Stroke Drops to Fourth Leading Cause of Death in 2008

/PRNewswire/ -- Stroke is now the fourth leading cause of death in the United States, down from the third place ranking it has held for decades, according to preliminary 2008 death statistics released today by CDC's National Center for Health Statistics. While deaths from stroke and several other chronic diseases are down, deaths due to chronic lower respiratory disease increased in 2008.

There were 133,750 deaths from stroke in 2008. Age-adjusted death rates from stroke declined 3.8 percent between 2007 and 2008. Meantime, there were 141,075 deaths from chronic lower respiratory disease, and the death rate increased by 7.8 percent.

Some of the increase in deaths may be due to a modification made by the World Health Organization in the way deaths from chronic lower respiratory diseases are classified and coded. The National Center for Health Statistics will conduct a thorough analysis on this change and its effect on the chronic lower respiratory disease category before the final 2008 deaths data are released.

"Deaths: Preliminary Data for 2008," also finds that life expectancy at birth dropped slightly to 77.8 years from 77.9 years in 2007. Life expectancy was down by one-tenth of a year (a little over a month) for both men and women. However, black males had a record high life expectancy in 2008 of 70.2 years – up from 70 years in 2007. The life expectancy gap between the white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007.

The data are based on 99 percent of death certificates reported to NCHS through the National Vital Statistics System from all 50 states, the District of Columbia and U.S. territories.

Other findings:

* Heart disease and cancer, the two leading causes of death, still accounted for nearly half (48 percent) of all deaths in 2008.
* In addition to stroke, mortality rates declined significantly for five of the other 15 leading causes of death: accidents/unintentional injuries (3.5 percent), homicide (3.3 percent), diabetes (3.1 percent), heart disease (2.2 percent), and cancer (1.6 percent).
* In addition to chronic lower respiratory disease, death rates increased significantly in 2008 for Alzheimer's disease (7.5 percent), influenza and pneumonia (4.9 percent), high blood pressure (4.1 percent), suicide (2.7 percent), and kidney disease (2.1 percent).
* The preliminary infant mortality rate for 2008 was 6.59 infant deaths per 1,000 live births, a 2.4 percent decline from the 2007 rate of 6.77 and an all-time record low. Birth defects were the leading cause of infant death in 2008, followed by disorders related to preterm birth and low birth weight. Sudden infant death syndrome (SIDS) was the third leading cause of infant death in the United States.
* Overall, there were 2,473,018 deaths in the United States in 2008, according to the preliminary deaths report -- 49,306 more deaths than the 2007 total.
* The age-adjusted death rate for the U.S. population fell to 758.7 deaths per 100,000 in 2008 compared to the 2007 rate of 760.2.

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Study Compares Risk With Two Diabetes Drugs

/PRNewswire/ -- In contrast to previous reports, the risks of the composite endpoint of heart attack, heart failure, both, or death were the same - about 4 percent - for patients taking the diabetes drugs rosiglitazone or pioglitazone, according to a study published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.

"This study provides patients and their doctors with another source of information about rosiglitazone and pioglitazone (sold as Avandia and Actos, respectively) as they determine the best therapy for diabetes patients," said Debra Wertz, Pharm.D., lead author and outcomes research manager at HealthCore, Inc., the research subsidiary of health insurance company WellPoint, Inc.

This study evaluated more than 36,000 diabetes patients. Of the 28,938 patients who were propensity-score matched, a methodology used to provide an estimation of treatment-effects that is as unbiased as possible, 602 patients taking rosiglitazone and 599 taking pioglitazone over a 33-month period suffered either a heart attack, heart failure, both, or died. This translates to about 4 percent of all patients taking either medication. The individual specific adverse events were also not significantly different between the two groups, and were:

-- Heart attack - 96 patients on rosiglitazone and 121 patients on
pioglitazone;
-- Heart failure - 265 patients taking rosiglitazone and 243 taking
pioglitazone;
-- Heart attack and heart failure - 24 patients on rosiglitazone and 18
on pioglitazone; and
-- Death - 217 patients taking rosiglitazone and 217 taking pioglitazone.


The study included 36,628 patients who had submitted insurance claims to WellPoint affiliates for either of the two diabetes medications between 2001 and 2005. Patients' average age was 54, and 58 percent were male. Wertz and her team obtained death records from the National Death Index, a central database administered by the National Center for Health Statistics.

The investigators divided patients into two equal groups, one receiving rosiglitazone and the other, pioglitazone. After adjusting the data for (removing/minimizing the effect of) age, gender, prior heart and blood vessel diseases and diabetes-related complications and severity indicators, they compared the incidence of heart attack, heart failure and death for an average 14 months of treatment and 19 months of post-treatment follow-up.

Diabetes is a disease in which the body cannot adequately produce the hormone insulin or uses it improperly. The disease can cause a potentially dangerous buildup of sugar in the blood and also increases the risk of heart and blood vessel diseases, which are the main causes of death for people with diabetes.

Rosiglitazone, sold under the trade name Avandia by GlaxoSmithKline, and pioglitazone, sold as Actos by Takeda Pharmaceuticals, belong to the same class of drugs, called TZDs or thiazolidinediones. They help the body use insulin more effectively by boosting the body's sensitivity to the hormone and thus help control blood sugar.

This study has results different from earlier ones that found a greater risk of heart attack among rosiglitazone users compared to patients on other treatments or placebo. In 2007, the Food and Drug Administration decided that the benefits of rosiglitazone outweighed the risks, and it remained on the market although its use decreased significantly. In July 2010, an FDA advisory committee again reviewed numerous studies, including this study, and recommended that rosiglitazone remain on the market, although with additional warnings or restrictions. The FDA has not yet ruled on this latest recommendation.

"Besides its findings that rosiglitazone and pioglitazone have comparable risks, what distinguishes this latest study from other claims-based analyses is its analysis of death records, which include out-of-hospital deaths," Wertz said. The study also followed patients for a longer period of time than some of the earlier research, according to the investigators.

"One of the reasons we embarked on this analysis was to see if there were any differences in effect that we could identify between these two agents," said Mark J. Cziraky, Pharm.D., study co-author, and vice president of research development and operations at HealthCore. "We did not find that with the approach and methods we took within this population."

Other co-authors are Chun-Lan Chang, Ph.D.; Chaitanya A Sarawate, M.S.; Vincent J. Willey, Pharm.D.; and Rhonda L. Bohn, M.P.H., Sc.D.

Author disclosures are on the manuscript. WellPoint, Inc. funded this research.


An accompanying editorial, "Improving Surveillance for Drug Safety: Lessons from Rosiglitazone," by Frederick A Masoudi, M.D., M.S.P.H., is available.


Statements and conclusions of study authors published in American
Heart Association scientific journals are solely those of the study
authors and do not necessarily reflect the association's policy or
position. The association makes no representation or guarantee as to
their accuracy or reliability. The association receives funding
primarily from individuals; foundations and corporations (including
pharmaceutical, device manufacturers and other companies) also make
donations and fund specific association programs and events. The
association has strict policies to prevent these relationships from
influencing the science content. Revenues from pharmaceutical and
device corporations are available at http://www.americanheart.org/
corporatefunding.

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'Legacy of Katrina' Report Details Impact of Stalled Recovery on Mental Health Status of Children

/PRNewswire/ -- Five years ago Hurricane Katrina and the flooding of New Orleans caused the evacuation of 1.5 million Gulf Coast residents. After a year, 500,000 people remained displaced, many residing in highly transitional shelters, including the notorious FEMA trailer parks. Now at the five-year mark, substantial consequences from this prolonged displacement have resulted in widespread mental health issues in children living in the region, according to a new study by the National Center for Disaster Preparedness (NCDP) at Columbia University's Mailman School of Public Health and a related white paper from the Children's Health Fund (CHF). Together, these documents indicate that although considerable progress has been made in rebuilding the local economy and infrastructure, there is still an alarming level of psychological distress and housing instability. Investigators believe that housing and community instability and the uncertainty of recovery undermine family resilience and the emotional health of children. These factors characterize what researchers are calling a failed recovery for the Gulf region's most vulnerable population: economically disadvantaged children whose families remain displaced.

The CHF report, "Legacy of Katrina: The Impact of a Flawed Recovery on Vulnerable Children of the Gulf Coast," expands upon on a study by NCDP researchers, who have followed a cohort of more than 1,000 families affected by Katrina and the ensuing disruption. According to the Gulf Coast Child & Family Health Study, funded by the Children's Health Fund and published in the current issue of American Medical Association's Journal of Disaster Management and Public Health Preparedness, the widespread mental health problems still experienced by Gulf Coast children serve as a barometer for the failed recovery of their families and their communities. Over one-third of the children in displaced families have been clinically diagnosed with at least one mental health problem since Katrina -- with behavioral and conduct disorders the most common of these problems. Yet fewer than 50% of parents seeking needed mental health counseling for their children were able to access professional services. Furthermore, nearly half of the households in the study were still living in unstable conditions and, five years later, 60% of respondents still report their situation as being unstable or worse than it was before Katrina.

