Stop Flu At School Vaccination Clinics Begin, Hawaii

Just in time for the flu season, the Hawai’i State Department of Health (DOH) this week began administering free flu vaccine to thousands of Hawai’i elementary and middle school students statewide through the Protect Hawai’i’s Keiki: Stop Flu At School program. Three hundred thirty-eight school clinics are scheduled between October and December 2008.

More than 60,000 children are signed up to receive flu vaccine this fall through the program. Of participating students, approximately 53,000 attend public schools. Additionally, close to 7,000 teachers and school staff will receive the flu vaccine, pushing the total number of vaccinations near 70,000.

“We hope this program helps to remind everyone about the importance of getting their seasonal flu vaccine this year,” said Health Director Dr. Chiyome Leinaala Fukino. “The students and faculty participating in this program are a great example for all of us. Getting the flu vaccine is everyone’s best protection against the flu.”

“Following the success of last year’s program, we are excited to be offering the free flu vaccine to elementary and middle school students at their schools,” said Patricia Hamamoto, superintendent of Hawai’i public schools. “We anticipate that participation in the Stop Flu at School program will translate into fewer sick days and more quality learning time in the classroom.”

According to recent studies, school children vaccinated against flu have fewer illnesses, fewer absences from school, and lower rates of illness in their families during flu season, compared with unvaccinated children.

“We are encouraged so many parents and caregivers are taking advantage of this program so we can counter one of the biggest sources of flu transmission in our communities,” said State Epidemiologist Dr. Sarah Y. Park. “Our goal is to continue to build on this program in order to make our communities stronger and healthier.”

Stop Flu at School partners include the Hawai’i State Department of Health, Hawai’i State Department of Education, Hawai’i Association of Independent Schools, and Hawai’i Catholic Schools with support from the U.S. Centers for Disease Control and Prevention, Hawai’i chapters of the American Academy of Pediatrics and American Academy of Family Physicians, the Hawai’i Medical Reserve Corps, the University of Hawai’i Nursing Program, the Hawai’i Pacific University Nursing Program, UH Hilo Nursing Program, Kaua’i Community College Nursing Program, Maui Community College Nursing Program, MedImmune, Sanofi Pasteur, Kaiser Permanente, and the Hawai’i Medical Service Association (HMSA).

Information about the program for parents and caregivers is available online at stopfluatschool or by calling Aloha United Way’s 2-1-1 hotline.

Judy Kern
Communications Office
Hawai’i State Department of Health

Research Carried Out In Mice Will Contribute To The Study Of Hereditary Diseases That Lead To Blindness

Researchers of the University of Granada (Spain) have used a technique consisting of the induction of neuronal degeneration neuronal for intense light exposure in the mouse’s retina that will be helpful for the study of retinitis pigmentosa (RP), a group of hereditary diseases which lead to blindness and affect more than one million persons a year all over the world. In addition, the results of this research work could be very useful for the detection of new factors or molecules originated by microglial cells and related to degenerative processes of the retina.

The doctoral thesis of Ana Mar?­a Santos Carro, researcher of the Department of Cell Biology of the University of Granada, is based on the study of microglial cells, a type of cell of the Nervous System that develop a phagocytic or purifying role against damages or infections in such system. Her work has analysed the distribution of microglial cells in la retina of the mouse during all its development, both embryonic and postnatal and adult, and has studied the response of these cells to a neurodegenerative process induced in the retina by intense light exposure.

Parkinson’s and Alzheimer’s

The researcher of the UGR insists that “it is important to get to know the response of the microglial cells against neurodegenerative, because such cells are practically involved in all the diseases and damages of the nervous system, including Parkinson’s and Alzheimer’s, and knowing their behaviour in pathologic situations could be helpful in the design of therapeutic strategies”.

Microglial cells are the resident population of macrophages in the central nervous system (CNS) and play a relevant role in the immune defence. The research group of the UGR “Embryology of the Nervous System” has been studying for years the origin, distribution and migratory characteristics of these cells, both in situations of normal development of the healthy CNS and in response to damages or injuries using as a model of study the retina of birds and mammals.

The doctoral thesis of Ana Mar?­a Santos Carro has been supervised by Professors Miguel ??ngel Cuadros Ojeda, Julio Navascu?©s Mart?­nez and Jos?© Luis Mar?­n-Teva.

