graphically in figure 1, is a “cytokine storm” often leading to acute respiratory distress syndrome in the viral host, while proving entirely ineffective in blunting prodigious replication of the H5N1 virus.

Respiratory tissues sampled on days 1, 2 4 and 7 post-infection were subjected to pathological, viral and microarray analysis. Although the 1918 ressortant strains were found to be highly virulent, they were outmatched by H5N1′s rapid onset, overwhelming transcription induction of cytokine and chemokine genes and headlong, sustained viral replication with wider distribution in the lungs. As Baskin notes, referring to the group’s measurements of Tissue Culture Infectious Dose or TCID over the course of H5N1′s infection, “the take home message is that for H5N1 there is hardly any viable tissue left to infect by day 7, yet there is still very strong viral replication.” Further, despite the broad and sustained upregulation of inflammatory genes, they were of no use in limiting the H5N1 infection.

While the new study found that the 1918 ressortant strains and H5N1 each attacked specialized respiratory cells called pneumocytes, the 1918 chimaraes showed preference for so-called type I pneumocytes, responsible for air exchange in the lungs. In contrast, H5N1 characteristically infects the more numerous type II pneumocytes, a critical distinction, as Dr. Baskin explains: “Basically, when you injure type II pneumocytes as opposed to type I, you impair the ability of lung tissue to repair itself. In addition, when type II are infected, they produce chemokines and cytokines, which contribute directly to the overall inflammatory response.” In this way, H5N1 delivers a devastating one-two punch to the host’s ability to recover from the infectious siege. The researchers observed that within 24 hours, H5N1 had caused severe bronchiolar and alveolar lesions in lung tissue.

H5N1′s penchant for infecting type II rather than type I pneumocytes is due to the receptor preference found in avian viruses as opposed to human viruses, (including the 1918 ressortants used in the study), which primarily attack type I cells in the lung.

H5N1′s attack on type II pneumocytes was sustained, from the point of initial infection through the 7 days of the study, as seen in figure 2. Examination of lung tissue showed widespread, prolonged replication of viruses and associated tissue destruction. “The fact that the infection of type II pneumocytes was so protracted directly contributed to the damage we saw,” notes Baskin.

Another aspect of lung function debilitated by H5N1 involves the loss of surfactants, produced by type II pneumocytes and responsible for pliability of lung tissue. Without such surfactants, breathing becomes impossible.

The final act

A further critical finding of the study is that H5N1, having swamped the innate immune response, turns its attention next to the body’s adaptive response, specifically, dendritic cells whose job it is to phagocytize protein components from the virus and present these to T cells, either locally or at the lymph nodes that drain the lungs. Normally, through this process, specific antibodies are then produced to combat the viral infection. Tissue sampling for the H5N1 found a notable absence of these dendritic cells, suggesting they were destroyed during the infection process, which would point to H5N1′s ability not only to disable the present infection but to block the body’s ability to build immunity against later infection by the same type of virus.

Baskin points out that the new research presented to PNAS has been several years in the making, supported in part by her career award from the National Institute of Infectious Disease and by a large program project grant from the same. “The study was done at Battelle Biomedical Research Center, which had the required containment level, ABSL-3ag. These facilities are very rare and in great demand.” Referring to the challenges of such complicated, long distance collaborations, she insists “you have to have just the right people to make something like this happen.”

Continuing studies of host-pathogen responses at the tissue, cellular and molecular level may provide the understanding needed to stave off a viral pandemic, whether from H5N1 or some other emergent strain. Time is critical. Currently, the anti-viral known as Tamiflu, taken before or immediately after infection, offers the only known protection against highly pathogenic avian influenza and the first Tamiflu-resistant strains have already emerged.

In terms of how many modifications would be required for H5N1 to become a highly contagious human virus, Baskin expresses concern: “There have been some estimations and it’s not a lot,” she notes. “That’s the short and simple answer.”

Carole Baskin, formerly an assistant research professor at Arizona’s Biodesign Institute, now a Program Director at Science Foundation Arizona, worked with a multidisciplinary team from Washington University, the CDC in Atlanta, Colorado State University, Battelle Biomedical Research Center in West Jefferson, Ohio, and Mount Sinai School of Medicine in New York. The research was supported by Battelle Internal Research and Development funds, and by several grants from the National Institute of Health.

Richard Harth
Science Writer
The Biodesign Institute at
Arizona State University

About the Biodesign Institute at ASU

The Biodesign Institute at Arizona State University pursues research to create personalized medical diagnostics and treatments, outpace infectious disease, clean the environment, develop alternative energy sources, and secure a safer world. Using a team approach that fuses the biosciences with nanoscale engineering and advanced computing, the Biodesign Institute collaborates with academic, industrial and governmental organizations globally to accelerate these discoveries to market. For more information, go to: biodesign.asu

Source: Joe Caspermeyer

Arizona State University

View drug information on Tamiflu capsule.

