Smokeless Tobacco Use Declining Among Professional Baseball Players – Study Links Steady Decline In Use And Prevalence Of Oral Lesions

Fewer professional baseball players are using smokeless tobacco, and consequently reporting fewer unhealthy oral conditions. A 10-year study of a professional baseball club links the two factors, noting that changes in league rules regarding tobacco and regular education and support for tobacco cessation programs may explain the declining use. The study is the first to report annual data on smokeless tobacco use and its harmful effects on professional baseball players over this length of time. It is published in the July issue of Medicine & Science in Sports & Exercise®, the official journal of the American College of Sports Medicine (ACSM).

Smokeless tobacco (also called “spit tobacco”) has long been associated with baseball and its professional athletes. To gauge whether patterns of use and negative health effects change among this high-risk group, researchers performed 2,266 mouth examinations on players and management of the Pittsburgh Pirates baseball club during spring training camps from 1991 to 2000. The average sample size of participants ranged from 190 to 259 annually.

The prevalence of smokeless tobacco use declined from 41 percent (year one) to 25 percent (year 10). Tobacco users were likely to possess oral leukoplakia (lesions or patches in and around the mouth that can progress to oral cancer), but as the overall prevalence of smokeless tobacco use fell, the presence of these lesions declined in this entire player population (from 22 to 9 percent).

“Over the course of our study, a significant number of the players expressed a desire to quit using smokeless tobacco. The percentage wanting to quit almost doubled from 29 percent in 1991 to 52 percent in 2000,” said Keith Sinusas, M.D., the study’s lead author. “We believe that the behavior change was a result of league rules enforced at the minor league level plus education and support for tobacco cessation that resulted in this decade-long trend.”

Researchers pointed out that their study reached more than 90 percent of the men in these specific training camps, with 20 to 25 percent new participants each year due to high turnover rates in the league by trade, retirement, and release of contracts.

In 1986, the U.S. Surgeon General designated a clear association between smokeless tobacco use and oral cancers. Previous studies and surveys have shown a relationship between baseball players and a high prevalence of conditions such as oral lesions, gum disorders, and nicotine dependence. Smokeless tobacco use also has been implicated in the development of coronary artery disease, peripheral vascular disease, hypertension, peptic ulcers, and fetal mortality and morbidity.

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 advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

Medicine & Science in Sports & Exercise® is the official journal of the American College of Sports Medicine, and is available from Lippincott Williams & Wilkins at 1-800-638-6423.

American College of Sports Medicine

Bush Repeats Pledge to Veto Legislation That Loosens Restrictions on Embryonic Stem Cell Research

President Bush on Tuesday at a news conference in the White House Rose Garden repeated his promise to veto legislation… (S 471/HR 810) that would loosen restrictions on federal funding for human embryonic stem cell research, the Los Angeles Times reports (Wallsten/Chen, Los Angeles Times, 6/1). The measure, which the House approved 238-194 last week and the Senate is expected to approve soon, would expand federal funding for embryonic stem cell research and allow research using stem cells derived from embryos originally created for fertility treatments and willingly donated by patients. The bill would not allow federal funding for embryonic stem cell research on stem cell lines or embryos created expressly for research purposes. The current embryonic stem cell research policy allows federal funding for the research only when the cells are extracted from stem cell lines created on or before Aug. 9, 2001, the date that President Bush announced the policy. However, critics of Bush’s policy have said that the available stem cell lines are not biologically diverse, are contaminated with nonhuman material and are useless for research into possible cures for degenerative diseases (Kaiser Daily Reproductive Health Report, 5/31).