Part of the results of this research work has been recently published in the specialized Journal of Comparative Neurology. Likewise, some of the results obtained have been presented in oral communications and posters in different national and international scientific meetings: VIII European Meeting on Glial Cell Functions in Health and Disease (Londres), VII European Meeting on Glial Cell Functions in Health and Disease (Amsterdam), IV Meeting of the Spanish Glial Network (Madrid), etc.

Ana Mar?­a Santos Carro

University of Granada

Folate Deficiency Is Associated With A Three-Fold Increased Risk Of Dementia

Among elderly people, lower levels of folate can be associated with a
three-fold increase in risk for dementia, claims a study published in
the Journal of Neurology, Neurosurgery, and Psychiatry,
part of the British Medical Journal Specialist Journals, on February 5,

Folate, vitamin B12, and the protein homocysteine are involved in
reactions that are needed to produce several chemicals, including some
neurotransmitters, lipids, and nucleotides. Previously, studies have
shown a link between deficiencies in these chemicals and the prevalence
of dementia, however, the results have been controversial because of
the physical changes dementia often creates. High levels of
homocysteine have also been associated with cardiovascular disease.

In this study, the researchers followed 518 people over 2 years
(2001-2003), tracking the development of dementia within the
population. All participants were more than 65 years old and lived in
one rural or one urban area in the south of the country. To do this, at
the beginning and the end of the two year period, validated tests were
run to test for any dementing illness. Additionally, blood tests were
taken to assess folate, vitamin B12

blood tests were taken to assess levels of folate, vitamin B12, and
homocysteine levels, and the changes with time were observed. At the
beginning of the period, almost one in five participants showed high
levels of homocysteine, almost the same had low levels of vitamin B12,
and 3.5% were deficient in folate. Higher levels of folate were
associated with higher vitamin B12 levels and lower homocysteine.

At the end of the study, 45 of the participants had developed dementia.
Of these, 34 had been diagnosed with Alzheimer’s disease, seven with
vascular dementia, and four with “other” types of dementia. Dementia
showed more prevalence in older patients, in the relatively uneducated,
the inactive, and those with deposits of the protein ApoE.

Dementia onset was more likely in those who were older, relatively
poorly educated, inactive, and had deposits of ApoE, a protein
associated with the breakdown of lipids. It was also much more likely
in those whose folate levels fell further over the two years while
homocysteine levels increased. Individuals with folate deficiency at
the start of the study were at risk for dementia almost 3.5 times more
than others.

This suggests, according to the authors, that changes in micronutrients
such as folate could be linked with the other typical signs that lead
up to dementia, such as weight loss and low blood pressure. Weight loss
could indicate a dietary change in quality or quantity of food intake,
but it is unlikely to itself change the levels of micronutrients in the

Changes in folate, vitamin B12 and homocysteine associated
with incident dementia
J-M Kim, R Stewart, S-W Kim, I-S Shin, S-J Yang, H-Y Shin, J-S Yoon
Journal of Neurology, Neurosurgery, and Psychiatry
doi 10.1136/jnnp.2007.131482
Here For Abstract

Anna Sophia McKenney

Misfolded Protein Clumps Common To Dementia, Lou Gehrig’s Disease, Discovered By Researchers

Scientists have identified a misfolded, or incorrectly formed, protein common to two devastating neurological diseases, frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), according to a report in the Oct. 6, 2006, issue of Science. The findings suggest that certain forms of FTD, ALS and possibly other neurological diseases might share a common pathological process.

Virginia Lee, Ph.D., and John Trojanowski, M.D., Ph.D., of the University of Pennsylvania, led an international team of scientists in this discovery. The work was funded by the National Institute on Aging (NIA), part of the National Institutes of Health (NIH), and was done at the NIA-funded Alzheimer’s Disease Center at the University of Pennsylvania School of Medicine Institute on Aging.

“This exciting basic science discovery provides the first molecular link between a dementia–FTD–and a motor neuron disease–ALS. It will advance understanding of the pathological processes of FTD and ALS, and possibly of other neurological disorders,” says NIA director Richard J. Hodes, M.D. Improved understanding of underlying disease processes is critically important in pointing researchers toward the development of therapies for FTD, ALS and other neurodegenerative diseases, Hodes and the study authors note.

FTD affects the frontal and temporal lobes of the brain. People with FTD may exhibit uninhibited and socially inappropriate behavior, changes in personality and, in late stages, loss of memory, motor skills and speech. After Alzheimer’s disease, it is the most common cause of dementia in people under age 65.

