Thursday, January 31, 2013

In Clinical Study, Peanut Therapy Shows Promise In Treating Peanut Allergy

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The multicenter study was supported by the NIH's National Institute of Allergy and Infectious Diseases (NIAID) and conducted by the Consortium of Food Allergy Research (CoFAR) at clinical sites in Baltimore; Chapel Hill, N.C.; Denver; Little Rock, Ark.; and New York City. CoFAR investigators David Fleischer, M.D., associate professor of pediatrics in the Division of Pediatric Allergy and Immunology at National Jewish Health in Denver, and A. Wesley Burks, M.D., chair of the Department of Pediatrics at the University of North Carolina, Chapel Hill, led the trial.

ARTICLE:
DM Fleischer et al. Sublingual immunotherapy for peanut allergy: a randomized, double-blind, placebo-controlled multicenter trial. Journal of Allergy and Clinical Immunology DOI: 10.1016/j.jaci.2012.11.011 (2013).

Marshall Plaut, M.D., chief, Food Allergy, Atopic Dermatitis, and Allergic Mechanisms Section, NIAID's Division of Allergy, Immunology, and Transplantation, is available to discuss this study.

RESOURCE INFORMATION:
This work was funded by NIAID, NIH, under grant numbers U19AI066738 and U01AI066560, and by the National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH, under grant numbers UL1RR025780, UL1TR000067, UL1TR000039, UL1RR024128, and UL1RR025005. The ClinicalTrials.gov identifier for the study A Randomized, Double-Blind Placebo-Controlled Peanut Sublingual Immunotherapy Trial is NCT00580606.

NIH/National Institute of Allergy and Infectious Diseases

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Sports Concussion-Risk Studies At Virginia Tech Expanded To Include Hockey And Baseball

Main Category: Sports Medicine / Fitness
Also Included In: Neurology / Neuroscience;  Public Health
Article Date: 31 Jan 2013 - 0:00 PST

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The Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences is expanding its ground-breaking research of testing football helmets to reduce the number of concussions to now include hockey, baseball, softball, and lacrosse.

The five-year plan will see the Virginia Tech research center, headed by Stefan Duma, rate helmets worn by hockey, baseball, softball, and lacrosse athletes in their ability to lessen the likelihood of a concussion resulting from a violent head impact.

Ratings on hockey helmets are expected in fall 2013, followed by youth football in 2015, and then baseball, softball, and lacrosse in 2016. During that time, all ratings for adult and youth football helmets will continually be updated and released to the public.

The expansion into helmeted sports other than football comes on the heels of new research that allows for better prediction of sports-related concussions resulting from linear and rotational head accelerations. These accelerations result from head impacts that cause the head to translate and twist about the neck. The new research is published this month in the Annals of Biomedical Engineering.

The new research is being funded by Virginia Tech, the National Highway Traffic Safety Administration, the National Institutes of Health, and the Institute for Critical Technology and Applied Science at Virginia Tech.

New ratings for football helmets will include data for linear and rotational accelerations starting in 2015, said Duma, professor of biomedical engineering and department head of the Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences. Serving as lead author on the research paper is Steven Rowson, assistant professor of biomedical engineering at Virginia Tech.

"All head impacts result in both linear and rotational accelerations, and this publication provides the foundation for our research to address both accelerations relative to reducing the risk of concussion," said Duma. "Our goal with the five-year plan is to provide manufacturers with a schedule detailing when we will release helmet ratings for each sport."

The helmet rating system is based on more than a decade of data collection by Duma and his research staff, and utilizes the STAR, or Summation of Tests for the Analysis of Risk, formula that assesses the ability of football helmets to reduce concussion risk. Sport-specific testing methodologies will be added to the website that lists the rated helmets prior to the initial release of each sport's helmets ratings.

Using data collected from more than 63,000 head impacts during a period of 10 years, Duma and Rowson related linear and rotational head acceleration to the probability of sustaining a concussion in the form of an injury risk function.

"This new analysis utilizes data measured from 62 concussions sustained by high school, college, and professional football players," said Rowson. "We use these data to determine the best method to predict concussions when we test helmets in our laboratory." In their research paper, the researchers write, "With as many as 3.8 million sports-related concussions occurring annually in the United States and research suggesting possible long term neurodegenerative processes resulting from repetitive concussions, reducing the incidence of concussion in sports has become a public health priority."