Bush Comments
Bush on Tuesday recommended that unused embryos created for fertility treatments be given to couples seeking to become pregnant instead of being used for stem cell research, LifeNews reports (Ertelt, LifeNews, 5/31). However, Bush “sidestepped” a question about what should be done with embryos that are created at fertility clinics but not implanted, according to the Times (Los Angeles Times, 6/1). As of May 2003, approximately 400,000 unused frozen embryos were being stored at U.S. fertility clinics (Kaiser Daily Reproductive Health Report, 5/31). “I understand the folks that are deeply concerned for their — a child who might have juvenile diabetes,” Bush said, adding, “I know that the moms and dads across the country are in agony about the fate of their child. And my message to them is that there is research going on and hopefully we’ll find the cure. But at the same time, it’s important in the society to balance ethics and science” (Los Angeles Times, 6/1). Bush said he does not want to use federal funding “to destroy life in order to hopefully find a cure for terrible disease,” adding, “I stand strong on that, to the point where I’ll veto the bill as it now exists” (White House release, 5/31).

“Reprinted with permission from kaisernetwork kaisernetwork. You can view the entire Kaiser Daily Reproductive Health Report, search the archives, or sign up for email delivery at www.kaisernetwork/dailyreports/repro The Kaiser Daily Reproductive Health 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.

Research Aimed At Reducing Strokes In Children With Sickle Cell Disease Funded By $1.5M Grant

A researcher from the biomedical engineering department operated by Georgia Tech and Emory University has received a $1.5 million NIH Director’s New Innovator Award to support a project aimed at reducing the incidence of stroke in children with sickle cell disease. Manu Platt, an assistant professor in the Wallace H. Coulter Department of Biomedical Engineering, will use the National Institutes of Health (NIH) funding to develop models for identifying which children with the disease are at risk for stroke.

The first case of sickle cell disease was identified in 1910 and today it affects more than 70,000 Americans. It is seen mostly in persons of African descent, but also in individuals of Middle Eastern, Mediterranean, Central and South American, and Asian Indian heritage. Approximately 10 percent of children with sickle cell disease suffer a stroke. Having experienced one stroke, they are at high risk of having another.

“Current therapies to prevent strokes in children with sickle cell disease have substantial side effects, so we need to create better ways to predict which patients need intervention,” said Platt, who is also a Georgia Cancer Coalition Distinguished Cancer Scholar. “My goal is to use experimental and clinical data to develop a mathematical model for predicting stroke risk in pediatric patients with sickle cell disease to allow for earlier intervention.”

Now in its fourth year, the 2010 NIH Director’s New Innovator Awards will support 52 exceptionally creative new investigators who propose highly innovative projects that have the potential for unusually high impact.

“NIH is pleased to be supporting early-stage investigators from across the country who are taking considered risks in a wide range of areas in order to accelerate research,” said Francis S. Collins, M.D., Ph.D., director of the National Institutes of Health. “We look forward to the results of their work.”

Platt’s research project will integrate cell biology, clinical pediatric hematology, enzyme kinetic modeling and dynamics, predictive statistical regression modeling, biomechanics, tissue remodeling and personalized medicine.

“Successful integration of all these areas would significantly advance the diagnosis and therapeutic intervention of strokes in children with sickle cell disease in a way that has not been seen in the one hundred years since this disease was first identified,” said Platt.

The disease hits close to home for Platt, whose brother was recently diagnosed with sickle cell trait — meaning he inherited a sickle cell gene from one of his parents and a normal gene from the other. In Georgia, one in every 1,300 children is born with sickle cell disease.

Sickle cell disease is a genetic condition present at birth. It involves an altered gene that produces abnormal hemoglobin — the protein that carries oxygen in the blood. In sickle cell disease, red blood cells become hard, sticky and “C” shaped. Sickle cells die early, which causes a constant shortage of red blood cells.

The abnormal cells also clog the flow in small blood vessels, causing chronic pain and other serious problems such as infections and acute chest syndrome. Strokes, however, occur in large arteries with high blood flow rates and other biomechanical parameters known to cause plaque formation in atherosclerosis. The damage caused by sickled red blood cells in the arteries and links to remodeling of the arteries have not been extensively studied.