"This study points to a major crisis facing the children of the post-Katrina Gulf Region," says Irwin Redlener, M.D., director of the National Center for Disaster Preparedness at Columbia's Mailman School of Public Health and president of the Children's Health Fund. "From the perspective of the Gulf's most vulnerable children and families, the recovery from Katrina and the flooding of New Orleans has been a dismal failure."

"Previous studies have demonstrated a significant increase in the prevalence of anxiety, depression, and post-traumatic stress disorder, following Hurricane Katrina, as well as a rise in violence and suicide," said Italo Subbarao D.O., MBA, deputy editor of AMA's Disaster Medicine and Public Health Preparedness Journal. "This study adds further credence to widely accepted views that adults and children affected by catastrophic emergencies can experience up to a 40% increase in mental and behavioral illness."

According to David M. Abramson, Ph.D., MPH, director of research at the NCDP and senior author of the study which looked at the roles of parents and communities in children's recovery, "Children are completely dependent upon others in their lives to provide the security and stability that will help them recover. This suggests that the many support systems in children's lives - their parents, their communities, and their schools - are not yet functioning properly. The slow recovery of children's mental health in Gulf Coast populations is a bellwether indicator of how well the region is recovering."

Additional key findings:

-- Even as long as four and a half years after the event, about 45% of
parents report that their children are experiencing emotional or
psychological problems that they hadn't experienced prior to Katrina.

-- Children post-Katrina are 4.5 times more likely to have serious
emotional disturbance than pre-Katrina. For the purposes of this
study, such disturbances were defined as emotional issues,
hyperactivity, conduct and problems relating to peers.

-- Nearly half of people who had been displaced for over a year by
Katrina are still living in unstable conditions.


The study findings are supported by clinical data from the Children's Health Fund, which provides mobile clinics that travel to underserved areas in the Gulf Coast to provide care for families and children. In the period of June 2009 through June 2010, despite improvement in housing conditions in Louisiana, psychiatric, developmental or learning-related disorders in children were diagnosed as frequently as respiratory illness. And in New Orleans alone, approximately 30,000 school children were not able to return to public school. However, data also shows that children who were relocated sooner did better in school than students with longer periods of displacement and those who were enrolled in higher performing schools did the best, thus highlighting the importance of social systems in a child's post-disaster recovery.

Both the study and the clinical reports from the Children's Health Fund's Gulf Coast pediatric programs paint a clear picture of how insufficient government response and recovery efforts continue to take a toll on children's welfare, especially those who are the most underserved. Dr. Redlener, a pediatrician and professor at Columbia University's Mailman School of Public Health, outlined a number of implications for policymakers and others: "Affected families need urgent assistance to return to a state of 'normalcy' characterized by safe communities and stable housing. Nearly two out of three children affected by Katrina continue to experience serious mental and behavioral problems or the stress of unstable housing or both, with children living in poverty over two times as susceptible to serious emotional disorders. We believe that this represents at least 20,000 children affected by Katrina--and perhaps considerably more. Immediate action needs to be taken to increase mental health services in the region."

Dr. Redlener continues, "And it's not just clinical services that are needed by these marginalized families. Every effort must be made to rapidly bring back a 'state of normalcy', that is, stable safe housing for every family in communities with appropriate access to essential services and economic stability."

The Gulf Coast Child & Family Health Study has collected mental health data in the Gulf Coast since January 2006 and covers a random sample of 1,079 households in Louisiana and Mississippi, including 427 children. Face-to-face interviews were conducted by trained interviewers, and the key outcome variable was Serious Emotional Disturbance, based upon the Strengths and Difficulties Questionnaire (SDQ), a widely validated diagnostic screener. The data were collected in four waves over the course of four years with the majority of data for this analysis drawn from the fourth round of data, collected through March 2010.

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CDC: Two-Thirds of Emergency Visits Occur During Non-Business Hours; Percentage of Non-Urgent Emergency Patients Drops To Less than 8 Percent

/PRNewswire/ -- A new report from the Centers for Disease Control and Prevention once again debunks the myth that emergency departments are crowded with non-urgent patients, a finding noted by the American College of Emergency Physicians (ACEP).

"The percentage of non-urgent patients dropped to only 7.9 percent in 2007 [from 12.1 percent in 2006]," said Dr. Angela Gardner, president of ACEP. "The report also makes the excellent point that non-urgent does not imply unnecessary. As we have said repeatedly, our patients are in the ER because that's where they need to be.

There were approximately 222 visits to U.S. emergency departments every minute in 2007 (http://bit.ly/9B5kHJ) and the number of visits increased by 23 percent between 1997 and 2007, according to the report. Preliminary data for 2008 indicate that emergency visits will increase to a record high of more than 123 million (http://bit.ly/ak6oRx).

The report, "National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary" offers far more detail than the data brief released by the Centers for Disease Control and Prevention (CDC) in May. The U.S. Department of Health and Human Services, of which the CDC is a part, has indicated that this is the last fully detailed report of its kind to be issued about emergency department visits.

Dr. Gardner is urging the CDC to reconsider:

"It is essential to know what is happening in our emergency departments as we implement health care reform. This report is rich in data about who our patients are, how old they are and why they are seeking care in the ER. From a planning perspective, this information is invaluable. It would be a mistake for the CDC to discontinue tracking what is happening on the front lines of healthcare, the nation's emergency departments."

Babies under 12 months old had the highest visit rate at 88.5 visits per 100 infants. The second highest visit rate was by adults age 75 and older, with 62 visits per 100 people.

Approximately one-quarter of all visits were by patients insured by either Medicaid or the State Children's Health Insurance Program. The uninsured represented about 15 percent of all visits.

"Most doctors' offices are open for around 45 hours a week, as opposed to the 168 hours a week emergency departments are open," said Dr. Gardner. "That nearly two-thirds of emergency patients came to the ER between 5 p.m. and 8 a.m. during the week or on weekends highlights the unpredictable nature of health emergencies. When you are the one who has a sick child, the last thing you want is a 'closed' sign or after-hours message."

The report also notes that only 0.1 percent of patients die in the emergency department.

"We do an excellent job of stabilizing and treating our patients, but the persistent problems of overcrowding, ambulance diversion and boarding admitted patients in the ER are not going away," said Dr. Gardner. "We know from the Massachusetts experience that visits will continue to rise with health care reform. We also know that as Baby Boomers age, a tsunami of patients in need of emergency care is just around the corner. We need help and we need it now."

The report says the main issue contributing to overcrowding has been delays in moving the sickest patients to inpatient beds. Admitted patients have often been boarded in the emergency departments or hospital hallways for hours to days, resulting in overcrowding and diversion of incoming ambulances to other hospitals.

ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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Length of Stay in ERs Reaches New High, Delays in Moving Admitted Patients Out of ERs Blamed

/PRNewswire/ -- Average length of stay in the nation's emergency departments increased to four hours and seven minutes, and the nation's emergency physicians are very concerned about patient safety being jeopardized by long wait times. Press Ganey's Pulse Report 2010, released yesterday, confirms what the American College of Emergency Physicians has reported previously: The recession, high unemployment and insurance losses are increasing pressure on emergency departments and their patients.

Dr. Angela Gardner, president of the American College of Emergency Physicians, assessed the report's findings:

"The report finds pockets of good news, such as shorter times overall in Nevada, but nobody can possibly call a national average of more than four hours in the emergency department something to cheer about. Last year the GAO reported that even patients who need to be seen in 1 to 14 minutes are waiting an average of 37 minutes for care. Emergency physicians have become masters of improvisation and troubleshooting under extreme conditions, but the fundamental problems in our emergency departments remain unsolved.

"Hospitals need to stop boarding admitted patients in the emergency department and get them to the appropriate inpatient floor quickly. That is what's best for the admitted patients but it's also what's best for the patients suffering in the waiting room. The full capacity protocol (http://bit.ly/9c44JH) has been proven effective in numerous emergency departments, but many hospitals continue to resist implementing it. That's bad for patients.

"Policymakers and the public should also have no illusions that the recently passed health care legislation is going to decrease ER use. Massachusetts, which enacted health care reform in 2006, has seen an increase in emergency department visits, with no decrease in patient acuity. It proves that health care coverage is no guarantee of health care access.

"Hospital emergency departments continue to close, which reduces access to emergency care still further. More patients plus fewer ERs equals longer wait times. Nearly one-quarter of hospitals report periods of ambulance diversion because they are over capacity. A longer ride to the hospital is not good medicine.

"This report is yet another wake-up call that health care reform has yet to address the acute care needs of 123 million emergency patients a year. They may report being satisfied with the care they are receiving in the ER, but emergency physicians are dissatisfied with an average time in the emergency department that is nearly equal to a coast to coast airplane ride."

ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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Arthritis Impacts African-Americans and Hispanics More than Whites

/PRNewswire/ -- Arthritis causes more pain and limitations for African-Americans and Hispanics than for whites, according to a study released today by the Centers for Disease Control and Prevention.

African-Americans were 17 percent less likely to report having arthritis than whites, and Hispanics were 46 percent less likely to report the condition than whites, the study said. However, African-Americans and Hispanics with arthritis were almost twice as likely to report severe joint pain and work limitations attributed to their arthritis when compared to whites, it said.

The study, "Difference in the Prevalence and Impact of Arthritis among Racial / Ethnic Groups," was published in the journal Preventing Chronic Disease.

Arthritis is the leading cause of disability in the United States, affecting 1 in 5 adults. It interferes with work and other daily activities and can complicate the management of other chronic diseases. Arthritis encompasses more than 100 diseases and conditions that affect joints and other connective tissue.

The reason for the racial and ethnic differences, while unknown, may result from a lack of access to health care, language barriers and cultural differences, the report says.

"We must address these stark differences in arthritis impact by using what we know,'' said Jennifer Hootman, an epidemiologist for the CDC National Center for Chronic Disease Prevention and Health Promotion and co-author of the report. "We can educate those with arthritis about increasing physical activity and self-management and reducing obesity, especially those in groups bearing a disproportionate burden from arthritis."

The data, collected from the CDC National Health Interview Survey, are the first to estimate the national prevalence of arthritis and assess its impact among smaller racial and ethnic groups that are usually grouped together when reporting health statistics.

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New Study Evaluates Effectiveness of Vitamins for the Treatment of Sun-Damaged Skin

/PRNewswire/ -- While everyone knows that getting an adequate daily dose of vitamins and minerals is important in maintaining one's overall health, many question whether or not the vitamins touted in skin care products work in reducing the signs of sun-damaged skin. Now, a new study reviews the currently published scientific literature to determine what evidence exists to support the use of vitamins in skin care products to slow or reverse the effects of sun damage.

In the report entitled, "Vitamins and photoaging: Do scientific data support their use?", published online in the Journal of the American Academy of Dermatology, dermatologist Jenny Kim, M.D., Ph.D., FAAD, associate professor in the division of dermatology, department of medicine, at the University of California, Los Angeles (UCLA), David Geffen School of Medicine in Los Angeles, presented results of a study that may support the use of certain vitamins in oral or topical formulations.

"It is well documented that ultraviolet (UV) radiation contributes to premature skin aging through the process of photoaging, and there is increasing evidence that the antioxidant properties of vitamins may contribute to the prevention and treatment of photoaging," said Dr. Kim. "In fact, numerous companies developing cosmeceuticals base their effectiveness claims on the fact that their formulations contain vitamins proven in laboratories to modify cellular processes thought to contribute to the appearance of photoaged skin. As dermatologists, we can help our patients navigate this maze of marketing claims by sharing scientific data on the known efficacy of vitamins in skin care products."

Based on a comprehensive review of the available published data on the role of vitamins in skin care products, Dr. Kim and her colleagues, Jamie Zussman, M.D., FAAD, and Jennifer Ahdout, M.D., found there is evidence to support the potential role of vitamins A, C, E, and B3 in modifying the photoaging process.

"While it's evident that these vitamins can play a role in fighting sun damage, the question still remains whether these properties are effective when delivered in skin care products," notes Dr Kim.

Vitamin A: Effective in treating a variety of skin conditions

The two most common forms of vitamin A studied for their role in protecting the skin from UV-induced damage are retinols and carotenoids. Retinol is found in foods such as liver, milk and eggs, and is the most biologically active form of the vitamin. Carotenoids are found in many fruits and vegetables, and have strong antioxidant capabilities.

While carotenoids are not shown to be beneficial in the treatment of photoaging, research suggests that they may play a role in photoprotection by preventing UV-induced collagen breakdown.

"Although the evidence available at this time is not strong enough to offer definitive support for the use of dietary carotenoids for photoprotection, a role for carotenoids as a supplement to photoprotective agents should not be discounted yet," said Dr. Kim. "We hope to see larger-scale clinical trials conducted to further explore the photoprotective effects of carotenoids."

Unlike carotenoids, there is vast evidence supporting the role of topical retinoids (the class of substances formed by retinol and its natural and synthetic derivatives) in treating photoaged skin. For example, prescription retinoid formulations have the most scientific data to support their use in this area.

Dr. Kim noted that both tretinoin cream (0.025% and 0.05%) and tazarotene cream (0.1%) are already FDA-approved for the treatment of fine wrinkles, skin roughness and mottled hyperpigmentation caused by aging and sun exposure. In addition, she added that studies of other retinoids have shown that a once-daily application of 0.1% isotretinoin cream for 36 weeks was effective in reducing fine wrinkles.

Retinoids also are found in over-the-counter cosmeceuticals, but there is less clinical evidence supporting their effectiveness in improving photoaged skin. "An important point to remember with retinoids is that we cannot assume that all retinoids are equal in their ability to fight photoaging," said Dr. Kim. "In over-the-counter products, retinol appears to be the most effective retinoid based on clinical studies completed to date. However, patients should consult their dermatologist before using any topical retinoid, as side effects can occur when used with other topical products. When properly instructed by a dermatologist, most patients can tolerate topical retinoids and benefit from their effect."

Dr. Kim added that unlike topical retinoids, there is minimal evidence supporting the use of oral retinoids in the treatment of photoaging.

Vitamin C: Possible skin care product value

Vitamin C, a water-soluble vitamin also known as ascorbic acid that is found in citrus fruits and dark green leafy vegetables, plays an essential role in the production of collagen and elastin. Because of its antioxidant properties, vitamin C may reverse the negative effects of UV radiation in the skin, but there are few clinically controlled studies to confirm this theory.

"An animal study examining the role of vitamin C in reversing sun damage found that when 5% ascorbate was applied two hours before UVB and UVA exposure, UVB-induced skin wrinkling was reduced," said Dr. Kim. "Some of the human clinical trials have shown similar favorable results when applying a daily dose of L-ascorbic acid treatment, but all of these studies involved small sample sizes."

In addition, Dr. Kim pointed out that one concern of adding vitamin C to cosmeceuticals is that vitamin C is unstable when used in formulations, and it is not known how much, if any, intact molecule remains when applied to the skin.

"This problem has been partially overcome by chemically modifying ascorbic acid," said Dr. Kim. "However, for the body to use the supplied ascorbic acid, it must convert it to L-ascorbic acid, and many of the stabilized, commercially available forms have not been examined to determine whether this conversion is possible. For that reason, the average consumer will not be able to determine if a cosmeceutical containing vitamin C will be effective."

Vitamin E: A primary antioxidant

Vitamin E, or tocopherol, is a fat-soluble vitamin, and its synthetic form is found in many over-the-counter products. Working as an antioxidant, vitamin E protects cell membranes and is thought to play an important role in skin aging because of its antioxidant properties. While topical vitamin E is available in a variety of products, there is no data which support claims that it improves skin wrinkling, discoloration and texture.

"Topical vitamin E has been studied in humans, as in mice, more as a protectant to be used before sun exposure than as an agent to be included in cosmeceuticals to reduce the signs of skin aging," said Dr. Kim. "Through research we have learned that UV exposure significantly decreases levels of cutaneous vitamin E, and vitamin C should be included in any formulation containing vitamin E because of the important role it plays in maintaining active vitamin E levels."

Research also has explored combining vitamins E and C as an oral supplement to provide sun protection. Multiple studies suggest that this combination therapy is beneficial for photoprotection. However, Dr. Kim noted that overzealous oral vitamin E supplements may be harmful, and two new studies also suggest that a high intake of vitamin E may be associated with an increased risk of basal cell carcinoma.

Vitamin B3: A possible treatment for photoaging

The B vitamins consist of eight different water-soluble vitamins that are found in a variety of foods. Vitamin B3 has been shown to reduce blood cholesterol and atherosclerosis (a condition in which fatty materials collect along artery walls), but now new insights are examining its role as an effective treatment for several skin conditions - from acne to photoaging.

Specifically, Dr. Kim noted that vitamin B3 has been found to increase collagen production in in vitro studies and to reduce skin hyperpigmentation (dark spots) in clinical studies.

"There has been one clinical trial conducted in Caucasian women in which 50 women applied 5% niacinamide (topical vitamin B3) to one side of their faces twice per day for 12 weeks, and these women experienced significant reductions in the appearance of hyperpigmented spots, redness, wrinkles, and yellowing, as well as improved skin elasticity," said Dr. Kim. "While initial studies show promise that topical vitamin B3 may prevent UV-induced skin aging, larger clinical trials are needed to confirm its role as a definitive treatment of photoaging."