ALS is a progressive disease of brain and spinal cord motor neurons that control movement. Over time, walking, eating, speaking and breathing become more difficult in this fatal disease. Some people with ALS also have FTD, and some with FTD also develop ALS, suggesting that common mechanisms might underlie these two diseases.

In certain neurodegenerative diseases, including ALS and some forms of FTD, scientists have identified clumps of protein–or inclusion bodies–that accumulate in brain cells and neurons. However, understanding why they form and what they contain has been elusive. Lee and Trojanowski have long sought to solve that mystery.

Following years of research, they have now identified TDP-43 as a constituent part of the clumps that form in ALS and in the most common form of FTD. Although its precise role is not well understood, TDP-43 is involved in the complex process of transcribing and regulating genetic information in the nucleus of the cell.

“There is much more to learn about how this nuclear protein is clumped in the cytoplasm of cells and about the mechanism by which it is implicated in two distinctly different diseases,” says Stephen Snyder, Ph.D., program director, etiology of Alzheimer’s disease, NIA Neuroscience and Neuropsychology of Aging Program. “It is possible that the TDP-43 protein will be a key to a more complete understanding of both FTD and ALS.”

NIA leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people, including Alzheimer’s disease and age-related cognitive decline. For information on dementia and aging, please visit the NIA’s Alzheimer’s Disease Education and Referral (ADEAR) Center at nia.nih/alzheimers. For more general information on research and aging, go to nia.nih/.

The National Institutes of Health (NIH) — the nation’s medical research agency — includes 27 institutes and centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nih/.

Reference: M Neumann et al. Ubiquinated TDP-43 in Frontotemporal Lobar Degeneration and Amyotrophic Lateral Sclerosis. Science DOI: 10.1126/science.1134108 (2006).

Contact: Linda Joy

NIH/National Institute on Aging

MSF Calls On Gilead To Increase Access To Reduced-Cost Viread

The international aid organization Medecins Sans Frontieres on Tuesday said Foster City, Calif.-based Gilead Sciences has not met its pledge to provide its antiretroviral drug Viread at reduced costs to programs in developing countries, the AP/South Florida Sun-Sentinel reports (Elias, AP/South Florida Sun-Sentinel, 2/7). The company in December 2002 announced that it would offer Viread, known generically as tenofovir, at-cost to all African nations and 15 other developing countries under its Gilead Access Program. The initiative allows qualified programs to purchase the drug at a lower price (Kaiser Daily HIV/AIDS Report, 3/18/05). Gilead later expanded the program to 97 developing countries, and in August 2005 the company announced it would lower the prices of Viread and its antiretroviral Truvada by 31% and 12%, respectively, for the access program. The company said the not-for-profit price of a 30-day supply is $17 for Viread and $26.25 for Truvada (Kaiser Daily HIV/AIDS Report, 8/31/05). According to MSF, Viread currently is available in six countries — the Bahamas, Gambia, Kenya, Rwanda, Uganda and Zambia. The drug also is approved for use in Botswana, the Democratic Republic of the Congo, Namibia and Ghana, Gilead spokesperson Amy Flood said. She added that the company has submitted applications for the drug to be approved in 48 countries. “The process for regulatory approval has proven to be more time-consuming than we anticipated,” Flood said, adding, “In some countries, our application has been pending for more than two years” (Bloomberg/Inside Bay Area, 2/8). However, Alexandra Calmy an HIV/AIDS specialist for MSF’s Campaign for Access to Essential Medicines, in a release said, “[O]ther than issuing press releases and empty promises, [Gilead] has done little to ensure that the medicine is available to those who need it most in developing countries.” According to MSF, Gilead did not complete its application to distribute Viread in South Africa until November 2005, almost three years after it originally announced the program (MSF release, 2/7). Flood said the program to date has provided reduced-cost antiretrovirals to about 20,000 HIV-positive people, adding, “This is a commitment that Gilead takes very seriously” (AP/South Florida Sun-Sentinel, 2/7).

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

View drug information on Viread.

Asthma Hits Black Patients Worse, Not Matter What The Disease Severity Is

Hospitalization or a visit to the emergency department is more likely for black patients with asthma than for white patients, regardless of what the managed care settings are, according to an article published in Archives of Internal Medicine (JAMA/Archives), September 24th issue.

As background information, the authors explain that black patients who suffer from asthma have worse control of their symptoms and are more likely to be hospitalized than white patients. The reasons could be differences in access to good health care, lower socioeconomic status, behavioral, genetic, environmental, poor communication between patient and doctor, and racial bias among doctors. Prior studies had found that even when such variables as socioeconomic status were factored in the racial disparities in asthma outcomes persisted.