To understand the coordination of the mechanisms that produce structural changes in the arterial wall leading to stroke, Platt plans to model sickle cell disease from the molecular level to the human level based on clinical data, novel biomarkers and patient outcomes. First, he plans to develop a quantitative model that will detail the activation and inactivation of proteases — enzymes that break down proteins — in the artery walls of individuals with sickle cell disease.

“I will focus on incorporating different cathepsins, elastin and collagens into the model,” said Platt. “I plan to use an assay recently developed in my laboratory that reliably detects and quantifies mature cathepsins using a technique called gelatin zymography.”

After determining which proteases play a role in sickle cell disease, Platt will then determine how biomechanical conditions of sickle cell disease, such as altered blood flow and red blood cell stiffness, affect cell-mediated remodeling of arteries by these proteases. This will be done in collaboration with Coulter Department professor Gilda Barabino. With this information, Platt can link quantitative measures of blood flow and inflammatory markers found in sickle cell disease to the narrowing of artery openings and associated protease remodeling.

These markers will first be validated with animal models of sickle cell disease, in collaboration with Solomon Ofori-Acquah, an assistant professor of pediatrics at Emory University and the Children’s Healthcare of Atlanta Aflac Cancer Center and Blood Disorders Service. Further validation will come from blood samples collected from individuals with sickle cell disease, which will be provided by Beatrice Gee, medical director of the Hematology and Sickle Cell Program at Children’s Healthcare of Atlanta at Hughes Spalding and an associate professor of clinical pediatrics at the Morehouse School of Medicine.

Overall, Platt will integrate biochemical and biomechanical mechanisms of cardiovascular disease with predictive mathematical models that robustly interpret clinical biomarkers to develop a personalized medicine protocol that will predict strokes in individuals with sickle cell disease and reveal new mechanisms for therapeutic targets. If these methods are successful, they could be expanded to broader categories of cardiovascular disease, such as atherosclerosis, myocardial infarctions and heart valve stenosis.

Source:
Abby Vogel Robinson

Georgia Institute of Technology Research News

Research Evaluates Support Treatments For Severe Ankle Sprains

New research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme has found that the most clinically and cost-effective treatment for pain relief and recovery from severe ankle sprain, where patients cannot put any weight through that leg, is a below the knee plaster cast.

There are a number of different treatments for severe ankle injuries including no intervention, physiotherapy, different types of supports, immobilisation, and surgical repair of the ligaments. However, there is a lack of good quality evidence to help aid clinical decision-making as to which is the best treatment.

The clinical trial, led by Professor Matthew W Cooke of the Warwick Medical School & Heart of England NHS Foundation Trust and Professor Sallie Lamb of Warwick Medical School assessed the clinical and cost-effectiveness of four methods of ankle support. A below the knee plaster cast; an aircast plastic splint; and a ‘ski boot’ style support were compared to a double layer tubular compression bandage, chosen as the reference treatment. The ankle supports were assessed in terms of recovery of function, recovery of normal occupation and prevention of residual problems. Eight emergency departments across the UK participated in the trial and researchers recruited around 600 patients with the most severe ankle sprains. They were randomised to receive one of the four treatments. Patients could still have other treatments as usual, such as painkillers and medical creams to ease pain. They were followed up with questionnaires over a nine month period to assess mobility following treatment.

Researchers found that the below knee plaster case was best at relieving pain at four and 12 weeks. The aircast plastic splint and the ski boot offered no significant advantage over the compression bandage. After 9 months there was little difference between patients regardless of the intervention they received. While the compression bandage was the cheapest option (ВЈ1.44), the plaster cast was so much better at relieving pain that it was the most cost-effective intervention.

“Our aim was to measure which treatment was the most beneficial ankle support for patients, enabling them to continue their daily routine with minimum discomfort and to aid a faster healing process, as well as being cost-effective.” says Professor Cooke. “All treatments are available through the NHS and the findings of the trial will help inform clinicians’ decisions on the most effective method to use for severe ankle sprains.”