Indeed, long-term, repetitive injuries that can cripple or eventually kill years after play have prompted dozens of headlines in major media outlets and several national studies, and even President Obama to recently weigh in on the subject. Dozens of former NFL players are suing the league over injuries sustained during years of play, and headlines were made this summer when former football great Alex Karras died at age 77 from various ailments, several allegedly said to be caused by years of hard hits.

In studying football-related injuries during the past decade, Duma and his research team have used on-field real-time sensors installed in the helmets of hundreds of adult and youth football players to study injuries, as well as a mechanical lab-tested 5-star rating system to track and grade commercially sold helmets.

The former can help indicate head injuries that require immediate attention while on the field of play. The latter has provided the only independent biomechanical data for consumers to make helmet purchasing decisions, Duma said.

Duma's goal is not to end the sport of football, but make it safer while still keep the same expected adrenaline rush and action for players, and viewers.

"It is important to note that no helmet can prevent all concussions. The most effective strategies to reduce concussions in sports involve modifying league rules and player technique to limit exposure to head impacts," Duma said.

"Beyond this, head impacts are a given in sport. Our research focuses on identifying helmets that reduce concussion risk so that athletes can make informed decisions based on independent data when purchasing equipment, which in turn, incentivizes helmet manufacturers to design helmets that better reduce head acceleration."

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Stress May Increase Risk For Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Anxiety / Stress
Article Date: 29 Jan 2013 - 1:00 PST

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Prostate cancer patients have increased levels of stress and anxiety; however, several recent studies have found that men who take drugs that interfere with the stress hormone adrenaline have a lower incidence of prostate cancer.

In this issue of the Journal of Clinical Investigation George Kulik and colleagues at Wake Forest University examined the relationship between stress and cancer progression in a mouse model of prostate cancer. Kulik and colleagues found that mice that had been subjected to stress (exposed to the scent of a predator) exhibited a significantly reduced response to a drug that induces cancer cell death compared to their unstressed counterparts. Administration of adrenaline also blocked cancer cell death. Conversely, drugs that inhibited adrenaline signaling ablated the effect of stress on prostate cancer.

These findings suggest that beta-blockers, which are used for the treatment of high blood pressure and block the effects of adrenaline, could increase the efficacy of anti-cancer therapies.

In a companion commentary, Anil Sood and colleagues at MD Anderson Cancer Center discuss additional studies that will be required to move these findings from bench to bedside.

TITLE: Behavioral stress accelerates prostate cancer development in mice

View this article at: http://www.jci.org/articles/view/63324?key=6ae78db845f6f7d9379b

ACCOMPANYING COMMENTARY TITLE: Why stress is BAD for cancer patients

View this article at: http://www.jci.org/articles/view/67887?key=741bcde7c39c877f58de

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Journal of Clinical Investigation Journal of Clinical Investigation
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Exposure To Antiepileptic Drug In Womb Linked To Autism Risk

Main Category: Pregnancy / Obstetrics
Also Included In: Epilepsy;  Autism
Article Date: 31 Jan 2013 - 2:00 PST

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Increases risk of other neurodevelopmental disorders too when taken separately or with other drugs

Children whose mothers take the antiepileptic drug sodium valproate while pregnant are at significantly increased risk of autism and other neurodevelopmental disorders, suggests a small study published online in the Journal of Neurology Neurosurgery and Psychiatry.

The authors base their findings on children born to 528 pregnant women between 2000 and 2004 in the North West of England.

Just fewer than half the mums (243) had epilepsy, all but 34 of whom took antiepileptic drugs during their pregnancy. Fifty nine mums took carbamazepine; 59 took valproate; 36 took lamotrigine; 41 took a combination; and 15 took other drugs.

The children's physical and intellectual development was assessed at the ages of 12 months, three and six years. Information was also obtained from their mothers about whether they had had to consult specialists about their child's behaviour, development, educational progress or health.

Full data on all three assessments were available for 415 children. In all, 19 children had been diagnosed with a neurodevelopmental disorder by the time they were six years old, three of whom also had a physical abnormality.