Dangers Of Global Food Security

The global food security crisis endangers the lives of millions of people, particularly the world’s poorest who live in countries already suffering from acute and chronic malnutrition.

Multiple factors are behind the crisis, including:

– rapidly increasing energy prices
– lack of agricultural sector investment
– rapidly rising demand for food arising from economic growth and higher incomes
– trade distorting subsidies
– recurrent bad weather and environmental degradation
– subsidized production of bio-fuels that substitute food production
– imposition of export restrictions leading to hoarding and panic buying

The health implications are immense, particularly in the 21 countries that WHO says suffer from acute or chronic malnutrition.

To respond to the health threats, WHO provides guidance to the UN Secretary-General’s High Level Task-Force on the Global Food Security Crisis. The Task-Force was formed in April 2008 to create and coordinate the implementation of a prioritized action plan.

WHO’s fundamental considerations are to:

– Underscore the human dimension of the crisis.
– Monitor its impact on nutrition, health and poverty, plus its effect on the Millennium Development Goals.
– Provide sound information and analyses to target the most vulnerable groups.
The consequences of inaction will be enormous for public health, and include:

– Increased malnutrition, child and maternal mortality and morbidity, and communicable diseases.
– An inability for the poorest to afford healthy food, forcing them to buy low-quality products, negatively changing dietary patterns, and increasing the burden of noncommunicable diseases.
– Less money to spend on health services because of higher food bills. This will affect greatly people living with HIV/AIDS and tuberculosis in particular.
– Likely impaired mental development, diminished learning ability, reduced work productivity, and increased prevalence of chronic disease.
– Likely increase in wasting (low weight for height) among young children, plus anaemia and other micronutrient deficiency conditions, especially among women and children.
– A delay in attaining health and nutrition-related Millennium Development Goals (1, 4, 5 and 6).

- WHO and the Global Food Crisis: The Health and Nutrition Dimensions

World Health Organization (WHO)
who.int

Smoking Ban In Enclosed Public Places In England From July 1

If you want to have a cigarette in England after July 1, make sure it is not in an enclosed public place – otherwise you will be breaking the law. As of July 1, it will be illegal to smoke in enclosed public places – offices, pubs, bars, factories and public buildings. You can still smoke outdoors and in your home.

This new law is aimed at protecting the health of the non-smoker, who allegedly risks his/her health by breathing secondhand smoke (passive smoking). Some government ministers have said they hope this new legislation will encourage many smokers to quit.

In England, just over 100,000 people die prematurely as a result of smoking. Cancer charities say countries which have imposed similar legislation have witnessed a significant drop in the number of smokers.

Not everyone is happy about this new law. Some argue that people’s civil liberties are being undermined. Others quote health figures, for example, childhood asthma – there are many more children with asthma today than there were 30 years ago, however, 30 years ago there were nearly twice as many smokers in England.

Although the smoking ban is generally popular throughout the country, some pubgoers are horrified at the prospect of not being able to light up at their ‘local’. Many say that it is more a case of victimization than common sense; why not insist on first-class ventilation systems in pubs, or allow publicans to decide for themselves whether smoking should be allowed. There are scores of non-smoking pubs throughout the country anyway, people say.

As the date looms, thousands of pubs throughout England are scrambling to have their garden smoking shack ready by Sunday (where smokers may retire to for a quick puff).

Whether or not this spells the beginning of the end of the English pub remains to be seen.

:

BLF Supports Fresh Calls To Tackle Air Pollution

The British Lung Foundation (BLF) welcomes the Environmental Audit Committee report, out today, which raises awareness of the importance of tackling air pollution in the UK.

The report says that more could be done to prevent the early deaths of up to 50,000 people each year hastened by air pollution. Furthermore, it states that failure to reduce pollution had put an “enormous” cost on the NHS and could cost millions in EU fines.

In the recent Manifesto, the British Lung Foundation calls for action to be taken to reduce the harmful emissions and improve the UK’s air quality. The report is now a step forward in highlighting the dangers of air pollution for people with lung conditions such as asthma or chronic obstructive pulmonary disease (COPD), an umbrella term for emphysema and chronic bronchitis.

Research suggests that air pollution contributes to the development of COPD and it may also play a significant role in causing other lung problems. It is estimated that 38% of the population are at risk from suffering adverse health effects from exposure to air pollution.[1]

The Environmental Audit Committee report says that the most likely victims of air pollution are those who already have a respiratory illness such as asthma or COPD. It adds ‘poor air quality reduces the life expectancy of everyone by an average of 7-8 months and up to 50,000 people a year may die prematurely; however, in pollution hotspots the life expectancy falls by 8-9 years’.