Professor Cooke went on to advise, “there were no differences in the patients wellbeing in the long term following all four treatments, so it would be beneficial to select an ankle support that is preferred by the patient as this could affect the speed of recovery.”

To view and download the full report visit hta.ac/1309 The results of the trial also published in The Lancet Volume 373, Issue 9663, pages 575 – 581, 14 February 2009.

1. The Ski Boot support used was the Bledsoe Boot which supports the ankle and has a hinge to allow for movement.

2. The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with over 400 issues published to date. The journal’s 2007 Impact Factor (3.87) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, hta.ac. The HTA programme is coordinated by the NIHR Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.

3. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. nihr.ac

Source
National Institute for Health Research

Growing Old In Good Health: Significant Disparities Between European Countries

Although life expectancy is constantly increasing in the countries of the European Union, living longer is not always synonymous with ageing well and knowing to what age a person will live in good health remains a very different question. Jean-Marie Robine, Inserm research director, conducted research within the scope of the European Health Expectancy Monitoring Unit to answer this question. The study results show that men live on average without health problems up to an age of 67 years and women up to 69 years. However, significant disparities still persist between the countries of the European Union.

These new data are published in the November 17 edition of the The Lancet.

In 2005, the mean life expectancy in the European Union was 78 years for men and 83 years for women. In addition, an improvement in the quality of life of older people has become a major public health concern in industrialised countries. Past a certain age, health problems such as chronic diseases, cardiovascular disorders and problems of dementia become more frequent, etc. Although life expectancy has improved, the question of the number of additional years really lived in good health must still be asked. To answer this, Jean-Marie Robine and his team used an indicator based on the health status of men and women today aged over 50 years. This indicator consisted in asking the study subjects about their difficulties or not, for at least six months, in carrying out daily life activities (going to work, cooking, washing, etc.). The study results show that in Europe, men live on average without health problems up to an age of 67 years and women up to 69 years.

Nevertheless strong disparities exist between the various countries. For men, the lowest mean value was observed in Estonia where it was 59 years for men and 61 years for women. In Denmark, on the contrary this mean rose to 73 years for men and 74 years for women. France was very close to the European average, with figures of 68 years for men and 69 years and 8 months for women.

These results are correlated with the gross domestic product (GDP) of the various countries and the average health expenditure by the countries on older people. In general, high GDP and health expenditure were associated with better health of people over 50 years. In men only, long periods out of work (more than 12 months), few years at school and a low educational level were also responsible for fewer healthy life years.

The observed disparities were even greater when the last 10 countries to have integrated the European Union were studied separately. In most of these countries, the retirement age was greater or equal to the average age to which the people can hope to live without health problems. For the scientists, “without an improvement in the state of health of older people, it will be difficult to raise the retirement age in certain European Union countries”.

INSTITUT NATIONAL DE LA SANTГ‰ ET DE LA RECHERCHE MГ‰DICALE – TOLBIAC (INSERM)

101, rue de Tolbiac
75654
Paris Cedex 13

inserm.fr

RPSGB And No Smoking Day Announce Alliance, UK

The Royal Pharmaceutical Society is working in partnership with the charity No Smoking Day to help thousands of smokers to kick the habit and stop smoking on Wednesday, 9th March 2011. This year’s “Time to Quit?” campaign will encourage and support smokers across the UK to start counting down to the 9th March, to quit smoking and start a healthier and wealthier life.

Dan Tickle, Chief Executive of No Smoking Day says: “Our message to smokers who are planning to quit on the 9th March, is to take advantage of the support available at their local pharmacy; you’ll get friendly and expert advice and treatment to help you to stop smoking for good.

“No Smoking Day is a fantastic campaign and a brilliant opportunity for pharmacists to remind the public and local community that they are there to provide help and support to anyone thinking about stopping smoking.

Visiting a local pharmacy for help and advice on how to stop smoking significantly increases the chances of success.”