Of these, 12 had a form of autism, one of whom was also diagnosed with attention deficit hyperactivity disorder (ADHD). Three had ADHD alone, while a further four had dyspraxia, a condition that results in poor physical coordination and excessive clumsiness.

Neurodevelopmental problems were significantly more common among those children whose mums had epilepsy - 7.46% compared with 1.87% of those whose mums did not have the condition.

And those children whose mums had taken valproate singly or in combination with other drugs while pregnant were significantly more likely to have been diagnosed with a neurodevelopmental condition than were those whose mums taking other drugs to treat their condition.

When all the figures were analysed and factors likely to influence the results accounted for, the findings showed that children exposed to valproate alone in the womb were six times more likely to be diagnosed with a neurodevelopmental disorder. Those exposed to valproate plus other drugs were 10 times more likely to do so than were children whose mums did not have the condition.

More than one in 10 (12%; 6 out of 50) children whose mums had taken valproate alone during their pregnancy had a neurodevelopmental problem, as did one in seven (15%; 3 out of 20) of those whose mums had taken valproate with other drugs.

No child born to a mum with epilepsy, but who didn't take drugs for the condition during her pregnancy, was diagnosed with a neurodevelopmental disorder, although the numbers of women in this group were small, caution the authors.

Boys were three times more likely than girls to be diagnosed with a neurodevelopmental disorder, but no significant associations were found for the mother's age or IQ, length of pregnancy, or epileptic seizure type.

The authors point out that other research has pointed to the potentially harmful effects of valproate on the developing fetus, and that the findings of the current study back other preliminary research. But further research would be needed before definitive conclusions could be reached, they caution.

"If sodium valproate is the treatment of choice, women should be provided with as much information as possible to enable them to make an informed decision," and children whose mums took the drug during pregnancy should be monitored closely, write the authors.

"But on no account should pregnant women just stop taking the drug for fear of harming their developing child," urge the authors.*

*Direct quote from lead author; not in text of article.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pregnancy / obstetrics section for the latest news on this subject.
“The prevalence of neurodevelopmental disorders in children prenatally exposed to antiepileptic drugs”,
Rebecca Louise Bromley et al.
Journal Of Neurology Neurosurgery And Psychiatry. Online First doi 10.1136/jnnp-2012-304270
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PET Scans Now Identify Brain Disease In Living NFL Players

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Main Category: Sports Medicine / Fitness
Also Included In: Neurology / Neuroscience
Article Date: 23 Jan 2013 - 11:00 PST

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A new brain-imaging technique has been developed to identify chronic traumatic encephalopathy (CTE) in living patients.

Sports-related head injuries and mild traumatic brain injuries have been plastered among headlines during the previous few months, informing the public of long-term damage that has become more apparent among former and current athletes - most notably, professional football players.

No method for early detection or tracking of brain changes caused by these types of injuries has been created before, despite the catastrophic outcomes associated with them and the vast number of athletes engaging in contact sports who put themselves at risk.

For the first time, a group of researchers from UCLA have developed a brain-imaging tool to recognize the unusual tau proteins linked with this type of recurring head injury in five former NFL players who are still living. Before this, identification of the presence of this protein, which is also linked to Alzheimer's disease, could only be confirmed via autopsy.

These initial findings came from a small study that was published in the American Journal of Geriatric Psychiatry.

Concussions Linked to CTE

Previous studies have shown that professional athletes in contact sports who receive recurring concussions or mild traumatic brain injuries could develop CTE, a degenerative condition characterized by an excess of tau protein.

CTE is linked to the following:

  • confusion
  • progressive dementia
  • depression
  • abnormal gait
  • tremors
  • memory loss
  • suicidal behavior
  • personality changes
Lead study author Dr. Gary Small, UCLA's Parlow Solomon, Professor on Aging and a professor of psychiatry and biobehavioral sciences at the Semel Institute for Neuroscience and Human Behavior at UCLA, says:

"Early detection of tau proteins may help us to understand what is happening sooner in the brains of these injured athletes. Our findings may also guide us in developing strategies and interventions to protect those with early symptoms, rather than try to repair damage once it becomes extensive."

