Dusting Up Vehicle Emissions

Queensland University of Technology (QUT) researchers have identified a silver lining in the cloud of red dust that enveloped much of eastern Australia two years ago.

Research fellow Dr Rohan Jayaratne from QUT’s International Laboratory for Air Quality and Health (ILAQH) said that data, from what is believed to be the first air quality test undertaken during an Australian dust storm, showed that large dust particles swept up the smaller, potentially fatal ultrafine particles caused by everyday vehicle emissions.

Air quality tests taken during the September 2009 dust storm showed that Brisbane’s most harmful ultrafine particle pollution from vehicle emissions, which contain 250 well-known carcinogens, almost disappeared as the eerie orange haze settled over the city.

Dr Jayaratne’s team, led by ILAQH director Professor Lidia Morawska, said the dramatic shift in air quality was the result of a process of polydisperse coagulation whereby smaller particles, such as diesel emissions, diffuse on to the surface of larger particles, such as dust.

“We have seen this happen in the laboratory but never in an environment like this, given the very specific conditions,” he said.

“One of the reasons vehicle emissions are so scary is that the ultrafine particles are able to penetrate deeper into the lungs, in the alveoli, whereas larger particles such as dust tend to get trapped in the upper-respiratory system. Asthma is often caused by larger particles, but the finer particles are associated with long-term health issues such as cardiovascular mortality.”

The threshold for the process of polydisperse coagulation usually occurs when large dust particles reach concentrations of “a couple of hundred” micrograms per cubic metre.

On a typical day in an urban area, such as Brisbane, the dust concentration is about 50 micrograms.

However, at the peak of the dust storm in the Brisbane CBD at noon on September 23, 2009, the measured concentration shot up to 6000 micrograms per cubic metre, causing the vehicle emission particles to almost disappear.

The QUT findings were recently reported in the internationally reputed journal Atmospheric Environment.

Dr Jayaratne said he also investigated causes of severe Australian dust storms in order to predict future occurrences and believes we may see a similarly severe storm this year if dry conditions continue.

“We found dust storms in Australia usually occur after flood events, similar to what Brisbane experienced in January,” he said.

“Sediment is carried along inland rivers and settles as fine alluvial dust on the desert floor.

“If these conditions are followed by a prolonged dry season, which we have had, and the heavy winds that are characteristic in September and October, then there is every chance we will see another dust storm similar to the one we experienced in 2009.”

ASH Compares Critics Of Link Between Smoking Bans And Dramatic Heart Attack Reductions AIDS Dissidents WHo Deny Link Between HIV And AIDS

Action on Smoking and Health (UK) has, in a published (peer-reviewed) article, compared those who question the link between smoking bans and dramatic reductions in heart attacks with dissidents who deny the link between the HIV virus and AIDS.

And, in a separate article published in another journal, a different set of anti-smoking advocates (Pascal Diethelm and Martin McKee) have compared those who question the link between passive smoking and heart disease/lung cancer with those who deny the existence of the Holocaust.

In the commentary, I discuss the implications of these articles, concluding that the tobacco control movement has now become a religion. It is based solely on ideology, not science. And worse still, there is a McCarthyist-like nature to the movement, where those who question any of its doctrines are attacked, discredited, and blacklisted out of further discourse on the issue.

The commentary appears this morning in its entirety on my tobacco policy blog.

Excerpt from the commentary:

In an article published this month online ahead of print in the journal Expert Review of Pharmacoeconomics and Outcomes Research, Martin Dockrell – policy and campaigns manager for Action on Smoking and Health in London (ASH-UK) – argues that those who have questioned the causal relationship between smoking bans and dramatic, immediate reductions in heart attacks are comparable to dissidents who deny the causal link between the HIV virus and AIDS (see: Dockrell M. Eye and heart at mortal war: coronaries and controversy in a smoke-free Scotland. Expert Review of Pharmacoeconomics and Outcomes Research 2009).

Dockrell argues that the Pell et al. study, which reported a 17% decline in acute coronary syndrome cases during the first year following the implementation of a smoking ban in Scotland, is conclusive evidence of a causal relationship between the smoking ban and a dramatic and immediate decline in acute cardiac events. He further argues that anyone who disagrees with this conclusion is a denialist, similar to the AIDS denialists, and that such opinion is an orchestrated artifact of tobacco industry lobbying, rather than sincere scientific criticism of the study conclusions.

Specifically, Dockrell argues that: “Organized groups who seek to deny and discredit this work are comparable in nature and intent, but not in origin, to the self-styled AIDS dissidents who continue to deny the causal link between HIV and AIDS and offer a comparable threat to an evidence-based health policy.”

Moreover, Dockrell asserts that this dissidence is not pure: it is the result of orchestration by the tobacco industry: “While AIDS dissidence was largely an indigenous phenomenon, tobacco dissidence is the carefully conceived creature of tobacco industry lobbyists.”