Helen Gordon Chief Executive of Royal Pharmaceutical Society adds:

” We are delighted to be able to partner with No Smoking Day on the new “Time to Quit ?” campaign. It will cement the role of pharmacists in quitting smoking in the minds of the public and provides the sector with a trusted advocate of pharmacy services. The campaign promises to be innovate and interactive and I would encourage all our members to get involved” There will be thousands of No Smoking Day events taking place all over the UK, including those run by stop smoking services, local councils, GPs, supermarkets, and of course pharmacies and they will be actively seeking to help and support smokers who have decided that their time to quit smoking has finally come.

Notes

No Smoking Day, organised by a charity of the same name, is run by four full time staff. Based in London, the charity is funded by a coalition of governmental and voluntary sector organisations with an interest in health.

No Smoking Day aims to help people who want to stop smoking by creating a supportive environment for them, and by highlighting the many sources of help available to people who want to quit.

Now in its 28th year it is a firm fixture in the UK calendar because of its popularity amongst smokers and continued success. Three quarters of smokers would like to stop and on No Smoking Day over a million try. Stopping smoking requires much planning, encouragement, support and motivation. Helping others to prepare to quit can be done year round, but the Day provides an excellent focus and motivation for many smokers to stop.

Source:

Royal Pharmaceutical Society of Great Britain

White Patients Have Better Surgical Survival Than Blacks In Teaching Hospitals

Elderly patients who undergo surgery at teaching-intensive hospitals have better survival rates than at nonteaching hospitals, but these better survival rates apparently occur in white patients, not black patients.

“We found an advantage in surgical outcomes for patients in teaching-intensive hospitals compared to nonteaching hospitals, as we had expected from other studies,” said study leader Jeffrey H. Silber, M.D., Ph.D., director of the Center for Outcomes Research at The Children’s Hospital of Philadelphia, and a professor at the University of Pennsylvania. “What we didn’t expect was that better outcomes in teaching hospitals occurred for white patients but not for black patients.” Furthermore, he added, the survival advantage from teaching hospitals came from lower death rates after complications (lower rates of a measurement called “failure-to-rescue”), not from lower complication rates.

The study appears in the February issue of the Archives of Surgery.

The study group analyzed Medicare claims from 4.6 million patients aged 65 to 90 admitted for general, orthopedic and vascular surgery at 3,270 acute care hospitals in the United States from 2000 to 2005. Hospitals were classified as nonteaching hospitals if they had no residents, and teaching hospitals were scaled by their ratio of residents to hospital beds.

The researchers measured mortality 30 days after surgery, in-hospital complications and failure-to-rescue, defined as the probability of death following complications. They found that compared to nonteaching hospitals, hospitals with the highest ratio of residents to beds had 15 percent lower mortality after surgery, no difference in complications, and 15 percent lower odds of death after complications (failure-to-rescue). However, these benefits were observed in white patients, not black patients. These associations were adjusted for patient illness on admission, and adjusting for income level did not change these results. Unlike whites, for black patients, the odds of death, complication and failure to rescue were similar at both teaching and nonteaching hospitals.

Silber’s group did not find lower rates of complications in teaching-intensive hospitals. “Overall, the improved survival rates were not because patients were less likely to have complications, but because they were less likely to die from those complications in teaching hospitals,” said Silber, who first developed failure-to-rescue as a quality of care measure more than a decade ago. The National Quality Forum subsequently adopted it as a hospital quality indicator.

Black patients displayed higher complication rates than white patients at both teaching and nonteaching hospitals, though there was no difference in complication rates between teaching and nonteaching hospitals for both black or white patients. While white patients at teaching hospitals experienced better survival rates after complications than black patients when compared to nonteaching hospitals, black patients experienced the same survival after complications at both types of hospitals. The researchers found this racial disparity existed not only across different hospitals, but also for white and black patients within the same hospitals.

“We don’t yet know why these racial disparities exist in surgical outcomes, but we have some working hypotheses,” said Silber. His group offers possible explanations, such as unintentional differences in communication between patients and providers. Also, in previous work, Silber and colleagues found that surgical procedures take longer for black patients than white patients in some hospitals. “That finding raised the question of whether less experienced physicians might be more often operating on black patients,” he added.