The researchers recruited five former NFL players who were 45 years of age or older. Each participant had a history of at least one concussion and a few were suffering from mood or cognitive symptoms. The players were from all different positions: guard, center, defensive lineman, linebacker, and quarterback.

Wayne Clark, a player in the study who had normal cognitive function, commented: "I hope that my participation in these kinds of studies will lead to a better understanding of the consequences of repeated head injury and new standards to protect players from sports concussions."

Scientists from UCLA used a brain-imaging tool that was originally developed for examining neurological changes linked to Alzheimer's disease.

They put to work a chemical marker they made named FDDNP, which binds to deposits of amyloid beta "plaques" and neurofibrillary tau "tangles" (telltale signs of Alzheimer's) - then they viewed it using a PET (positron emission tomography) scan. The researchers were able to identify where in the brain these irregular proteins built up.

Participants received intravenous injections of FDDNP, while the researchers then performed PET brain scans and compared them to those of healthy men with comparable BMI, education, age, and family history of dementia.

The scientists discovered that in comparison to healthy men, the NFL players had increased levels of FDDNP in the amygdala and subcortical regions of the brain - the areas that control emotions, behavior, memory, and learning. Participants who had a greater number of concussions had higher levels of FDDNP.

Study author Dr. Jorge R. Barrio, a professor of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA, said, "The FDDNP binding patterns in the players' scans were consistent with the tau deposit patterns that have been observed at autopsy in CTE cases."

The participants also received a standard clinical assessment to measure their degree of depression and cognitive ability. The NFL players had more depressive symptoms than the healthy men and scored lower on cognitive ability tests, exhibiting evidence of cognitive loss. The signs of FDDNP appear to show a range of mental symptoms that have been previously seen in CTE cases, the authors point out.

Early Detection Could Save Lives

Small points out that larger follow-up studies are required to measure the impact and usefulness of identifying these tau proteins early, but with the large number of people at risk for concussions, a testing method showing what happens in the brain during the early stages may have a significant influence on public health.

Study author Dr. Julian Bailes, director of the Brain Injury Research Institute and the Bennett Tarkington Chairman of the department of neurosurgery at NorthShore University HealthSystem based in Evanston, IL, concluded on the topic of CTE research:

"It is the holy grail of CTE research to be able to identify those who are suffering from the syndrome early, while they're still alive. Discovering the effects of prior brain trauma earlier opens up possibilities for symptom treatment and prevention."

Written by Kelly Fitzgerald
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Artificial Muscle Created By Controlled Crumpling Of Graphene

Main Category: Bones / Orthopedics
Also Included In: Medical Devices / Diagnostics;  Rehabilitation / Physical Therapy
Article Date: 27 Jan 2013 - 0:00 PST

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Duke University engineers are layering atom-thick lattices of carbon with polymers to create unique materials with a broad range of applications, including artificial muscles.

The lattice, known as graphene, is made of pure carbon and appears under magnification like chicken wire. Because of its unique optical, electrical and mechanical properties, graphene is used in electronics, energy storage, composite materials and biomedicine.

However, graphene is extremely difficult to handle in that it easily "crumples." Unfortunately, scientists have been unable to control the crumpling and unfolding of large-area graphene to take advantage of its properties.

Duke engineer Xuanhe Zhao, assistant professor in Duke's Pratt School of Engineering, likens the challenge of controlling graphene to the difference between unfolding paper and wet tissue.

"If you crumpled up normal paper, you can pretty easily flatten it out," Zhao said. "However, graphene is more like wet tissue paper. It is extremely thin and sticky and difficult to unfold once crumpled. We have developed a method to solve this problem and control the crumpling and unfolding of large-area graphene films."

The Duke engineers attached the graphene to a rubber film that had been pre-stretched to many times its original size. Once the rubber film was relaxed, parts of the graphene detached from the rubber while other parts kept adhering to it, forming an attached-detached pattern with a feature size of a few nanometers. As the rubber relaxed, the detached graphene was compressed to crumple. But as the rubber film was stretched back, the adhered spots of graphene pulled on the crumpled areas to unfold the sheet.

"In this way, the crumpling and unfolding of large-area, atomic-thick graphene can be controlled by simply stretching and relaxing a rubber film, even by hands," Zhao said.