Sara E. Erickson, M.D., of the University of California, San Francisco, and team looked at 678 patients from a large health plan who had been hospitalized for asthma during the period 2000-2004. After they had been discharged the patients were interviewed – the aim was to find out about their disease and what impact it had on their lives, health status and socioeconomic status. By drawing on information from the US Census, the researchers were also able to retrieve socioeconomic data from within one block of each patient’s home. To find out how many patients were re-hospitalized or had to visit an emergency room after the interviews, they were followed up for a median of 1.9 years.

Of the 678 patients, 154 were black and 524 were white. Despite there being no difference in asthma severity, physical health status or controller medication use, the black patients were much more likely than the white ones to have had outpatient visits because of their asthma during the follow-up. 35.7% of black patients and 21% of white patients visited the emergency department for asthma symptoms. Hospitalization rates post follow-up were 26.6% for blacks and 15.3% for whites. Even when socioeconomic status and differences in asthma therapy were taken into account, the figures persisted, say the authors.

The researchers wrote “The reasons underlying the racial disparities observed in this study are not clear, although they are likely to be complex.” As knowledge of the racial disparities regarding asthma is widespread, perhaps doctors are more likely to encourage black patients to seek emergency care. Also, for the same reason, maybe emergency room doctors might be more likely to admit (hospitalize) blacks, the authors write.

They conclude “Even in a health care setting that provides uniform access to care; black race was associated with worse asthma outcomes, including a greater risk of emergency department visits and hospitalizations. These findings suggest that genetic differences may underlie these racial disparities.”

Archives of Internal Medicine


Hopkins emergency physician warns of post-hurricane disease and illness

A Johns Hopkins emergency physician who spent the past five weeks working on public health issues in the Gulf Coast region following hurricane Katrina warns that the disaster’s potential for wreaking havoc and damage to people’s health may continue for months after the hurricane has passed.

In an editorial published this month in The New England Journal of Medicine, Thomas Kirsch, M.D., M.P.H., an assistant professor and director of emergency operations at The Johns Hopkins University School of Medicine, reports that large numbers of displaced people are at increased risk of infectious diseases, such as chicken pox, gastroenteritis, scabies and influenza, which can spread quickly in disaster shelters. In these confined quarters, Kirsch says, crowded and poor sanitary conditions, including limited access to clean water and insufficient numbers of toilets, help spread disease from person to person.

However, Kirsch notes that people with chronic health conditions face the biggest threats by far, lacking immediate access to their routine medical services for hemodialysis, or access to medications for diabetes, heart disease, HIV or tuberculosis.

Kirsch, who went to the Gulf Coast area to conduct medical needs assessments for the American Red Cross, says constant monitoring and surveillance are required to contain disease outbreaks. More importantly, he adds, improving the current public health care system so that it is strong enough to prevent disease through mass vaccinations and large enough to survive a natural disaster is the best means of guarding population health.

David March
Johns Hopkins Medical Institutions

Greater Risk For Cardiac Stress On Airline Flights For People With Obstructive Sleep Apnea

People with severe obstructive sleep apnea (OSA) on commercial airline flights may have a greater risk of adverse events from cardiac stress than healthy people, according to new research presented at the American Thoracic Society’s 2008 International Conference in Toronto.

The researchers compared oxygen levels and ventilation of healthy people and people with severe OSA during simulated flight conditions replicating the oxygen and pressure levels of typical commercial flights that have “cabin altitudes” (a measure of the air pressure and oxygen) ranging from 6,000 feet and 8,000 feet – the maximum allowed, even if the airplane is flying at 30,000 feet. This is the first study to use these measurements to assess fitness to fly without supplemental oxygen.

“It is normal for the rate of breathing to increase when air pressure falls. We predicted that patients with OSA would have a much sharper fall in oxygen levels because they might not increase their breathing as much,” said Leigh Seccombe, M.Sc., senior scientist in the Department of Thoracic Medicine at Concord Repatriation General Hospital in Sydney, Australia. “And in fact, we found that patients with OSA do have a lower blood oxygen level before and during aircraft cabin condition stimulation, but that the change in oxygen was similar. We also found that their breathing intensity increases at about the same rate as it does in healthy people.”

But what was different was the physiological stress and demand for oxygen was increased in people with OSA. “In short, the work they do to run the core range of body functions (heart, lungs, brain) is much greater under cabin conditions,” explained Ms. Seccombe, who is currently part of a group working on a consensus statement which will help guide respiratory physicians as to whether their patients are at risk from air travel.