Bottom Line: Maintain healthy lifestyle, healthy diet, practice sun protection

Dr. Kim added that it is important for everyone to get an adequate daily supply of vitamins to maintain a healthy lifestyle, and any insufficiencies may negatively impact the skin's overall appearance.

"Research has shown a potential role for various vitamins in reducing the damaging effects of sun exposure on the skin. Whether topical or oral formulations containing these vitamins have a protective effect is uncertain. Given the number, type and variability of preparations available, consumers should understand from our study that skin care products with vitamins may not provide clinically meaningful improvement," said Dr. Kim. "What is known is that proper sun protection is key to the prevention of photoaging and should be top of mind at all times."

For more information on improving the appearance of your skin, go to the "AgingSkinNet" section of www.SkinCarePhysicians.com, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.

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A Better Genetic Test for Autism

/PRNewswire/ -- A large study from Children's Hospital Boston and the Boston-based Autism Consortium finds that a genetic test that samples the entire genome, known as chromosomal microarray analysis, has about three times the detection rate for genetic changes related to autism spectrum disorders (ASDs) than standard tests. Publishing in the April issue of Pediatrics (and online March 15), the authors urge that CMA become part of the first-line genetic work-up for ASDs.

Expectant parents who have family members with ASDs, as well as families who already have an affected child, often request genetic testing. However, there is still only limited knowledge about actual causative genes. The currently recommended tests (karyotyping to look for chromosomal abnormalities and testing for Fragile X, the single largest known genetic cause of ASDs) often come up negative. Chromosomal microarray analysis (CMA) is a genome-wide assay that examines the chromosomes for tiny, sub-microscopic deletions or duplications of DNA sequences, known as copy-number variants.

CMA offers about 100-fold greater resolution than standard karyotyping. However, since it is new, it is often considered a second-tier test. Depending on where a person lives, or what insurance they have, CMA may not be covered by health insurance. "Based on our findings, CMA should be considered as part of the initial clinical diagnostic evaluation of patients with ASDs," says Bai-Lin Wu, PhD, Director of Children's DNA Diagnostic Lab in the Department of Laboratory Medicine, which has offered CMA to families since 2006.

The research team, led by co-senior authors Wu (heading the Children's team), and David Miller, MD, PhD, of Children's Division of Genetics and Department of Laboratory Medicine (heading the Autism Consortium team), assessed the diagnostic value of CMA in the largest cohort to date - 933 patients with a clinical diagnosis of ASD (by DSM-IV-TR criteria) who received clinical genetic testing in 2006, 2007 and 2008.

Half were Children's patients who had their samples submitted to the hospital's DNA Diagnostic Laboratory, and the others were recruited through the Autism Consortium, a research and clinical collaboration of five Boston-area medical centers. Nearly half of the patients were diagnosed with autistic disorder, nearly half with PDD-NOS (pervasive developmental disorder - not otherwise specified) and about 3 percent with Asperger disorder. Ages ranged from 13 months to 22 years.

Testing included the two currently used tests (G-banded karyotype and fragile X), as well as CMA. When the researchers compared the tests' diagnostic yield, they found:

-- Karyotyping yielded abnormal results in 2.23 percent of patients
-- Fragile X testing was abnormal in 0.46 percent
-- CMA results were judged to be abnormal in 7.3 percent of patients when
the entire length of the chromosomes (the whole genome) was sampled.


Extrapolating from these results, the researchers estimate that without CMA, genetic diagnosis will be missed in at least 5 percent of ASD cases. CMA performed best in certain subgroups, such as girls with autistic disorder, and past studies indicate that it also has a higher yield in patients with intellectual disability (who constituted only 12 percent of this sample).

"CMA clearly detects more abnormalities than other genetic tests that have been the standard of care for many years," says Miller. "We're hoping this evidence will convince insurance companies to cover this testing universally."

In all, roughly 15 percent of people with autism have a known genetic cause. Establishing a clear genetic diagnosis helps families obtain early intervention and services for autism, and helps parents predict the possibility of having another child with autism.

In addition, by pinpointing bits of chromosomes that are deleted or duplicated, CMA can help researchers zero in on specific causative genes within that stretch of DNA. They can also begin to classify patients according to the type of deletion or duplication they have, and try to find specific treatment approaches for each sub-type of autism.

"Just in the last two years, a number of studies have revealed the clinical importance of ever smaller chromosome deletions and duplications found with advanced microarray technology," says Wu. "These new, highly-efficient tests can help in the evaluation or confirmation of autism spectrum disorders and other developmental disorders, leading to early diagnosis and intervention and a significantly improved developmental outcome."

Two known chromosome locations - on chromosome 16 (16p11.2) and chromosome 15 (15q13.2q13.3) accounted for 17 percent of abnormal CMA findings. Both chromosome abnormalities were initially linked with ASDs by Children's Hospital Boston and collaborators in The New England Journal of Medicine and the Journal of Medical Genetics, respectively, in 2008. Children's now offers specific tests targeting both of these "hot spots."

However, the researchers note that most copy-number changes were unique or identified in only a small number of patients, so their implications need further study. Many of them are presumed to be related to ASDs because they involve important genes, cover a large region of the chromosome, or because the child is the first person in that family to have the change.

"Some deletions and duplications are rare and specific to one individual or one family," says Miller. "Learning about them is going to be an evolving process. There won't be one single test that finds all genetic changes related to autism, until we completely understand the entire genome."

The paper's co-first authors were Autism Consortium members Yiping Shen, PhD, of Children's Department of Laboratory Medicine and the Center for Human Genetic Research at Massachusetts General Hospital, and Kira Dies, ScM, LGC, of the Family Research Network of the Autism Consortium and Children's Multi-Disciplinary Tuberous Sclerosis Program. A number of specialists from Children's Departments of Neurology, Developmental Medicine and Clinical Genetics and physicians from other medical centers in greater Boston were also authors on the study. The research was supported by the Nancy Lurie Marks Family Foundation, the Simons Foundation, Autism Speaks and the National Institutes of Health.

Families interested in scheduling an appointment at Children's may call the Developmental Medicine Center (617-355-7025) or the Department of Neurology (617-355-2711).

Citation: Shen Y; et al. Clinical genetic testing for patients with autism spectrum disorders. Pediatrics 2010 Apr; 125(4):e1-e17. (Published online March 15)

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New, National Amnesty International Report Finds Appalling U.S. Death Rate for Women Having Babies, Systemic Failures and Shocking Disparities in Maternal Health Care System; Georgia is 50th Among All States in Maternal Mortality

/PRNewswire/ -- In releasing a new report on maternal health nationwide, Amnesty International today revealed that flaws and shocking disparities in maternal health care that the government is ignoring lead to two to three women dying daily in the United States from pregnancy-related complications, with half of these deaths believed preventable, according to the Centers for Disease Control. A state-by-state examination shows that Georgia is 50th on a maternal mortality ranking, with 20.5 deaths per 100,000 live births.*

The new Amnesty International report, Deadly Delivery: The Maternal Health Care Crisis in the USA, also reveals that severe pregnancy-related complications that nearly cause death -- known as "near misses" -- are rising at an alarming rate, increasing by 25 percent since 1998; currently nearly 34,000 women annually experience a "near miss" during delivery. With a lifetime risk of maternal deaths that is greater than in 40 other countries, including virtually all of the industrialized countries, the United States has failed to reverse the two-decade upward trend in preventable maternal deaths, despite pledges to do so.

The report cited numerous causes for the crisis and offers lengthy recommendations on improving maternal health care.

Inadequate prenatal care is cited as a contributing factor in the crisis; women who do not get prenatal care are three to four times more likely to die than women who do. In Georgia, almost one in six women (15.8 percent) receive delayed or no prenatal care. The number rises to one in five women (21.9 percent) among women of color.

Obstacles to care are widespread: the most obvious being that across the United States nearly 13 million women of reproductive age (15 to 44), or one in five, have no health insurance. In Georgia nearly one in five women (19.7 percent) are uninsured; among women of color the number of uninsured climbs to 27.6 percent. The state's Medicaid eligibility level for working parents is also very low, $9,072. Lack of access to health care centers and providers is a problem nationwide, the report found; in Georgia 41 percent of women live in medically underserved areas.

"No issue can be more central to the health and well-being of our nation than maternal health care," said Jared Feuer, Southern Regional Director for Amnesty International USA. "The government should accept its duty and its moral obligation to address this inexcusable crisis by developing a comprehensive plan to ensure quality health care for all pregnant women. If the federal government can address steroid use in baseball, certainly lawmakers can address maternal health, which affects every family in the United States."