The results were published online in the journal Nature Materials.

"Our approach has opened avenues to exploit unprecedented properties and functions of graphene," said Jianfeng Zang, a postdoctoral fellow in Zhao's group and the first author of the paper. "For example, we can tune the graphene from being transparent to opaque by crumpling it, and tune it back by unfolding it."

In addition, the Duke engineers layered the graphene with different polymer films to make a "soft" material that can act like muscle tissues by contracting and expanding on demand. When electricity is applied to the graphene, the artificial muscle expands in area; when the electricity is cut off, it relaxes. Varying the voltage controls the degree of contraction and relaxation.

"The crumpling and unfolding of graphene allows large deformation of the artificial muscle," Zang said.

"New artificial muscles are enabling diverse technologies ranging from robotics and drug delivery to energy harvesting and storage," Zhao said. "In particular, they promise to greatly improve the quality of life for millions of disabled people by providing affordable devices such as lightweight prostheses and full-page Braille displays."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our bones / orthopedics section for the latest news on this subject.
Zhao's work is supported by the National Science Foundation's (NSF) Triangle Materials Research Science and Engineering Center, NSF Materials and Surface Engineering program, and National Institutes of Health (NIH). Other members of the team are Duke's Qiming Wang and Qing Tu.
Duke University
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Wednesday, January 30, 2013

Sustained EHR Technical Assistance Is Vital To Boost Quality Of Care By Small Physician Practices In New York City

Main Category: IT / Internet / E-mail
Also Included In: Medical Practice Management;  Primary Care / General Practice
Article Date: 09 Jan 2013 - 1:00 PST

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The relationship between a physician practice's adoption of electronic health records (EHR) and quality improvements in patient care remains unclear. However, a new study published in the January issue of Health Affairs by Weill Cornell Medical College and the Primary Care Information Project (PCIP) of the New York City Health Department shows evidence that EHR implementation can improve patient care in small physician practices in New York City when combined with sustained high-intensity technical assistance.

To evaluate the effects EHRs have on patient care within small physician practices, the research team used an independent data source using multi-payer medical claims in New York state (New York Quality Alliance), linking the data to small practices enrolled in the Primary Care Information Project. This New York City Health Department initiative provided subsidized EHR software with clinical decision support and onsite technical assistance to 3,300 physicians at 600 primary care practices in underserved neighborhoods serving disadvantaged populations to improve quality of care. This is the United States' largest community-based EHR implementation program, and the PCIP continues to provide technical assistance and education to more than 7,200 providers through its regional extension center, NYC REACH.

The research study found EHR implementation alone was not enough to improve patient care overall or known "EHR sensitive" quality improvement measures, such as cancer screenings and diabetes care. In fact, the researchers reported it took physician practices a minimum of nine months of EHR exposure, combined with eight or more technical assistance visits, to demonstrate any significant statistical improvements in certain key quality measures, including breast cancer screening, retinal exam and urine testing for diabetes patients, chlamydia screening for women and colorectal cancer screening. Physician offices with minimal or no technical support did not show any significant improvements, even when these practices had been using EHRs for up to two years.

"EHRs were once thought to be a cure-all for helping improve patient care, but there are implementation issues and the technology has a steep learning curve," says lead author Dr. Andrew M. Ryan, assistant professor of public health at Weill Cornell Medical College. "Our study shows EHRs can in fact be a tool for quality improvement, but not in isolation. Technical assistance must be at the heart of the EHR implementation process. Under resourced, small physician practices, especially those taking care of underserved populations; need help to effectively use EHR technology to improve patient quality of care."

"These study findings are consistent with observations from our field staff that small physician practices serving the disadvantaged areas of New York City need considerably more technical support to use EHRs to improve quality," says Sarah Shih, executive director of Health Care Quality Information and Program Evaluation at PCIP. "High-intensity technical support has helped improve the quality of care provided by small physician practices in some key quality measures after nine months. In addition, PCIP has made major strides in using EHRs to improve population health among other key quality indicators not measured by claims data. We have also observed improved quality trends for smoking cessation counseling, blood pressure control, cholesterol screening and treatment."