However, Silber noted, the current study relied on Medicare claims data, not on detailed medical records, so it did not provide specific information on patient care that might shed light on the reasons for the observed racial disparities. “Our findings provide a starting point for further studies of detailed patient care that might shed light on why these disparities exist and how they could be reduced.”

Funding for the study came from the National Heart, Lung, and Blood Institute of the National Institutes of Health, the U.S. Department of Veterans Affairs and the National Science Foundation. Silber’s co-authors were from The Children’s Hospital of Philadelphia; the University of Pennsylvania; Veteran’s Administration Hospital, Philadelphia; the University of California Davis School of Medicine; Boston University School of Public Health; and the Veteran’s Administration Hospital, Boston.

About The Children’s Hospital of Philadelphia: The Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit chop.edu.

Children’s Hospital of Philadelphia
34th & Civic Center Blvd.
Philadelphia
PA 19104
United States
chop.edu

Stem Cells Offer New Hope For Kidney Disease Patients

Several cell-based therapy approaches could provide new treatments for patients with Alport syndrome, reports an upcoming paper in the Journal of the American Society of Nephrology (JASN). “Our study opens up many considerations of how new therapies related to the use of stem cells can be devised for our kidney patients with chronic disease,” comments Raghu Kalluri, MD, PhD (Harvard Medical School, Boston, MA).

Led by Valerie LeBleu, PhD (also of Harvard Medical School), the researchers tested various types of cell-based therapy in mice with a gene defect similar to that causing Alport syndrome, a genetic kidney disease. Most often occurring in boys, Alport syndrome causes progressive kidney disease leading to kidney failure at a young age. Patients may develop hearing loss and eye disease as well. Although treatment can slow the progression of kidney disease, there is currently no cure for Alport syndrome.

The experiments provide evidence that stem cell treatments could repair the kidney defects associated with Alport syndrome. “We found that stem cells derived from adult bone marrow are equally useful as embryonic stem cells,” says Kalluri. “This will make it easier to translate these scientific discoveries to a treatment protocol for patients with Alport syndrome.”

Transplantation of bone marrow from unaffected animals significantly improved kidney function in mice in the late stages of disease. Importantly, the results suggested that the beneficial effects of bone marrow transplantation may be achieved without the need for radiation.

Simple blood transfusion from healthy mice also achieved dramatic improvements in kidney function and survival in the mice with end-stage kidney disease. “Bone marrow transplant and blood transfusion protocols have already been approved for previous clinical use in patients with end-stage kidney disease and Alport syndrome,” says Kalluri. “Therefore, clinical application of this procedure is quite feasible and may help our patients immediately.” Although the results in mice are promising, real effectiveness can only be tested in human clinical trials. Kalluri adds, “Our study is an important step towards that goal.”

The authors received past and present funding from the Emerald Foundation, New York, National Institutes of Health, and the Department of Medicine at the Beth Israel Deaconess Medical Center.

The study entitled, “Stem Cell Therapies Benefit Alport Syndrome,” will appear online at jasn.asnjournals/ on October 15, 2009 5:00 PM ET, doi 10.1681/ASN.2009010123.

The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, ASN is the world’s largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

Source
American Society of Nephrology (ASN)

Many U.S. Physicians Are Unfamiliar With Chagas’ Disease, According To Survey

According to recent survey results published in the October issue of The American Journal of Tropical Medicine and Hygiene, obstetricians and gynecologists in the United States are unfamiliar with Chagas’ disease, a condition that affects an estimated 300,000 people in the United States and can cause serious cardiovascular and digestive complications. The disease can be transmitted from mother to her unborn child, and as many as 300 congenital infections are estimated to occur annually in the United States. However, the survey revealed that knowledge and understanding of this condition among obstetrician-gynecologists, is low. The survey of U.S. physician members of the American College of Obstetricians and Gynecologists was developed by ACOG, with technical input provided by the CDC.