Readers should keep in mind that I am in fact a major dissenter, as I have criticized the Pell et al. study (critique 1 ; critique 2 ; critique 3; critique 4 ; critique 5 ;hcritique 6) and in fact have reported follow-up data which I believe demonstrate that the conclusion from that study was wrong. I have challenged anti-smoking groups to publicize the follow-up data which show that the decline in cardiac events during the first-year after Scotland’s smoking ban was followed by an increase in cardiac events during the second year, thus disproving Pell et al.’s conclusion (post 1 ; post 2 ).

I take it this means that Dockrell is calling me a denialist and comparing me to AIDS dissidents who still deny that HIV causes AIDS. I also take it to mean that Dockrell is accusing me of being in the pocket of the tobacco companies and acting at their beck and call and presumably -their payments.

In fact, ASH-UK appears to make precisely such an accusation when it states in its press release to accompany the article: “A number of studies have been published recently showing a decline in admissions to hospital for heart attack following the implementation of smokefree laws in various countries. Many of these studies, including one on the impact of the Scottish smoking ban have also been the subject of criticism by so-called “dissidents” who claim that the research is nothing more than ‘junk’ science. In a recently published review ASH’s Director of Policy and Research, Martin Dockrell, looks behind the scenes to see what has prompted this criticism and to what extent it is justified. The analysis finds parallels with those who were in denial about the causes of AIDS long after the scientific debate was over. … We found an unholy alliance of conspiracy theorists, tobacco industry lobbyists and journalists impatient for a good story.”

Dockrell is particularly critical of Michael Blastland, who wrote a commentary published by BBC News on November 14, 2007 which presented data showing that the actual decline in heart attacks in all of Scotland in the year following the smoking ban was similar to that observed in the three years preceding the ban, and that a dramatic decline in heart attacks occurred in 2000, in the absence of a smoking ban. Based on these findings, Blastland questioned the validity of the study’s conclusion that the smoking ban was causally related to a 17% decline in acute cardiac events.

Dockrell argues in the article that Blastland is a denialist and conspiracy theorist and concludes that his criticism has been carefully conceived and orchestrated by the tobacco industry: “While AIDS dissidence was largely an indigenous phenomenon, tobacco dissidence is the carefully conceived creature of tobacco industry lobbyists.”

The Rest of the Story

This article demonstrates the religious-like and McCarthyist-like nature of the modern-day anti-smoking movement. If you do not subscribe to the accepted dogma of the movement, even when there is legitimate scientific evidence that brings that dogma into question, you are a dissident and a denialist — on no firmer ground than those who deny that AIDS is caused by the HIV virus. Moreover, you are not expressing a sincere opinion, but are in the pocket of the tobacco industry, part of an orchestrated industry campaign.

The absurdity of the article is evident in its implication that I – a strong anti-smoking advocate – am a denialist who is being orchestrated by the tobacco companies to disseminate conspiracy theories – since I myself have been a vocal critic of the conclusions of these heart attack/smoking ban studies.

Someone who has argued that secondhand smoke kills over 50,000 Americans each year and whose testimony about the tobacco industry’s deception of the public contributed towards a $145 billion verdict against the companies is hardly someone who fits the description of being a denialist who is waving around conspiracy theories under orchestration by Big Tobacco.

To be sure, historically the tobacco industry has orchestrated campaigns to undermine the public’s appreciation of the recognized hazards of active smoking and secondhand smoke exposure. If you want to read about that history, you need go only so far as to read my testimony in the Engle tobacco case, which initially resulted in a $145 billion verdict against the tobacco companies. It is also true that a number of supposedly independent scientists who have challenged the link between smoking or secondhand smoke and disease have been funded by the industry and have been part of a campaign orchestrated by the industry.

However, the criticism of the research linking smoking bans with a causal effect on acute cardiac events is largely a different story. First, the nature of the evidence is very different. While there is abundant evidence linking smoking and disease and one would have to be a denialist to argue that smoking is not harmful, the research being used to conclude that smoking bans result in huge, immediate declines in heart attacks is very weak. These conclusions are based on time trend analyses, often without a control group, they cannot adequately determine whether observed changes reflect random variation, secular trends, or a real effect of the smoking ban, and thus causal conclusions from these studies are very shaky.

I will not take the time here to explain all the methodologic weaknesses of these studies, but interested readers will find an extensive set of commentaries on my blog which critique this literature.

Perhaps the most important fact to point out here is that studies which have used national, population-based data for all of Scotland have failed to find a 17% decline in heart attacks in Scotland in the year after the smoking ban, and actually found that heart attacks increased in the second year after the ban, thus negating the earlier decline. Overall, there was little change in heart attack admissions in all of Scotland from before the smoking ban to two years after the ban.