Researchers say it will be important to continue to evaluate the effectiveness of various levels of technical support provided by regional extension centers in improving health outcomes.

EHRs supply physicians with clinical decision support, tools to reduce medical errors, e-prescribing, test result displays, patient health registry information, population data management and improved communication with patients and other providers. The rate of EHR adoption for outpatient care is rising. Physician use of basic EHR systems has increased from 22 percent in 2009 to 35 percent in 2011. But small practices, which constitute the majority of practices in the U.S., have the lowest rate of EHR adoption. Some evidence suggests small practices, especially those in underserved communities like New York City, are less likely to use EHRs.

"EHRs hold a lot of hope and promise and the technology is taking health care a step in the right direction. Our study supports proof of concept that EHRs can improve outcomes, but widespread implementation of the technology and strong technical assistance is needed," says Dr. Ryan. "Our hope is the extension of EHRs with proper technical support will have a direct impact on population health."

The study findings are consistent with other research showing that EHRs alone do not consistently improve quality of care. This is one of the few studies to have evaluated the effect of EHRs implementation on the quality of care in a community outpatient setting focusing on physicians in small practices who serve primarily disadvantaged patients.

"Our study results stand in contrast to widespread perceptions that EHRs automatically improve quality of care. It shows that regional extension centers like NYC REACH have an important role to play in facilitating the use of EHRs to improve the quality of care patients receive -- which is always our ultimate goal," says the study's senior author Dr. Lawrence P. Casalino, the Livingston Farrand Associate Professor of Public Health and chief of the Division of Outcomes and Effectiveness Research at Weill Cornell. In addition, Dr. Tara F. Bishop, assistant professor of public health and medicine at Weill Cornell, is a co-author of the study.

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This research was funded by the Robert Wood Johnson Foundation and performed in close collaboration with the New York City Department of Health and Mental Hygiene, who shared data from its Primary Care Information Project.Weill Cornell Medical College

Weill Cornell Medical College

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n.p. (2013, January 9). "Sustained EHR Technical Assistance Is Vital To Boost Quality Of Care By Small Physician Practices In New York City." Medical News Today. Retrieved from
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Higher Levels Of Psychosomatic Symptoms Reported By Physically Abused Children

Main Category: Body Aches
Also Included In: Pediatrics / Children's Health;  Primary Care / General Practice
Article Date: 13 Feb 2012 - 1:00 PST

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Children who display multiple psychosomatic symptoms, such as regular aches and pains and sleep and appetite problems, are more than twice as likely to be experiencing physical abuse at home than children who do not display symptoms, according to a study in the March edition of Acta Paediatrica.

Swedish researchers who studied 2,510 children aged 10, 12 and 15 from 44 schools found a strong association between reported physical abuse and three or more psychosomatic symptoms. The association was highest in children who were physically abused and also witnessed intimate partner violence (IPV). However, there was no significant association between IPV on its own and multiple symptoms.

"The children were asked if they had experienced any of the following symptoms at least twice in the last month: stomach ache, headache, sleeplessness, dizziness, back pain and loss of appetite" explains co-author Professor Staffan Janson from the Division of Public Health Sciences at Karlstad University, Sweden.

"They were also asked about 13 common chronic conditions, bullying and school performance, to eliminate any other factors that could cause the symptoms, and about whether they had been physically abused and witnessed IPV at home."

The study sample was equally split between girls and boys, with approximately one third of the sample coming from each of the three age groups.

Key findings of the study included:

  • Most of the children were born in Sweden (89%) and living with both biological parents (74%). Just under half (42%) had at least one chronic condition, 10% had two chronic conditions and 4% had three or more.
  • One in six of the children (16%) had suffered physical abuse or witnessed IPV in the home - 9% reported just physical abuse, 4% reported IPV alone and 3% reported both.
  • Two-thirds of the children (66%) reported at least one psychosomatic symptom and just over a third of these children (35%) reported three symptoms or more.
  • The most common symptoms were headache (38%), sleeplessness (36%) and stomach ache (31%).
  • 86% of the children who reported that they were physically abused and had witnessed IPV at home reported at least one psychosomatic symptom, with 41% reporting three or more, compared with 17% of the non-abused children.
  • 82% of the children who reported physical abuse only reported at least one symptom, with 35% reporting three or more symptoms compared with 17% of the non-abused children.
  • There was no significant difference in the symptoms reported by children who did or did not report just IPV.
  • When confounding factors, such as chronic conditions, bullying and school performance were taken into account, the odds of a child suffering physical abuse, with or without IPV, was 112% higher (OR 2.12) than a child who was not being abused. When IPV was added into the equation, this rose to 171% higher (OR 2.71)
  • The odds for a child suffering physical abuse only was 72% higher (OR 1.72) and the odds for IPV only was 9% higher (OR 1.09).
  • Abused children with chronic conditions reported significantly more psychosomatic symptoms than abused children without chronic conditions.
"Our study demonstrates a clear association between high levels of psychosomatic symptoms and an increased risk of physical abuse" says Professor Janson. "The association was even stronger in abused children who also witnessed intimate partner violence at home.

"The findings suggest that healthcare professionals should consider the possibility of physical abuse if a child presents with three or more regular psychosomatic symptoms a month.

"However, it is also important that they rule out any confounding factors, such as chronic illness, bullying and school performance when assessing the child."

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Multiple psychosomatic symptoms can indicate child physical abuse - results from a study of Swedish schoolchildren. Jernbro et al. Acta Paediatrica. 101, pp. 324-329. (March 2012). DOI:10.1111/j.1651-2227.2011.02518.x
Wiley-Blackwell
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New Study Provides Compelling Evidence That Commercially Available Electronic Health Records Are Associated With Better Physician Performance

Main Category: IT / Internet / E-mail
Also Included In: Primary Care / General Practice;  Medical Practice Management
Article Date: 11 Oct 2012 - 1:00 PDT

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A new study by Weill Cornell Medical College researchers, published in the Journal of General Internal Medicine, provides compelling evidence that electronic health records (EHRs) enhance the quality of patient care in a community-based setting with multiple payers, which is representative of how medicine is generally practiced across the United States.

The use of EHRs is on the rise, in part because the federal government has invested up to $29 billion in incentives promoting the meaningful use of these systems, with the aim of tracking and improving patient outcomes. Previous studies have provided conflicting evidence about the impact of EHRs, and until now it had been not clear whether they improved the quality of patient care, particularly in typical communities that use commercially available systems.

"The previous studies on the effects of electronic health records in the outpatient setting have been mixed," says the study's lead investigator, Dr. Lisa M. Kern, associate professor of public health and medicine at Weill Cornell Medical College. "This is one of the first studies to find a positive association between the use of EHRs and quality of care in a typical community-based setting, using an off-the-shelf electronic health record that has not been extensively tailored and refined. This increases the generalizability of these findings."

"This study starts to grow the evidence that the use of these systems can systematically improve the quality of care, although their maximum value likely lies in their ability to support new health care delivery models," says the study's senior investigator Dr. Rainu Kaushal, director of the Center for Healthcare Informatics and Policy and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell Medical College. "The findings of this study lend support to the very significant investments in health information technology that are being made by the federal government, states, and health care providers."

This study was conducted with the Health Information Technology Evaluation Collaborative (HITEC)--a multi-institutional effort directed by Drs. Kaushal and Kern and funded by New York State, in order to evaluate and assess the impact of New York's health information technology strategy. In 2008, the researchers collected data about the quality of patient care across nine measures from nearly 500 physicians and 75,000 patients in ambulatory practices in the Hudson Valley region of New York, where there has been a concerted effort to implement EHRs. They gathered data from five different health plans, including two national commercial plans, two regional commercial plans and one regional Medicaid health maintenance organization.

"This study reflects data from five different health plans, which is another strength of the study and which is critical for understanding the experiences of patients in the community," says Dr. Kern. "If you only have one health plan, then you will not be seeing the whole picture."

The team found that the 56 percent of physicians who used commercially available EHRs provided significantly better quality of care than physicians using paper records for four measures, including hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening and colorectal cancer screening. EHRs typically provide reminders about these clinical tests. Moreover, the combined score across all nine measures indicated that EHRs led to better patient care than paper records.