Maternal health is a human right for every woman in the United States, regardless of race or income. Yet, the United States lacks a systematic, robust government response to this critical problem. Amnesty International is urging President Obama to work with Health and Human Services Secretary Kathleen Sebelius to establish, and seek Congressional funding, for a single office responsible for ensuring that all women receive quality maternal health care. An Office of Maternal Health would lead government action to reduce the soaring pregnancy-related complications and maternal deaths nationwide.

Additionally, Amnesty International calls for vigorous enforcement of federal non-discrimination laws and an increase in support for Federally Qualified Health Centers by 2011 to expand the number of women who can access affordable maternal health care.

"This country's extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful," said Larry Cox, executive director of Amnesty International USA. "Mothers die not because the United States can't provide good care, but because it lacks the political will to make sure good care is available to all women."

Amnesty International's analysis shows that health care reform before Congress does not address the crisis of maternal health care.

"Reform is primarily focused on health care coverage and reducing health care costs, and even optimistic estimates predict that any proposal on the table will still leave millions without access to affordable care," said Rachel Ward, one of the authors of the Deadly Delivery report. "Furthermore, it does not address discrimination, systemic failures and government accountability documented in Amnesty International's report."

Rapid and comprehensive federal leadership is required, as the report found numerous systemic failures, including the following:

-- Burdensome bureaucratic procedures in Medicaid enrollment
substantially delay access to vital prenatal care for pregnant women
seeking government-funded care. Twenty-one states do not offer
"presumptive eligibility" which allows pregnant women to temporarily
access medical care while their permanent application for Medicaid is
pending. Women who do not receive any prenatal care are three to four
times more likely to die than women who do.
-- The number of deaths is significantly understated because there are no
federal requirements to report maternal deaths or complications and
data collection at the state level is insufficient.
-- Oversight and accountability is lacking. 29 states and the District of
Columbia have no maternal death review process at all.


Amnesty International is a Nobel Peace Prize-winning grassroots activist organization with more than 2.2 million supporters, activists and volunteers in more than 150 countries campaigning for human rights worldwide. The organization investigates and exposes abuses, educates and mobilizes the public, and works to protect people wherever justice, freedom, truth and dignity are denied.

For more information or to take action, please visit: www.amnestyusa.org/deadlydelivery

*National Women's Law Center, National Report Card on Women's Health, Maternal Mortality Rate Table; available at

http://hrc.nwlc.org/Status-Indicators/Key-Conditions/Maternal-Mortality-Ra te.aspx.

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CDC Foundation Launches Viral Hepatitis Action Coalition

/PRNewswire/ -- In anticipation of the release of the Institute of Medicine (IOM) report on viral hepatitis, the CDC Foundation (the independent nonprofit partner of the Centers for Disease Control and Prevention), in partnership with CDC's Division of Viral Hepatitis, recently launched the Viral Hepatitis Action Coalition. The Coalition is comprised of private-sector organizations committed to supporting high priority research, education and program evaluation projects initiated by CDC's Division of Viral Hepatitis. In addition to providing funding for specific projects, Coalition members also will support CDC by sharing research data, connecting CDC to appropriate stakeholders and networks, and providing feedback on the information and tools needed in the field to respond to the recommendations outlined in the IOM report.

Founding Viral Hepatitis Action Coalition members include: Gilead Sciences, Inc.; Merck & Co., Inc.; OraSure Technologies; and Vertex Pharmaceuticals. In addition to supporting the overall Coalition, members will have the opportunity to fund and partner with CDC on CDC-led research and education projects as priorities are identified. Two initial priority projects include a study called Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C (BEST-C) and a national hepatitis education campaign. For each project, Coalition members will reach out to other critical partners in the hepatitis community as appropriate, including partners from academia, patient advocacy and other hepatitis-related groups. Coalition members are committed to engaging the entire hepatitis community in efforts to improve screening and treatment of viral hepatitis.

The Viral Hepatitis Action Coalition is seeking additional membership, and those interested in membership should contact Leah-Lane Lowe at 404.653.0790 or llowe@cdcfoundation.org. To learn more about CDC's Division of Viral Hepatitis, please visit www.cdc.gov/hepatitis.

Established by Congress, the CDC Foundation is the independent, nonprofit partner of the Centers for Disease Control and Prevention. The CDC Foundation helps CDC do more, faster by forging effective partnerships between CDC and individuals, corporations and foundations to fight threats to health and safety. To learn more, please visit www.cdcfoundation.org.

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New Pediatrics Report Urges Medical Community to Address Underlying Pathologies in Patients With Autism

/PRNewswire/ -- An article published today in the journal Pediatrics confirms what parents and advocacy organizations have been saying for years: many individuals with autism suffer from gastrointestinal disease that can contribute to behaviors and symptoms associated with autism.

Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report is the result of expert panel study and discussion led by Dr. Timothy Buie of the Harvard Medical School Department of Pediatrics. The panel's findings point out not only the existence of underlying GI disturbances that can manifest as behavioral problems, but also notes that such medical issues have often gone undiagnosed or been ignored in the past by physicians treating patients diagnosed with autism.

"We are finally getting mainstream acknowledgement that our kids are physically sick, and not the victims of some mysterious genetic behavioral disorder," commented Lori McIlwain, National Autism Association (NAA) board chair. "With one in 110 children now diagnosed with autism, we are in the midst of a national health emergency. Physicians must address the underlying medical conditions involved in this epidemic if they are to help us find answers and relief for our children."

The panel arrived at several conclusions regarding current clinical practice guidelines and made recommendations for future medical and research priorities. These include:

-- Current treatment guidelines do not routinely consider potential
medical problems
-- Problem behaviors including self-injury, aggression, irritability,
and sleep disturbance may be manifestations of abdominal pain
-- Behavioral treatment should not substitute for medical treatment
-- Gastrointestinal symptoms should be considered an urgent indication
for medical investigation
-- Immunologic dysfunction, inflammation, metabolic dysfunction, and
allergies are all potentially associated with autism
-- Research is needed to determine the role of abnormal GI permeability
in neuropsychiatric manifestations of autism
-- Greater awareness is needed among health care providers of the
atypical manifestations of GI disorders
-- Awareness of unrecognized medical conditions in autism must become a
priority of professional societies including the American Academy of
Pediatrics
-- Diagnostics should be performed to accurately identify co-morbid
allergic disease
-- Research is needed to determine the role of immune dysfunction in
autism


"This is definitely a step in the right direction," said Ms. McIlwain. "Our kids need and deserve clinical investigation and treatment for the underlying medical conditions from which they suffer."

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New Study Shows That American Public is Willing to Accept Major Reforms in Medicare Program

/PRNewswire/ -- Although Americans see Medicare as a key part of the country's social contract and want to preserve it in some recognizable form, they are willing to consider significant changes in the program to hold down its costs as the U.S. population ages.

In day-long "Choice-Dialogues" in which Americans from all walks of life considered the pros and cons of a range of choices for reforming Medicare, common ground was found in several key areas:

-- Allow Medicare to negotiate prices for prescription drugs (94 percent
support).
-- Encourage hospice care instead of heroic end-of-life measures (85
percent support).
-- Only cover treatments that are scientifically proven to be effective
(68 percent support).
-- Emphasize preventive care and personal responsibility (89 percent
consider preventive care very important or essential).
-- Gradually increase the Medicare eligibility age from 65 to 67 (68
percent support).


If additional money is needed to maintain Medicare in a way that is familiar in the future, Americans would rather see the government raise taxes than increase the federal debt.

These are among the central findings in a report released today by The Concord Coalition and Viewpoint Learning, Inc. The report is entitled "Medicare: It's Not Just Another Program."

The report, which was written by Viewpoint Learning, also underscores public dismay at the health care system in general. It comes as Congress and the Obama administration are working on massive changes in the entire system.

"Participants repeatedly expressed concerns over what they saw as a Byzantine and unaccountable health care system," the Medicare report says. "Most felt that the medical industry (especially the pharmaceutical companies) puts profits before people."

Robert L. Bixby, executive director of The Concord Coalition, says the report shows that Americans are prepared to accept significant changes in the program that plays a central role in the federal government's long-term fiscal problems.

"Medicare is on an unsustainable path and must be reformed," Bixby said. "According to conventional wisdom, however, the public is not ready to accept any change in the status quo. The good news from these Choice-Dialogues is that the conventional wisdom is wrong; the public is ready and willing to consider some very fundamental Medicare reforms so long as the program is preserved as a vital part of the social contract."

"Politicians who are truly interested in saving Medicare should stop the scare tactics and start engaging the public in a dialogue on the real trade-offs that must be confronted," Bixby added. "Changes will still be difficult, but the results will be more acceptable."

Viewpoint Learning conducted the dialogues with randomly selected representative samples of 35-40 citizens in Oak Brook, Illinois; Columbia Maryland; Phoenix and Houston. This project builds on the findings of a broader two-year project, "The America We Want," that examined public opinion on a broader range of federal programs and budget issues.