As Christopher Snowdon explained: “Much was made of an apparent reduction in the number of patients being diagnosed with the life-threatening heart condition after the smoking ban came into effect in 2006, including a study published in the New England Journal of Medicine which claimed that the ban had caused emergency ACS [acute coronary syndrome] admissions to fall by 17%. However, official statistics show that the decline in hospitals admissions for acute coronary syndrome has been greatly exaggerated. The real decline in the first year of the smoking ban was just 7.2% – not 17% – and the rate then rose by 7.8% in the second year, cancelling out the earlier drop.”

“In the last 12 months before Scotland enacted its smoking ban (April 05 to March 06) there were 16,199 admissions for acute coronary syndrome. In the second year of the smoking ban (April 07 to March 08) there were 16,212 admissions, slightly more than there had been before the legislation was enacted.” …

“Hospital admissions for acute coronary syndrome have been declining in Scotland for many years. The new data show that the well-publicised fall in admissions following Scotland’s smoke-free legislation was in line with the existing downward trend and was significantly less steep than has previously been claimed.” … “If the 2006-07 decline had really been the result of the smoke-free legislation, it would be expected for rates to remain low in subsequent years. The fact that Scottish hospitals have seen an unusually sharp rise – despite the smoking ban being rigorously enforced – suggests that whatever lay behind the 2006-07 dip, it was not the smoking ban.”

Despite the accusation that Blastland is part of some tobacco-industry orchestrated campaign and that he nothing more than a denialist, Dockrell presents no evidence that either of these is the case. First, he fails to present any evidence showing that Blastland is being paid by Big Tobacco or that he has had any alliance, association, or communication with tobacco companies over his commentaries. Reading other articles Blastland, it appears that he is in fact not particularly focused on tobacco, but that he writes in general about many areas in which he believes that statistics have been inaccurately used to draw policy-relevant conclusions.

Second, Dockrell fails to present any evidence to suggest that Blastland’s critiques of the smoking ban studies are anything other than legitimate scientific opinions. In fact, I find Blastland’s commentary to be quite compelling and from a scientific standpoint, on much more solid ground than the Pell et al. article which was published in the New England Journal of Medicine.

The problem with the Pell et al. study is that its conclusion is based on a comparison of apples to oranges. In order to compare the change in heart attacks in Scotland from 2006-2007 to the trend in heart attacks during the preceding ten-year period, one needs to use the same data source to compare these trends. In the Pell et al. article, the researchers use one source of data to estimate the change in heart attacks from 2006-2007 (observed changes in admissions for nine hospitals representing a portion of the country) and a different source of data to estimate the trend in heart attacks from 1996-2006 (national data from the Scottish National Health Service).

A critical basis for the article’s conclusion is that the year-to-year decline in heart attacks in Scotland never exceeded 10%, while the researchers found a 17% decline in heart attacks during the year following the smoking ban. However, the relevant question is not what the national health service data show, but what changes in heart attack admissions would have been found using the same methods employed by the researchers to count heart attack admissions for 2006-2007. What would the annual changes have been using the same 9 hospitals and using the same method of counting heart attack admissions?

In contrast, Blastland presents a consistent data source for hospital admissions throughout all of Scotland for a long period of time: 1998-2007. The graph he presents illustrates that there is no visible change in heart attacks in Scotland in 2006-2007. In fact, the graph shows that the rate of decline in heart attacks in Scotland remained exactly the same as it was prior to the smoking ban.

In addition, the graph shows that there was a substantial decline in heart attacks from 1999-2000 which occurred in the absence of a smoking ban, illustrating that the magnitude of decline in heart attacks in 2006-2007 is actually less than the random variation and secular trends in heart attacks that were observed in Scotland in prior years.

Thus, rather than being denialism, Blastland’s criticism of the study is well-founded. Whether he is correct or not, there are absolutely no grounds to dismiss his criticism as being denialism, conspiracy theory, or tobacco industry propaganda being delivered by a paid hack, all of which are implied by Dockrell in his article and press release.

Action on Smoking and Health (UK) evidently views the anti-smoking movement as a religion. Any challenge to the doctrines of the religion amounts to heresy. Scientific discourse is not allowed. You have to accept everything anti-smoking researchers claim with blind faith.

ASH-UK would have the tobacco control movement turn into non-critical automatons, who merely accept, on blind faith, any research which is favorable to the cause. Science would no longer play a role. It would, in fact, become a religion rather than a science-based public health movement.

Moreover, Dockrell’s article illustrates the McCarthyist nature of the modern day anti-smoking movement. If you challenge the doctrines of the movement, not only are you viewed as a denialist, but you are automatically attacked as being a Big Tobacco hack. In other words, without any evidence, you are publicly maligned in an attempt to permanently discredit you and blacklist you from any further participation in public discourse.