Dame Helena Shovelton, Chief Executive of the British Lung Foundation says: “We welcome this report which raises the awareness of the dangerous impact air pollution has. Air pollution has been a longstanding problem for the 1 in 7 people living with a lung condition, exacerbating and possibly even causing COPD (chronic obstructive pulmonary disease), lung cancer and other lung conditions. The British Lung Foundation is calling for more action to improve air quality and to implement initiatives that will lower harmful emissions and improve air quality.”

Notes

1.The British Lung Foundation is the only UK charity working for everyone affected by lung disease. The charity focuses its resources on providing support for people affected by lung disease today; and works in a variety of ways (including funding world-class research) to bring about positive change, to improve treatment, care and support for people affected by lung disease in the future.

2.It provides information via the website lunguk.

3.One person in every seven in the UK is affected by lung disease – this equates to approximately 8 million people

4.Respiratory disease is the second biggest killer in the UK (117,456 deaths in 2004) after all non-respiratory cancers combined which only account for slightly more deaths (122,500 deaths in UK in 2004)

5.Respiratory disease now kills one in five people in the UK

6.The UK’s death rate from respiratory disease is almost double the European average and the 6th highest in Europe

7.Respiratory disease is the most commonly reported long term illness in children and the third most commonly reported in adults. One in 7 boys and 1 in 8 girls aged 2 – 15 report having long term respiratory illness in England

Source
British Lung Foundation

Warning To Hospitals That Harmful Bacteria And Yeast Transmitted By Wet Breathing System Filters

Doctors have highlighted potential problems with the breathing system filters used in anaesthesia, including intensive care units, after demonstrating that they don’t provide protection from harmful bacteria and yeast when they become wet.

Research in the July issue of Anaesthesia has shown that when they were wet, six commonly available filters allowed substantial passage of Candida albicans (a yeast infection linked to a range of chronic illnesses) and coagulase-negative staphylococci (a common hospital-acquired bacterial infection).

“Breathing systems filters are commonly used to reduce the passage of drug-resistant respiratory infections, but current international standards only require them to prevent bacterial transfer when dry” explains Dr David H T Scott, Consultant Cardiothoracic Anaesthetist and Intensive Care Specialist at the Royal Infirmary of Edinburgh, UK.

“The current ISO standard does not replicate the circumstances in clinical practice, where filters get wet with condensed water and airway secretions. We believe that our study shows that commonly available breathing filters cannot be relied upon to prevent bacterial transfer.”

The researchers used six breathing system filters available in hospitals in Edinburgh:
three hydrophobic pleated filters designed for use as heat and moisture exchanging filters (PhobA, PhobB and PhobC)
one hydrophilic unpleated heat and moisture exchanging filter (PhilD)
two simple filters (FilE and FilF).

These were tested using suspensions of two microbes:
Candida albicans, because of its large cell unit size (12 micrometres)
coagulase staphylococcus, because it is a common organism and its cell unit size (one micrometre) is representative of a large range of potential pathogens.

“All the filters tested permitted substantial passage of bacteria and yeast” says Dr Scott. “Even in a one microlitre loop of filtered solution, the number of colony-forming units transmitted through the filters was too large to quantify.

“In most cases the bacterial cultures from filters could not be distinguished from the samples created using unfiltered bacteria.”

The authors conclude that their study shows that viable organisms pass across all types of breathing systems filters tested under conditions that may occur in clinical practice.

“In particular, simple filters required very little pressure to permit passage of microorganisms” says Dr Scott. “Although our experiment involved saturating the filters with test fluid, it provides important proof of the principle: organisms may traverse some filters very easily and even large yeasts like Candida albicans survive the passage.”

The authors are keen to point out that, although they tested six commonly available filters, the structure of gas filters suggest that products made by other manufacturers are just as likely to show the problem.

“It is important that clinicians are aware of the potential for microorganisms to pass through wet filters” says Dr Scott.

“Further studies are also required to investigate the potential for cross-contamination between patients if filters are used as the sole method of infection control in breathing systems for anaesthesia and intensive care.

“It should be pointed out that a microbe would have to make a long journey to infect a new patient by this route. Although a search of previous studies has revealed no evidence of cross-contamination relating to filter use, it could be theoretically possible in certain conditions.”

Notes:


Passage of pathogenic microorganisms through breathing system filters used in anaesthesia and intensive care. Scott et al. Anaesthesia. 65, pp 670-673. (July 2010). DOI: 10.1111/j.1365-2044.2010.06327.x

Source:
Annette Whibley

Wiley-Blackwell