The new report found that many Americans lacked a strong understanding of the Medicare program, how it is funded, and the severity of the fiscal challenges facing the United States in the years ahead.

Yet most participants in the dialogues, after studying these issues in depth and spending much of a day discussing the problems and possible solutions with others, were able to agree on a set of Medicare changes.

But to win public support, the report cautions, "proposals for major reform to Medicare need to recognize the extent to which Americans see Medicare as an essential part of the social contract and not just as another government program."

Steven Rosell, president of Viewpoint Learning, said "The findings from these daylong dialogues with Americans from very different backgrounds and perspectives reveal deep disconnects between how Washington talks about Medicare and health care reform and how the public talks about them. In case after case, the report shows how leaders and the public are talking past each other, and how this deep disconnect and misunderstanding lead to the heat and the rancor that have made advancing real reform so difficult."

When most people talk about the "cost of health care," for example, they are focused on what they pay in premiums, co-pays and drug expenses. When health care experts talk about costs, however, they usually focus on the costs to businesses, government and other institutions.

Rosell also noted that many Americans do not realize that they are essentially paying for the cost of care for the uninsured already.

The new report, he said, provides insight for leaders about how best to bridge such disconnects and begin to create a learning curve that could lead to public support for significant Medicare reform.

Some elements in the new report also echo the findings of The Concord Coalition's fiscal advisory councils that met in early December in Washington. Working in six different parts of the country on Concord's Fiscal Stewardship Project, these advisory councils called for sweeping reforms in the health care system and some changes in Medicare to put the government on a more sustainable fiscal path. More information on the advisory councils' work is available at:

http://concordcoalition.org/fiscal-stewardship-project/fiscal-stewardship- project.

The full report, entitled "Medicare: It's Not Just Another Program," is available at: http://www.concordcoalition.org/files/uploaded-pdfs/Medicare_Report_Dec09_PRIN T.pdf

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CSTE National Assessment Finds Critical Public Health Disease Surveillance Capacity Lacking

/PRNewswire/ -- Today, CDC's Morbidity and Mortality Weekly Report (MMWR) released a report showing that the number of state-level epidemiologists has decreased steadily since 2004, with a marked decline of over 10% since 2006. There was also a substantial decrease in core epidemiology capacity over this same period, including epidemiology capacity for bioterrorism and emergency response. For some important subject areas such as occupational health, substance abuse, and oral health, basic epidemiology capacity in most states is described as minimal to non-existent, and many states still lack the 21st century technology capacity needed for state-of-the-art surveillance. Dr. James Hadler, the lead author of this article, concluded that "The current condition of national epidemiology is a preparedness and public health vulnerability." States indicated a substantial need for more epidemiologists in all program areas. The deterioration of state epidemiology capacity is a consequence of declines in funding for bioterrorism preparedness and emergency response as well as an effect of the economic downturn on state budgets.

CSTE's 2009 Epidemiology Capacity Assessment (ECA) is the most recent in a series of epidemiology capacity assessments that enumerate and characterize epidemiologists, measure core epidemiology capacity, and assess competency-specific training. The 2009 ECA also conducted initial assessments of surveillance system technologic capacity and substance abuse program capacity. The 2009 ECA builds on the previous ECAs of 2004 and 2006. This year's assessment indicates a substantial decline in overall epidemiology capacity across the nation.

Epidemiologists are best known for their "disease detective" work with infectious diseases that are naturally occurring or intentionally released, but they are mainly involved in everyday surveillance/monitoring and study of many diseases and conditions that affect the health of the their state's population. These activities can range from food and waterborne disease investigations to disease monitoring for environmental health conditions, chronic diseases, maternal and child health, injury, occupational and oral health and substance abuse.

"State, federal and local agencies need to work together to address the understaffed epidemiology workforce, the downward trends in capacity and the looming epidemiology workforce shortage. Public health needs to achieve a full, well-trained and competent workforce prepared with the appropriate tools and skills for the 21st century," says co-author Matthew Boulton from the University of Michigan School of Public Health, Center of Excellence in Public Health Workforce Studies. Access to the full report, 2009 Epidemiology Capacity Assessment: Findings and Recommendations, can be found at www.cste.org.

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Highest Rates of Obesity, Diabetes in the South, Appalachia, and Some Tribal Lands

Wide sections of the Southeast, Appalachia, and some tribal lands in the West and Northern Plains have the nation's highest rates of obesity and diabetes, according to estimates released today by the Centers for Disease Control and Prevention. In many counties in those regions, rates of diagnosed diabetes exceed 10 percent and obesity prevalence is more than 30 percent.

The estimates, in this week's Morbidity and Mortality Weekly Report, are the first to provide county-level snapshots of obesity across the United States. They also update diabetes county-level estimates released in 2008.

Eighty-one percent of counties in the Appalachian region that includes Kentucky, Tennessee, and West Virginia have high rates of diabetes and obesity. So do three-quarters of counties in the southern region that includes Alabama, Georgia, Louisiana, Mississippi, and South Carolina.

"Diabetes is costly in human and economic terms, and it's urgent that we take action to prevent and control this serious disease," said Dr. Ann Albright, director of CDC's Division of Diabetes Translation. "The study shows strong regional patterns of diabetes and can help focus prevention efforts where they are most needed."

The estimates come from the agency's Behavioral Risk Factor Surveillance System (BRFSS), which uses self-reported data from state-based adult telephone surveys, and 2007 census information. The information may help public health workers, health care providers, community organizations, and policymakers focus on high-risk regions to prevent type 2 diabetes and its complications as well as other chronic diseases linked to obesity, including heart disease, stroke, and some cancers.

The proportion of U.S. adults who are obese was 26.1 percent in 2008, according to BRFSS data. CDC estimates that nearly 8 percent of the population, or about 24 million people, have diabetes. Of these, 5.7 million are undiagnosed.

"The small-area estimates for obesity will be an important tool to help communities better understand and battle this serious public health problem. Communities are in the best position to prevent and reduce obesity among their citizens through innovative programs," said Dr. William H. Dietz, director of CDC's Division of Nutrition, Physical Activity and Obesity.

The medical costs of obesity reached an estimated $147 billion in 2008, and the medical costs of diabetes were $116 billion. People with diagnosed diabetes have medical costs that are 2.3 times higher than those without the disease.

Obesity is one of several factors linked to type 2 diabetes. Where people live, how much money they earn, their culture and their family history also play a role. An unhealthy diet, lack of physical activity, and socioeconomic factors contribute to both obesity and type 2 diabetes as well as to complications of diabetes. Some population groups also are at higher risk, including a number of racial and ethnic minorities.

CDC and its partners are working on a variety of initiatives to prevent type 2 diabetes and to reduce obesity. CDC has recommended 24 community strategies to prevent obesity, from providing greater access to healthy foods to redesigning communities to encourage more physical activity. The agency is also in a new partnership with state, federal, and nonprofit agencies targeting health disparities in Mississippi, which has the nation's highest obesity rate and one of the highest rates of diabetes. CDC's national diabetes prevention and control program provides resources and technical assistance to state health departments, national organizations, and communities.

To see county-level estimates of obesity and diagnosed diabetes, go to www.cdc.gov/diabetes/statistics. For more information on diabetes and preventing the disease, visit www.cdc.gov/diabetes. To learn more about CDC s efforts in the fight against obesity or for more information about nutrition, physical activity, and maintaining a healthy weight, go to www.cdc.gov/obesity/index.html.

/PRNewswire-USNewswire

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Fewer U.S. Schools Selling Less Nutritious Food and Beverages

/PRNewswire/ -- Fewer secondary schools in the United States are selling less nutritious foods and beverages, such as candy and soda, according to a survey from the Centers for Disease Control and Prevention.

The greatest improvements were seen in states that have adopted strong school nutrition standards and policies for foods and beverages sold outside school meal programs.

The report, "Availability of Less Nutritious Snack Foods and Beverages in Secondary Schools - Selected States, 2002-2008," was published today in CDC's Morbidity and Mortality Weekly Report.

The report shows that among the 34 states that collected data in 2006 and 2008, the median percentage of secondary schools that did not sell soda or fruit drinks that are not 100 percent juice increased from 38 percent to 63 percent. The median percentage of secondary schools in these states that did not sell candy or salty snacks not low in fat increased from 46 percent in 2006 to 64 percent in 2008.

"The school environment is a key setting for influencing children's food choices and eating habits," said Howell Wechsler, Ed.D, M.P.H., director of CDC's Division of Adolescent and School Health. "By ensuring that only healthy food options are available, schools can model healthy eating behaviors, help improve students' diets, and help young people establish lifelong healthy eating habits."

Mississippi and Tennessee made the greatest progress in improving the nutrition environment in their schools. In Mississippi, the percentage of secondary schools that did not sell soda or fruit drinks that are not 100 percent juice increased from 22 percent in 2006 to 75 percent in 2008, while in Tennessee the percentage increased from 27 percent to 74 percent. These two states are national leaders in implementing strong statewide school nutrition standards.