Dockrell has accused Michael Blastland of being a tobacco industry hack who is not expressing his sincere scientific criticism, but instead is being orchestrated by the tobacco industry to spout out conspiracy theories. This is not only arguably defamation, but it is essentially McCarthyism. It is an attempt to permanently malign Blastland’s reputation and remove him from public discourse. And all of this solely because of the nature, not the quality, of his scientific argument.

Lest readers think that this article from ASH-UK is simply an isolated example, consider that just last week, the European Journal of Public Health published an article in which two other anti-smoking advocates – Pascal Diethelm and Martin McKee – accused all those who do not accept the causal relationship between secondhand smoke and lung cancer/heart disease as being denialists comparable to those who deny the existence of the Holocaust.

Diethelm and McKee argue that the paper by Drs. James Enstrom and Geoffrey Kabat – a meta-analysis which failed to find evidence of a causal relationship between secondhand smoke and lung cancer or heart disease – and its use by various groups is comparable to Holocaust denial.

There are many reputable scientists who have challenged the conclusion that secondhand smoke causes heart disease and lung cancer. While I disagree with their interpretation of the scientific evidence, I would never suggest that their opposing opinion is denialism and that it is comparable to Holocaust denial.

Once again, Diethelm and McKee view the anti-smoking movement as a religion. You have to accept the claims on blind faith and if you don’t, you are guilty of heresy. Even worse, you will be publicly attacked and have your character maligned in an attempt to silence you by blacklisting you out of public discourse on the issue.

The rest of the story is that the anti-smoking movement is quickly losing its science base. It is becoming a religious-like, McCarthyist-like movement which attacks and attempts to blacklist anyone who doesn’t accept the doctrines of the movement. Its personal attacks are on character, not on science, and are doled out based not on the quality of science in the opposing arguments, but the position that the dissenter has taken.

The most important implication of today’s story is that this shift in the movement is now evident not only in the informal statements of the anti-smoking groups, but in the peer-reviewed, published literature. Tobacco control as a religion, rather than as a science-based field of public health practice, is now becoming formally institutionalized.

Michael Siegel, MD, MPH
Professor
Associate Chair of Academics
Social and Behavioral Sciences Department
Boston University School of Public Health
801 Massachusetts Avenue, 3rd Floor
Boston, MA 02118
bu.edu

Development Of Resistance-Detecting Field Kit Funded By ВЈ1.1m Grant

Liverpool School of Tropical Medicine (LSTM) has been awarded a ВЈ1.1m grant by the US National Institutes of Health to lead a five year project to develop a Field Applicable Screening Tool (FAST) kit to detect resistance to public health insecticides in mosquitoes.

The two principal methods for control of malaria in sub-Saharan Africa are the use of insecticide-treated bednets (ITNs) and indoor residual spraying (IRS) of insecticides. Scientists at LSTM, the Centers for Disease Control and Prevention in the US, Ghana’s Biotechnology and Nuclear Agricultural Research Institute and Uganda’s National Livestock Resources Research Institute will be working in partnership to identify genes that render malaria-carrying mosquitoes resistant to a range of insecticides that are used for IRS and ITN. At present information on underlying resistance mechanisms of the two most important mosquito species is very limited.

Based upon this knowledge, a rapid and cost-effective DNA-based screening kit will be designed, tested and rolled out for use by control programme staff in the regions of sub-Saharan Africa where malaria and filariasis, a disabling and disfiguring condition also spread by mosquitoes, is endemic. The new screening tools will provide information vital for predicting the success of IRS and ITN programmes.

Project leader Dr Martin Donnelly, Senior Lecturer in Vector Biology at LSTM said: “Malaria control in Africa is reliant upon the use of insecticides against mosquitoes. Therefore if the mosquitoes develop high levels of resistance to these insecticides the public health impact could be devastating. We are proposing to develop DNA-based tests which are sensitive enough to detect resistance when it is at a low level and thereby enable control programme staff to take action to reduce the build up of resistance.”

The rollout of FAST kits will be facilitated in collaboration with existing programmes run by IVCC, TDR (a World Health Organisation programme for research and training in tropical diseases) and PMI (US President’s Malaria Initiative).

Source:
Billy Dean

Liverpool School of Tropical Medicine

National Achievement Award Presented To Boxing Champ, UK

A Rochdale man who transformed his life after the death of his fiancГ©, depression and serious illness and now helps underprivileged children has been recognised with a national award.

30 year old Marcus Dean has been named Fitness First New You Achiever of the Year 2008 in the prestigious awards for his amazing story and desire to help others.

In 2003 Marcus’ fiancГ© died leaving him to care for their three year old daughter. His grief led to a downward spiral involving drink, over eating, depression and the onset of two serious stomach problems.

He lost his job, his confidence, his self esteem and felt unable to look after his daughter.