“There are potentially 100,000 women living in the U.S. who are at risk of infecting their unborn babies,” said Edward T. Ryan, MD, President, American Society of Tropical Medicine and Hygiene. “We need to educate obstetricians, family practitioners, nurse midwives, and pediatricians about Chagas’, especially those who care for families from Latin America.”

For obstetricians/gynecologists in the United States, increased awareness around Chagas’ disease is important because many newly diagnosed patients are identified among blood donors who are women of child-bearing age and at risk of transmitting the infection to their newborns. Many of these women in the United States are from Mexico, Central or South America where they acquired the infection; most have no symptoms and are unaware of the danger to their baby should they decide to become pregnant.

Chagas’ disease is endemic in Latin America, and affects an estimated 8-11 million people in Mexico, Central and South America. Many people infected with Chagas’ disease, caused by a parasite, are undiagnosed and unaware of the potential seriousness of the condition. The disease is transmitted primarily through triatomine bugs, more commonly known as “kissing bugs.” Infection can also occur through blood transfusions, ingestion of contaminated food or drink, organ transplants, and from an infected mother to her unborn child.

If left untreated, Chagas’ disease can cause complications such as cardiomyopathy (an enlarged heart that no longer pumps effectively), heart disease, heart failure, enlargement of the colon, enlargement of the esophagus (which can make swallowing difficult), and malnutrition. An estimated 20 to 30 percent of patients will develop the cardiovascular/digestive complications, decades after the initial infection. For those with the infection, there are two approaches to treatment: treatment to kill the parasite, and treatment to manage the symptoms and signs of infection. There is currently no vaccine against Chagas’ disease.

“The good news about the survey results is that the majority of physicians respondents were not misinformed, they just did not have information about Chagas’ disease,” said Jennifer R. Verani, MD, CDC, Atlanta. “Now that we know this, we can educate clinicians who regularly see patients who are at risk.”

Although congenital Chagas’ disease is relatively rare in the United States, the estimated number of annual cases is similar to other rare diseases for which all newborns in the United States are routinely screened at birth. The majority of obstetricians/gynecologists were unaware of the testing recommendations for newborn babies of infected mothers, which indicate that the babies should be tested at birth, at 4-6 weeks and at 9-12 months.

The survey results found that only three percent of the physicians surveyed considered their knowledge about Chagas’ disease “excellent” or “good,” compared to a large majority (88 percent) who described their knowledge as “limited” or “very limited”; almost ten percent of those surveyed reported never having heard of the disease at all. One-third of survey respondents “did not know” what causes the disease and only 58 percent were able to correctly identify it as a parasitic infection.

Source: American Society of Tropical Medicine and Hygiene

BMA warns of double standards in Government anti-smoking campaign, UK

The British Medical Association has warned that the Government’s anti-smoking campaign launched today (5/9/05) smacks of double standards if it doesn’t take action to protect the health of all workers from second-hand smoke.

Dr Vivienne Nathanson, Head of Science at the BMA, said:

“This campaign targets smokers because of the danger their smoking poses to others. Public Health Minister Caroline Flint says that ‘both smokers and non-smokers don’t appreciate the full dangers of second-hand smoke’ – smoke which contains ‘more than 50 known cancer-causing substances’.

“But if the Government is aware of the hazards, how can it defend only a partial ban on smoking in public places – exposing many workers to toxic chemicals just because they’re unlucky enough to work in pubs and bars not selling food?

“While the new campaign highlights the individual smoker’s responsibility, it is inexcusable for the Government to absolve itself of its own responsibility for its half-hearted stance on protecting vulnerable workers.

“Education campaigns are vital for alerting people to the true dangers of smoking and passive smoking – particularly when pro-smoking groups like Forest promote messages that fly in the face of overwhelming evidence.

“But education campaigns must be backed up with policy. The Government is the guardian of the public’s health – actions speak louder than words.”

bma