"Efforts to improve the school nutrition environment are working, and Mississippi and Tennessee are excellent examples of this progress. However, there are still far too many schools selling less nutritious foods and beverages," said Wechsler.

The School Health Profiles Survey is conducted among a representative sample of secondary schools in a state, large urban school district, or territory. The data are collected from self-administered questionnaires from the principal and the lead health education teacher at each sampled school. The 2008 report includes data from 47 states, 20 cities, and four territories.

The 2008 study results varied dramatically across states.
-- In Hawaii, Connecticut, California, and Maine, more than two-thirds of
secondary schools did not sell baked goods, salty snacks not low in
fat, candy, soda or fruit drinks that were not 100 percent juice.

-- In Utah, Kansas, Idaho, and Nebraska, less than one-third of secondary
schools did not sell these items.

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Statement by Dr. Anthony Fauci, NIH Regarding Early Results from Clinical Trials of 2009 H1N1 Influenza Vaccines in Healthy Adults

Statement by Dr. Anthony Fauci
Director, National Institute of Allergy and Infections Diseases, NIH
Regarding Early Results from Clinical Trials of 2009 H1N1 Influenza
Vaccines in Healthy Adults

We are encouraged by reports that are now emerging from various clinical trials of 2009 H1N1 influenza vaccines, conducted by various vaccine manufacturers. We expect additional companies to announce their preliminary trial results shortly. The early data from these trials
indicate that 2009 H1N1 influenza vaccines are well tolerated and induce a strong immune response in most healthy adults when administered in a single unadjuvanted 15-microgram dose. We congratulate the companies on these trials, which are an important part of the ongoing worldwide effort to develop vaccines to protect the public from 2009 H1N1 influenza.

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, also is conducting clinical trials of 2009 H1N1 influenza vaccines, produced by Sanofi Pasteur and CSL Limited. The NIAID trials are testing two different dosages (15 micrograms versus 30 micrograms) and evaluating the immune response to one and two doses of these vaccines. More than 2,800 people are participating in ongoing NIAID trials of these vaccines.

We are pleased to note that preliminary analyses of early data from the NIAID trials align with the recently announced findings and those to be announced imminently by other companies in that both vaccines studied induced what is likely to be a protective immune response in most adults following a single dose in the same amount (15 micrograms) used in seasonal flu vaccines. Specifically, in blood samples obtained 8 to 10 days after vaccination:

* Among healthy adults who received a single 15-microgram dose of
the Sanofi Pasteur vaccine, a robust immune response was measured in 96
percent of adults aged 18 to 64 and in 56 percent of adults aged 65 and
older.
* Similarly, among healthy adults who received a single
15-microgram dose of the CSL Limited vaccine, a robust immune response
was measured in 80 percent of adults aged 18 to 64 and in 60 percent of
adults aged 65 and older.

Additional data from the NIAID trials are forthcoming. However, on the basis of these strong early data, our results are consonant with other reports that a single 15-microgram dose of unadjuvanted 2009 H1N1 influenza vaccine is well tolerated and induces a robust immune response in healthy adults between the ages of 18 and 64. For adults aged 65 and over, the immune response to 2009 H1N1 influenza vaccine is somewhat less robust, as is the case with seasonal influenza vaccines.

We note that the slight discrepancies seen in our trials between the Sanofi Pasteur and CSL Limited vaccines may be due to technical differences in the preliminary measurement of the amounts of antigen in the doses used in the clinical trial lots and the relatively limited numbers of samples studied to date, as well as the fact that our data are drawn from a very early time point after immunization.

NIAID will continue to provide timely updates on these trials as well as those in children and in pregnant women, which began later.

Information from the NIAID studies will help inform the development of recommendations for immunization schedules, including the optimal dosage and number of doses for different age groups.

NIAID is conducting these clinical trials through its longstanding vaccine clinical trials infrastructure: the Vaccine and Treatment Evaluation Units, a network of medical centers that offers rapid response capability to test vaccines for emerging public health concerns. Detailed information is available from the NIAID Web site (www.niaid.nih.gov) and from http://ClinicalTrials.gov.

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Avian Influenza Strain Primes Brain for Parkinson's Disease

/PRNewswire/ -- At least one strain of the H5N1 avian influenza virus leaves survivors at significantly increased risk for Parkinson's disease and possibly other neurological problems later in life, according to new research from St. Jude Children's Research Hospital.

In the August 10 online early edition of the Proceedings of the National Academy of Sciences, researchers reported that mice which survived infection with an H5N1 flu strain were more likely than uninfected mice to develop brain changes associated with neurological disorders like Parkinson's and Alzheimer's diseases. Parkinson's and Alzheimer's involve loss of brain cells crucial to a variety of tasks, including movement, memory and intellectual functioning. The study revealed the H5N1 flu strain caused a 17 percent loss of the same neurons lost in Parkinson's as well as accumulation in certain brain cells of a protein implicated in both diseases.

"This avian flu strain does not directly cause Parkinson's disease, but it does make you more susceptible," said Richard Smeyne, Ph.D., associate member in St. Jude Developmental Neurobiology. Smeyne is the paper's senior author.

"Around age 40, people start to get a decline in brain cells. Most people die before they lose enough neurons to get Parkinson's. But we believe this H5N1 infection changes the curve. It makes the brain more sensitive to another hit, possibly involving other environmental toxins," Smeyne explained.

Smeyne noted the work involved a single strain of the H5N1 flu virus, the A/Vietnam/1203/04 strain. The threat posed by other viruses, including the current H1N1 pandemic flu virus, is still being studied.

Early indications are that the H1N1 pandemic strain carries a low neurologic risk, said Richard Webby, Ph.D., director of the World Health Organization Collaborating Center for Studies on the Ecology of Influenza in Animals and Birds, which is based at St. Jude. Webby, who is also an associate member of the St. Jude Department of Infectious Diseases, was not involved in the H5N1 study led by Smeyne.

This study also supports the theory that a hit-and-run mechanism is at work in Parkinson's disease. The investigators believe the H5N1 infection sparks an immune response that persists long after the initial threat is gone, setting patients up for further devastating losses from a second hit, possibly from another infection, drug or environmental toxin. In this case, researchers believe the flu virus is the first hit that sets up development of Parkinson's at a later time.

An estimated 4.1 million Americans, including 1 to 2 percent age 55 and older, have Parkinson's. Many suspect both genetic and environmental factors play a role in its development. The disease is linked to the death of dopamine-secreting cells in an area of the midbrain known as the substantia nigra pars compacta (SNpc). Dopamine is a neurotransmitter responsible for stimulating the motor neurons that control movement. Parkinson's is usually diagnosed after individuals lose 70 to 80 percent of the dopamine-producing cells. Treatment is available, but there is no cure.

Flu is primarily a respiratory disease, but indirect evidence dating back to 1385 links it to neurological problems, including the brain inflammation known as encephalitis. The association between flu and brain disorders like Parkinson's was strengthened by an outbreak of encephalitic lethargic, also known as von Economo's encephalopathy, following the 1918 Spanish flu pandemic. Some of those patients developed Parkinson's symptoms.

St. Jude researchers launched this study nearly three years ago in response to the threat posed by avian flu. Smeyne said there was concern about possible long-term neurological risks facing H5N1 survivors.

Previous studies had isolated H5N1 in the nervous system. But this is the first to show the path the virus takes to enter the brain as well as the aftermath of the infection. Smeyne said the virus' path from the stomach through the nervous system and into the brain is reminiscent of how Parkinson's unfolds.

In this study, mice were infected with an H5N1 flu strain isolated in 2004 from a patient in Vietnam. Robert Webster, Ph.D., said the strain remains the most virulent of the avian flu viruses. Webster, a co-author of the study, holds the Rose Marie Thomas Chair in Infectious Diseases at St. Jude.

About two-thirds of the mice developed flu symptoms, primarily weight loss. After three weeks there was no evidence of H5N1 in the nervous systems of the mice that survived.

But the inflammation the infection triggered within the brain continued for months. It was similar to inflammation associated with inherited forms of Parkinson's. Although the tremor and movement problems disappeared as flu symptoms eased, investigators reported that 60 days later mice had lost roughly 17 percent of dopamine-producing cells in SNpc, a structure found in the midbrain.

Researchers also found evidence that the avian flu infection led to over-production of a protein found in the brain cells of individuals with both Alzheimer's and Parkinson's diseases. The protein, alpha-synuclein, collected in H5N1-infected cells throughout the brain, including the midbrain where key dopamine-producing cells are located. There was little protein accumulation in the brain cells of uninfected mice.

The study marks the first time scientists were able to naturally trigger the protein build-up in an experimental Parkinson's system. "The virus activates this protein," Smeyne explained.