But a visit to Fitness First set Marcus on the road to recovery and a new life as a successful boxer.

“I knew where Fitness First was because it was next to a takeaway I used to visit,” said Marcus who was an unfit 18 stone when he began his transformation in 2006. “I joined the Get Results programme, teamed up with personal trainer Dean Whamby and haven’t looked back.”

He said Fitness First had given him a new lease of life and within weeks of beginning his training Marcus had taken up boxing – winning his first fight and becoming the 2007 East Lancashire Champion.

“I’d always wanted to box and I’m now also working with youngsters to help them channel their energies into boxing,” he said.

Judges in the New You Achievement Awards said Marcus has shown tremendous courage and commitment to turn his life around and become a great role model for his daughter and other young people.

He won the Sport category in the awards for his boxing success together with the overall award пїЅпїЅ” and a holiday of a lifetime for him and his family.

An overjoyed Marcus said that he owed Fitness First everything. “Fitness First has given me stability, I have made so many new friends, my health is great and I love helping others.”

Marcus was one of 15 finalists in the Fitness First New You Achievement Awards and judges described his story as truly inspirational.

“Marcus is exactly what these awards set out to recognise,” said Fitness First’s managing director John Gamble. “All of the finalists had amazing stories but Marcus stood out for overcoming so many hurdles and now using his experience to help so many other people.”

Awards were also presented to Alison Grant from Dundee who shed more than 11 stone to win the Shape category, to Paul Silcock from Halifax who had two major heart attacks and fought back to fitness to win the Health Award.

The Fitness category was won by 38 year old Jacqui Goodwin from Middlesborough who has transformed her life as an overweight mother of four to become a marathon runner while personal trainer Dean Whitfield won the Staff award for his amazing fightback from near death after a car crash to become a personal trainer with Fitness First.

Pictured: Sport category – from left to right – Dean Wharmby Marcus’ personal trainer at the Rochdale club, Marcus Dean and Dr Hilary Jones Fitness First medical advisor

Marcus wins – from left to right, Dean Wharmby, Marcus and Dr Hilary

Notes

Fitness First is the largest privately owned health club group in the world with over 550 Fitness First clubs worldwide reaching over 1.7 million members. In the UK alone there are 172 Fitness First clubs with over 465,000 members. Log on to www.fitnessfirst for more information and to find a club.

Fitness First is a member of the Fitness Industry Association (F.I.A), the industry trade body which represents both private and public organisations that are involved in the fitness industry, visit fia.

Fitness First

Group Training Makes Fitness Fun For Older Adults – Classes Offer More Than Physical Benefits

In the United States, the 65-and-over population will increase to 40 million by 2010; however, around one third of these people live alone, making it difficult for them to begin and continue a personal exercise program.

Group training classes can be a fun, motivating way for older adults to stick with a fitness routine. Also, many prevalent chronic health conditions can be eased or eliminated through regular exercise.

Fitness expert Rodney Corn, M.A., spoke on the benefits and how-to’s of group training for older adults during a presentation at the American College of Sports Medicine (ACSM) 11th-annual Health & Fitness Summit & Exposition in Dallas, Texas.

Options for group training classes are numerous, from step aerobics to spinning to weight training. According to Corn, classes that offer varying skills levels are best, as they allow participants to safely accomplish routines and progress to higher levels within the same program.

“(Group classes) should be interactive, fun, and focus on necessary skills such as flexibility, coordination, balance and reaction,” Corn said. He added that instructors for group training classes should cultivate this fun atmosphere and be experienced in working with older adults.

Corn says that exercises involving dumbbells, speed ladders, rubber bands and cones can be especially effective with older adults. Agility drills to increase quickness and coordination are also beneficial.

In addition to physical benefits, Corn cited psychological and social benefits of group training for older adults, such as a heightened sense of well being, companionship with fellow trainers, and a feeling of independence.

The Summit is presented this year with the National Academy of Sports Medicine (NASM) as an educational partner.

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 International, National and Regional members are dedicated to promoting and integrating scientific research, education and practical applications of sports medicine and exercise science to maintain and enhance physical performance, fitness, health and quality of life.

acsm

Obesity, Drinking, Smoking Contribute To Risk Of Second Breast Cancers

Obesity, smoking and alcohol use increase the risk that survivors of estrogen receptor-positive breast cancer will develop the disease in the other breast, according to a study published this week in the Journal of Clinical Oncology, Reuters reports. The study examined data on 365 women with a first estrogen receptor-positive breast cancer and a second cancer in the other breast, and 726 similar subjects without the second cancer.

According to the study, a cancer survivor with a body mass index greater than 30 is 40% more likely to develop cancer in the other breast than a woman with a BMI lower than 25. The study also found that drinking seven or more alcoholic beverages weekly was linked with a 90% increased chance of developing a second cancer, compared with drinking no alcohol. Current smoking was associated with a 120% increased chance of developing a second cancer, compared with never smoking, the study found.