"EHRs may improve the quality of care by making information more accessible to physicians, providing medical decision-making support in real time and allowing patients and providers to communicate regularly and securely," says Dr. Kaushal. "However, the real value of these systems is their ability to organize data and to allow transformative models of health care delivery, such as the patient-centered medical home, to be layered on top."

To follow up on this study, the researchers plan to determine how the effects of EHRs on patient care vary over time and across different locations in New York, to examine the effects EHRs on the cost of patient care and to work on improving ways to measure the quality of patient care.

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This work was supported by the Commonwealth Fund, the Taconic Independent Practice Association, and the New York State Department of Health (contract #C023699).

Co-authors of the study include Yolanda BarrĂ³n, Rina V. Dhopeshwarkar, and Alison Edwards of Weill Cornell Medical College, as well as the HITEC investigators.

Weill Cornell Medical College

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Genes Related To Aggressive Endometrial Cancer Identified

Main Category: Cancer / Oncology
Also Included In: Women's Health / Gynecology;  Genetics
Article Date: 30 Jan 2013 - 0:00 PST

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In a major breakthrough for uterine serous carcinoma (USC) - a chemo-resistant, aggressive form of endometrial cancer, Yale researchers have defined the genetic landscape of USC tumors, findings that point to new treatment opportunities.

The collaborative team - which included researchers with expertise in gynecological cancer, genomics, and computational biology - identified a number of new genes that are frequently mutated in USC. The results of this comprehensive genetic analysis of USC are published in Proceedings of the National Academy of Sciences (PNAS) online early edition. The researchers were supported as part of a collaborative program with Gilead Sciences, Inc.

Endometrial cancer is the most prevalent gynecologic tumor in women, with over 47,000 newly diagnosed cases and about 8,000 deaths in 2012 in the United States alone. Patients with type I endometrial cancer tumors generally have a good outcome, but those with type II, or USC, have more relapses and deaths, and the disease is more aggressive.

"We have clearly identified the mutations that are responsible for USC tumors," said senior author of the study Alessandro Santin, M.D., professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine, and program leader of the gynecological cancers program at Smilow Cancer Hospital at Yale-New Haven and a member of Yale Cancer Center. "In addition to a number of well-known cancer genes, we found three genes that had not previously been associated with cancer that are found in these tumors. This finding points to new pathways that could be important in developing therapies down the road."

The team collected tumors from 57 women affected with USC to try to determine the molecular basis of the tumor's aggressive behavior. They sequenced all the genes from the tumors and identified mutations that are crucial for these tumors to grow. The team also studied the copy number variations - genes that are not mutated but are amplified in the tumors to give them a growth advantage over normal tissues.

The newly-identified cancer-related genes included two - CHD4 and MBD3 - that are found in the same protein complex and play a role in remodeling the genome to allow certain regions to be turned on and off. The discovery of a third gene, TAF1, was a surprise to researchers because it is a core component of the machinery responsible for transcribing a large fraction of the protein coding genes in the human genome.

"The detailed study of different cancers continues to produce new and unexpected discoveries," said corresponding author Richard P. Lifton, M.D., Sterling Professor, chair of genetics at Yale, and a Howard Hughes Medical Institute investigator. "These new findings define the biological basis of this cancer, and suggest new opportunities for personalized therapy."

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Other authors on the study include first author Siming Zhao, Murim Choi, John D. Overton, Stefania Bellone, Dana M. Roque, Emiliano Cocco, Federica Guzzo, Diana P. English, Joyce Varughese, Sara Gasparrini, Ileana Bortolomai, Natalia Buza, Pei Hui, Maysa Abu-Khalaf, Antonella Ravaggi, Eliana Bignotti, Elisabetta Bandiera, Chiara Romani, Paola Todeschini, Renata Tassi, Laura Zanotti, Luisa Carrara, Sergio Pecorelli, Dan-Arin Silasi, Elena Ratner, Masoud Azodi, Peter E. Schwartz, Thomas J. Rutherford, Amy L. Stiegler, Shrikant Mane, Titus J. Boggon, and Joseph Schlessinger.
In addition to Gilead, the study was funded in part by grants from the National Institutes of Health, the National Cancer Institute, and the Howard Hughes Medical Institute.
Citation: PNAS doi/10.1073/pnas.1222577110
Yale University
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