“We addressed OSA because it is becoming so much more common as obesity increases and there are greater numbers of obese passengers on commercial flights,” said Ms. Seccombe. “Half of the patients with OSA would require supplemental oxygen in-flight if current guidelines (for those with lung disease) were strictly followed if these results are typical.”

Source: Keely Savoie

American Thoracic Society

Smokers Consuming Both Marijuana And Tobacco Have An Increased Risk Of COPD

A study in CMAJ reports the risk of respiratory symptoms and chronic obstructive pulmonary disease (COPD) increases when smoking both tobacco and marijuana. The increased risks however were not linked when smoking marijuana only.

The study differed from others since the population involved was older, and the incidence of tobacco smoking was lower in the 878 participants all from Vancouver, Canada aged 40 or over. The research was part of Burden of Obstructive Lung Disease (BOLD) Initiative that aims to find out the incidence of COPD in adults over 40 years old in the general population.

COPD is identified by diseased lungs and narrowed airways and linked to a high death rate.

Smokers were defined by the authors, as people having reportedly smoked at least 365 cigarettes in their lifetime and individuals who reported having smoked only marijuana.

The increased risk was linked with tobacco smoking. For smokers of both tobacco and marijuana the risk of developing respiratory symptoms was 2.5 higher and 3 times higher of having COPD as defined by spirometric testing.

“We were able to detect a significant synergistic effect between marijuana smoking and tobacco smoking,” explains Dr. Wan Tan, University of British Columbia and St. Paul’s Hospital and collaborators. “This effect suggests that smoking marijuana (at least in relatively low doses) may act as a primer, or sensitizer, in the airways to amplify the adverse effects of tobacco on respiratory health.”

The limitations of the research were restricted to the available information on the potential differences in marijuana strength, on the variations in inhalation and the number of smokers who mix both substances in the same cigarette.

In an associated observation, Dr. Donald Tashkin, University of California Los Angeles (UCLA) says “the findings of Tan and colleagues add to the limited evidence of an association between marijuana use and COPD because their study focuses on an older population (aged 40 or older) that is at greater risk of COPD.” Earlier studies were unsuccessful in discovering an additive effect of marijuana and tobacco on either chronic respiratory symptoms or abnormal lung functions in younger smokers. Dr. Tashkin remarks that “we can be close to concluding that marijuana smoking by itself does not lead to COPD.”

However, Dr Wan Tan and colleagues write in conclusion that “Although our study had insufficient power to show an association between marijuana alone and increased risk for COPD, it remains uncertain whether marijuana by itself is harmful for the lungs. Larger studies are needed to address this critically important issue in the future.”

“Marijuana and chronic obstructive lung disease: a population-based study”
Wan C. Tan, MB, Christine Lo, BSc, Aimee Jong, BSc, Li Xing, MSc, Mark J. FitzGerald, MB, William M. Vollmer, PhD, Sonia A. Buist, MD PhD, Don D. Sin, MD MPH for the Vancouver Burden of Obstructive Lung Disease (BOLD) Research Group

CMAJ ??? April 14, 2009; 180 (8). doi:10.1503/cmaj.081040.

Stephanie Brunner (B.A.)

Pets On Planes Campaign Wraps Up After Thousands Call For Action

The Lung Association released the following statement with regards to their campaign to ban pets on board airplanes:

“Since July 2009, thousands of Canadians from across the country have joined our campaign to ensure pet-free flights from Canada’s major airlines. While Air Canada and WestJet continue to be uninterested in protecting the health of those with asthma, COPD, lung cancer and severe pet allergies, the House of Commons Standing Committee on Health has heard the concerns expressed. Committee Vice-Chairs Joyce Murray (L-BC) and Judy Wasylycia-Leis (NDP-MB) have agreed to move this issue forward when the Standing Committee resumes sitting next week.

Unfortunately, the voices of thousands of Canadians could not sway Committee Chair Joy Smith. However, we are confident that once hearings are called on this issue, she will see the public health merits in taking action to protect air passengers and crew who suffer from asthma, COPD, lung cancer and severe pet allergies. Ms. Smith has previously committed to being a strong ally in the fight to improve lung health in Canada, and this issue provides her with an opportunity to demonstrate that.

The Lung Association thanks all those Canadians who took part in this important public health effort. You made your voices count and we thank each of you for doing so.”

The Lung Association