Lead author Christopher Li of the Fred Hutchinson Cancer Research Center in Seattle said the study shows that women who maintain healthy weights, avoid smoking and drink in moderation can reduce their risk of developing second cancers. In an accompanying editorial, Jennifer Ligibel of the Dana-Farber Cancer Institute wrote that “randomized trials of weight loss and other behavioral interventions after breast cancer diagnosis (are) needed to determine whether changes in potentially modifiable risk factors in the years after breast cancer diagnosis could help lower the risk of second primary breast cancer and other adverse events in breast cancer survivors” (Reuters, 9/9).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

Donor Kidneys From Hepatitis C Patients Needlessly Denied To Patients With That Infection

More than half of donor kidneys in the United State infected with hepatitis C are thrown away, despite the need among hepatitis C patients who may die waiting for an infection-free organ, Johns Hopkins research suggests.

In a study of national data published online in the American Journal of Transplantation, the researchers say that while outcomes are slightly worse when hepatitis C-positive patients receive hepatitis C-positive organs, the advantages of more timely transplants may outweigh the risk of waiting perhaps more than year for a hepatitis C-negative kidney.

Patients with hepatitis C-positive make up about 12 percent of the population with kidney failure, and those patients have an increased risk of death on dialysis compared with those without the virus, the study says.

“Nationwide, kidneys from infected donors are inappropriately thrown out and denied to patients in need,” says transplant surgeon Dorry L. Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine and the study’s leader. “Many transplant centers don’t use these kidneys at all, effectively consigning hepatitis C-positive patients to an average unnecessary wait of a year longer for an uninfected organ.”

That, he says, “means an extra year on dialysis, in which the risk of death is 10 to 15 percent.”

The use of hepatitis C-positive kidneys has been controversial in the past, owing in part to a 1 percent difference in one-year survival for patients who receive the infected kidneys and a 2 percent difference in three-year survival. Segev says this difference “is easily made up for by getting off dialysis sooner.”

Hepatitis C-positive kidneys rarely go to hepatitis C-negative patients because the organ would infect the recipient with the chronic liver disease.

In looking at data from more than 93,000 deceased kidney donors between 1995 and 2009, Segev and his colleagues found that hepatitis C-positive kidneys were two and a half times more likely to be discarded than hepatitis C-negative kidneys. Since 1995, more than 3,500 hepatitis C-positive kidneys were thrown away.

“That’s a lot of kidneys we could have transplanted into people who need them,” Segev says.

Meanwhile, he adds, some 4,800 hepatitis C patients got hepatitis C-negative kidneys. “Using hepatitis C-positive kidneys in people who are infected with the virus could help those with hepatitis C and also expand the organ supply for everyone.”

One-third of the nation’s transplant centers, according to the study, did not use any hepatitis C-positive kidneys for their hepatitis C patients, while 13 percent transplanted more than half of their hepatitis C patients with hepatitis C-positive kidneys.

At The Johns Hopkins Hospital, where doctors specialize in patients with hepatitis C and kidney failure, a patient with hepatitis C could likely be successfully transplanted with a hepatitis C-positive kidney within several months of being put on the waiting list, Segev says. Recipients of hepatitis C-positive kidneys waited, on average, 395 days less than those recipients who waited for hepatitis C-negative kidneys at the same transplant center, the study shows.

Other Johns Hopkins researchers on the study include Lauren M. Kucirka, Sc.M.; Andrew L. Singer, M.D., Ph.D.; R. Loris Ros, Sc.M.; Robert A. Montgomery, M.D., Ph.D.; and Nabil N. Dagher, M.D.

Source: Johns Hopkins Medicine

Couples Say Relationships Damaged By Stroke

Dr Assumpta Ryan and Hilary Thompson recently published findings from a study involving 16 married stroke survivors nine males and seven females aged between 33 and 78.

The study found that sexual relationships were significantly affected after a stroke, gender roles became blurred and feelings like anger and frustration were confounded by a lack of independence and ongoing fatigue.

Dr Ryan from Ulster’s Nursing Research Institute was co-author of the study alongside MSc student, Hilary Thompson, a Stroke Nurse Specialist within the Southern Health and Social Services Trust.

“All the participants perceived a stroke as a life-changing event. They faced a continuous daily struggle to achieve some sense of normality and that required huge amounts of physical and mental effort,” said Dr. Ryan.

Key findings from the report, which were recently published in the Journal of Clinical Nursing, included:

– Sexual relationships changed. A 35 year old female stroke survivor summed up the general feeling well.

“It’s not a husband and wife role anymore” she said. “It’s a carer and a patient and it’s not very pleasant and it’s not fair.”