Other authors in this paper include Haeman Jang, David Boltz and Yun Jiao (St. Jude); and Katharine Sturm-Ramirez and Kennie Shephard (formerly of St. Jude).

This work was supported in part by the National Institute of Allergy and Infectious Diseases, National Parkinson's Foundation, Michael J. Fox Foundation, National Institutes of Health and ALSAC.

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Study Estimates Medical Cost of Obesity May Be As High as $147 Billion Annually

/PRNewswire-USNewswire/ -- The health cost of obesity in the United States is as high as $147 billion annually, based on a new study from Research Triangle Institute and the Centers for Disease Control and Prevention. The study, which appeared online July 27 in the journal Health Affairs, was released at CDC's Weight of the Nation conference in Washington, D.C.

The proportion of all annual medical costs that are due to obesity increased from 6.5 percent in 1998 to 9.1 percent in 2006, the study said. This total includes payment by Medicare, Medicaid, and private insurers, and includes prescription drug spending. Overall, persons who are obese spent $1,429 (42 percent) more for medical care in 2006 than did normal weight people. These estimates were compiled using national data that compare medical expenses for normal weight and obese persons.

The study is titled "Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates." Recognizing the large health and economic burden of obesity, CDC has issued its first comprehensive set of evidence-based recommendations to help communities tackle the problem of obesity through programs and policies that promote healthy eating and physical activity.

The report, "Recommended Community Strategies and Measurements to Prevent Obesity in the United States," along with a companion implementation guide, appears in CDC's MMWR Recommendations and Reports. A companion implementation guide is also available on the CDC Web site.

"It is critical that we take effective steps to contain and reduce the enormous burden of obesity on our nation," said CDC Director Thomas Frieden, M.D., M.P.H. "These new recommendations and their proposed measurements are a powerful and practical tool to help state and local governments, school districts, and local partners take necessary action."

The Common Community Measures for Obesity Prevention Project was guided by a systematic process that included expert opinion and a review of the published scientific literature, resulting in the adoption of 24 recommended environmental and policy level strategies to prevent obesity.

The strategies promote the availability of affordable healthy food and beverages, support healthy food and beverage choices, encourage breastfeeding, encourage physical activity or limit sedentary activity, support safe communities that support physical activity, and encourage communities to organize for change.

"Obesity is a risk for a number of chronic diseases, including diabetes, cardiovascular disease, and some cancers," said William H. Dietz, M.D., Ph.D., director of CDC's Division of Nutrition, Physical Activity and Obesity. "Reversing this epidemic requires a multifaceted and coordinated approach that uses policy and environmental change to transform communities into places that support and promote healthy lifestyle choices for all people."

CDC partnered with the International City/County Management Association to pilot test an initial set of obesity prevention measures in 20 communities. The resulting 24 recommended strategies and suggested measures are now being pilot tested by Minnesota and Massachusetts state health departments in order to determine their success. The strategies include:

-- Communities should support locating schools within easy walking
distance of residential areas.

-- Communities should improve availability of affordable healthier food
and beverage choices


The community measures project is a collaborative effort among CDC, the Robert Wood Johnson Foundation, the Kellogg Foundation, Kaiser Permanente, and the CDC Foundation. ICF Macro serves as the coordinating center for the project and the international City/County Management Association pilot tested the measures for each strategy in 20 communities.

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Former Senate Majority Leaders Baker, Daschle and Dole Release Bipartisan Framework for Comprehensive Health Reform

/PRNewswire/ -- Former U.S. Senate Majority Leaders Howard Baker, Tom Daschle and Bob Dole, members of the Bipartisan Policy Center's (BPC) Advisory Board, today released a bipartisan, budget-neutral framework for comprehensive health reform to ensure that every American has affordable, quality health coverage. The Leaders' Project on the State of American Health Care report, entitled "Crossing Our Lines: Working Together to Reform the U.S. Health System," offers realistic, bipartisan and politically-viable policy recommendations to address the delivery, cost, coverage and financing challenges facing the nation's health care system.

The report calls for refocusing the nation's health care system on a commitment to quality and value -- rather than quantity and volume -- to improve medical outcomes and constrain unsustainable cost growth. In so doing, the Leaders underscore the need to rededicate the country to prevention and wellness as a better prescription to address the flaws of our health care system. To achieve the commitment of coverage for all Americans, the report embraces the need for strong insurance reforms that require guaranteed issue; the elimination of medical underwriting for pre-existing conditions and rating limitations; new state and regional coverage options through exchanges; reforms that constrain cost growth; and financial assistance through Medicaid and tax credits.

In developing their recommendations, the Leaders addressed many politically sensitive issues, recognizing that effective agreements often require tough choices. Specifically, their budget-neutral plan calls for: a personal responsibility requirement for all Americans to purchase affordable health insurance; refundable tax credits that limit premium contributions to a percentage of income; tax credits for small businesses that offer coverage; limited fees for employers not offering or paying for health benefits; a tax exclusion linked to the value of benefits received by Members of Congress; and the establishment of an Independent Health Care Council to promote coordination among federal health care programs.

Consistent with the federal/state health reform model, the Leaders' plan provides for initial financial and technical support to states that choose to establish competing state plan options. These plans would have to compete on a level playing field. The Leaders also provide for a process that allows the President to submit a plan to Congress for a vote under expedited procedures if, after five years, the HHS Secretary has certified that the existing options do not provide for affordable coverage.

Arguing that flexibility from all sides is required to break the long stalemate over improving the health care system, the Leaders each embraced positions that have long been controversial within their own parties.

"Health reform can be achieved," said Senator Baker. "But in order for that to happen we must work beyond our points of disagreement and focus on reaching bipartisan solutions to create the health care system that the American people deserve."

Addressing the compromises the Leaders made in developing this report, Senator Daschle said, "A number of proposals would have looked different if they had been crafted by only Democrats or only Republicans. But in the spirit of our bipartisan effort, my colleagues and I agreed to this compromise in the hopes that we can begin to bridge any rifts in the debate and move forward with achieving our common goal of reforming the health care system."

Senator Dole stressed the need for preventive care and personal responsibility. "We need to improve health care delivery, while providing individuals with the knowledge, tools and choices they need to be accountable for their health," he said. "These and other reforms are needed to fix the nation's 'sick care' system."

The Leaders' Project on the State of American Health Care was launched in April 2008 with the goal of developing a comprehensive, but achievable set of policies to ensure that all Americans have quality, affordable health insurance coverage, while constraining cost growth, promoting innovative delivery of care, and focusing treatments more on the patient, and not just the illness.

The proposal reflects a series of forums that took place throughout 2008, each hosted by one of the Leaders. The events addressed four key topics, or "pillars," of health care reform: promoting high-quality, high-value care; making health insurance available, meaningful and affordable; emphasizing and supporting personal responsibility and healthy choices; and developing a workable, sustainable approach to health care financing. The project was co-directed by health care experts Chris Jennings and Mark McClellan.

To support the development of their recommendations, the Leaders sought advice and input from a broad range of health care providers, businesses, labor representatives, state and local policymakers, health plans, academics and consumer advocates through their public policy forums and targeted outreach activities. Ultimately, the Leaders' report seeks to establish a constructive center in the often polarized debate about health reform, and to advance a coherent strategy for modernizing the health care system and create a consistent source of health coverage for every American. For more information or to download a full copy of the report, "Crossing Our Lines: Working Together to Reform the U.S. Health System," please visit: www.bpcleadersproject.org.

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Minorities, Low Income Americans More Likely to Be Sick, Less Likely to Get Care

U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius yesterday released a new report on health disparities in America and participated in a White House Health Care Stakeholder Discussion on the importance of reform that reduces disparities that exist in our current health care system. The new report Health Disparities: A Case for Closing the Gap is
available at www.HealthReform.gov.

"Minorities and low income Americans are more likely to be sick and less likely to get the care they need," Secretary Sebelius said. "These disparities have plagued our health system and our country for too long. Now, it's time for Democrats and Republicans to come together to pass
reforms this year that help reduce disparities and give all Americans the care they need and deserve."

A Case for Closing the Gap highlights some of the glaring disparities that exist in the current health system. Under the status quo:

- Forty-eight percent of all African Americans adults suffer from
a chronic disease compared to 39 percent of the general population.
- Eight percent of white Americans develop diabetes while 15
percent of African Americans, 14 percent of Hispanics, and 18 percent of
American Indians develop diabetes.
-Hispanics were one-third less likely to be counseled on obesity
than were whites -- only 44 percent of Hispanics received counseling.
- African Americans are 15 percent more likely to be obese than
whites.

The report also notes that 40 percent of low-income Americans do not have health insurance. About one-third of the uninsured have a chronic disease, and they are six times less likely to receive care for a health problem than the insured. In contrast, only 6 percent of high-income
Americans lack insurance.

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