– All but one of the respondents reported a reduction or total loss of sexual desire after their stroke. Some felt that this was down to medication and fear of another stroke. As one 61-year-old man told the researchers, “I want her there now as a friend but not really as my wife.”

– Most of the females lost interest in their appearance, regardless of their age. “No interest in clothes, no interest in make-up, no interest in hair. Weeks go by that I don’t even wash my hair,” said one 57-year-old woman.

– All the respondents said they had changed since their stroke and irritability, anger, agitation and intolerance were frequently mentioned. “I’m normally easy going, but now the slightest little thing sets off the temper” said a 53-year-old man.

– A lot of the survivors said their outbursts reflected their frustration at not being able to perform routine daily activities, such as making a cup of tea. One 67-year-old man said that that his wife was a “reasonably healthy person” and asked “why should she be lumbered with me?”.

– Over-protective spouses appeared to increase anger and feelings of frustration. One 78-year-old woman explained that her husband wouldn’t give her time to do the things she could still do because “he’s afraid of me falling”.

– Survivors said they felt safe and comfortable at home but were reluctant to resume social activities with their spouse because of swallowing problems, anxiety and fatigue. “I would be asked enough times but won’t go” said a 46-year-old man.

– Fatigue was a real issue for survivors and this was often associated with reduced independence and guilt. It made it difficult to plan ahead because they didn’t know how they would feel from day to day.

“There is no doubt that strokes have a profound effect on relationships and our research showed many of the physical, psychological, social and emotional issues a stroke can raise,” said Ms Thompson, who was named RCN Patient Choice Nurse of the Year 2009.

“It is important to point out that stroke can happen at any age and many of the survivors who took part in our study were relatively young. Four respondents were aged between 33 and 43, two between 44 and 54, six between 55 and 65 and four between 66 and 78. The time since their stroke ranged from two months to four years, with an average of 18 months.

“Work is currently in progress – driven by the recent Northern Ireland Stroke Strategy – throughout the province to address the gap in service provision for the promotion of long term psychological adjustment for stroke survivors and their carers.”

As a result of the study, which was part funded by Northern Ireland Chest Heart and Stroke the researchers have come up with four key recommendations for health care professionals.

Nurse education should focus on both the physical and psychosocial effects of stroke so that nurses can provide holistic care to stroke survivors and their spouses.

Health care professionals and service providers must recognise and be sensitive to the profound impact of stroke on sexuality and sexual function.

Statutory counselling services should be available to people with stroke and their spouses on both an acute and long-term basis to help them cope with the complex issues described.

Evidence-based guidance is needed to demonstrate how nurses can address the psychosocial needs of stroke survivors most effectively.

Source: Ulster University

Sleep Apnoea Frequently The Cause Of Long-Term Sick Leave And Even Loss Of Employment

People with sleep apnoea have an increased risk of needing to
take long-term sick leave or give up working completely. So concludes a
major Norwegian study on over 7,000 subjects, to be published in the
European Respiratory Journal (ERJ), the
scientific publication of the European Respiratory Society (ERS).
This finding is especially alarming since sleep apnoea, although
widespread, is little known not only to the public but also to many
doctors.

Snoring and sleep apnoea, constant fatigue and daytime sleepiness may
all point to obstructive sleep apnoea syndrome, which is caused by
repeated episodes of upper airway obstruction at night. Such
interruptions to breathing lead to fragmented sleep and a reduction
in blood oxygen levels. At least 5% of the population suffers from
the condition. In fact, specialists believe that the real figure is
likely to be much higher, and emphasise that obstructive sleep apnoea
syndrome is little known to the public and to many doctors.
Diagnosis, which can be made tentatively following discussion with
the patient, may be confirmed by the doctor by means of a
polysomnographic recording made overnight. However, this specialized
test is not applied systematically.

Sleep apnoea is more widespread among overweight patients and those
with high blood pressure, diabetes or cardiovascular disease. As many
studies have found, the condition is far from harmless. If left
untreated, it can have serious consequences: an increased risk of
death (be it from road accidents or heart disease), a considerable
reduction in quality of life, and a predisposition to diabetes,
impotence and strokes.

Yet little research had taken place to evaluate sleep apnoea’s impact
on professional life. So BГёrge Sivertsen (Department of Clinical
Psychology, University of Bergen, Norway) and his Norwegian and
Australian colleagues decided to take a closer look.

Over 7,000 subjects aged 40-45

The participants in their study, whose results are published today in
the ERJ, were recruited from within the Hordaland Health Study
(Husk), a vast epidemiological study. In total, the cohort consists
of 29,400 subjects living in the county of Hordaland in western
Norway, aged 40 to 45 when they joined the study between 1997 and 1999.
Out of 8,896 randomly selected subjects, Sivertsen and his team
retained 7,028 as participants in their study. They had all completed
a questionnaire to identify symptoms of obstructive sleep apnoea,
such as snoring or interruptions to breathing (noted by the subjects
themselves or their partners).

In parallel, the researchers recorded the frequency of episodes of
fatigue and sleepiness at work or during free time. Finally,
Sivertsen obtained data from the Norwegian national medical insurance
fund concerning long-term sick leave (over eight weeks) and permanent
health-related inability to work registered for the subjects.

Impact on work almost doubled

The results are striking: 6.3% of subjects were considered to be
affected by obstructive sleep apnoea syndrome (with a
disproportionately high number of men and people with a low
educational level), and the authors conclude that these patients have
almost double the risk (1.7 times, to be precise) of needing to take
long-term sick leave. The increase in risk is independent of the
other parameters, the team emphasises in the ERJ.

Furthermore, patients with sleep apnoea were also found to have
double the risk of needing to retire from work on health grounds. The
researchers believe this link may be partially explained by the
depressive syndromes that often accompany sleep apnoea. “Even when
all of the other variables are accounted for, obstructive sleep
apnoea syndrome remains a significant risk factor for ill-health
retirement (the relative risk is 1.92)”, Sivertsen points out.

Closer examination reveals that, of the three symptoms recorded by
the questionnaires, daytime sleepiness seems to contribute the most
to the need for sick leave and ill-health retirement. “Better
identification of sufferers and earlier treatment should
significantly reduce these socio-economic consequences,” according to
Sivertsen.

“Where a patient complains of poor sleep, doctors should thus look
for other symptoms of sleep apnoea, such as snoring, pauses in
breathing and daytime sleepiness, and if necessary send the patient
to a specialised service for polysomnographic testing,” he concludes.

TITLE OF THE ORIGINAL ARTICLE
The effect of OSAS on sick leave and work disability

About the European Respiratory Journal (ERJ)

The European Respiratory Journal is the peer-reviewed scientific
publication of the European Respiratory Society (more than 8,000
specialists in lung diseases and respiratory medicine in Europe, the United
States and Australia).

European Respiratory Journal

More Effective Method Of Predicting Lead-Poisoning Risk

As health departments across the United States seek a better way to determine which children should be tested for lead poisoning, a method created by Michigan State University scientists has proven to be more accurate and cost-effective than current strategies.

In 2009, the Centers for Disease Control and Prevention recommended an end to universal testing for children on Medicaid as long as state and local health departments are pursuing other methods of assessing the risk of elevated blood lead levels. The existing strategy relies primarily on Medicaid status and classifying ZIP codes as high or low risk.

The MSU risk assessment – based on a decade of research – is considerably better, according to an article in the March-April issue of the journal Public Health Reports by Stan Kaplowitz and Harry Perlstadt, MSU professors of sociology, and Lori Post, a former MSU researcher now at Yale University.

“The key benefit of our method is that it identifies even more of those children who need testing and will lead to fewer unnecessary tests,” said Kaplowitz, principal investigator on the project. “Hence it will improve the health of children and families at less cost to the taxpayers.”

The researchers created risk scores for more than 500,000 children in Michigan who were tested for lead poisoning from 1998 to 2005. The scores are based on race, Medicaid eligibility and statistics about the socio-demographic characteristics and age of the housing in the child’s neighborhood. The researchers found that their scores would have been better predictors of whether a child should be tested than the criteria used by universal testing.

If Michigan health officials had used the researchers’ risk assessment, the method would have saved about $153,000 between 2002 and 2005 by not having to administer thousands of tests that came up negative, the researchers say. At the same time, the new method would have suggested testing even more of those who had elevated blood lead levels than did the old method.

To implement the method, parents or medical providers in Michigan use a specialized Web site. They input a child’s address, Medicaid eligibility and race, and immediately are provided with a highly reliable assessment of whether the child’s lead-poisoning risk is high enough to merit a blood test.

The Web site was developed in cooperation with the Michigan Department of Community Health and funded by the CDC. The site currently is being updated and should be operational again this summer, Kaplowitz said.

Under the 2009 regulations, states may continue to test all Medicaid children or develop objective criteria to determine which populations should be tested.

“We believe our method could be used by other states,” Perlstadt said. “We already had one inquiry about the feasibility of doing this, and our article was widely distributed to public health employees in another.”

Some 250,000 U.S. children under the age of 6 have blood lead levels greater than 10 micrograms of lead per deciliter of blood, the level at which CDC recommends public health actions be initiated. If undetected, lead poisoning can cause permanent developmental disabilities, brain damage and even death.

Children in the United States absorb lead primarily by ingesting chips or dust from lead paint. This occurs either when the paint deteriorates or from household remodeling projects. Another source is lead contamination found in water and soil.

Source:
Stan Kaplowitz
Michigan State University